1
|
dos Santos DF, Mendonça MR, Antunes DE, Sabino EFP, Pereira RC, Goulart LR, Goulart IMB. Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts. PLoS Negl Trop Dis 2018; 12:e0006494. [PMID: 29782495 PMCID: PMC5983863 DOI: 10.1371/journal.pntd.0006494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/01/2018] [Accepted: 05/02/2018] [Indexed: 11/22/2022] Open
Abstract
Background Household contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs. Methods We have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations. Results/Principal findings The positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044). Conclusions/Significance ELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment. Despite the apparent progress observed in recent years in leprosy control, early identification of cases remains one of the primary objectives of control programs. In addition, the failure of the current therapeutic scheme on the incidence of leprosy demonstrates that the disease elimination as a public health program promoted by the World Health Organization (WHO) depends on an incisive action to interrupt its transmission chain. The long incubation period of leprosy, its insidious symptoms and signs may difficult its diagnosis. Several studies have recently demonstrated that IgM anti-PGL-I seropositive contacts present higher chances to become ill than seronegative ones. Therefore, our question was: do seropositive contacts at greater risk of becoming sick already present subclinical neural damage? Therefore, our approach was to analyse anti-PGL-I seropositive contacts through electroneuromyography. The development and implementation of more specific and sensitive methods for the detection of M. leprae and its neural impairment, using immunological, molecular and neurophysiological tools are mandatory to increase the knowledge of leprosy epidemiology, to break its chain of transmission, thereby enabling effective control of this disease. This report demonstrated that seropositive contacts is the population group with higher chances of neural impairment.
Collapse
Affiliation(s)
- Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Matheus Rocha Mendonça
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Elaine Fávaro Pípi Sabino
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Raquel Campos Pereira
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Institute of Biotechnology, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Department of Medical Microbiology and Immunology, University of California Davis, Davis, CA, United States of America
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, MG, Brazil
- * E-mail:
| |
Collapse
|
2
|
Bandeira SS, Pires CA, Quaresma JAS. Nerve Damage in Young Patients with Leprosy Diagnosed in an Endemic Area of the Brazilian Amazon: A Cross-Sectional Study. J Pediatr 2017; 185:143-148. [PMID: 28285750 DOI: 10.1016/j.jpeds.2017.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe nerve damage and its association with clinical and epidemiologic characteristics in young patients with leprosy diagnosed in an endemic area of the Brazilian Amazon. STUDY DESIGN All 45 patients with leprosy younger than 15 years of age and diagnosed at a health referral unit in northern Brazil were invited to participate in a cross-sectional, descriptive, analytical study. Subjects were submitted to a templated simple neurologic examination of the peripheral nerves and answered a structured questionnaire. RESULTS Of 41 cases, referral was the mode of detection in 33 participants (80.5%); 19 (46.3%) had been seen by 3 or more physicians to obtain a diagnosis, and 26 (63.4%) had received other diagnoses. The interval between the onset of symptoms and diagnosis was more than 1 year in 30 cases (73.2%). Borderline leprosy was the predominant clinical form (48.8%); 63.4% of the participants had multibacillary leprosy, 31.7% had nerve damage, and 17.1% exhibited disabilities. The following variables showed a statistically significant association (P???.05) with nerve damage at diagnosis: home visit by the community health worker, number of doctors seen, number of skin lesions (>5), and lesions along the path of nerve trunks. CONCLUSION Centralized healthcare, a low frequency of home visits by community health workers, and the difficulty in diagnosing leprosy in children are factors that contribute to late treatment initiation and an increased risk of peripheral nerve damage. In addition, multiple skin lesions and lesions along the path of nerve trunks require rigorous monitoring.
Collapse
Affiliation(s)
- Sabrina Sampaio Bandeira
- Sanitary Dermatology Referral Unit "Dr. Marcello Cândia", Secretary of State for Public Health, Marituba, PA, Brazil; Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil
| | - Carla Avelar Pires
- Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil; Center of Health and Biological Sciences, State University of Para, Belem, PA, Brazil
| | - Juarez Antonio Simões Quaresma
- Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil; Center of Health and Biological Sciences, State University of Para, Belem, PA, Brazil.
| |
Collapse
|
3
|
Pardal-Fernandez JM, Ezsol-Lendvai S, Rodriguez-Vazquez M, Agudo-Mena JL, Godes-Medrano B. [Pure neural leprosy. Diagnostic aspects of a clinical case]. Rev Neurol 2016; 63:257-261. [PMID: 27600740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Leprosy is an infectious disease caused by the bacteria Mycobacterium leprae. It is particularly prone to affect the skin and the nerve trunks and, in fact, both are compromised in most infected patients. It is transmitted by exposure to those with the disease and sometimes by reactivation. One uncommon possibility is pure neural leprosy, which is characterised by neuropathy, but without skin lesions. We report the case of a patient with pure neural leprosy and review the diagnostic aspects. CASE REPORT A 40-year-old male, an immigrant who was diagnosed and treated for leprosy 20 earlier. The patient visited due to painful paraesthesias and dysesthesias in the hands and legs without the presence of any skin lesions. Acute multiple mononeuritis with mainly ulnar involvement was observed. The disease, typified as paucibacillary/tuberculoid, was treated and in a few weeks there was a clear improvement. CONCLUSIONS In this case of pure neural leprosy due to reactivation, early diagnosis allowed timely treatment to be established. Evaluation of neuropathy together with clinical, electrophysiological and ultrasound criteria is recommended. By so doing, a high degree of sensitivity is achieved as well as allowing early diagnosis and treatment, and therefore a better functional recovery.
Collapse
Affiliation(s)
| | - S Ezsol-Lendvai
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | | | - J L Agudo-Mena
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| | - B Godes-Medrano
- Complejo Hospitalario Universitario de Albacete, Albacete, Espana
| |
Collapse
|
4
|
Wang H, Yang X, shi Y, Zhou Y, Li C, Chen Y, Yu H, Wang Q, Liu J, Cheng J, Zhao Y, Han J, Xiang L. Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients. Medicine (Baltimore) 2016; 95:e4523. [PMID: 27559953 PMCID: PMC5400320 DOI: 10.1097/md.0000000000004523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/07/2016] [Accepted: 07/15/2016] [Indexed: 11/30/2022] Open
Abstract
Many studies about the characteristics of spinal tuberculosis (STB) have been published, but none has investigated the predictive factors for lower-extremity motor or sensory deficits (LMSD) in patients with STB.The objective of this study was to find early predictive factors for LMSD and evaluate surgical results of patients with STB.From 2001 through 2010, 329 patients with STB were treated in our department and surgical treatment was performed in 274 patients. The factors assessed included age, sex, duration of symptoms, worsening of illness, clinical symptoms, clinical signs, imaging characteristics, kyphotic angle, Oswestry disability index (ODI), and visual analogue scale (VAS) scores.Of the 329 patients studied, 164 presented with LMSD (the LMSD group), of which 93 patients (28.3%) had motor deficits and 177 patients (53.8%) had sensory disturbance. The other 165 patients were included in the control group (the No LMSD group). Using univariate logistic regression analysis, we found that the sex (P = 0.042), age (P = 0.001), worsening of sickness (P = 0.013), location (P = 0.009), and spinal compression (P = 0.035) were the risk factors of LMSD. Furthermore, the multivariate logistic regression analysis indicated that age (OR = 1.761, 95% CI: 1.227-2.526, P = 0.002), worsening of sickness (yes vs no: OR = 1.910, 95% CI: 1.161-3.141, P = 0.011), location (T vs C: OR = 0.204, 95% CI: 0.063-0.662, P = 0.008), and spinal compression (yes vs no: OR = 1.672, 95% CI: 1.020-2.741, P = 0.042) were independent risk factors of LMSD. Surgical treatment was performed in 274 patients. The kyphotic angle improved from 25.8 ± 9.1° preoperatively to 14.0 ± 7.6°, with a mean correction of 11.8 ± 4.0°, and a mean correction loss of 1.5 ± 1.8° at final visit. There were significant differences between the preoperative and the final ODI and VAS scores in both groups (P < 0.001 and P < 0.001, respectively).Spinal tuberculosis with cervical or lumbar vertebra involvement among the elder patients with a history of worsening of illness and spinal compression tended to cause LMSD, such as motor deficits or sensory disturbance. We should implement an appropriate treatment regimen to prevent exacerbation of STB such as operation, which can achieve thoroughness of debridement, adequate spinal stabilization, and better functional recovery.
