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Rahimian S, Najafi H, Webber CA, Jalali H. Advances in Exosome-Based Therapies for the Repair of Peripheral Nerve Injuries. Neurochem Res 2024; 49:1905-1925. [PMID: 38807021 DOI: 10.1007/s11064-024-04157-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/07/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
Peripheral nerve injuries (PNIs) are the term used to describe injuries that occur to the nerve fibers of the peripheral nervous system (PNS). Such injuries may be caused by trauma, infection, or aberrant immunological response. Although the peripheral nervous system has a limited capacity for self-repair, in cases of severe damage, this process is either interrupted entirely or is only partially completed. The evaluation of variables that promote the repair of peripheral nerves has consistently been a focal point. Exosomes are a subtype of extracellular vesicles that originate from cellular sources and possess abundant proteins, lipids, and nucleic acids, play a critical role in facilitating intercellular communication. Due to their modifiable composition, they possess exceptional capabilities as carriers for therapeutic compounds, including but not limited to mRNAs or microRNAs. Exosome-based therapies have gained significant attention in the treatment of several nervous system diseases due to their advantageous properties, such as low toxicity, high stability, and limited immune system activation. The objective of this review article is to provide an overview of exosome-based treatments that have been developed in recent years for a range of PNIs, including nerve trauma, diabetic neuropathy, amyotrophic lateral sclerosis (ALS), glaucoma, and Guillain-Barre syndrome (GBS). It was concluded that exosomes could provide favorable results in the improvement of peripheral PNIs by facilitating the transfer of regenerative factors. The development of bioengineered exosome therapy for PNIs should be given more attention to enhance the efficacy of exosome treatment for PNIs.
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Affiliation(s)
- Sana Rahimian
- Division of Nanobiotehnology, Department of Cell and Molecular Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Hossein Najafi
- Division of Nanobiotehnology, Department of Cell and Molecular Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Christine A Webber
- Division of Anatomy, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Hanieh Jalali
- Division of Cell and Developmental Biology, Department of Animal Biology, Faculty of Biological Sciences, Kharazmi University, No. 43, South Moffateh Ave, Tehran, 15719-14911, Iran.
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Liu S, Zhang WW, Jia L, Zhang HL. Guillain-Barré syndrome: immunopathogenesis and therapeutic targets. Expert Opin Ther Targets 2024; 28:131-143. [PMID: 38470316 DOI: 10.1080/14728222.2024.2330435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/10/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is a group of acute immune-mediated disorders in the peripheral nervous system. Both infectious and noninfectious factors are associated with GBS, which may act as triggers of autoimmune responses leading to neural damage and dysfunction. AREAS COVERED Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines as well as flaviviruses have been associated with GBS, although a robust conclusion has yet to be reached. Immunomodulatory treatments, including intravenous immunoglobulins (IVIg) and plasma exchange (PE), have long been the first-line therapies for GBS. Depending on GBS subtype and severity at initial presentation, the efficacy of IVIg and PE can be variable. Several new therapies showing benefits to experimental animals merit further investigation before translation into clinical practice. We review the state-of-the-art knowledge on the immunopathogenesis of GBS in the context of coronavirus disease 2019 (COVID-19). Immunomodulatory therapies in GBS, including IVIg, PE, corticosteroids, and potential therapies, are summarized. EXPERT OPINION The association with SARS-CoV-2 remains uncertain, with geographical differences that are difficult to explain. Evidence and guidelines are lacking for the decision-making of initiating immunomodulatory therapies in mildly affected patients or patients with regional subtypes of GBS.
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Affiliation(s)
- Shan Liu
- Department of Nuclear Medicine, Second Hospital of Jilin University, Changchun, China
| | - Wei Wei Zhang
- Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Zhou X, Peng A, Li C, Li L, Yao D, Hao Y, Zhao C, Yan Q, Li Y, Liu J, Liu S, Zhu W, Du Y, Zhang W. Combined central and peripheral demyelination: a case report resembling encephalomyeloradiculoneuropathy. Front Neurol 2024; 14:1288546. [PMID: 38292033 PMCID: PMC10825037 DOI: 10.3389/fneur.2023.1288546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Combined central and peripheral demyelination (CCPD) is an extremely rare disease characterized by inflammatory demyelination in both the central and peripheral nervous systems. Herein, we reported case of a 14-year-old teenager who initially presented with the symptoms of acute myelitis (AM). Subsequently, the patient developed symptoms consistent with Guillain-Barré syndrome (GBS), which was supported by nerve conduction studies (NCV) and cerebrospinal fluid (CSF) analysis. Throughout the course of the disease, the patient experienced abdominal pain and abnormal liver function. After a comprehensive evaluation, we determined that the abnormal liver function was a result of hepatitis E virus (HEV) infection, which may have acted as a trigger for GBS. The patient was treated with corticosteroids, intravenous immunoglobulin and Rituximab, resulting in symptom relief and clinical improvement after therapy and follow-up. This case highlights the potential responsiveness and reversibility of CCPD. Given the heterogeneous nature of CCPD, there is currently no standardized diagnostic criteria or clear consensus on its treatment. Therefore, we recommend a thorough assessment of all possibilities and the development of consolidated management guidelines based on available data for this disorder.
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Affiliation(s)
- Xuan Zhou
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Ali Peng
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Chuan Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Lin Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Dan Yao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Yunfeng Hao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Chao Zhao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Qi Yan
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Ying Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Juntong Liu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Shuyu Liu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Wenping Zhu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
- Xi’an Medical University, Xi’an, Shaanxi Province, China
| | - Ying Du
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
| | - Wei Zhang
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi Province, China
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Jia L, Ni F, Zhang HL. Is Guillain-Barré syndrome related to systemic lupus erythematosus or other autoimmune diseases? Front Neurol 2024; 14:1336794. [PMID: 38269005 PMCID: PMC10806246 DOI: 10.3389/fneur.2023.1336794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengming Ni
- Department of Gastroenterology, Digestive Endoscopy Center, First Hospital, Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Aljezani MA, Althubaiti F, Alhamed L, Alharthi A, Alamoodi A, Bakheet Y, Badawi M, Hindawi S. Plasma Exchange in Pediatric Neurology Patients: A Single-Center Experience. Cureus 2024; 16:e52691. [PMID: 38384617 PMCID: PMC10879651 DOI: 10.7759/cureus.52691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is a procedure involving the filtration of a patient's plasma to eliminate pathogenic components or address deficiencies. This technique finds varied indications in the pediatric age group, particularly in neuroinflammatory diseases. OBJECTIVES The objective of this study is to delve into our local experience with TPE, focusing on indications, outcomes, and complications among children with neurological diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. RESULTS Conducted at the pediatric department of KAUH in Jeddah from November 2008 to July 2023, this retrospective cohort study examined 15 patients, revealing a notable male predominance with 12 male patients (80%) and three female patients (20%). About two-thirds of patients exhibited an average illness severity, with a Glasgow Coma Scale (GCS) score of 10.7 and an Expanded Disability Status Scale (EDSS) score of 4.8. The median length of hospital stay was 23 days, and in the pediatric intensive care unit (PICU), it was 8.5 days. Presenting symptoms included limb weakness (n = 6), loss of consciousness (n = 3), dysphagia (n = 3), photophobia (n = 1), and ascending paralysis (n = 1). The TPE was performed for Guillain-Barré syndrome (GBS) (n = 7), myasthenia gravis (MG) (n = 3), transverse myelitis (TM) (n = 2), neuromyelitis optica (NMO) (n = 2), and systemic lupus erythematosus (SLE) cerebritis (n = 1). Twelve patients were admitted to the PICU, and mechanical ventilation was required for 10 patients. In magnetic resonance imaging (MRI) findings, abnormalities were observed in 10 cases, while the remaining five either had normal results or did not undergo MRI. Most patients required five sessions of TPE (n = 7). The median age at the initiation of TPE was 13 years. Twelve patients improved with TPE treatment, while three did not. Complications observed during and following TPE included fever (n = 5), electrolyte disturbance (n = 5), hypotension (n = 3), hypocalcemia (n = 2), bradycardia (n = 2), vomiting (n = 1), tachycardia (n = 1), eye rash (n = 1), infection (n = 1), and bleeding originating from the TPE procedure site (n = 1). CONCLUSION In conclusion, our study underscores the significance of TPE as a therapeutic modality, emphasizing the imperative for ongoing research to fully exploit its potential across diverse medical contexts for enhancing patient care. Our findings, consistent with prior research, reveal plasma exchange's (PLEX's) wide-ranging applications and complications in neurological disorders.
