Evaluation of immunocompetence and nutritional status in patients with bulimia nervosa

Increased use of antimicrobial medication in bulimia nervosa and binge-eating disorder prior to the eating disorder treatment

OBJECTIVE

We examined the use of antimicrobial medication as a proxy for infections in large patient cohort treated for binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) over the five-year period preceding eating disorder treatment.

METHOD

Patients (N = 1592) at the Eating Disorder Unit of Helsinki University Central Hospital between 2000 and 2010 were compared with matched general population controls (N = 6368). The study population was linked to the prescription data of antibacterial, antifungal and antiviral medication from the Register on Reimbursed Prescription Medicine. Data were analyzed using regression models.

RESULTS

Individuals with BN and BED had received more often antimicrobial medication prescriptions compared to their controls (OR: 1.7, 95% CI: 1.3-2.1; OR: 2.6, 95% CI: 1.4-4.6, respectively), while no significant difference emerged in AN (OR: 0.9, 95% CI: 0.7-1.0, p = 0.10). Of the main drug categories, the respective pattern was seen in antibacterial and antifungal medication, while increased use for antivirals appeared only in BN (OR: 1.6, 95% CI: 1.1-2.3). Measured with the mean number of prescriptions or mean Defined Daily Doses per individual, patients with BN, BED and males with AN had also higher total antimicrobial medication use.

DISCUSSION

Indicating increased infections, we found elevated use of antimicrobial medication in BN, BED and in males with AN. Infections may be consequence of hyperglycemia, weight gain, or dysregulation of intestinal microbiota associated with core eating disorder behaviors. Or the other way round; changes in intestinal microbiota due to infections, inflammation, or antibacterial medications might contribute to eating disorders in multiple ways. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:542-552).

Hostility and helper T-cells in patients with bulimia nervosa

OBJECTIVE

The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN).

METHOD

Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment.

RESULTS

Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items.

CONCLUSIONS

These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Involvement of cytokines in eating disorders: a critical review of the human literature

A number of findings from clinical and animal studies indicate that pro-inflammatory cytokines may play roles in eating disorders. The measurement of pro-inflammatory cytokines (IL-1, IL-6, TNFalpha), which are known to decrease food intake, provides highly variable data from which firm conclusions cannot be drawn. In most of the longitudinal studies where pro-inflammatory cytokines have been shown to be impaired in anorexia or bulimia nervosa, a return to normal values was observed after renutrition. However these findings do not exclude the possibility that pro-inflammatory cytokines might be overproduced in specific brain areas and act locally without concomitantly increased serum or immune production. It was also pointed out that the production of the major type-1 cytokines (especially IL-2) was depressed in anorexia nervosa. It remains unclear whether this is due to undernutrition or to a specific underlying cause common to eating disorders. The impaired cytokine profile observed in eating disorders could be related to several factors including impaired nutrition, psychopathological and neuroendocrine factors. More particular attention should be devoted to the deregulation of the anti/pro-inflammatory balance. Deregulation of the cytokine network may be responsible for medical complications in eating disorder patients who are afflicted with chronic underweight.

Lymphocyte subset, lymphocyte proliferative response, and soluble interleukin-2 receptor in anorexic patients

BACKGROUND

Despite a prominent malnourished state, anorexics are unexpectedly free from infection. Several studies have shown that the cell-mediated immunity of anorexics might be well preserved, but results are conflicting.

METHODS

Lymphocyte subsets, lymphoproliferative response to phytohemagglutinin, and soluble interleukin-2 receptor (sIL-2R) were measured in 7 patients with anorexia nervosa restricting type (RAN), 6 with anorexia nervosa binge-eating/purging type (ANBP), and 8 controls (C).

RESULTS

Compared with controls, significantly elevated percentage of CD4 and CD4/CD8 ratio in ANBP was found. Although there was no significant difference in lymphoproliferative response among the three groups, sIL-2R in RAN was significantly lower than that in the C group, but not in ANBP.

CONCLUSIONS

Although detail mechanism still remains to be unknown, some kinds of compensatory mechanism for cell-mediated immunity is working, especially in chronic underweight anorexic patients.