Collapse
Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics,
General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016
Liaoning, China (e-mail: ) or Lianbi Xiang, Department
of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA,
Shenyang, 110016 Liaoning, China (e-mail:
)
| | - Xiao Yang
- Department of Nursing, People's Liberation Army 463rd
Hospital, Shenyang, Liaoning
| | - Ying shi
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, The Third
Military Medical University, Chongqing
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, The Third
Military Medical University, Chongqing
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Qi Wang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Jiwei Cheng
- Department of Orthopedics, People's Liberation Army
113th Hospital, Ningbo, Zhejiang
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of
Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of
Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics,
General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016
Liaoning, China (e-mail: ) or Lianbi Xiang, Department
of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA,
Shenyang, 110016 Liaoning, China (e-mail:
)
| |
Collapse
|
5
|
Lambert SM, Alembo DT, Nigusse SD, Yamuah LK, Walker SL, Lockwood DNJ. A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia. PLoS Negl Trop Dis 2016; 10:e0004502. [PMID: 27046330 PMCID: PMC4821535 DOI: 10.1371/journal.pntd.0004502] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Leprosy Type 1 (T1R) reactions are immune-mediated events leading to nerve damage and preventable disability affecting hands, feet and eyes. Type 1 Reactions are treated with oral corticosteroids. There is little evidence on alternative treatments for patients who do not respond to steroids or experience steroid adverse effects. We report the results of a randomized controlled trial testing the efficacy and adverse effect profile of ciclosporin and prednisolone (CnP) in comparison to prednisolone only (P) in patients with new T1R in Ethiopia. Ciclosporin is a potent immunosuppressant. Outcomes were measured using a clinical severity score, recurrence rate, adverse events and quality of life. Results Seventy three patients with new T1R were randomized to receive CnP or P for 20 weeks. Recovery rates in skin signs was similar in both groups (91% vs 88%). Improvements in nerve function both, new and old, sensory (66% vs 49%) and motor (75% vs 74%) loss were higher (but not significantly so) in the patients on CnP. Recurrences rates of T1R (85%) were high in both groups, and recurrences occurred significantly earlier (8 weeks) in patients CnP, who needed 10% more additional prednisolone. Serious major and minor adverse events rates were similar in patients in the two treatment arms of the study. Both groups had a significant improvement in their quality of life after the study, measured by the SF-36. Conclusions This is the first double-blind RCT assessing ciclosporin, in the management of T1R in Africa. Ciclosporin could be a safe alternative second-line drug for patients with T1R who are not improving with prednisolone or are experiencing adverse events related to prednisolone. This study illustrates the difficulty in switching off leprosy inflammation. Better treatment agents for leprosy patients with reactions and nerve damage are needed. Leprosy infection is cured with multi-drug therapy (MDT), but patients may develop immune mediated skin and nerve lesions. These immunological reactions lead to disability and deformity secondary to neuropathy. Prednisolone is the main drug used to treat reactions but is only partially effective and patients have a high rate of side effects. Identifying better agents for treating leprosy reactions is an important clinical goal. We tested the safety and efficacy of ciclosporin, an immunosuppressant used in many inflammatory conditions, in Type 1 reactions (T1R) in leprosy patients in Ethiopia. A double-blind randomized controlled clinical trial comparing the efficacy and adverse event profiles of ciclosporin and prednisolone was conducted in patients presenting with acute T1R. Patients on ciclosporin and prednisolone had similar improvements in clinical outcomes which were measured as skin and nerve function improvement. Both groups had a high rate of T1R recurrence (85%) and the patients on ciclosporin required more additional prednisolone to treat recurrences. We assessed patient quality of life and this was significantly improved with both treatments. This is the first assessment of patient quality of life in a leprosy patients trial. Ciclosporin may be a useful alternative in the treatment of T1R, but that the need for additional steroids decreases its value.
Collapse
Affiliation(s)
- Saba M. Lambert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- All Africa Leprosy Rehabilitation and Training (ALERT) Centre, Addis Ababa, Ethiopia
- * E-mail: ;
| | - Digafe T. Alembo
- All Africa Leprosy Rehabilitation and Training (ALERT) Centre, Addis Ababa, Ethiopia
| | - Shimelis D. Nigusse
- All Africa Leprosy Rehabilitation and Training (ALERT) Centre, Addis Ababa, Ethiopia
| | - Lawrence K. Yamuah
- Data Management, Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Stephen L. Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Diana N. J. Lockwood
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
6
|
Vegosen L, Breysse PN, Agnew J, Gray GC, Nachamkin I, Sheikh K, Kamel F, Silbergeld E. Occupational Exposure to Swine, Poultry, and Cattle and Antibody Biomarkers of Campylobacter jejuni Exposure and Autoimmune Peripheral Neuropathy. PLoS One 2015; 10:e0143587. [PMID: 26636679 PMCID: PMC4670215 DOI: 10.1371/journal.pone.0143587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 11/07/2015] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Foodborne Campylobacter jejuni infection has been associated with an increased risk of autoimmune peripheral neuropathy, but risks of occupational exposure to C. jejuni have received less attention. This study compared anti-C. jejuni IgA, IgG, and IgM antibody levels, as well as the likelihood of testing positive for any of five anti-ganglioside autoantibodies, between animal farmers and non-farmers. Anti-C. jejuni antibody levels were also compared between farmers with different animal herd or flock sizes. The relationship between anti-C. jejuni antibody levels and detection of anti-ganglioside autoantibodies was also assessed. METHODS Serum samples from 129 Agricultural Health Study swine farmers (some of whom also worked with other animals) and 46 non-farmers, all from Iowa, were analyzed for anti-C. jejuni antibodies and anti-ganglioside autoantibodies using ELISA. Information on animal exposures was assessed using questionnaire data. Anti-C. jejuni antibody levels were compared using Mann-Whitney tests and linear regression on log-transformed outcomes. Fisher's Exact Tests and logistic regression were used to compare likelihood of positivity for anti-ganglioside autoantibodies. RESULTS Farmers had significantly higher levels of anti-C. jejuni IgA (p < 0.0001) and IgG (p = 0.02) antibodies compared to non-farmers. There was no consistent pattern of anti-C. jejuni antibody levels based on animal herd or flock size. A higher percentage of farmers (21%) tested positive for anti-ganglioside autoantibodies compared to non-farmers (9%), but this difference was not statistically significant (p = 0.11). There was no significant association between anti-C. jejuni antibody levels and anti-ganglioside autoantibodies. CONCLUSIONS The findings provide evidence that farmers who work with animals may be at increased risk of exposure to C. jejuni. Future research should include longitudinal studies of exposures and outcomes, as well as studies of interventions to reduce exposure. Policies to reduce occupational exposure to C. jejuni should be considered.