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Affiliation(s)
- Maram A Aljezani
- Pediatric Neurology, King Abdulaziz University Hospital (KAUH), Jeddah, SAU
- Pediatric Neurology, King Fahad Medical City (KFMC), Riyadh, SAU
| | | | | | | | | | | | - Maha Badawi
- Hematology, King Abdulaziz University, Jeddah, SAU
| | - Salwa Hindawi
- Hematology/Blood Transfusion Services, King Abdulaziz University, Jeddah, SAU
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Harrison A, Mudhar O, Yoo J, Rampal M. Diplopia in a patient presenting with "blurred vision": a case report. J Med Case Rep 2023; 17:402. [PMID: 37679826 PMCID: PMC10485954 DOI: 10.1186/s13256-023-04089-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/18/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Myasthenia gravis is an autoimmune condition affecting the neuromuscular junction and causing muscle weakness along with fatigue (myasthenia). When the clinical manifestations of myasthenia gravis are isolated to the eye muscles, only causing weak eye movements, it is referred to as ocular myasthenia gravis, which can mimic a 1 and ½ syndrome. CASE PRESENTATION An African-American female in her fifties with past medical history of hypertension presented to our outpatient clinic with complaints of blurred vision for two weeks. Her symptoms were associated with facial discomfort and a generalized headache. On physical examination upon her initial presentation, there was demonstratable swelling of the left upper eyelid with drooping. Her extraocular movements revealed defects with the abduction and adduction of the right eye, and the left eye would not adduct, although the outward movement was normal. The left eye failed to lift/elevate completely when looking upwards, a pseudo 1 and ½ syndrome. A positive Cogan lid twitch was also noticed. Imaging of the brain and orbit ruled out central causes. Diagnosis of ocular myasthenia gravis was made in accordance with positive anti-acetylcholine receptor antibodies. With 120 mg pyridostigmine oral dose, the patient experienced improvement subjectively and objectively, and the patient was discharged on oral pyridostigmine and prednisone. Six months later, with prednisone having been tapered off, the patient developed a myasthenic crisis and was treated with plasmapheresis and intravenous immunoglobulins. After recovering from the myasthenic crisis, efgartigimod infusions were instituted, which helped our patient restore normal life. CONCLUSION Our patient who presented with "blurred vision" was discovered to have binocular diplopia due to significant dysconjugate eye movements. After diligently ruling out central etiologies, we concluded that her presentation was due to a peripheral etiology. Her serologies and her presentation helped confirm a diagnosis of ocular myasthenia gravis. Also, as in most cases, our patient also progressed to develop generalized myasthenia gravis while on pyridostigmine. Efgartigimod infusions instituted after our patient recovered from a myasthenic crisis have helped her restore a normal life.
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Affiliation(s)
- Anil Harrison
- Department of Internal Medicine, UCF/HCA, Pensacola, FL, USA
| | - Onkar Mudhar
- Internal Medicine Resident, Department of Internal Medicine, Touro University, Stockton, CA, USA
| | - Jun Yoo
- Department of Internal Medicine, UCF/HCA, Pensacola, FL, USA.
| | - Mayank Rampal
- Department of Internal Medicine, UCF/HCA, Pensacola, FL, USA
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Changadiya K, Anadure R, Sreen A, Gupta S, Singh S, Mhatre R. Two unusual cases of Guillain-Barre syndrome after snake bite: the rare immune mediated complication of Elapid venom. Med J Armed Forces India 2023; 79:321-327. [PMID: 37193514 PMCID: PMC10182293 DOI: 10.1016/j.mjafi.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023] Open
Abstract
In this report, we present a series of two unusual cases of elapid snakebite with acute neuroparalysis, that after initial response to standard anti-snake venom therapy, developed recurrence of disabling quadriparesis with dysautonomia, that on detailed evaluation turned out to be immune-mediated polyradiculoneuropathy (GB syndrome). Both the cases then responded to therapy with intravenous immunoglobulins. These cases bring out the rare immune-mediated late complication of snake venom, which if recognized and treated in time, can significantly reduce the morbidity and mortality.
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Affiliation(s)
- Keval Changadiya
- Senior Resident (Neurology), Army Hospital (R&R), New Delhi, India
| | - R.K. Anadure
- Professor & Head (Neurology), Army Hospital (R&R), New Delhi, India
| | - Amit Sreen
- Senior Advisor (Neurology), Army Hospital (R&R), New Delhi, India
| | - Salil Gupta
- Professor & Head (Medicine), Command Hospital (Air Forces), Bengaluru, India
| | - Sindhu Singh
- Senior Resident (Neurology), Army Hospital (R&R), New Delhi, India
| | - Radhika Mhatre
- Senior Resident (Neuropathology), NIMHANS, Bengaluru, India
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Kommu S, Cirra V, Pesala SPR, Arepally S. Atypical Guillain-Barre Syndrome With a Sensory Level and Hyper-Acute Presentation: A Case Report. Cureus 2023; 15:e38262. [PMID: 37139032 PMCID: PMC10151066 DOI: 10.7759/cureus.38262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
A 46-year-old man with a prior history of cervical spondylosis and myelopathy needing cervical spinal surgery three years back presented to the emergency department with acute onset areflexic flaccid weakness of both lower extremities, with a sensory level at T10. Magnetic resonance imaging studies (MRI) of the cervical, thoracic, and lumbar spine ruled out significant cord compression, spinal cord ischemia, spinal shock, or findings to suggest transverse myelitis. CSF analysis showed normal albumin and protein; however, with the features of paraplegia with flaccidity, areflexia, absence of bowel and bladder symptoms, and MRI ruling out other possibilities, a diagnosis of Guillain-Barre syndrome (GBS) was made. The patient was treated with intravenous immunoglobulin (IVIG) and showed a clinical response, with improvement in strength in both lower extremities. This case is rare and unique, as it exhibits atypical features for a GBS case, including a sensory level and hyper-acute presentation, with the onset of weakness to a nadir within an hour. This case highlights the importance of awareness of such atypical GBS presentations so that the diagnosis is not missed and is appropriately managed for favorable patient outcomes.
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Affiliation(s)
- Sharath Kommu
- Hospital Medicine, Marshfield Clinic Health System, Rice Lake, USA
| | - Vidyasagar Cirra
- Hospital Medicine, Marshfield Clinic Health System, Rice Lake, USA
| | | | - Shalini Arepally
- Family Medicine, Marshfield Clinic Health System, Rice Lake, USA
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Fujii K, Shiohama T, Uchida T, Ikehara H, Fukuhara T, Sawada D, Aoyama H, Uchikawa H, Yoshii S, Arahata Y, Shimojo N, Misawa S, Kuwabara S. Nationwide survey of childhood Guillain-Barré syndrome, Fisher syndrome, and Bickerstaff brainstem encephalitis in Japan. Brain Dev 2023; 45:16-25. [PMID: 36511273 DOI: 10.1016/j.braindev.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Guillain-Barré syndrome (GBS), Fisher syndrome (FS), and Bickerstaff brainstem encephalitis (BBE) are immune-mediated neuropathies presenting with symptoms such as weakness, ophthalmoplegia, ataxia, and consciousness disturbances. Although the epidemiology of GBS and BBE in patients of all ages has been reported, childhood data have not been well-investigated. We aimed to determine the clinical features, therapeutics, and prognoses of childhood GBS, FS, and BBE in Japan. METHODS We sent questionnaires to 1068 pediatric neurologists in Japan from 2014 to 2016 to determine the number of children less than 15 years old with GBS, FS, or BBE and their age and sex. We subsequently performed a secondary survey to investigate the clinical features, laboratory data, treatment, and prognosis. RESULTS Five-hundred thirty-eight pediatric neurology specialists (50.4%) responded to the first survey. The total number of children with GBS, FS, and BBE in Japan from 2014 to 2016 were 87, 10, and 6, respectively. GBS was classified as acute inflammatory demyelinating neuropathy (35.6%), acute motor axonal neuropathy (20.7%), or acute motor-sensory axonal neuropathy (10.3%), with a male-to-female ratio of 1.29:1.0 and a wide distribution of onset ages. The disease severities of GBS, FS, and BBE were variable, but all children could walk within one year. CONCLUSION The prognoses of childhood GBS, FS, and BBE were generally favorable, as long as the patient was promptly treated with either intravenous immunoglobulin or plasma exchange.
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Affiliation(s)
- Katsunori Fujii
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pediatrics, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan.
