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Soh BWT, Salim A, O'Riordan R, Owens P, Matiullah S. Unveiling the devastations of Streptococcus sanguinis infective endocarditis masquerading as iron deficiency anaemia: a case report. Eur Heart J Case Rep 2024; 8:ytae388. [PMID: 39161718 PMCID: PMC11332270 DOI: 10.1093/ehjcr/ytae388] [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: 04/02/2024] [Revised: 06/03/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024]
Abstract
Background Iron deficiency is the leading cause of anaemia worldwide and frequently observed in adolescent women, particularly those with eating disorders like anorexia nervosa. Consequently, clinicians may overlook iron deficiency anaemia, potentially missing a more serious diagnosis. Case summary A 19-year-old woman was referred to the hospital by her general practitioner due to worsening symptomatic iron deficiency anaemia, despite treatment with oral iron supplementation. Her blood cultures consistently grew Streptococcus sanguinis, and an echocardiogram revealed vegetations on the mitral and tricuspid valves, confirming the diagnosis of infective endocarditis. Several systemic complications of varying acuity were identified, including a ruptured left common iliac artery aneurysm with active haemorrhage into the left psoas muscle, enlarging cerebral, hepatic, and right common femoral artery aneurysms, splenic infarction with abscess formation, and an infected left psoas muscle haematoma. Multimodal imaging and collaboration within the multidisciplinary endocarditis team were crucial for coordinating further evaluation and managing the complex array of peripheral lesions in infective endocarditis. The patient was discharged with a good clinical outcome after 81 days. Discussion This case highlights the risks of overlooking iron deficiency anaemia in adolescent women with anorexia nervosa and the serious consequences of untreated complicated infective endocarditis. It emphasizes the need for thorough investigation of anorexia nervosa patients for infections due to their reduced clinical response, to ensure early diagnosis and treatment.
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Affiliation(s)
- Bing Wei Thaddeus Soh
- Department of Cardiology, University Hospital Waterford, Dunmore Rd, Ballynakill, Waterford X91 ER8E, Ireland
| | - Arifa Salim
- Department of Infectious Diseases, University Hospital Waterford, Dunmore Rd, Ballynakill, Waterford X91 ER8E, Ireland
| | - Ruth O'Riordan
- Department of Infectious Diseases, University Hospital Waterford, Dunmore Rd, Ballynakill, Waterford X91 ER8E, Ireland
| | - Patrick Owens
- Department of Cardiology, University Hospital Waterford, Dunmore Rd, Ballynakill, Waterford X91 ER8E, Ireland
| | - Sajjad Matiullah
- Department of Cardiology, University Hospital Waterford, Dunmore Rd, Ballynakill, Waterford X91 ER8E, Ireland
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2
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Yoshinouchi T, Yamamoto K, Migita M, Yokoyama T, Nakamura T, Matsuoka M. Diagnosis and clinical management of Exophiala dermatitidis pneumonia in a patient with anorexia nervosa: A case report. Med Mycol Case Rep 2023; 42:100617. [PMID: 38022890 PMCID: PMC10661607 DOI: 10.1016/j.mmcr.2023.100617] [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: 08/24/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
We report a patient with anorexia nervosa without bronchiectasis and cystic fibrosis who developed acute pneumonia caused by Exophiala dermatitidis (E. dermatitidis). The black fungus found in multiple sputum cultures was determined to be E. dermatitidis using mass spectrometry and identified using genetic analysis. Although the initiation of antifungal therapy was late, the pneumonia gradually improved with long-term treatment. This case highlights the need for early diagnosis and effective long-term treatment of the fungal etiologic agent.
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Affiliation(s)
- Tatsuya Yoshinouchi
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Keiichi Yamamoto
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Mitsuru Migita
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Toshiro Yokoyama
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
| | - Tomofumi Nakamura
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
| | - Masao Matsuoka
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, 860-8556, Japan
- Department of Hematology, Rheumatology, and Infectious Diseases, Faculty of Life Sciences, Kumamoto University, Kumamoto, 860-8556, Japan
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3
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Winston AP, Taylor MJ, Himmerich H, Ibrahim MAA, Okereke U, Wilson R. Medical morbidity and risk of general hospital admission associated with concurrent anorexia nervosa and COVID-19: An observational study. Int J Eat Disord 2023; 56:282-287. [PMID: 36374243 PMCID: PMC10100157 DOI: 10.1002/eat.23851] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Investigate medical morbidity and risk of general hospital admission for patients with concurrent coronavirus disease 2019 (COVID-19) and anorexia nervosa (AN) who have not received severe acute respiratory syndrome coronavirus 2 vaccination. METHODS United Kingdom eating disorders clinicians contributed to a database of patients with an eating disorder and COVID-19. We used this to investigate demography, symptoms, hospitalization, treatment, and outcomes for those with AN. RESULTS We describe data for 49 patients (median age 21.5 years [interquartile range 17.0-33.5], 46 female) including 36 adults and 13 under-18-year-olds. Three (6.1% [95% confidence interval 1.3%-17.9]) were admitted to a general hospital. For this sample, the expected age-standardized hospital admission rate per COVID-19 case (based on the general population of England) was 2.6% and therefore not significantly different to the hospitalization rate we observed. Three (including two of those admitted to hospital) contracted pneumonia. One had severe pneumonia and was admitted to an intensive care unit. No deaths or use of mechanical ventilation were recorded. DISCUSSION To our knowledge, this represents the first study investigating medical morbidity or frequency of hospitalization for patients with COVID-19 and AN. We did not find evidence that patients with AN are at increased risk of severe COVID-19. PUBLIC SIGNIFICANCE Medical morbidity and risk of hospitalization associated with concurrent COVID-19 and anorexia nervosa (AN) had not, to our knowledge, been studied before. We used a database of patients with eating disorders and COVID-19 (to which United Kingdom clinicians had contributed) to investigate presentation, treatment, outcomes, and COVID-19 severity for those with AN and COVID-19. We did not find evidence that patients with AN are at increased risk of severe COVID-19.