Collapse
Affiliation(s)
- Leora Vegosen
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Patrick N. Breysse
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jacqueline Agnew
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Gregory C. Gray
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States of America
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Kazim Sheikh
- Department of Neurology, University of Texas Medical School, Houston, TX, United States of America
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Research Triangle Park, NC, United States of America
| | - Ellen Silbergeld
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Infections are important, potentially treatable causes of peripheral nervous system disease. This article reviews the clinical presentation and management of several common peripheral nervous system diseases due to viral, bacterial, spirochetal, and parasitic infections. RECENT FINDINGS The clinical presentation and evaluation of infectious peripheral nervous system diseases are well established. Advances in the treatment and, in some cases, the prevention of these diseases are still evolving. SUMMARY A diverse range of peripheral nervous system diseases, including peripheral neuropathy, radiculopathy, radiculomyelopathy, cranial neuropathy, and motor neuropathy, are caused by numerous infectious agents. In some patients, peripheral neuropathy may be a side effect of anti-infectious drugs. Infectious neuropathies are important to recognize as they are potentially treatable. This article discusses the clinical presentation, evaluation, and treatment of several common peripheral nervous system diseases caused by viral, bacterial, spirochetal, and parasitic infections, as well as some peripheral nerve disorders caused by adverse effects of the treatments of these infectious diseases.
Collapse
|
8
|
Abstract
Peripheral neuropathy is a common complication of a variety of diseases and treatments, including diabetes, cancer chemotherapy, and infectious causes (HIV, hepatitis C, and Campylobacter jejuni). Despite the fundamental difference between these insults, peripheral neuropathy develops as a combination of just six primary mechanisms: altered metabolism, covalent modification, altered organelle function and reactive oxygen species formation, altered intracellular and inflammatory signaling, slowed axonal transport, and altered ion channel dynamics and expression. All of these pathways converge to lead to axon dysfunction and symptoms of neuropathy. The detailed mechanisms of axon degeneration itself have begun to be elucidated with studies of animal models with altered degeneration kinetics, including the slowed Wallerian degeneration (Wld(S)) and Sarm knockout animal models. These studies have shown axonal degeneration to occur through a programmed pathway of injury signaling and cytoskeletal degradation. Insights into the common disease insults that converge on the axonal degeneration pathway promise to facilitate the development of therapeutics that may be effective against other mechanisms of neurodegeneration.
Collapse
Affiliation(s)
- Christopher R Cashman
- Departments of Neuroscience and Neurology, USA; MSTP- MD/PhD Program, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Ahmet Höke
- Departments of Neuroscience and Neurology, USA.
| |
Collapse
|
9
|
Veiga A, Costa A, Taipa R, Guimarães A, Pires MM. Hansen Neuropathy: Still a Possible Diagnosis in the Investigation of a Peripheral Neuropathy. ACTA MEDICA PORT 2015; 28:329-332. [PMID: 26421785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 05/11/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Leprosy is still one of the most frequent causes of peripheral neuropathy. Although regarded as eradicated in Portugal, is still documented in neuropathological study of patients with clinical peripheral neuropathy without proper diagnosis. MATERIAL AND METHODS Review of the cases of Hansen disease neuropathy diagnosed in Neuropathology Unit of Centro Hospitalar do Porto between 1978 and 2013, atending to gender, age, clinical manifestations and neuropathological findings. RESULTS Twenty one patients were identified with neuropathological diagnosis of Hansenâs disease neuropathy, predominantly male. The mean age at diagnosis was 52 years, and sensory symptoms predominate as neurological manifestation of disease. Interval between symptoms and diagnosis was 1-38 years. In most nerve samples tuberculoid type of disease was identified. Bacilli were detected in skin and nerve in 44% of cases. DISCUSSION Mononeuritis is the most common presentation of leprosy but other clinical manifestations are possible, including skin lesions. Infection with M. leprae injures myelinated and unmyelinated fibres, with replacement of nerve tissue by collagen fibrosis. The diagnosis of leprosy is only achieved by neuropathological study of skin lesions and / or peripheral nerve, supported by the identification of the bacillus. CONCLUSION Hansen disease remains a public health problem in tropical areas and, although rare, still described in Western countries reason why should still be considered as a diagnostic possibility in the investigation of peripheral neuropathy.
Collapse
Affiliation(s)
- Andreia Veiga
- Serviço de Neurologia. Centro Hospitalar de Trás os Montes e Alto Douro. Vila Real. Portugal
| | - Alexandre Costa
- Serviço de Neurologia. Centro Hospitalar de Trás os Montes e Alto Douro. Vila Real. Portugal
| | - Ricardo Taipa
- Unidade de Neuropatologia. Centro Hospitalar do Porto. Porto. Portugal
| | - António Guimarães
- Unidade de Neuropatologia. Centro Hospitalar do Porto. Porto. Portugal
| | - Manuel Melo Pires
- Unidade de Neuropatologia. Centro Hospitalar do Porto. Porto. Portugal
| |
Collapse
|
10
|
Abstract
Objective:Motor and sensory nerve conductions, F responses, sympathetic skin responses and R-R interval variations (RRIV) were studied to determine the type of peripheral neuropathy among patients with leprosy.Methods:Twenty-nine consecutive patients with leprosy (25 male, 4 female) hospitalized in the “Istanbul Leprosy Hospital'' between January - December, 1999 were included in this study. Ten patients had borderline lepromatous leprosy, and 19 had lepromatous leprosy. None of the patients studied had the tuberculoid form. The mean age was 55±12 years. The control group consisted of 30 (26 male, 4 female) healthy volunteers (mean age: 58.1±7.8 years). All subjects included in the study underwent neurological examination and electrophysiological evaluation. Standard procedures were performed for evaluating sensory and motor conduction studies. Motor studies were carried out on both left and right median, ulnar, tibial and common peroneal nerves while median, ulnar, sural and superficial peroneal nerves were examined for sensory studies. Sympathetic skin response recordings on both hands and RRIV recordings on precordial region were done in order to evaluate the autonomic involvement.Results:The lower extremity was found to be more severely affected than the upper, and sensory impairment predominated over motor. Of 58 upper limbs examined, no sympathetic skin responses was recorded in 46 (79.3%). Compared with the controls, the RRIVs of the leprosy patients were found to be reduced during both resting and deep forced hyperventilation.Conclusion:Our results indicate that leprosy causes a predominantly axonal polyneuropathy that is more severe in the lower extremities. Sensory nerve damage is accompanied by autonomic involvement.
Collapse
Affiliation(s)
- Aysun Soysal
- Bakirkoy State Hospital for Neurological and Psychiatric Diseases, Neurology Department, Istanbul, Turkey
| | | | | | | |
Collapse
|
11
|
Cardoso FDM, De Freitas MRG, Escada TM, Nevares MT, Nascimento OJ. Late onset neuropathy in leprosy patients released from treatment: not all due to reactions? LEPROSY REV 2013; 84:128-135. [PMID: 24171238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the clinical, neurophysiological and histological features of cases of neuropathy developing after completion of anti-leprosy treatment, where biopsy showed inflammatory changes. PATIENTS AND METHODS Seven patients were evaluated by a single neurologist. Electro-neuro-myography and peripheral nerve biopsy were performed in all patients. RESULTS Median age was 50-6 years. Time from release from treatment and onset of symptoms ranged from 1 to 12 years (median of 6.6 years). Sensory symptoms were the most common complaint, including pain (71%) and paresthesiae (71%). Muscle weakness was found in 51% and muscle atrophy in 43% of the subjects. Peripheral nerve thickening was present in all patients. Neurophysiological studies suggested sensory-motor polyneuropathy and multiple mono-neuropathy. Nerve biopsy showed inflammatory processes with fibrosis of endoneurium, perineurium and epineurium and total or partial loss of fibres. No bacilli were detected with Wade staining. Patients treated with corticosteroids had some relief of symptoms. CONCLUSION After release from treatment, leprosy patients may insidiously develop progressive peripheral nerve symptoms not fulfilling criteria for relapse or leprosy reactions. Sensory symptoms predominate and peripheral nerve thickening is an important finding. We speculate that these late onset symptoms are secondary to chronic immune-mediated processes in response to antigens of M. leprae.