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Uchida
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Ikehara
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyuki Fukuhara
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Sawada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiromi Aoyama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Uchikawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoko Yoshii
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yukie Arahata
- Department of Pediatrics, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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V. R, S. D, Kumar PB, N. S, G. S. Physiotherapy for complete motor recovery in 4-year-old child with Guillain Barre syndrome- A case study. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was conducted in 4-year-old male child in sub-acute stage of Guillain Barre Syndrome (GBS) for 12 weeks in a local clinical setup after discharge from the hospital completing IVIG dose. Physiotherapy was given for 12 weeks, 5 days in a week of 1 and half hour session per day with rest periods between the session. Physiotherapy intervention includes passive – active exercise, resisted exercise, weight bearing exercise, mat activities, breathing exercises, task-oriented exercise, balance and coordination exercise, abdominal strengthening, gait training, and play activities. Outcomes used before and after the intervention were Manual Muscle Test (MMT), Five Times Sit to Stand Test (FTSST), Functional independent Measure (FIM), Time Up and Go test (TUG) and Hand dynamometer to analyse the effects of physiotherapy intervention. This study concluded that there was a significant improvement in patient’s motor functions and independence in daily activities after an effective physiotherapy treatment. There was a complete motor recovery after 12 weeks of physiotherapy.
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Dudek B, Rybka J, Bugla-Płoskońska G, Korzeniowska-Kowal A, Futoma-Kołoch B, Pawlak A, Gamian A. Biological functions of sialic acid as a component of bacterial endotoxin. Front Microbiol 2022; 13:1028796. [PMID: 36338080 PMCID: PMC9631793 DOI: 10.3389/fmicb.2022.1028796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/05/2022] [Indexed: 11/28/2022] Open
Abstract
Lipopolysaccharide (endotoxin, LPS) is an important Gram-negative bacteria antigen. LPS of some bacteria contains sialic acid (Neu5Ac) as a component of O-antigen (O-Ag), in this review we present an overview of bacteria in which the presence of Neu5Ac has been confirmed in their outer envelope and the possible ways that bacteria can acquire Neu5Ac. We explain the role of Neu5Ac in bacterial pathogenesis, and also involvement of Neu5Ac in bacterial evading the host innate immunity response and molecular mimicry phenomenon. We also highlight the role of sialic acid in the mechanism of bacterial resistance to action of serum complement. Despite a number of studies on involvement of Neu5Ac in bacterial pathogenesis many aspects of this phenomenon are still not understood.
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Affiliation(s)
- Bartłomiej Dudek
- Department of Microbiology, University of Wrocław, Wrocław, Poland
- *Correspondence: Bartłomiej Dudek,
| | - Jacek Rybka
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | | | - Agnieszka Korzeniowska-Kowal
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
| | | | | | - Andrzej Gamian
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wrocław, Poland
- Andrzej Gamian,
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Zhang B, Duan L, Ma L, Cai Q, Wu H, Chang L, Li W, Lin Z. Rapidly progressive Guillain-Barré syndrome following amitriptyline overdose and severe Klebsiella pneumoniae infection: A case report and literature review. Front Med (Lausanne) 2022; 9:991182. [PMID: 36267621 PMCID: PMC9576939 DOI: 10.3389/fmed.2022.991182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Guillain–Barré syndrome (GBS) is a potentially life-threatening post-infectious autoimmune disease characterized by rapidly progressive symmetrical weakness of the extremities. Herein, we report a case of GBS associated with drug poisoning complicated by Klebsiella pneumoniae infection. A 38-year-old woman was admitted to the intensive care unit after taking an overdose of amitriptyline and was later diagnosed with coma, Klebsiella pneumoniae infection, and septic shock. Thirteen days after admission, she was diagnosed with GBS based on acute muscle pain, flaccid paralysis, hyporeflexia, reduced amplitude of compound muscle action potential, and albuminocytologic dissociation in the cerebrospinal fluid. GBS rarely occurs after a drug overdose and septic shock, and this is the first report of a rapidly progressive GBS following amitriptyline overdose and severe Klebsiella pneumoniae infection.
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Affiliation(s)
- Boyu Zhang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Liwei Duan
- Department of Emergency Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Linhao Ma
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China,*Correspondence: Linhao Ma
| | - Qingqing Cai
- Genoxor Medical & Science Technology Inc., Shanghai, China
| | - Hao Wu
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Liang Chang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wenfang Li
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhaofen Lin
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China
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do Rosário MS, de Jesus PAP, Farias DS, Novaes MAC, Francisco MVLO, Santos CS, Moura D, Lima FWDM, Alcantara LCJ, de Siqueira IC. Guillain-Barré Syndrome and Miller Fisher Syndrome in Association With an Arboviral Outbreak: A Brazilian Case Series. Front Med (Lausanne) 2022; 9:911175. [PMID: 35836942 PMCID: PMC9274265 DOI: 10.3389/fmed.2022.911175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) in association with arboviruses, such as Zika, chikungunya, and dengue, has been previously documented; however, Miller-Fisher Syndrome (MFS) and other GBS subtypes are rarely reported. Methods We identified a series of GBS and MFS cases that were followed during the Zika virus outbreak in Salvador, Brazil (2015–2016). Blood and CSF samples were collected for virus diagnosis. In addition, serological studies to verify previous arboviral infection and electromyography (EMG) were performed. Results Of the 14 patients enrolled, 10 were diagnosed with GBS, including three GBS subtypes (two cases of bifacial weakness with paresthesia and one case of paraparetic GBS), and four as MFS. IgM antibodies against one or more of three arboviruses were present in 11 (78.6%) patients: anti-zika IgM positivity in eight (57%), anti-Chikungunya IgM in three (21%), and anti-Dengue in one (7%) individual. A single case was positive for both anti-Dengue IgM and anti-Chikungunya IgM, suggesting co-infection. EMG revealed an AIDP pattern in all nine patients analyzed. Conclusion The current case series contributes to our knowledge on the clinical presentation of arbovirus-associated GBS and its subtypes, including MFS, and serves as an alert to clinicians and other healthcare professionals in regions affected by arbovirus outbreaks. We highlight the importance of recognizing arboviruses in diagnosing GBS and its subtypes.
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Affiliation(s)
- Mateus Santana do Rosário
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Secretaria Estadual da Saúde da Bahia, Hospital Geral Roberto Santos, Salvador, Brazil
- Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, Brazil
| | - Pedro Antônio Pereira de Jesus
- Secretaria Estadual da Saúde da Bahia, Hospital Geral Roberto Santos, Salvador, Brazil
- Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, Brazil
| | - Daniel Santana Farias
- Secretaria Estadual da Saúde da Bahia, Hospital Geral Roberto Santos, Salvador, Brazil
- Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, Brazil
| | | | | | | | - Daniel Moura
- Faculdade de Farmácia, Laboratório de Imunologia das Doenças Infecciosas, Universidade Federal da Bahia, Salvador, Brazil
| | - Fernanda Washington de M. Lima
- Faculdade de Farmácia, Laboratório de Imunologia das Doenças Infecciosas, Universidade Federal da Bahia, Salvador, Brazil
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14
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Abidoye O, Raybon-Rojas E, Ogbuagu H. A Rare Case of Epstein-Barr Virus: Infectious Mononucleosis Complicated by Guillain-Barré Syndrome. Cureus 2022; 14:e21085. [PMID: 35165547 PMCID: PMC8827493 DOI: 10.7759/cureus.21085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 11/28/2022] Open
Abstract
Infectious mononucleosis (IM) is an acute disease caused by Epstein-Barr virus (EBV) infection affecting adolescents and young adults. Clinically, IM presents with fever, lymphadenopathy, and tonsillar pharyngitis. Guillain-Barré syndrome (GBS) has been reported as a possible rare complication of IM. IM-induced GBS is known but rarely reported in the literature. Here, we describe the case of a 19-year-old male with no significant medical history who was diagnosed with GBS following EBV-associated IM. A 19-year-old Caucasian male presented from a referring facility after complaining of generalized weakness involving the upper and lower extremity for about five days. Symptoms began with a sensation of tingling and numbness in the fingertips and toes that progressed over five days to where he was no longer able to ambulate. Physical examination was significant for oropharyngeal exudates, posterior oropharyngeal erythema, tonsillar hypertrophy, cervical lymphadenopathy, flaccid paralysis with areflexia, and paresthesia. Diagnostic workup was consistent with IM and GBS based on cerebrospinal findings. He was subsequently admitted to the intensive care unit, where he received plasmapheresis and intravenous immunoglobulin with significant improvement. This is a rare case of EBV-associated IM GBS. IM is a self-limiting disease but can lead to GBS as one of the known but rare complications. Neurological events have been reported in approximately 2% of patients. Only a few cases of IM leading to GBS have been reported in the literature. Detailed history and physical examination can help identify patients with IM-induced GBS. Moreover, increased awareness can help physicians easily identify and manage GBS, enabling timely recognition and initiation of prompt supportive care to improve recovery time.
