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Ghareghani M, Reiter RJ, Zibara K, Farhadi N. Latitude, Vitamin D, Melatonin, and Gut Microbiota Act in Concert to Initiate Multiple Sclerosis: A New Mechanistic Pathway. Front Immunol 2018; 9:2484. [PMID: 30459766 PMCID: PMC6232868 DOI: 10.3389/fimmu.2018.02484] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/08/2018] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS). While the etiology of MS is still largely unknown, scientists believe that the interaction of several endogenous and exogenous factors may be involved in this disease. Epidemiologists have seen an increased prevalence of MS in countries at high latitudes, where the sunlight is limited and where the populations have vitamin D deficiency and high melatonin levels. Although the functions and synthesis of vitamin D and melatonin are contrary to each other, both are involved in the immune system. While melatonin synthesis is affected by light, vitamin D deficiency may be involved in melatonin secretion. On the other hand, vitamin D deficiency reduces intestinal calcium absorption leading to gut stasis and subsequently increasing gut permeability. The latter allows gut microbiota to transfer more endotoxins such as lipopolysaccharides (LPS) into the blood. LPS stimulates the production of inflammatory cytokines within the CNS, especially the pineal gland. This review summarizes the current findings on the correlation between latitude, sunlight and vitamin D, and details their effects on intestinal calcium absorption, gut microbiota and neuroinflammatory mediators in MS. We also propose a new mechanistic pathway for the initiation of MS.
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Affiliation(s)
- Majid Ghareghani
- CERVO Brain Research Center, Quebec City, QC, Canada.,Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Russel J Reiter
- Department of Cell Systems and Anatomy, The University of Texas Health Science Center, San Antonio, TX, United States
| | - Kazem Zibara
- PRASE, Biology Department, Faculty of Sciences-I, Lebanese University, Beirut, Lebanon
| | - Naser Farhadi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Wormser GP, Strle F, Shapiro ED, Dattwyler RJ, Auwaerter PG. A critical appraisal of the mild axonal peripheral neuropathy of late neurologic Lyme disease. Diagn Microbiol Infect Dis 2016; 87:163-167. [PMID: 27914746 DOI: 10.1016/j.diagmicrobio.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/07/2016] [Indexed: 02/07/2023]
Abstract
In older studies, a chronic distal symmetric sensory neuropathy was reported as a relatively common manifestation of late Lyme disease in the United States. However, the original papers describing this entity had notable inconsistencies and certain inexplicable findings, such as reports that this condition developed in patients despite prior antibiotic treatment known to be highly effective for other manifestations of Lyme disease. More recent literature suggests that this entity is seen rarely, if at all. A chronic distal symmetric sensory neuropathy as a manifestation of late Lyme disease in North America should be regarded as controversial and in need of rigorous validation studies before acceptance as a documented clinical entity.
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Affiliation(s)
- Gary P Wormser
- Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA.
| | - Franc Strle
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, 1515, Slovenia
| | - Eugene D Shapiro
- Departments of Pediatrics, of Epidemiology of Microbial Diseases, and of Investigative Medicine, Yale University, New Haven, CT 06520, USA
| | - Raymond J Dattwyler
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Zammarchi L, Antonelli A, Bartolini L, Pecile P, Trotta M, Rogasi PG, Santini MG, Dilaghi B, Grifoni S, Rossolini GM, Bartoloni A. Louse-Borne Relapsing Fever with Meningeal Involvement in an Immigrant from Somalia to Italy, October 2015. Vector Borne Zoonotic Dis 2016; 16:352-5. [PMID: 26938933 DOI: 10.1089/vbz.2015.1928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia. CASE STUDY In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1. CONCLUSIONS LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.
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Affiliation(s)
- Lorenzo Zammarchi
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | - Alberto Antonelli
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy
| | - Laura Bartolini
- 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Patrizia Pecile
- 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Michele Trotta
- 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | - Pier Giorgio Rogasi
- 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
| | | | - Beatrice Dilaghi
- 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Stefano Grifoni
- 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy
| | - Gian Maria Rossolini
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy .,4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .,7 I.R.C.C.S. Fondazione Don Carlo Gnocchi , Florence, Italy
| | - Alessandro Bartoloni
- 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .,2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy
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Abstract
A large number of causal agents produce spinal cord lesions in the tropics. Most etiologies found in temperate regions also occur in the tropics including trauma, herniated discs, tumors, epidural abscess, and congenital malformations. However, infectious and nutritional disorders occur with higher prevalence in tropical regions. Among the most common infectious etiologies are tuberculous Pott's disease, brucellosis, and neuroborreliosis. Parasitic diseases such as schistosomiasis, neurocysticercosis, and eosinophilic meningitis are frequent causes of nontraumatic paraplegia. The retrovirus HTLV-1 is a cause of tropical spastic paraparesis. Nutritional causes of paraparesis include deficiencies of vitamin B12 and folate; endemic clusters of konzo and tropical ataxic myeloneuropathy are associated in Africa with malnutrition and excessive consumption of cyanide-containing bitter cassava. Other toxic etiologies of tropical paraplegia include lathyrism and fluorosis. Nutritional forms of myelopathy are associated often with optic and sensory neuropathy, hence the name tropical myeloneuropathies. Acute transverse myelopathy is seen in association with vaccination, infections, and fibrocartilaginous embolism of the nucleus pulposus. Multiple sclerosis and optic myelopathy occur in the tropics but with lesser prevalence than in temperate regions. The advent of modern imaging in the tropics, including computed tomography and magnetic resonance imaging, has allowed better diagnosis and treatment of these conditions that are a frequent cause of death and disability.
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Pawate S, Sriram S. The role of infections in the pathogenesis and course of multiple sclerosis. Ann Indian Acad Neurol 2010; 13:80-6. [PMID: 20814489 PMCID: PMC2924524 DOI: 10.4103/0972-2327.64622] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/13/2010] [Accepted: 04/14/2010] [Indexed: 11/04/2022] Open
Abstract
Interplay between susceptibility genes and environmental factors is considered important player in the genesis of multiple sclerosis (MS). Among environmental factors, a role for an infectious pathogen has long been considered central to the disease process. This opinion has support both from epidemiological data and the findings of immunological abnormalities in spinal fluid that reflect an immune response to an as yet undetermined antigen, possibly a pathogen, in the cerebrospinal fluid. Our review will outline the current understanding of the role of infection in the causation and progression of MS. We will review the data that point to an infectious cause of MS and consider the specific agents Chlamydophila (Chlamydia) pneumoniae, Human Herpes Virus 6, and Epstein-Barr Virus, that are implicated in either the development or progression of MS.
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Affiliation(s)
- Siddharama Pawate
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Meer-Scherrer L, Chang Loa C, Adelson ME, Mordechai E, Lobrinus JA, Fallon BA, Tilton RC. Lyme disease associated with Alzheimer's disease. Curr Microbiol 2006; 52:330-2. [PMID: 16528463 DOI: 10.1007/s00284-005-0454-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/07/2005] [Indexed: 11/29/2022]
Abstract
This case report discusses a patient with co-occurring neuroborreliosis and Alzheimer's disease (AD). Although no claim is made for causality nor is there objective evidence that spirochetes are involved in AD, co-infection may exacerbate the symptoms of either neuroborreliosis or AD. Much is to be learned about the role of spirochetes in degenerative central nervous system disease.
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