Collapse
|
12
|
Chugh S, Barman KD, Goel K, Garg VK. Leprosy nerve abscess in Indian male, misdiagnosed as tuberculous lymphadenitis and neuroma. LEPROSY REV 2013; 84:158-160. [PMID: 24171243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Shikha Chugh
- Department of Dermatology & VD, Maulana Azad Medical College, Bahadur SahZafar Marg, New Delhi 110002, India
| | | | | | | |
Collapse
|
13
|
Karmakar PS, Chatterjee S, Mitra R, Bari R, Ray MK, Ghosh A, Ghosh A. Staphylococcal septicaemia associated with peripheral neuropathy in three different clinical settings. J Assoc Physicians India 2013; 61:206-209. [PMID: 24475686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Among the various etiologies of peripheral neuropathy, S. aureus is a rare cause that is not even mentioned in standard textbooks. Here we like to report three clinical scenarios where patients with different manifestations of S. aureus infection developed peripheral neuropathy presenting as quadriparesis, which subsided gradually with control of infection and supportive care. No other known causes of peripheral neuropathy were present in these cases.
Collapse
Affiliation(s)
- P S Karmakar
- Department of Medicine, Institute of Post Graduate Medical Education and Research, Kolkata-700 020
| | - S Chatterjee
- JNM College of Medicine, Kalyani, Nadia, West Bengal
| | - R Mitra
- Department of Pulmonary Medicine, Institute of Post Graduate Medical Education And Research, Kolkata - 700020
| | - R Bari
- Department of Medicine, Institute of Post Graduate Medical Education And Research, Kolkata - 700020
| | - M K Ray
- Department of Medicine, Institute of Post Graduate Medical Education And Research, Kolkata - 700020
| | - A Ghosh
- Department of Medicine, Institute of Post Graduate Medical Education And Research, Kolkata - 700020
| | - A Ghosh
- Department of Medicine, Institute of Post Graduate Medical Education And Research, Kolkata - 700020
| |
Collapse
|
14
|
Ottenhoff THM. New insights and tools to combat leprosy nerve damage. LEPROSY REV 2011; 82:334-337. [PMID: 22439272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
15
|
Michelotti F, Camathias C, Gaston M, Rutz E. Severe septic arthritis of the shoulder with an axillary nerve lesion in a 4-year-old child. J Orthop Sci 2011; 16:821-4. [PMID: 21556892 DOI: 10.1007/s00776-011-0074-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/27/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Flurina Michelotti
- Pediatric Orthopaedic Department, University Children's Hospital Basle, UKBB, 4031, Basle, Switzerland
| | | | | | | |
Collapse
|
16
|
Björkholm M, Kalin M, Grane P, Celsing F. Long-term treatment of invasive sinus, tracheobroncheal, pulmonary and intracerebral aspergillosis in acute lymphoblastic leukaemia. Infection 2011; 40:81-5. [PMID: 21779887 DOI: 10.1007/s15010-011-0158-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 06/21/2011] [Indexed: 11/25/2022]
Abstract
A 59-year-old male with acute lymphoblastic leukemia developed sinus, tracheobroncheal, pulmonary, and intracerebral aspergillosis. All lesions except the intracerebral aspergillosis healed after combination antifungal treatment. Long-term voriconazole--but not posaconazole--therapy induced partial regression of the cerebral manifestations. At the time of writing, 3.5 years after the initial diagnosis, the patient is working half-time and suffers from a possible voriconazole-induced polyneuropathy.
Collapse
Affiliation(s)
- M Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
| | | | | | | |
Collapse
|
17
|
Kole AK, Roy R, Kar SS, Chanda D. Outcomes of respiratory diphtheria in a tertiary referral infectious disease hospital. Indian J Med Sci 2010; 64:373-377. [PMID: 22945781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Diphtheria is a fatal disease and may cause serious complications if not recognized early and treated properly. OBJECTIVES To study the epidemiology, clinical features, complications, and outcomes in respiratory diphtheria. MATERIALS AND METHODS Diphtheria cases admitted in the infectious disease hospital, Beliaghata, Kolkata, India between January 2009 to January 2011 were evaluated in respect to demographic profile, immunization status, clinical features, complications, and outcomes. RESULTS 200 diphtheria cases were studied. 150 (75%) patients had history of an adequate immunization, and 100 (50%) patients were from lower socio-economic groups. Common clinical features observed were throat pain in 148 (74%) cases and fever in 112 (56%) cases. Complications observed were myocarditis in 136 (68%) cases, neuropathy in 30 (15%) cases, and respiratory compromise in 14 (7%) cases. Death occurred in 5 (2.5%) patients. CONCLUSIONS diphtheria is still a public health problem in many developing countries. Strict public health measures like an increased immunization coverage, improvement of socio-economic status, easy availability of anti-diphtheritic serum (ADS), early recognition and effective treatment-all may reduce the incidence and mortality.
Collapse
Affiliation(s)
- A K Kole
- Department of Medicine, ID and BG Hospital, Kolkata-10, India.
| | | | | | | |
Collapse
|
18
|
Turpín-Fenoll L, Martín-Estefanía C, Berenguer L, Lucas-Costa A, Bañuls-Roca J, Alcaraz-Mateos E. [Lepra: an uncommon cause of infectious neuropathy]. Neurologia 2009; 24:269-273. [PMID: 19603298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Lepra is an uncommon disease within our setting. However, it was considered the most frequent cause of polyneuropathy only 50 years ago. CASE REPORT We present the case of a 37 year-old woman who consulted due to paresthesias in both hands and feet, livedo reticularis and complaints of frequent hand lesions. Examination of the skin detected nodular lesions and the neurophysiological study confirmed distal symmetric sensitive polyneuropathy with axonal predominance. The skin biopsy also showed histocytic infiltrate and mycobacterium lepra type intracytoplasmatic bacilli. This led to the diagnosis of Multibacillary lepromatous leprosy. Multiple treatment was begun, according to the World Health Organization recommendations, with good evolution. In spite of the attempts to eradicate lepra, its incidence continues to be elevated, especially in endemic areas, among which the south of Spain is included. It is generally associated to overcrowding and low social-economic level. CONCLUSIONS This is the last endemic case in the Valencian Community. The possibility of lepra should be considered among the possible causes of sensitive polyneuropathy, above all in patients in endemic areas.
Collapse
Affiliation(s)
- L Turpín-Fenoll
- Servicios de Neurologia, Hospital General Universitario, Alicante.
| | | | | | | | | | | |
Collapse
|
19
|
Kaya S, Kostakoğlu U. [A brucellosis case with macular rash and peripheral neuropathy]. MIKROBIYOL BUL 2009; 43:147-151. [PMID: 19334392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Brucellosis is a significant health problem especially in developing countries as Turkey. Skeletal system involvement is relatively a common complication of human brucellosis, however genitourinary, cardiovascular, neurovascular and skin involvements are less frequent. In this case report, a 36-years-old female patient with fever, arthralgia, disseminated macular rash at the extremities and body and peripheral polineuropathy has been presented. The patient, living at a rural area, had a history of consumption of raw milk products. Polyneuropathy of the patient presenting as glove-sock type paresthesia was evaluated with electromyography and reported as mild demyelinated sensorial polyneuropathy and radiculopathy compatible with right L(4-5) involvement. Brucella agglutination test was found to be positive at a titer of 1/1280 in the serum sample. Other bacterial and viral agents presenting with maculopapular rash were ruled out by serological tests. Bacterial growth was detected in the blood culture by automated BacT/ALERT 3D system (bioMerieux, USA) and the bacteria was identified as Brucella melitensis by automated VITEK-2 system (bioMerieux, France). Microbiologic diagnosis was confirmed by detection of agglutination with polyvalent and monovalent anti-M Brucella sera. The patient was successfully treated with rifampicin and doxycycline combination for six weeks. The macular rash was recruited leaving a brown pigmentation in the first week of treatment, whereas the neurologic signs and symptoms disappeared at the end of the first month. Brucella infection should be considered in the differential diagnosis of skin rash and neurologic disorders especially in endemic areas such as Turkey.