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15
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Severe Acute Motor Axonal Neuropathy associated with Influenza-A (H1N1) Infection and Prolonged Respiratory Failure - A Case Report. J Crit Care Med (Targu Mures) 2021; 7:302-307. [PMID: 34934821 PMCID: PMC8647670 DOI: 10.2478/jccm-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Acute Motor Axonal Neuropathy (AMAN) is an immune-mediated disorder of the peripheral nervous system, part of the spectrum of the Guillain-Barre syndrome (GBS). An infectious event most often triggers it reported a few weeks before the onset. The reported case is of a 56 years-old woman who developed acute motor axonal neuropathy three weeks after respiratory infection with influenza A virus subtype H1N1. Despite early treatment with plasmapheresis and intravenous immunoglobulins, the patient remained tetraplegic, mechanically ventilated for five months, with repetitive unsuccessful weaning trails. The probable cause was considered to be phrenic nerve palsy in the context of acute motor axonal neuropathy. This case highlights that acute motor axonal neuropathy is a severe and life-threatening form of Guillain-Barre syndrome associated with significant mortality and morbidity. Neurological and physical recovery strongly depend on the inter-professional effort in an intensive care unit and neurology professionals.
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16
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Tagaloa E, Venter F, Liang L, Bhaika J, Aguirre D, Patel J, Nasrawi F. A Rare Case of Guillain-Barré Syndrome With Severe Pandysautonomia. J Investig Med High Impact Case Rep 2021; 9:23247096211019558. [PMID: 34027705 PMCID: PMC8150453 DOI: 10.1177/23247096211019558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute pandysautonomia is a rare disorder characterized by autonomic failure affecting sympathetic, parasympathetic, and enteric functions. We present a case of acute inflammatory demyelinating polyneuropathy (AIDP) with severe pandysautonomia in a young, otherwise healthy, female who presented with gastrointestinal symptoms and sensory demyelinating polyneuropathy, which progressively worsened and subsequently developed bladder dysfunction and orthostatic hypotension. We discuss the challenges with diagnostic workup as well as the challenges we encountered as part of the management.
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Affiliation(s)
| | | | - Li Liang
- Kern Medical Center, Bakersfield, CA, USA
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17
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Jain E, Nuthalapati D, Babar HZ, Bloomfield D. Guillain-Barré Syndrome: Inverted Paralysis Post-Operatively in a Patient With Ulcerative Colitis. Cureus 2021; 13:e15457. [PMID: 34258120 PMCID: PMC8256637 DOI: 10.7759/cureus.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
Rapidly progressive and life-threatening, the pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) poses a unique perspective on the complications that may arise post-operatively, especially in patients with an underlying autoimmune disease like ulcerative colitis. GBS is an immune-mediated polyneuropathy typically consisting of ascending flaccid muscle paralysis and areflexia. There are several variants of GBS, which can present atypically and be misdiagnosed. We intend to focus on PCB, a rare, localized variant of GBS. Herein, we report an uncommon case of a recent post-surgical patient, with underlying ulcerative colitis, who developed the PCB variant of GBS.
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Affiliation(s)
- Esha Jain
- Medicine, American University of Antigua, St. John's, ATG
| | | | - Harris Z Babar
- Medicine, University of Maryland Medical Center, Baltimore, USA
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18
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Fulminant Guillain-Barré Syndrome Post Hemorrhagic Stroke: Two Case Reports. Neurol Int 2021; 13:190-194. [PMID: 34066316 PMCID: PMC8162529 DOI: 10.3390/neurolint13020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/16/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute, immune-mediated inflammatory peripheral polyneuropathy characterized by ascending paralysis. Most GBS cases follow gastrointestinal or chest infections. Some patients have been reported either following or concomitant with head trauma, neurosurgical procedures, and rarely hemorrhagic stroke. The exact pathogenesis is not entirely understood. However, blood-brain barrier damage may play an essential role in triggering the autoimmune activation that leads to post-stroke GBS. Here, we present two cases of fulminant GBS following hemorrhagic stroke to remind clinicians to be aware of this rare treatable complication if a stroke patient develops unexplainable flaccid paralysis with or without respiratory distress.
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19
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Raahimi MM, Kane A, Moore CE, Alareed AW. Late onset of Guillain-Barré syndrome following SARS-CoV-2 infection: part of 'long COVID-19 syndrome'? BMJ Case Rep 2021; 14:14/1/e240178. [PMID: 33462068 PMCID: PMC7813388 DOI: 10.1136/bcr-2020-240178] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We describe a case of delayed onset, acute demyelinating neuropathy secondary to novel SARS-CoV-2 infection. A previously healthy 46-year-old man presented with bilateral leg pain and loss of sensation in his feet 53 days after having COVID-19 pneumonitis. He developed painful sensory symptoms followed by a rapidly progressive lower motor neuron weakness involving all limbs, face and respiratory muscles, needing ventilatory support. In keeping with a diagnosis of Guillain-Barré syndrome, cerebrospinal fluid examination showed albuminocytologic dissociation and nerve conduction studies supported the diagnosis of an acute inflammatory demyelinating polyradiculoneuropathy. The delayed neurological dysfunction seen in our patient following SARS-CoV-2 infection may indicate a novel mechanism of disease that is part of the emerging ‘long COVID-19 syndrome’.
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Affiliation(s)
- Mina M Raahimi
- Critical Care, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Alice Kane
- Acute Medical Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Ahmad W Alareed
- Neurophysiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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20
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Mitoma H, Manto M, Hadjivassiliou M. Immune-Mediated Cerebellar Ataxias: Clinical Diagnosis and Treatment Based on Immunological and Physiological Mechanisms. J Mov Disord 2021; 14:10-28. [PMID: 33423437 PMCID: PMC7840241 DOI: 10.14802/jmd.20040] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022] Open
Abstract
Since the first description of immune-mediated cerebellar ataxias (IMCAs) by Charcot in 1868, several milestones have been reached in our understanding of this group of neurological disorders. IMCAs have diverse etiologies, such as gluten ataxia, postinfectious cerebellitis, paraneoplastic cerebellar degeneration, opsoclonus myoclonus syndrome, anti-GAD ataxia, and primary autoimmune cerebellar ataxia. The cerebellum, a vulnerable autoimmune target of the nervous system, has remarkable capacities (collectively known as the cerebellar reserve, closely linked to plasticity) to compensate and restore function following various pathological insults. Therefore, good prognosis is expected when immune-mediated therapeutic interventions are delivered during early stages when the cerebellar reserve can be preserved. However, some types of IMCAs show poor responses to immunotherapies, even if such therapies are introduced at an early stage. Thus, further research is needed to enhance our understanding of the autoimmune mechanisms underlying IMCAs, as such research could potentially lead to the development of more effective immunotherapies. We underscore the need to pursue the identification of robust biomarkers.
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Affiliation(s)
- Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, University of Mons, Mons, Belgium
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21
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Kappler K, Hennet T. Emergence and significance of carbohydrate-specific antibodies. Genes Immun 2020; 21:224-239. [PMID: 32753697 PMCID: PMC7449879 DOI: 10.1038/s41435-020-0105-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/14/2022]
Abstract
Carbohydrate-specific antibodies are widespread among all classes of immunoglobulins. Despite their broad occurrence, little is known about their formation and biological significance. Carbohydrate-specific antibodies are often classified as natural antibodies under the assumption that they arise without prior exposure to exogenous antigens. On the other hand, various carbohydrate-specific antibodies, including antibodies to ABO blood group antigens, emerge after the contact of immune cells with the intestinal microbiota, which expresses a vast diversity of carbohydrate antigens. Here we explore the development of carbohydrate-specific antibodies in humans, addressing the definition of natural antibodies and the production of carbohydrate-specific antibodies upon antigen stimulation. We focus on the significance of the intestinal microbiota in shaping carbohydrate-specific antibodies not just in the gut, but also in the blood circulation. The structural similarity between bacterial carbohydrate antigens and surface glycoconjugates of protists, fungi and animals leads to the production of carbohydrate-specific antibodies protective against a broad range of pathogens. Mimicry between bacterial and human glycoconjugates, however, can also lead to the generation of carbohydrate-specific antibodies that cross-react with human antigens, thereby contributing to the development of autoimmune disorders.
