Neurological aspects of mycoplasmal infection

Mycoplasmal infections may be complicated by a wide variety of systemic syndromes, including neurological disorders. Circumstantial evidence suggests that these are immunologically-induced. A detailed study of five patients with proven mycoplasma pneumoniae and central nervous system signs showed that immunological factors were involved and suggested that the neurological symptoms were due to a vasculopathy.

Anti-endothelial cell antibody and immune complexes in the sera of animals with acute experimental allergic encephalomyelitis and chronic relapsing experimental allergic encephalomyelitis

Blood-brain barrier (BBB) injury occurs in both acute and chronic relapsing experimental allergic encephalomyelitis (EAE). Sera from animals in which these forms of EAE had been induced were examined for anti-endothelial cell antibodies and immune complexes by enzyme-linked immunosorbent assay (ELISA) using either cultured endothelial cells or Raji cells. IgG binding to endothelial cells was significantly increased in the sera of animals with acute EAE and chronic relapsing EAE, compared to controls. Increased levels of circulating immune complexes were also detected in the sera of some animals with chronic relapsing EAE, especially those in an exacerbation. It is suggested that the anti-endothelial cell antibody and immune complexes detected may play pathogenetic roles in the destruction of the BBB in EAE.

Similarities between the Forssman carotid syndrome and experimental allergic encephalomyelitis

The Forssman carotid syndrome was induced in guinea pigs to study the mechanism of demyelination-like lesions in this animal model and to compare it with experimental allergic encephalomyelitis days after intracarotid injection of rabbit anti-Forssman antibody and chronic lesions at 7-21 days post injection, using routine histological, immunofluorescent, and electron-microscopic techniques. The results were compared to those in a group of guinea pigs with acute or chronic lesions of EAE. The picture was remarkably similar in the two conditions, in regard to localization in the central nervous system (CNS), composition of cellular infiltrates, diameter of lesions produced, myelin loss and axonal degeneration, together with gamma globulin deposition in small vessels in affected areas. The differences were that in the Forssman carotid syndrome, in contrast to EAE, there were no mononuclear cell infiltrates in the acute phase, and no evidence of macrophages invading myelin sheaths was detected. Perivascular lesions consisted of demyelination within infiltrates of mono-nuclear cell in chronic relapsing EAE, but not in the Forssman carotid syndrome. It is suggested that investigation of the CNS may be of benefit in the pathogenetic study of demyelinating disease.

The postviral fatigue syndrome--an analysis of the findings in 50 cases

The clinical, pathological, electrophysiological, immunological and virological abnormalities in 50 patients with the postviral fatigue syndrome are recorded. These findings confirm the organic nature of the disease. A metabolic disorder, caused by persistent virus infection and associated with defective immunoregulation, is suggested as the pathogenetic mechanism.

Search for autoantibodies to endothelial and smooth muscle cells in patients with multiple sclerosis

The blood-brain barrier (BBB) is disrupted in many of the lesions of multiple sclerosis (MS). Immunologically mediated injury to one of the major components of this barrier, the cerebral capillary, may play a role in the development of the lesion. We therefore examined the sera of 51 cases of MS for the presence of autoantibodies to endothelial and smooth muscle cells, using the indirect immunofluorescent technique. The results were compared to those in other groups of patients with neuroimmunological disorders. We found no anti-endothelial cell antibodies, but autoantibodies to vascular smooth muscle were detectable in 31% of the MS sera tested. They were also present, however, in 30% of sera from cases of myasthenia gravis and in the serum of one of 12 cases of polymyositis. It is considered to be unlikely that antibodies to vascular tissues play any pathogenetic role in multiple sclerosis.

Recent advances in polymyositis

The most typical clinical features of polymyositis (PM), the criteria of diagnosis and principles of treatment are outlined. An inflammatory disease of muscle, PM also frequently affects other organs such as the skin and hence the name dermatomyositis. The principal cardiac symptom is a peculiar disturbance of atrioventricular conduction, correlated with a specific anti-Ro autoantibody, present in 25% of patients. The etiology of PM is as yet unknown, although there is evidence for an autoimmune pathogenesis. It is frequently found in association with other immune-mediated diseases such as myasthenia gravis, pemphigus, immune-complex vasculitis and Sjogren syndrome. Laboratory investigations show hypergammaglobulinemia, a decrease of complement factors C3 and C4 and the presence of circulating immune complexes in 70% of patients. Very frequent, especially in cases of dermatomyositis, is a histologically detectable accumulation of IgG and complement in the walls of the intramuscular venous vessels. Cell-mediated hypersensitivity, emphasised formerly as highly significant in PM, has not been confirmed. The presence of specific antimyoglobin lymphocyto-toxicity, once considered to be the hallmark of muscle degeneration in PM, has been excluded by a number of laboratories. In a personal series of patients with various clinical forms of PM a severe loss of suppressor/cytotoxic lymphocytes was found in the peripheral blood and a relative increase in the first subset. These results support the hypothesis that a serious disturbance of immunoregulation is present in PM and is the cause of a multitude of immunological anomalies, the characterisation of which is under study.

Does Toxoplasma cause polymyositis? Report of a case of polymyositis associated with toxoplasmosis and a critical review of the literature

We report here a case of polymyositis and toxoplasmosis, and review the previous examples of this association. We suggest that in most cases this relationship is due to reactivation of latent infection in an immunocompromised host. Gross immunological aberrations underline the pathogenesis of polymyositis and these predispose the patient to the development of toxoplasmosis. Anti-protozoal therapy is necessary and produces some clinical benefit, but it does not cure the polymyositis.

Myalgic encephalomyelitis--report of an epidemic

The relationship between the group B Coxsackieviruses and a wide variety of illnesses, particularly pleurodynia and myo/pericarditis, is already well established. The detection of raised levels of neutralizing antibody to these viruses in a group of patients in a rural practice presenting with an illness resembling myalgic encephalomyelitis (ME) was therefore unexpected. This is a most distressing and debilitating illness for the patient and the affected family. What is the immunological failure in these patients which apparently allows this virus to persist causing such unusual and bizarre illness? At present ME is probably much commoner than is realized, the majority of patients being given the dismissive diagnosis of psychoneurosis.

Late onset of Guillain-Barré syndrome

The Guillain-Barré syndrome (GBS) usually occurs within one month of the precipitating cause. It is the purpose of this paper to show that typical cases may, however, appear weeks to months later. We have reviewed the collected data on these cases and suggest that they provide evidence which is in favour of a humoral, rather than a cell-mediated, aetiology for GBS.