Collapse
Affiliation(s)
- Selçuk Kaya
- Trabzon Numune Eğitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Trabzon.
| | | |
Collapse
|
20
|
Walker SL, Lockwood DNJ. Leprosy type 1 (reversal) reactions and their management. LEPROSY REV 2008; 79:372-386. [PMID: 19274984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The type of leprosy that affects an individual depends on the immune response mounted against the organism. This leads to a spectrum of disease which may be complicated by immunological phenomena called reactions. Antimicrobial chemotherapy is effective in treating the Mycobacterium leprae infection but up to 30% of individuals with borderline disease experience Type 1 reactions (T1Rs). T1Rs are immunologically mediated episodes, localised in skin and nerves, which are a major cause of nerve function impairment. Nerve function impairment may result in disability and deformity. We review the frequency and features of Type 1 reactions. The data from the limited number of randomised controlled trials of treatment are discussed. These four randomised controlled trials were all conducted in south Asia. The accepted treatment of T1Rs is with oral corticosteroids but there is no consensus about the dose or duration of treatment due to the lack of data. One randomised controlled trial showed that patients treated with a 5 month course of prednisolone (total dose 2.31 g) were less likely to need additional prednisolone than those treated with a 3 month course of prednisolone (total dose 2.94 g). This study did not use nerve function as an outcome measure. The improvement in nerve function impairment with steroid treatment is highly variable, with 33-73% of nerves recovering fully. Optimal steroid regimes and alternative treatments need to be identified if the disability associated with leprosy is to be minimised. Search strategy Papers for this review were identified by repeated searches of the Cochrane Clinical Trials Register, PubMed and LILACS with various combinations of the following search terms 'leprosy', 'lepra', 'reaction', 'steroids', 'corticosteroids', 'reversal', 'Type 1', 'Hansen*'. Searches were complete to the end of November 2008.
Collapse
Affiliation(s)
- Stephen L Walker
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK.
| | | |
Collapse
|
21
|
Scollard DM. The biology of nerve injury in leprosy. LEPROSY REV 2008; 79:242-253. [PMID: 19009974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The steps in the pathogenesis of nerve injury in leprosy are depicted in Figure 1. Localisation of M. leprae to nerve, Schwann cell infection & responses, as yet unknown mechanisms of injury, axonal atrophy, and finally demyelination. These steps, and the mechanisms responsible for them, occur quickly in the course of this disease (as noted, even the earliest diagnostic lesions have sensory abnormalities), but they are also chronic processes that may contribute to progressive nerve injury over a period of many years unless interrupted by treatment, and even after cure of the infection in some patients. A common feature throughout this pathogenesis is inflammation--within and around the nerve. Inflammation is not only defined by its chemical mediators such as cytokines and chemokines, but by one of the most basic phenomena of inflammation--edema. The extent to which edema might contribute to nerve injury in leprosy has not been reviewed because it has not been studied in nerves affected by leprosy, although clinically, surgeons who perform neurolysis are convinced that they are decompressing nerves sustaining injury due to increased (edematous?) pressure. Inflammation in and around nerves is undoubtedly driven, in part, by the immunological responses in each of the portions of the immunologic spectrum of leprosy, but some inflammatory phenomena may be non-specific inflammation related to infection and foreign material (i.e., mycobacterial components). Few if any fixed associations can be made between the steps outlined in this conceptual framework of events; even the depicted sequence of these events is uncertain. Considerable additional data is needed to determine the connections between these processes and their underlying mechanisms. Additionally, although much emphasis is given to myelinated fibres (and demyelination) in studies of the biology of leprosy neuropathy, the small, sensory fibres in the skin are not myelinated. Additional studies of mechanisms of injury to these nerves is required. The results of all of these studies can be reasonably expected to identify new points for clinical intervention in--and possibly the prevention of--nerve injury in leprosy.
Collapse
Affiliation(s)
- David M Scollard
- National Hansen's Disease Programs, LSU-SVM, Skip Bertman Dr. Baton Rouge, LA 70803, USA.
| |
Collapse
|
22
|
Mauermann ML, Klein CJ, Orenstein R, Dyck PJB. Disseminated sporotrichosis presenting with granulomatous inflammatory multiple mononeuropathies. Muscle Nerve 2008; 36:866-72. [PMID: 17623855 DOI: 10.1002/mus.20830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of sporotrichosis that disseminated to involve multiple nerves after initiation of immunosuppressive therapy and then precipitously worsened after withdrawal of therapy. This case illustrates that multiple mononeuropathies are not always caused by vasculitis, and a correct pathological diagnosis should be established before treatment. Based on clinical and pathological features, the mechanism of neuropathy may have been due to either direct nerve infection or a bystander effect of inflammatory/immune damage or, perhaps more likely, to both mechanisms.
Collapse
Affiliation(s)
- Michelle L Mauermann
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
23
|
Duncan ME. The A9 study: the longest cohort study in the history of leprosy--an overview. Ethiop Med J 2007; 45 Suppl 1:1-7. [PMID: 18710069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
24
|
Créange A. Sur quels éléments cliniques et épidémiologiques faut-il évoquer le diagnostic de la borréliose de Lyme? Aspects neurologiques et psychiatriques au cours de la maladie de Lyme. Med Mal Infect 2007; 37:532-9. [PMID: 17368785 DOI: 10.1016/j.medmal.2006.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/15/2006] [Indexed: 02/07/2023]
Abstract
Lyme disease is associated with various systemic and neurological manifestations. The neurological and psychiatric manifestations of Lyme disease are more frequently observed during its secondary phase (stage 2) than during its late tertiary phase (stage 3). In stage 2, cerebrospinal fluid and bacterial tests are consistent with the ongoing infection. Painful meningoradiculitis, encephalomyelitis and encephalitis, and symptoms of depression are the most characteristic at this stage. The diagnosis should be based on the association of clinical, epidemiological, and biological features. Adequate treatment usually leads to recovery. In stage 3 of the disease, the link between neurological manifestations and initial infection is uncertain. Distal axonal polyneuropathy and chronic encephalopathy are the most frequently reported presentations.
Collapse
Affiliation(s)
- A Créange
- Service de neurologie, centre hospitalier universitaire Henri-Mondor, APHP, université Paris-XII, 94000 Créteil, France.
| |
Collapse
|
25
|
Abstract
BACKGROUND Although a few studies have shown fine needle aspiration cytology (FNAC) to be a sensitive diagnostic tool in the detection of nerve involvement, its role as an initial diagnostic procedure in pure neuritic leprosy (PNL) and in the detection of skeletal lesions with unusual findings has not been documented before. CASES Three patients who presented with thickened nerves and a fourth with biopsy-proven lepromatous leprosy with lesions in hand bones underwent FNAC. Of the 3 patients with nerve thickening, 2 had a clinical suspicion or diagnosis of neuritic leprosy, whereas in the third patient a clinical differential diagnosis of a soft tissue tumor or parasitic cyst was considered. FNAC in all 3 cases revealed epithelioid cell granulomas, Langhans giant cells and caseous necrosis. Fites and Ziehl-Neelsen stains were negative for acid-fast bacilli. Cytologic diagnosis of pure neuritic leprosy was made in all 3 cases and confirmed by histopathologic examination. FNAC of skeletal lesions from the fourth patient confirmed involvement of bone with unusual cytologic findings of epithelioid cell granulomas and giant cells along with a significant proportion of foamy macrophages and strong Fites stain positivity. CONCLUSION FNAC is a simple, useful, minimally traumatic and routinely applicable procedure in the diagnosis of pure neuritic leprosy and leprous osteitis.