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Affiliation(s)
| | - Thierry Hennet
- Institute of Physiology, University of Zurich, Zurich, Switzerland.
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22
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Pons-Escoda A, Naval-Baudín P, Majós C, Camins A, Cardona P, Cos M, Calvo N. Neurologic Involvement in COVID-19: Cause or Coincidence? A Neuroimaging Perspective. AJNR Am J Neuroradiol 2020; 41:1365-1369. [PMID: 32527842 PMCID: PMC7658883 DOI: 10.3174/ajnr.a6627] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has shaken hospitals worldwide. Some authors suggest that neurologic involvement could further complicate the disease. This descriptive study is a cross-sectional review of 103 patients diagnosed with COVID-19 who underwent neuroimaging (of a total of 2249 patients with COVID-19 in our center). Analyzed variables were neurologic symptoms and acute imaging findings. The most frequent symptoms that motivated neuroimaging examinations were mild nonfocal neurologic symptoms, code stroke (refers to patients presenting with signs and symptoms of stroke whose hyperacute assessment and care is prioritized), focal neurologic symptoms, postsedation encephalopathy, and seizures. No cases of encephalitis or direct central nervous system involvement were detected. Thirteen patients presented with acute ischemic events, and 7, with hemorrhagic events; however, most reported multiple vascular risk factors. Despite the large cohort of patients with COVID-19, we found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19.
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Affiliation(s)
- A Pons-Escoda
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
| | - P Naval-Baudín
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
| | - C Majós
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
| | - A Camins
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
| | - P Cardona
- Neurology Department (P.C.), Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Cos
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
| | - N Calvo
- From the Radiology Department (A.P.-E., P.N.-B., C.M., A.C., M.C., N.C.), Institut de Diagnòstic per la Imatge
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23
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Guillain–Barré Syndrome Secondary to West Nile Virus in New York City. Case Rep Infect Dis 2020; 2020:6501658. [PMID: 32774950 PMCID: PMC7399731 DOI: 10.1155/2020/6501658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/20/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022] Open
Abstract
West Nile virus (WNV) is an arthropod-borne flavivirus belonging taxonomically to the Japanese encephalitis subgroup. Usually, it is transmitted by Culex pipiens mosquitoes. Consequently, an increase in WNV-positive mosquitoes presents a rise of the number of patients, as it has been seen in NYC. We present a 65-year-old patient with WNV infection who presented with Guillain–Barré syndrome (GBS). She had a rapidly progressing ascending paralysis, a common feature in GBS patients but an uncommon presentation in WNV. Realizing WNV as an emerging pathogen along with its uncommon presentation of GBS can be potentially lifesaving if caught at an early stage.
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24
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Scaber J, Molyneux AJ, Buckley C, Webb AJS. Two case reports of distal upper limb weakness following influenza-like illness: an emerging pattern of para-infectious myositis in adults. BMC Neurol 2020; 20:237. [PMID: 32522188 PMCID: PMC7285489 DOI: 10.1186/s12883-020-01821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Myositis is a recognised complication of numerous systemic viral infections including influenza. In adults the typical pattern is characterised by myalgia and marked proximal muscle weakness in upper and lower limbs and resolves slowly over weeks rather than days. Case presentation Here, we describe two male patients with myositis with an unusual distribution of weakness in the distal upper limbs, which both followed a flu-like illness and resolved spontaneously. Both patients had moderate elevations in creatine kinase, extensive negative serological investigations, normal nerve conduction studies and myopathic changes on electromyography. Conclusions In the para-infectious context, myositis is an important differential of acute distal upper limb weakness. This unusual pattern of acute muscle weakness should be recognised to avoid unnecessary in treatments. Similar cases in the recent literature in male patients between the ages of 25 to 55 are reviewed and suggest an emerging pattern of para-infectious myositis.
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Affiliation(s)
- Jakub Scaber
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Adam J Molyneux
- Department of Clinical Neurophysiology, Oxford University Hospitals, Foundation Trust, Oxford, UK
| | - Camilla Buckley
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Alastair J S Webb
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
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25
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Abstract
Recently, this Journal published a report about Guillain-Barré syndrome associated with COVID-19 infection. Guillain-Barré syndrome can be due to molecular mimicry phenomena. Molecular mimicry had already been described in another SARS. It could explain the autoimmune signs and symptoms that some patients affected by SARS-CoV-2 can experience.
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26
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Silva CT, Silva S, Silva MJ, Almeida AF, Fonseca J, Melo C, Sampaio M, Sousa R. Guillain-Barré Syndrome in a Teenage Girl: A Severe Case With Anti-GM2 Antibodies Associated With Acute CMV Infection and Literature Review. Clin Pediatr (Phila) 2020; 59:300-304. [PMID: 31888351 DOI: 10.1177/0009922819898186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Sónia Silva
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marta João Silva
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | | | - Jacinta Fonseca
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | - Cláudia Melo
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
| | - Mafalda Sampaio
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Raquel Sousa
- Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculdade de Medicina do Porto, Porto, Portugal
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27
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Gulia M, Dalal P, Gupta M, Kaur D. Concurrent Guillain-Barré syndrome and myositis complicating dengue fever. BMJ Case Rep 2020; 13:13/2/e232940. [PMID: 32047085 DOI: 10.1136/bcr-2019-232940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dengue is an arboviral infection that classically presents with fever, headache, joint pain, skin flush and morbilliform rashes. Neurological manifestations are well recognised but their exact incidence is unknown. Though myalgias are common in dengue virus infection, myositis and/or elevated serum creatine kinase is an uncommon complication. Guillain-Barré syndrome is another rare neurological manifestation associated with dengue fever. Here, we report the case of a 21-year-old man with serologically confirmed dengue fever presenting with severe myalgia, bilateral lower and upper limb weakness with raised creatine kinase, MRI suggestive of myositis and myonecrosis and nerve conduction velocity showing bilateral lower limb and axillary sensory motor neuropathy. He was managed conservatively and made an uneventful recovery.
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Affiliation(s)
- Manisha Gulia
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Preeti Dalal
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Daljinderjit Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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28
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Lynch RM, Mantus G, Encinales L, Pacheco N, Li G, Porras A, Mendoza AR, Peng J, Rengifo-Pardo M, Cruz MM, Harris E, Bethony JM, Simon GL, Chang AY. Augmented Zika and Dengue Neutralizing Antibodies Are Associated With Guillain-Barré Syndrome. J Infect Dis 2019; 219:26-30. [PMID: 30113672 PMCID: PMC6284544 DOI: 10.1093/infdis/jiy466] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/02/2018] [Indexed: 11/14/2022] Open
Abstract
The role of neutralizing antibodies in Zika-induced Guillain-Barré syndrome (GBS) has not yet been investigated. We conducted a case-control study using sera from the 2016 Zika epidemic in Colombia to determine the neutralizing antibody activity against Zika virus (ZIKV) and dengue virus serotype 2 (DENV2). We observed increased neutralizing antibody titers against DENV2 in ZIKV-infected individuals compared with uninfected controls and higher titers to both ZIKV and DENV2 in ZIKV-infected patients diagnosed with GBS compared with non-GBS ZIKV-infected controls. These data suggest that high neutralizing antibody titers to DENV and to ZIKV are associated with GBS during ZIKV infection.
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Affiliation(s)
- Rebecca M Lynch
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, District of Columbia
| | - Grace Mantus
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, District of Columbia
| | | | - Nelly Pacheco
- Department of Medicine, Allied Research Society LLC, Baranquilla
| | - Guangzhao Li
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, District of Columbia
| | - Alexandra Porras
- Grupo de Medicina Comunitaria, Universidad El Bosque, Bogotá, Colombia
| | | | - Jin Peng
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, District of Columbia
| | - Monica Rengifo-Pardo
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Magelda Montoya Cruz
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Jeff M Bethony
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, District of Columbia
| | - Gary L Simon
- Department of Medicine, George Washington University, Washington, District of Columbia
| | - Aileen Y Chang
- Department of Medicine, George Washington University, Washington, District of Columbia
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29
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Therapeutic Plasma Exchange in Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Presse Med 2019; 48:338-346. [PMID: 31679897 DOI: 10.1016/j.lpm.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 12/28/2022] Open
Abstract
Therapeutic plasma exchange (TPE) has been used as a treatment modality in many autoimmune disorders, including neurological conditions, such as Guillain-Barre syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The American Society for Apheresis (ASFA) publishes its guidelines on the use of therapeutic apheresis every 3 years based on published evidence to assist physicians with both the medical and technical aspects of apheresis consults. The ASFA Guidelines included the use of TPE in both GBS and CIDP as an acceptable first-line therapy, either alone and/or in conjunction with other therapeutic modalities. In this article, we briefly reviewed GBS and CIDP, discussed the role of apheresis in these conditions as well as various technical aspects of the TPE procedure, such as apheresis calculation, number of volume exchange, replacement fluid, and management of potential complications.