Case study of fulminant meningococcal septicemia diagnosed in a twenty-year-old woman with bulimia nervosa

Fulminant meningococcal septicemia accounts for 5% to 10% of patients with meningococcemia; it is rapidly progressive and is associated with high morbidity and mortality rates. The highest meningococcal incidence is found in the 6- to 20-month-old age group; whereas immunoincompetence is suggested in adults with the condition. Coincidentally, eating disorders are purported to be the most prevalent psychiatric or behavioral disturbance affecting adolescents, and studies indicate that vulnerability to infectious disease may be present in this group as a result of a subclinical malnutrition state. I report a case of fulminant meningococcal septicemia in a patient with a comorbid eating disorder of bulimia nervosa, who had a tumultuous disease course, and with rapid and aggressive management of her condition--an impressive recovery.

The immune system in eating disorders: an overview

Eating disorders, such as anorexia nervosa and bulimia nervosa, are becoming more and more common in our society. Although they are psychiatric illnesses, there are many factors involved, including abnormal food behavior. Nutrients play an important role in the development and functionality of immunocompetent cells. An impaired immunocompetence has been shown to be an important causal factor in the increased susceptibility of malnourished individuals to infectious disease. Therefore, studies on the immune system are of great interest when assessing the extent to which the nutritional status of these patients could be affected. However, the literature in this field is controversial, and the mechanisms are not yet completely defined, although some hypotheses try to clarify the disturbances caused in the organism under these bizarre circumstances. In spite of the fact that the immune system is altered by distorted food behaviors, such as in eating disorders, the awareness of characteristics of other systems involved, and therefore altered, by these pathologies would be very helpful for understanding the mechanisms triggered in these syndromes. In fact, the interactions among the immune and other systems in eating disorders are beginning to be studied. Finally, the main goals are to limit the evolution of these illnesses through early diagnosis, and to devise a long-lasting, definitive cure for these patients through appropriate therapy.

Septic arthritis of the shoulder: treating an atypical case

A wrestler developed septic arthritis in his glenohumeral joint. His case is unusual because septic arthritis most commonly affects weight-bearing joints and is usually seen in the very young, the very old, and people who are immunocompromised. Other risk factors include concurrent infection, endocarditis, invasive procedures, and intra-articular corticosteroid injection. Disease onset is usually insidious. Nonspecific findings include restricted motion, mild pain, and joint effusions; systemic signs of toxicity are often mild or absent. Diagnosis is confirmed with joint aspiration and analysis and culture of synovial fluids; definitive treatment often involves arthroscopic debridement followed by 2 to 6 weeks of antibiotics.

Septic Arthritis of the Shoulder

In brief A wrestler developed septic arthritis in his glenohumeral joint. His case is unusual because septic arthritis most commonly affects weight-bearing joints and is usually seen in the very young, the very old, and people who are immunocompromised. Other risk factors include concurrent infection, endocarditis, invasive procedures, and intra-articular corticosteroid injection. Disease onset is usually insidious. Nonspecific findings include restricted motion, mild pain, and joint effusions; systemic signs of toxicity are often mild or absent. Diagnosis is confirmed with joint aspiration and analysis and culture of synovial fluids; definitive treatment often involves arthroscopic debridement followed by 2 to 6 weeks of antibiotics.

Anxious symptoms influence delayed-type hypersensitivity skin test in subjects devoid of any psychiatric morbidity

The present study aimed to evaluate the relationship between anxious/depressive symptoms and cell-mediated immunity (Delayed-type Hypersensitivity skin test, DTH) in subjects devoid of any psychiatric morbidity. Forty-eight females and twenty-four males were studied, ages ranging 21-60. These subjects completed the Beck Depression Inventory (BDI) for evaluation of depressive symptoms and the State-Trait Anxiety Inventory (STAIX1, STAIX2) for evaluation of anxious symptoms; subsequently on the same day they were tested for DTH using the Multitest CMI system (Merieux Institute, France). Subjects were split into three groups using the 33rd and 66th percentiles of DTH response (cumulative induration diameter). In females, subjects with larger DTH response (DTH > 8 mm) had significantly lower levels of "state" anxiety (scores at STAIX1; Kruskall-Wallis test, P = .04). On the contrary, no differences were observed between groups considering scores obtained by males at self-evaluation rating scales. Our data seem to support the hypothesis that activity of immune system as measured by DTH skin test may be influenced by affective status in the context of everyday life.