Collapse
Affiliation(s)
- Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | | |
Collapse
|
26
|
Abstract
Although Lyme disease affects the nervous system in many ways (collectively known as neuroborreliosis), only rarely does it present as a medical emergency. In extreme cases, it may cause (1) encephalitis, (2) a rapidly progressive peripheral neuropathy, or (3) a painful truncal radiculopathy that may be confused with a severe visceral process. Knowing when to consider this spirochetosis in the differential diagnosis requires an understanding of its true clinical spectrum, and of an appropriate diagnostic and therapeutic approach.
Collapse
|
27
|
Abstract
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.
Collapse
Affiliation(s)
- D M Scollard
- Laboratory Research Branch, National Hansen's Disease Programs, LSU-SVM, Skip Bertman Dr., Baton Rouge, LA 70803, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Affiliation(s)
- Yusuf A Rajabally
- Department of Neurology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
| | | | | |
Collapse
|
29
|
Andrzejewski A, Woźniakowska-Gésicka T, Wiśniewska-Ligier M. [Specific features of Borrelia burgdorferi infection in children]. Przegl Epidemiol 2006; 60 Suppl 1:16-22. [PMID: 16909770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Clinical picture of Borrelia burgdorferi infection has been presented in 89 children from Lodz region. The analysis showed significant domination of cases with non specific symptoms (41.6%) as: fever or headache and cases with affected central and peripheral nervous system (30.3%). Peripheral cranial nerves paralysis and symptoms of cerebrospinal meningitis dominated among children with neuroborreliosis. Unlike descriptions concerning adults, majority of the observed symptoms were changes characteristic for I stage of the disease. Dermatosis was found only in (19%) child and symptoms of arthritis in (9%) of them. Contact with tick was stated in 56.8% of the analysed children. Incidence of the disease occurred throughout the whole year, more frequently in summer and autumn months.
Collapse
|
30
|
|
31
|
Seiler DK, Wilton J, Dellon AL. Detection of Neuropathy Due to Mycobacterium leprae Using Noninvasive Neurosensory Testing of Susceptible Peripheral Nerves. Ann Plast Surg 2005; 55:633-7. [PMID: 16327466 DOI: 10.1097/01.sap.0000185888.44243.d5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence of disability in patients with Hansen disease is related to peripheral nerve dysfunction. This dysfunction, which is due to chronic nerve compression, is the result of invasion of the peripheral nerve by Mycobacteria leprae. This suggests that early identification of M. leprae would be aided by detection of early stages of peripheral nerve compression. Traditional evaluation of peripheral nerve function with monofilaments, electrodiagnostic testing, or by observing motor palsy or digital ulcers unfortunately identifies only late sequelae of peripheral nerve dysfunction. The cutaneous pressure threshold required to identify 1 from 2 static-touch stimuli was obtained with the Pressure-Specified Sensory Device in upper and lower extremities of 51 patients who completed multidrug therapy for Hansen disease. Abnormal peripheral nerve function was identified in each patient and in each of the 120 bilateral nerves that were evaluated. The degree of nerve dysfunction included the range from early to late stages of nerve compression, suggesting that this method of neurosensory testing offers the possibility for early detection of peripheral nerve problems in Hansen disease.
Collapse
Affiliation(s)
- David K Seiler
- Institute for Peripheral Nerve Surgery, Baltimore, MD, USA
| | | | | |
Collapse
|
32
|
Affiliation(s)
- P Moonot
- SWLEOC, Epsom and St. Helier's NHS Trust, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK.
| | | | | |
Collapse
|
33
|
Xiang SL, Cai FC, Zhang XP, Deng B. [Immunopathological evidence of terminal residues containing sialic acid in Campylobacter jejuni lipopolysaccharide as the critical antigen to induce peripheral neuropathy]. Zhonghua Er Ke Za Zhi 2005; 43:665-70. [PMID: 16191299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore the important role of the terminal residues containing sialic acid (SA) in Campylobacter jejuni (CJ) lipopolysaccharide (LPS) as the critical antigen to induce nerve damage, and also to identify immunopathological evidence for the hypothesis of molecular mimicry and cross-immunity between CJ LPS and gangliosides. METHODS A mutant of Pen O:19 CJ with neuB1 gene inactivated and LPS outer core terminal residues losing SA was to be constructed. PCR and RT-PCR were used to confirm the mutant. Capability of CJ LPS binding to cholera toxin B subunit (CTB) was tested. Guinea pigs were systematically immunized with LPS of the wild and the mutant strains, respectively. Titers of anti-LPS and anti-ganglioside GM(1) IgG antibodies in sera of immunized guinea pigs were detected by ELISA. Pathological study for sciatic nerves of both Guinea pigs either immunized systematically or perineural injection with their immunized serum was finished. RESULTS (1) The mutant of CJ O:19 strain with inactivated neuB1 gene was successfully constructed and lost transcriptional activity of neuB1 gene in the mutant strain was confirmed by PCR and RT-PCR. SA was well demonstrated by both acidic ninhydrin reaction and periodate-resorcinol reaction in the LPS of wild strain but not in the mutant LPS; (2) Compared with the titers before immunization, the titers of anti-GM(1) IgG antibody increased in sera of guinea pigs immunized with LPS of the wild strain. However there were no detectable anti-GM(1) IgG antibody in sera of the animals immunized with mutant LPS and PBS. (3) The incidence of pathological fibers of sciatic nerves in wild CJ LPS group (17.3%) was significantly higher than the mutant CJ LPS group (chi(2) = 125, P < 0.01); the difference between the mutant CJ LPS group and control group was not statistically significant (chi(2) = 1.633, P > 0.05). (4) After perineural injection with immunized serum, the incidence of pathological fibers of sciatic nerves in wild strain group (67.8%) was also significantly higher than the incidence of mutant group (P < 0.01). CONCLUSION A mutant of CJ O:19 strain neuB1 gene inactivated and SA component of terminal structure of LPS lost was successfully constructed. And it no longer expressed SA component which is the normal terminal structure of LPS in wild strain. The capability of the wild strain to induce increased titers of anti-GM(1) antibody and immune-mediated nerve damage was simultaneously lost for the mutant strain. It could be a strong immunopathologic evidence to identify the molecular mimicry hypothesis between CJ LPS and ganglioside epitope in nerve on the pathogenesis of CJ related GBS. The terminal residues containing SA should be as the basic GM1-like structure in CJ LPS.
Collapse
Affiliation(s)
- Shu-li Xiang
- Pediatric Institute, Chongqing Children's Hospital, Chongqing University of Medical Sciences, Chongqing 400014, China
| | | | | | | |
Collapse
|
34
|
Martins RS, Siqueira MG, Carvalho AAS. A case of isolated tuberculoid leprosy of antebrachial medial cutaneous nerve. Neurol Sci 2005; 25:216-9. [PMID: 15549507 DOI: 10.1007/s10072-004-0324-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 05/29/2004] [Indexed: 11/29/2022]
Abstract
Leprosy is an infectious disease of prevalence still high in endemic areas in Brazil. The neurological presentation depends on the involved nerve and is usually associated with skin lesions and the formation of multiple abscesses. We present a case of isolated tuberculoid leprosy, discuss the occurrence, the differential diagnosis and the treatment of this rare presentation and reaffirm the importance of considering leprosy in the differential diagnosis of patients with polyneuropathy or nerve enlargement with no skin lesions.