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Whelan AJ, Tolaymat A, Rainey SC. Bumbling, Stumbling, Fumbling: Weakness, Steppage Gait, and Facial Droop in a 3-Year-Old Male. Glob Pediatr Health 2019; 6:2333794X19865858. [PMID: 31384634 PMCID: PMC6657125 DOI: 10.1177/2333794x19865858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Abstract
A previously healthy, unimmunized, 3-year-old Caucasian boy presented to the emergency department with right-sided facial droop, clumsiness, and intermittent bilateral hip pain. Two weeks ago, he had 24 hours of self-resolving rhinorrhea and fever. Examination was significant for right facial nerve palsy, lower extremity pain, areflexia of his right lower extremity, and diminished reflexes of his left lower extremity. He was admitted for urgent magnetic resonance imaging of the brain. Cerebrospinal fluid (CSF) protein was 85 mg/dL with elevated albumin and immunoglobulin, and CSF white blood cell was 3 cells/mm3. Serum Mycoplasma immunoglobulin (Ig) M and IgG were elevated. There was concern for Guillain-Barré syndrome (GBS). He was started on intravenous IG (IVIG) and was treated for presumed Mycoplasma infection. Weakness and gait disturbances in a child can present the clinician with a diagnostic challenge. Gait disturbance may indicate a neurological lesion anywhere from the central nervous system to the peripheral nerves, neuromuscular junction, or muscle. In the present case, the combination of peripheral facial palsy, presumed neuropathic pain, gait difficulties, and areflexia in the setting of an antecedent respiratory illness were suggestive of GBS. The cornerstone treatments involve hospitalization to facilitate continuous monitoring for serious sequelae, such as acute respiratory failure and cardiac dysrhythmia, followed by immunotherapy with IVIG or plasma exchange. Gait disturbance and weakness in a child is a diagnostic challenge. GBS is the most common cause of acute paralysis in the Western world and should remain high on the clinician's differential diagnosis. However, patients with GBS may also present nonclassically with extremity pain and cranial nerve palsies.
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Affiliation(s)
- Aviva J Whelan
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Abdullah Tolaymat
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Shane C Rainey
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Abstract
Intravenous immunoglobulin (IVIg) is used in the treatment of autoimmune diseases, including immune-mediated central and peripheral nervous system disorders. This article will review the indications, proposed mechanism of actions, and administration of immunoglobulin treatment in various neuropathies, neuromuscular junction disorders, and myopathies. IVIg may have more than one mechanism of action to alter the pathogenesis of underlying neuromuscular disease. IVIg treatment has been used as a first-line treatment in Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and second-line off-label treatment in medically refractory cases of polymyositis, dermatomyositis, and myasthenia gravis. IVIg is a well-tolerated and effective treatment for these neuromuscular diseases. With this review article, we hope to increase clinicians' awareness of the indications and efficiencies of IVIg in a broad spectrum of neuromuscular diseases.
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Affiliation(s)
- Ahmet Z Burakgazi
- Department of Internal Medicine, Neuroscience Section, Virginia Tech Carilion School of Medicine, Carilion Clinic Neurology, Roanoke, VA
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Joshi S, Musuka TD. Guillain-Barré syndrome as a complication of hypertensive basal ganglia haemorrhage. J Clin Neurosci 2019; 64:54-56. [PMID: 30852075 DOI: 10.1016/j.jocn.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/03/2019] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
We aimed to study the potential relationship of Guillain-Barré syndrome (GBS) and intracranial haemorrhage (ICH). We present a case of a 70-year-old hypertensive woman who developed global weakness, eventually becoming quadriplegic, during an inpatient stay for treatment of a basal ganglia haemorrhagic stroke. Guillain-Barré syndrome was confirmed and treatment initiated. She responded well to intravenous immunoglobulin treatment and then subsequently continued with rehabilitation. There have been a few case reports of GBS as a complication of spontaneous intracranial haemorrhage (ICH) or traumatic brain injury. It may not be a coincidence that our patient developed GBS shortly after presentation. There may be an immunological explanation with immune activation following neuronal injury after ICH with associated blood-brain barrier breakdown. GBS following ICH adds further complexity to treating patients who are already critically ill. If patients develop new weakness after ICH, there should be a high index of suspicion for GBS. It should be distinguished from critical illness neuropathy/myopathy and other causes of weakness in critical care patients because the treatment is very different. Immune activation and sensitization to myelin-associated proteins may be the underlying pathophysiological basis.
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Affiliation(s)
- Stuti Joshi
- Department of Neurology, Fiona Stanley Hospital, Western Australia, Australia.
| | - Tapuwa D Musuka
- Department of Neurology, Fiona Stanley Hospital, Western Australia, Australia
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Tominaga K, Tsuchiya A, Sato H, Kimura A, Oda C, Hosaka K, Kawata Y, Kimura N, Hayashi K, Yokoyama J, Terai S. Co-existent ulcerative colitis and Guillain-Barré syndrome: a case report and literature review. Clin J Gastroenterol 2019; 12:243-246. [PMID: 30778832 DOI: 10.1007/s12328-019-00939-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 12/25/2022]
Abstract
Ulcerative colitis (UC) is a chronic and recurrent inflammatory disease involving the intestine, and Guillain-Barré Syndrome (GBS) is rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. UC and GBS can be caused by immune system abnormalities and can co-exist. To date, there are 7 reported cases of GBS in patients with UC. However, only one patient developed UC after GBS treatment. We report a rare case of UC that appeared after intravenous immunoglobulin therapy for GBS. This case report and literature review will allow accurate and prompt diagnosis of co-existent GBS and UC.
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Affiliation(s)
- Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan.
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Atsushi Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Chiyumi Oda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunori Hosaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Yuzo Kawata
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Naruhiro Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Junji Yokoyama
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Aasahimachi-Dori, Chuo-Ku, Niigata, Niigata, 9518510, Japan
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Liao SJ, Marshall J, Hazelton ML, French NP. Extending statistical models for source attribution of zoonotic diseases: a study of campylobacteriosis. J R Soc Interface 2019; 16:20180534. [PMID: 30958154 PMCID: PMC6364659 DOI: 10.1098/rsif.2018.0534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/09/2019] [Indexed: 11/12/2022] Open
Abstract
Preventing and controlling zoonoses through the design and implementation of public health policies requires a thorough understanding of transmission pathways. Modelling jointly the epidemiological data and genetic information of microbial isolates derived from cases provides a methodology for tracing back the source of infection. In this paper, the attribution probability for human cases of campylobacteriosis for each source, conditional on the extent to which each case resides in a rural compared to urban environment, is estimated. A model that incorporates genetic data and evolutionary processes is applied alongside a newly developed genetic-free model. We show that inference from each model is comparable except for rare microbial genotypes. Further, the effect of 'rurality' may be modelled linearly on the logit scale, with increasing rurality leading to the increasing likelihood of ruminant-sourced campylobacteriosis.