Collapse
Affiliation(s)
- R S Martins
- Department of Neurosurgery, Department of Neurology, Hospital Santa Marcelina, São Paulo, SP, Brasil.
| | | | | |
Collapse
|
35
|
Caksen H, Uner A, Arslan S, Anlar O, Odabas D, Tosun N, Akgün C. Severe peripheral polyneuropathy in a child with infective endocarditis caused by Staphylococcus aureus. Acta Neurol Belg 2004; 104:114-6. [PMID: 15508265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Although central nervous system complications such as stroke, encephalopathy and meningitis are commonly described in Staphylococcus aureus endocarditis, peripheral nervous system involvement is rarely reported in the literature. In this article we report on a 13-year-old boy with infective endocarditis caused by Staphylococcus aureus in whom severe polyneuropathy developed during hospitalization. To the best of our knowledge this is the first child case with infective endocarditis associated with peripheral polyneuropathy in the literature.
Collapse
Affiliation(s)
- H Caksen
- Department of Pediatrics, Yüzüncü Yil University Faculty of Medicine, Van, Turkey.
| | | | | | | | | | | | | |
Collapse
|
36
|
Richardus JH, Nicholls PG, Croft RP, Withington SG, Smith WCS. Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up. Int J Epidemiol 2004; 33:337-43. [PMID: 15082636 DOI: 10.1093/ije/dyg225] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nerve function impairment (NFI) is the key outcome of the pathological processes of infection with Mycobacterium leprae, which can continue after completion of multidrug therapy (MDT) and lead to disability after leprosy patients are released from treatment. The objective of this study was to assess the need for and duration of surveillance of NFI. METHODS Prospective cohort study of 2664 new leprosy patients in Bangladesh, with an observation period of 36 months in paucibacillary (PB) patients, and 60 months in multibacillary (MB) patients. Incidence rates (IR) were calculated with the number of patients developing NFI, type 1 and type 2 reactions, and silent neuritis for the first time after registration as the numerator, and cumulative person-years at risk (PYAR) as the denominator. Survival curves to the first event of NFI were also calculated. RESULTS The IR of first event of NFI amongst MB patients was 16.1 per 100 PYAR, with 121/357 (34%) developing NFI during the observation period. Of the 121 with a first event of NFI, 77 (64%) had this within a year after registration, 35 (29%) in the second year, and the remaining 9 (7%) after 2 years. The IR of first event of NFI amongst PB patients was 0.9 per 100 PYAR, with 54/2153 (2.5%) developing NFI during the observation period. Of the 54 with a first event of NFI, 48 (89%) had this within a year after registration, 3 (5.5%) in the second year, and the remaining 3 (5.5%) cases after 2 years. The percentage of PB patients with no NFI at registration surviving without developing NFI during the observation period was 99% and for PB patients with NFI at registration 92%. In MB patients without NFI at registration, the percentage surviving with no NFI during the observation period was 84% and for MB patients with NFI at registration only 36%. CONCLUSION New episodes of NFI and reactions after registration are common, in particular in MB patients with long-standing NFI at registration. The study highlights the importance of continuing surveillance for NFI of this risk group after registration for 2 years. Active surveillance beyond 2 years is not indicated.
Collapse
Affiliation(s)
- Jan H Richardus
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Abstract
Peripheral neuropathy is a common condition in HIV-positive patients and is often experienced in diabetes mellitus. The primary mechanism of the disease, which can considerably aggravate the patient's state, is unknown. The perineurium of patients with peripheral neuropathy is frequently enveloped by apatite. Nanobacteria (NB) are protectd by a mineral shell consisting of apatite. Light has been shown to elevate the vitality level of cells, and was predicted to inhibit deposition of stressed NB in the cardiovascular system. Results indicate that light can durably restore the condition of patients with severe peripheral neuropathy.
Collapse
|
39
|
Affiliation(s)
- R P Gie
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
40
|
Ebenezer GJ, Daniel E. Expression of protein gene product 9.5 in lepromatous eyes showing ciliary body nerve damage and a "dying back" phenomenon in the posterior ciliary nerves. Br J Ophthalmol 2004; 88:178-81. [PMID: 14736767 PMCID: PMC1771971 DOI: 10.1136/bjo.2003.027276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Peripheral nerve destruction is the hallmark of leprosy. Ocular complications form a substantial part of the clinical manifestations but histopathology of nerve destruction within ocular structures has not been shown satisfactorily. The role of protein gene product (PGP) 9.5 in identifying nerve destruction in the ciliary body and posterior ciliary nerves of lepromatous eyes is shown. METHODS Serial sections from two lepromatous eyes and two non-lepromatous eyes were stained with PGP 9.5. Histopathological comparison was done on the expression of the PGP 9.5 stain in nerves within the ciliary body, posterior ciliary nerves adjacent to the optic nerve, and nerves tracking through the sclera. RESULTS In non-lepromatous eyes, PGP 9.5 was expressed in nerves within the ciliary body, the nerves within the sclera, and posterior ciliary nerves adjacent to the optic nerve. In lepromatous eyes no PGP 9.5 was expressed, signifying nerve destruction. CONCLUSIONS Nerve destruction in lepromatous eyes has been confirmed histopathologically by the absence of or patchy staining with PGP 9.5. Nerve destruction in the ciliary body can extend to the posterior ciliary nerves by an ascending axonopathy. This "dying back" phenomenon is akin to the "glove and stocking" anaesthesia found in lepromatous leprosy.
Collapse
Affiliation(s)
- G J Ebenezer
- Department of Histopathology and Experiment Pathology, Schieffelin Leprosy Research and Training Center, Karigiri, Vellore District, Tamilnadu, India-632106.
| | | |
Collapse
|
41
|
Birdi TJ, Antia NH. Mechanisms involved in peripheral nerve damage in leprosy with special reference to insights obtained from in vitro studies and the experimental mouse model. ACTA ACUST UNITED AC 2004; 71:345-54. [PMID: 14763884 DOI: 10.1489/1544-581x(2003)071<0345:miipnd>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The histopathological observations of Khanolkar and Iyer, that M. leprae has a predeliction for nerves, first highlighted the central role of peripheral nerves in the pathology of leprosy. It is now well recognized that nerve damage in leprosy will still continue to be an important problem in control and rehabilitation despite the presence of more efficient therapy. The multiplicity of mechanisms postulated, identified, and demonstrated in the last three decades has received little recognition from the scientific community at large. This review is therefore an attempt to collate these multiple studies on mechanisms of nerve damage into a cohesive analysis, which would facilitate the design of future studies. The objective of this review is to focus therefore only on studies which serve to illustrate mechanisms of nerve damage.
Collapse
Affiliation(s)
- Tannaz J Birdi
- The Foundation For Medical Research, 84-A, RG Thadani Marg, Worli, Mumbai 400 0018.
| | | |
Collapse
|
42
|
Affiliation(s)
- William R Faber
- Academic Medical Center, Department of Dermatology, Amsterdam, The Netherlands.
| | | |
Collapse
|
43
|
Zia S, Wareing D, Sutton C, Bolton E, Mitchell D, Goodacre JA. Health problems following Campylobacter jejuni enteritis in a Lancashire population. Rheumatology (Oxford) 2003; 42:1083-8. [PMID: 12730525 DOI: 10.1093/rheumatology/keg303] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Campylobacter jejuni enteritis can lead to musculoskeletal, neuropathic or other health sequelae. We investigated the coexistence, seasonal occurrence, strain-type associations and impact on work capacity of different health problems following C. jejuni enteritis in a Lancashire population during 1999 and 2001. METHODS A semistructured questionnaire was used to characterize health problems that occurred in the community after laboratory-confirmed episodes of C. jejuni enteritis. The questionnaire was posted to all adults in the Preston and Chorley area who developed C. jejuni enteritis in 1999 or 2001. All Campylobacter isolates from this population were serotyped. RESULTS Several types of sequelae occurred consistently in both years, including the coexistence of musculoskeletal and neuropathic problems. There was no evidence of C. jejuni strain-type associations or seasonal preponderance for any type of sequela. The overall health impact of C. jejuni enteritis, as measured by workdays lost, was high in this population. CONCLUSIONS A variety of health problems occur consistently following C. jejuni enteritis and substantially increase morbidity due to campylobacteriosis in the community.
Collapse
Affiliation(s)
- S Zia
- Consortium for Campylobacter Clinical and Molecular Research, Lancashire Postgraduate School of Medicine and Health, University of Central Lancashire, UK.
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Peripheral nerve biopsies from 4 borderline tuberculoid (BT) and 4 lepromatous (LL) patients who were on multidrug therapy were investigated by light and electron microscopic studies. The variation of diameters and distribution of myelinated and unmyelinated fibers between BT and LL patients were not significant. This study has shown significant changes in peripheral nerves and endoneural blood vessels. It was revealed that besides Schwann cells (SC), the endothelial cells (EC) of endoneural blood vessels frequently harbor M. leprae. In BT, peripheral nerves in addition to the degenerative changes of SC and presence of perineural and perivascular cuffing by mononuclear cells, the endoneurial blood vessels showed thickening of basement membrane with hypertrophy of EC leading to narrowing or complete occlusion of lumen. On the other hand, peripheral nerves of LL patients were infiltrated with large number of M. leprae shown to be present in the electron transparent zone (ETZ) of the SC. The EC of endoneurial blood vessels were found to be loaded with M. leprae, and this bacillary loaded EC was found to release M. leprae into the lumen through its ruptured membrane.
Collapse
Affiliation(s)
- V Kumar
- Division of Immunology, Central JALMA Institute for Leprosy, Indian Council of Medical Research, Taj Ganj Agra-282001, India.
| | | |
Collapse
|
45
|
Leprosy bug provides clues to early nerve degeneration. LEPROSY REV 2002; 73:402. [PMID: 12549849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
|
46
|
Gerard A, Sarrot-Reynauld F, Liozon E, Cathebras P, Besson G, Robin C, Vighetto A, Mosnier JF, Durieu I, Vital Durand D, Rousset H. Neurologic presentation of Whipple disease: report of 12 cases and review of the literature. Medicine (Baltimore) 2002; 81:443-57. [PMID: 12441901 DOI: 10.1097/00005792-200211000-00005] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report 12 cases of Whipple disease in patients with prominent neurologic symptoms, along with 122 cases of Whipple disease with nervous system involvement reported in the literature. We analyzed the clinical signs and results of additional examinations in 2 groups: the first group included patients with predominantly but not exclusively neurologic signs, and the second included patients with clinically isolated neurologic presentation of the disease. Whipple disease is a multisystemic infectious disease due to Tropheryma whippelii that may present with prominent or isolated symptoms of either the central or the peripheral nervous system. Recent reports stress the importance of polymerase chain reaction (PCR) analysis of cerebrospinal fluid, magnetic resonance imaging (MRI) during follow-up, and prolonged antibiotic therapy with drugs able to cross the blood-brain barrier. Cerebrospinal fluid should be analyzed repeatedly during follow-up, and treatment should be discontinued only when the results of PCR assay performed on cerebrospinal fluid are negative. Other examinations to be done include searching for gastrointestinal tract involvement with multiple duodenal biopsies and searching for systemic involvement with lymph node biopsies, which should be analyzed with light microscopy, electron microscopy, and PCR. When all examinations are negative, if Whipple disease is suspected and a lesion is found on brain MRI, a stereotactic cerebral biopsy should be performed. Treating Whipple disease with long-term trimethoprim-sulfamethoxazole is usually effective, but the use of third-generation cephalosporins in case of incomplete response deserves further attention.
Collapse
Affiliation(s)
- Antoine Gerard
- Service de Médecine Interne-Angiologie, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
McCaughan F, Holmes A, Lynn WA, Friedland JS. Mycobacterium tuberculosis infection complicated by Eales disease with peripheral neuropathy. Clin Infect Dis 2002; 35:e89-91. [PMID: 12355398 DOI: 10.1086/342888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2002] [Revised: 05/15/2002] [Indexed: 11/03/2022] Open
Abstract
Eales disease, which is reported mainly in patients from the Indian subcontinent, is characterized by ophthalmic abnormalities that are sometimes followed by neurologic sequelae, and it is associated with previous Mycobacterium tuberculosis infection. We describe the first patient, to our knowledge, to receive a diagnosis of active tuberculosis and concurrent, severe neurological Eales disease, including peripheral neuropathy. The patient recovered completely after receiving steroid therapy.
Collapse
Affiliation(s)
- Frank McCaughan
- Department of Infectious Diseases, Imperial College, Hammersmith Hospital, London, W12 0NN, United Kingdom
| | | | | | | |
Collapse
|
48
|
Massa R, Morello M, Sancesario G, Bernardi G. Sural nerve without nerve fibers in leprous neuropathy. Arch Neurol 2002; 59:306. [PMID: 11843705 DOI: 10.1001/archneur.59.2.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Roberto Massa
- Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma-Tor Vergata, Via di Tor Vergata 135, I-00133 Rome, Italy.
| | | | | | | |
Collapse
|
49
|
Andrzejewski A, Woźniakowska-Gesicka T, Kmieć K, Sass-Just M. [Clinical course of borreliosis in children]. Pol Merkur Lekarski 2002; 12:54-6. [PMID: 11957805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Clinical picture of Borrelia burgdorferi infection has been presented in 45 children, aged 2-16 years from Łódź region. The analysis showed significant domination of cases with affected central and peripheral nervous system (44.4%) and rather unspecific symptoms such as: fever (20%) or headache (13.3%). Peripheral cranial nerves paralysis and symptoms of cerebrospinal meningitis dominated among children with neuroborreliosis. Unlike descriptions concerning adults, majority of the observed symptoms were changes characteristic for I and II stage of the disease. Dermatosis was found only in 1 child and symptoms of arthritis in 2 of them. Contact with tick was stated in 52% of the analysed children. Incidence of the disease occurred throughout the whole year, more frequently in summer and autumn months.
Collapse
|
50
|
Schettini AP, Ferreira LC, Milagros R, Schettini MC, Pennini SN, Rebello PB. Enhancement in the histological diagnosis of leprosy in patients with only sensory loss by demonstration of mycobacterial antigens using anti-BCG polyclonal antibodies. Int J Lepr Other Mycobact Dis 2001; 69:335-40. [PMID: 12041513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This study was undertaken to assess whether the immunoperoxidase technique using anti-BCG serum is able to confirm the diagnosis of early leprosy among patients whose unique clinical manifestation is a localized area of sensory loss, in a higher proportion than the routine mycobacterial staining methods, namely hematoxylin-eosin and Wade. The study was held in the north of a hyper-endemic area of leprosy, Manaus, Amazonas (Brazil). Fifty-one paraffin-embedded skin biopsy blocks were retrieved and processed for the immunohistochemical study, by means of anti-BCG polyclonal antibodies for the detection of mycobacterial antigens. The routine stains confirmed the leprosy diagnosis in 17% of the cases, while the immunostaining method confirmed it in 47%. The McNemar test showed that the observed difference between these two techniques was statistically significant (p = < 0.05). In the same way, 50 blocks of skin conditions considered in the differential histopathological diagnosis of early leprosy were processed for the immunohistochemical test to analyze the possibility of false-positive results which occurred in 8 (16%) patients. The study suggests that immunostaining may increase the proportion of the routine histological diagnosis of leprosy in patients who have sensory loss only, even while using biopsies obtained in fieldwork conditions. This is very advantageous in hyper-endemic areas and in areas that are in the post-elimination period of leprosy control where sensory loss may be a sentinel sign of the disease.
Collapse
Affiliation(s)
- A P Schettini
- Fundação Alfredo da Matta, Av. Codajás no. 25, CEP 69065-130, Cachoeirinha, Manaus-Amazonas-Brasil.
| | | | | | | | | | | |
Collapse
|