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Affiliation(s)
- Sih-Jing Liao
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Jonathan Marshall
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Martin L. Hazelton
- School of Fundamental Sciences, Massey University, Palmerston North 4442, New Zealand
| | - Nigel P. French
- mEpiLab, Infectious Disease Research Centre, School of Veterinary Science, Massey University, Palmerston North 4442, New Zealand
- New Zealand Food Safety Science & Research Centre, Massey University, Palmerston North 4442, New Zealand
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Higgoda R, Perera D, Thirumavalavan K. Multifocal motor neuropathy presenting as a post-infectious complication of dengue: a CASE report. BMC Infect Dis 2018; 18:415. [PMID: 30134860 PMCID: PMC6103970 DOI: 10.1186/s12879-018-3334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 08/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Dengue infection is an endemic illness in the tropics and it is associated with a wide variety of post infectious complications. With the increasing prevalence of dengue infection in endemic regions, post-infectious neurological complications following dengue infection are now been reported more frequently. We report a patient who developed multifocal motor neuropathy (MMN) with conduction blocks following dengue infection during the immediate post-infectious period. MMN is a rare neurological disorder with an autoimmune etiology and to best of our knowledge this is the first reported case of MMN occurring following dengue infection as a post dengue neurological complication. Case presentation A 20 year old Sri Lankan male who was treated for serologically confirmed dengue infection presented to us with 1 month history of bilateral hand weakness which has started 5 days after the dengue infection (5 days after the discharge). On examination he had asymmetrical motor weakness of the hands and to a lesser degree in feet. There was no sensory impairment. Nerve conduction studies confirmed MMN with conduction blocks. He was started on intravenous immunoglobulin therapy for which he showed a good response. Conclusion The authors report the first case of MMN complicating dengue fever in a previously healthy male from Sri Lanka. Thus it should be borne in mind that although rare, MMN can occur as a post-infectious complication of dengue fever.
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An Unusual Presentation of Acute Weakness: Acute Inflammatory Demyelinating Polyneuropathy in a Patient with Psychiatric Illness. Case Rep Emerg Med 2018; 2018:4065342. [PMID: 30345121 PMCID: PMC6174749 DOI: 10.1155/2018/4065342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/25/2018] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
We report an unusual presentation of Guillain-Barré wherein a patient with an extensive history of psychiatric illness had a dream that his legs were crushed in an earthquake and awoke from the dream with paresthesias and rapid paralysis of bilateral lower extremities. This article discusses an atypical presentation of pathology and diagnostic evaluation for a form of Guillain-Barré called Acute Inflammatory Demyelinating Polyneuropathy (AIDP).
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Goodfellow JA, Willison HJ. Gangliosides and Autoimmune Peripheral Nerve Diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2018; 156:355-382. [DOI: 10.1016/bs.pmbts.2017.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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38
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Vanmarsenille C, Díaz Del Olmo I, Elseviers J, Hassanzadeh Ghassabeh G, Moonens K, Vertommen D, Martel A, Haesebrouck F, Pasmans F, Hernalsteens JP, De Greve H. Nanobodies targeting conserved epitopes on the major outer membrane protein of Campylobacter as potential tools for control of Campylobacter colonization. Vet Res 2017; 48:86. [PMID: 29216932 PMCID: PMC5721652 DOI: 10.1186/s13567-017-0491-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
Campylobacter infections are among the most prevalent foodborne infections in humans, resulting in a massive disease burden worldwide. Broilers have been identified as the major source of campylobacteriosis and reducing Campylobacter loads in the broiler caeca has been proposed as an effective measure to decrease the number of infections in humans. Failure of current methods to control Campylobacter in broilers stresses the urgency to develop novel mitigation measures. We obtained six nanobodies with a broad specificity, that recognize strains belonging to the two most relevant species, Campylobacter jejuni and Campylobacter coli. The target of the nanobodies was identified as the major outer membrane protein, a porin that contributes to bacterial virulence and viability. Multimerization of the nanobodies led to agglutination of C. jejuni cells, which may affect colonization in the chicken gut. These Campylobacter-specific nanobodies may be useful to develop a strategy for preserving chickens from Campylobacter colonization.
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Affiliation(s)
- Charlotte Vanmarsenille
- Structural Molecular Microbiology, VIB, Pleinlaan 2, 1050, Brussels, Belgium.,Structural Biology Brussels, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Genetische Virologie, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Inés Díaz Del Olmo
- Structural Molecular Microbiology, VIB, Pleinlaan 2, 1050, Brussels, Belgium.,Structural Biology Brussels, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Genetische Virologie, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Jelle Elseviers
- VIB Nanobody Service Facility, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | | | - Kristof Moonens
- Structural Molecular Microbiology, VIB, Pleinlaan 2, 1050, Brussels, Belgium.,Structural Biology Brussels, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Didier Vertommen
- Faculty of Medicine and de Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 74, 1200, Brussels, Belgium
| | - An Martel
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Freddy Haesebrouck
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Frank Pasmans
- Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | | | - Henri De Greve
- Structural Molecular Microbiology, VIB, Pleinlaan 2, 1050, Brussels, Belgium. .,Structural Biology Brussels, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
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Primary Cytomegalovirus Infection Causing Guillain-Barré Syndrome in a Living Renal Allograft Recipient. Case Rep Transplant 2017; 2017:7264793. [PMID: 29348962 PMCID: PMC5733958 DOI: 10.1155/2017/7264793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré Syndrome (GBS) is a common acute autoimmune polyneuropathy in adults. There have been few reported cases of Guillain-Barré Syndrome associated with active cytomegalovirus (CMV) infection in renal transplant recipients. Here we present a case of active CMV viremia inducing Guillain-Barré Syndrome in a renal transplant recipient. We discuss the treatment regimen utilized. Furthermore, we performed a review of the literature and discuss the cases of CMV induced GBS in renal transplant recipients.
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40
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Boo YL, Aris MAM, Chin PW, Sulaiman WAW, Basri H, Hoo FK. Guillain-Barré syndrome complicating dengue fever: Two case reports. Tzu Chi Med J 2017; 28:157-159. [PMID: 28757747 PMCID: PMC5442904 DOI: 10.1016/j.tcmj.2015.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/01/2015] [Accepted: 09/28/2015] [Indexed: 11/19/2022] Open
Abstract
Guillain–Barré syndrome is a rare neurological manifestation associated with dengue infection. More common antecedent infections include Campylobacter jejuni and Cytomegalovirus infection. Here, we report two cases of Guillain–Barré syndrome complicating dengue infection.
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Affiliation(s)
- Yang Liang Boo
- Department of Medicine, Hospital Enche’ Besar Hajjah Khalsom, Jalan Kota Tinggi, Kluang Johor Darul Takzim, Malaysia
| | - Mohd Azman M. Aris
- Department of Medicine, Hospital Enche’ Besar Hajjah Khalsom, Jalan Kota Tinggi, Kluang Johor Darul Takzim, Malaysia
| | - Pek Woon Chin
- Department of Medicine, Hospital Enche’ Besar Hajjah Khalsom, Jalan Kota Tinggi, Kluang Johor Darul Takzim, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Neurology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia
| | - Hamidon Basri
- Neurology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia
| | - Fan Kee Hoo
- Neurology Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia
- Corresponding author. Neurology Unit, Department of Internal Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400 Serdang, Selangor, Malaysia. Tel.: +60 3 8947 2300; fax: +60 3 8947 2585. E-mail address: (F.K. Hoo)
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Abstract
With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you ensure proper immunologic drug use in your practice.
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Kobori S, Kubo T, Otani M, Muramatsu K, Fujino Y, Adachi H, Horiguchi H, Fushimi K, Matsuda S. Coexisting infectious diseases on admission as a risk factor for mechanical ventilation in patients with Guillain-Barré syndrome. J Epidemiol 2017; 27:311-316. [PMID: 28283417 PMCID: PMC5498408 DOI: 10.1016/j.je.2016.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to investigate patient characteristics on admission to hospital that increase the risk of subsequent mechanical ventilation (MV) use for patients with Guillain–Barré syndrome (GBS). Methods We extracted data from the Japanese Diagnosis Procedure Combination (DPC) database for 4132 GBS patients admitted to hospital. Clinical characteristics of GBS patients with and without MV were compared. Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of requirement for MV with coexisting infectious diseases, after adjustment for potential confounding variables, age, sex, hospital type, and ambulance transportation. Results In total, 281 patients required MV, and 493 patients had coexisting respiratory diseases on admission. After adjustment for covariates and stratification by coexisting respiratory diseases, multivariate logistic regression analysis revealed that coexisting cytomegaloviral (CMV) disease (OR 8.81; 95% CI, 2.34–33.1) and herpes simplex viral (HSV) infections (OR 4.83; 95% CI, 1.16–20.1) were significantly associated with the requirement for MV in the group without coexisting respiratory diseases. Conclusion Our findings suggest that coexisting CMV and HSV infections on admission might be significantly associated with increased risk of respiratory failure in GBS patients. Subjects of this study were 4132 inpatients with Guillain–Barré syndrome. Data were derived from the Japanese Diagnosis Procedure Combination (DPC) database. Association between comorbidities and mechanical ventilation use was evaluated. Cytomegaloviral and herpes simplex viral infections were associated with ventilation.
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Affiliation(s)
- Shinichiro Kobori
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan; Department of Occupational Health Data Science Center, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
| | - Tatsuhiko Kubo
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Makoto Otani
- Department of Occupational Health Data Science Center, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yoshihisa Fujino
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hiroaki Adachi
- Department of Neurology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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43
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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Guillaine-barre syndrome; a rare complication of melioidosis. a case report. BMC Infect Dis 2016; 16:388. [PMID: 27506202 PMCID: PMC4977609 DOI: 10.1186/s12879-016-1719-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/15/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare. CASE PRESENTATION A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse. CONCLUSIONS Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.
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Yasmin T, Akter S, Debnath M, Ebihara A, Nakagawa T, Nabi AHMN. In silico proposition to predict cluster of B- and T-cell epitopes for the usefulness of vaccine design from invasive, virulent and membrane associated proteins of C. jejuni. In Silico Pharmacol 2016; 4:5. [PMID: 27376537 PMCID: PMC4932005 DOI: 10.1186/s40203-016-0020-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/22/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose Campylobacter jejuni is the one of the leading causes of bacterial diarrheal illness worldwide. This study aims to design specific epitopes for the utility of designing peptide vaccine(s) against C. jejuni by targeting invasive, virulent and membrane associated proteins like FlaA, Cia, CadF, PEB1, PEB3 and MOMP. Methods In the present study, various immunoinformatics approaches have been applied to design a potential epitope based vaccine against C. jejuni. The tools include Bepipred, ABCpred, Immune Epitope databse (IEDB) resource portal, Autodock vina etc. Results Peptides “EINKN”, “TGSRLN”, “KSNPDI”, “LDENGCE” respectively from FlaA, MOMP, PEB3, CadF proteins were found to be the most potential B cell epitopes while peptides “FRINTNVAA”, “NYFEGNLDM”, “YKYSPKLNF”, “YQDAIGLLV”, “FRNNIVAFV” and “LIMPVFHEL” respectively from Fla, CadF, MOMP, PEB1A, PEB3 and Cia might elicit cell mediated immunity and “IFYTTGSRL” from MOMP protein might elicit both humoral and cell-mediated immunity. All these potential peptidic epitopes showed almost 80–100 % conservancy in different strains of C jejuni with varying proportions of population coverage ranging from 22–60 %. Further authentication of these peptide epitopes as probable vaccine candidate was mediated by their binding to specific HLA alleles using in silico docking technique. Conclusion Based on the present study, it could be concluded that these predicted epitopes might be used to design a vaccine against C. jejuni bacteria and thus, could be validated in model hosts to verify their efficacy as vaccine. Electronic supplementary material The online version of this article (doi:10.1186/s40203-016-0020-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tahirah Yasmin
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka-, 1000, Bangladesh
| | - Salma Akter
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka-, 1000, Bangladesh
| | - Mouly Debnath
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka-, 1000, Bangladesh
| | - Akio Ebihara
- Laboratory of Applied Biochemistry, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - Tsutomu Nakagawa
- Laboratory of Applied Biochemistry, Faculty of Applied Biological Sciences, Gifu University, 1-1 Yanagido, Gifu, 501-1193, Japan
| | - A H M Nurun Nabi
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka-, 1000, Bangladesh.
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Abstract
In this case report, we describe a patient with myasthenia gravis (MG) and Miller Fisher syndrome (MFS) overlap. A 69-year-old woman presented with acute bilateral ptosis, ophthalmoplegia, ataxic gait, and areflexia. The MFS diagnosis was confirmed with by a positive anti-GQ1b IgG antibody test result. MG was diagnosed from electrophysiological, edrophonium, and serological test results. Although intravenous immunoglobulin therapy is effective for both diseases, two courses of the therapy did not improve the patient's symptoms. However, steroid therapy was effective. Although the overlap of MG and MFS is very rare, it should be considered in the differential diagnosis of neuro-ophthalmic diseases.
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Affiliation(s)
- Yuji Tanaka
- Department of Neurology, Gifu Municipal Hospital, Japan
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Lower urinary tract dysfunction in patients with peripheral nervous system lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:203-24. [PMID: 26003246 DOI: 10.1016/b978-0-444-63247-0.00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
The prevalence of lower urinary tract (LUT) dysfunction in peripheral nervous system (PNS) disorders is larger than in comparable control populations. This is particularly true for polyneuropathies with autonomic nervous system involvement, and for localized lesions with LUT innervation. LUT symptoms may be the guide to the diagnosis of processes localized in the lumbosacral spinal canal (as in cauda equina syndrome), and in the pelvis. Typical LUT dysfunctions (LUTD) caused by PNS involvement include bladder and sphincter hypoactivity with poor emptying, and incontinence. Paradoxically, bladder overactivity may also occur in pure PNS lesions. The acute cauda equina syndrome is an emergency requiring magnetic resonance imaging and surgery; in chronic neurogenic LUTD due to PNS involvement, the diagnosis of the lesion may be clarified by clinical neurophysiologic testing. Other important causes of neurogenic LUT dysfunction are perineoabdominal and pelvic surgeries. Surgeons are devising nerve-sparing techniques to prevent such major and often persistent complications in patients who are otherwise cured of the underlying disease. LUTD significantly affects the quality of life in patients and may lead to recurring urinary infections and upper urinary tract involvement. Thorough assessment of LUT function by urodynamics may be necessary in patients who are not improved by simple conservative measures.
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Kerasnoudis A, Pitarokoili K, Behrendt V, Gold R, Yoon MS. Bochum ultrasound score versus clinical and electrophysiological parameters in distinguishing acute-onset chronic from acute inflammatory demyelinating polyneuropathy. Muscle Nerve 2015; 51:846-52. [PMID: 25297575 DOI: 10.1002/mus.24484] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate whether a nerve ultrasound score (Bochum ultrasound score, BUS), clinical, and electrophysiological parameters could distinguish subacute chronic (CIDP) from acute inflammatory demyelinating polyneuropathy (AIDP). METHODS Phase 1: The charts of 35 patients with polyradiculoneuropathy were evaluated retrospectively regarding BUS, clinical, and electrophysiological parameters (A-waves, sural nerve sparing pattern, sensory ratio>1). Phase 2: All parameters were evaluated prospectively in 10 patients with subacute polyradiculoneuropathy. RESULTS Phase 1: A sum score of ≥2 points in BUS and the presence of sensory symptoms were significantly more frequent in the subacute CIDP group than in the AIDP group (P<0.001).The electrophysiological parameters showed no significant changes between the 2 groups. Phase 2: BUS (83.3%; 100%;), sensory symptoms (100%; 75%), absence of autonomic nervous system dysfunction (83.3%; 75%), or bulbar palsy (83.3%; 50%) showed the best sensitivity and specificity in distinguishing subacute CIDP from AIDP. CONCLUSIONS BUS is a useful diagnostic tool for distinguishing subacute CIDP from AIDP.
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Affiliation(s)
- Antonios Kerasnoudis
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Kallia Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Volker Behrendt
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstr. 56, 44791, Bochum, Germany
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Kachru C, Bahadur A, Dagar M, Agrawal R. Diagnosing Gullian Barre Syndrome in the Post-partum Period: A Case Report. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2015. [DOI: 10.46347/jmsh.2015.v01i01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Podnar S, Vodušek DB. Sexual dysfunction in patients with peripheral nervous system lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:179-202. [PMID: 26003245 DOI: 10.1016/b978-0-444-63247-0.00011-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Peripheral nervous system (PNS) disorders may cause sexual dysfunction (SD) in patients of both genders. These disorders include mainly polyneuropathies (particularly those affecting the autonomic nervous system (ANS)) and localized lesions affecting the innervation of genital organs. Impaired neural control may produce a malfunction of the genital response consisting of loss of genital sensitivity, erectile dysfunction, loss of vaginal lubrication, ejaculation disorder, and orgasmic disorder. In addition, there is often a loss of desire which actually has a complex pathogenesis, which goes beyond the mere loss of relevant nerve function. In patients who have no manifest health problems - particularly men with erectile dysfunction - one should always consider the possibility of an underlying polyneuropathy; in patients with SD after suspected denervation lesions of the innervation of genital organs within the lumbosacral spinal canal and in the pelvis, clinical neurophysiologic testing may clarify the PNS involvement. SD can alter self-esteem and lower patients' quality of life; opening up a discussion on sexual issues should be a part of the management of patients with PNS disorders. They may greatly benefit from counseling, education on coping strategies, and specific treatments.
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Affiliation(s)
- Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - David B Vodušek
- Division of Neurology, University Medical Center Ljubljana, and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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