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Affiliation(s)
- Anthony P Winston
- The Aspen Centre, Coventry and Warwickshire Partnership Trust, Warwick, UK
| | - Michael J Taylor
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Mohammad A A Ibrahim
- Immunobiology and Immunological Medicine, King's College London and King's Health Partners, London, UK
| | - Uju Okereke
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK
| | - Robert Wilson
- Healthcare Public Health Team, National Health Service England-Midlands, Nottingham, UK
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4
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Bugge E, Wynn R, Mollnes TE, Reitan SK, Lapid M, Grønli OK. C-reactive protein levels and depression in older and younger adults - A study of 19,947 individuals. The Tromsø study. Brain Behav Immun Health 2022; 27:100571. [PMID: 36583067 PMCID: PMC9793216 DOI: 10.1016/j.bbih.2022.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Erlend Bugge
- University Hospital of North Norway, Regional Centre for Research and Education in Forensic Psychiatry and Psychology, University Hospital of North-Norway, Tromsoe, Norway,Corresponding author.
| | - Rolf Wynn
- UiT the Arctic University of Norway, Department of Clinical Medicine, Tromsoe, Norway
| | - Tom Eirik Mollnes
- Oslo University Hospital, Institute of Clinical Medicine, Department of Immunology, Oslo, Norway
| | - Solveig Klæbo Reitan
- Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Department of Mental Health, Trondheim, Norway
| | - Maria Lapid
- Mayo Clinic, Division of Consultation, Department of Psychiatry & Psychology, Rochester MN, USA
| | - Ole Kristian Grønli
- University Hospital of North Norway, Department of Geriatric Psychiatry, University Hospital of North-Norway, Tromsoe, Norway
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5
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Skin microbiota analysis in patients with anorexia nervosa and healthy-weight controls reveals microbial indicators of healthy weight and associations with the antimicrobial peptide psoriasin. Sci Rep 2022; 12:15515. [PMID: 36109548 PMCID: PMC9477808 DOI: 10.1038/s41598-022-19676-6] [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: 05/20/2022] [Accepted: 09/01/2022] [Indexed: 12/29/2022] Open
Abstract
Anorexia nervosa (AN), a psychiatric condition defined by low body weight for age and height, is associated with numerous dermatological conditions. Yet, clinical observations report that patients with AN do not suffer from infectious skin diseases like those associated with primary malnutrition. Cell-mediated immunity appears to be amplified in AN; however, this proinflammatory state does not sufficiently explain the lower incidence of infections. Antimicrobial peptides (AMPs) are important components of the innate immune system protecting from pathogens and shaping the microbiota. In Drosophila melanogaster starvation precedes increased AMP gene expression. Here, we analyzed skin microbiota in patients with AN and age-matched, healthy-weight controls and investigated the influence of weight gain on microbial community structure. We then correlated features of the skin microbial community with psoriasin and RNase 7, two highly abundant AMPs in human skin, to clarify whether an association between AMPs and skin microbiota exists and whether such a relationship might contribute to the resistance to cutaneous infections observed in AN. We find significant statistical correlations between Shannon diversity and the highly abundant skin AMP psoriasin and bacterial load, respectively. Moreover, we reveal psoriasin significantly associates with Abiotrophia, an indicator for the healthy-weight control group. Additionally, we observe a significant correlation between an individual's body mass index and Lactobacillus, a microbial indicator of health. Future investigation may help clarify physiological mechanisms that link nutritional intake with skin physiology.
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6
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Simeunovic‐Ostojic M, Herremans EE, Thai K, Maas J. Anorexia nervosa and COVID-19 infection: Clinical case report. Clin Case Rep 2022; 10:e6216. [PMID: 36093463 PMCID: PMC9440278 DOI: 10.1002/ccr3.6216] [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: 12/27/2021] [Revised: 07/04/2022] [Accepted: 07/16/2022] [Indexed: 11/12/2022] Open
Abstract
The true risk of COVID-19 infection in anorexia nervosa (AN) including the duration of viral RNA shedding and infectivity is still unclear. We report on a case of a patient with severe AN with a mild course of COVID-19 and prolonged viral RNA shedding for at least 39 days after symptom onset. A careful evaluation of long-term infectivity must include viral load, live virus isolation, and viral genome sequencing.
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Affiliation(s)
| | - Evy E. Herremans
- Center for Eating Disorders HelmondMental Health Center Region Oost‐BrabantBoekelThe Netherlands
| | - Khoa Thai
- Star‐shl Medical Diagnostic CenterRotterdamThe Netherlands
| | - Joyce Maas
- Center for Eating Disorders HelmondMental Health Center Region Oost‐BrabantBoekelThe Netherlands
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7
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Yoshida K, Matsuda N, Sato T, Watanabe T, Nakamura K, Saito K, Kanai K, Ugawa Y. Candida brain abscesses in a patient with anorexia nervosa receiving total parenteral nutrition. Clin Neurol Neurosurg 2021; 212:107058. [PMID: 34844162 DOI: 10.1016/j.clineuro.2021.107058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
A 28-year-old woman with anorexia nervosa (AN) and Candida brain abscesses was transferred to our hospital for intensive treatment. On admission, she had a low-grade fever but no clinical neurological abnormalities were observed, even though she had a high-grade fever in the previous hospital. These clinical findings did not suggest a serious disorder in the brain. However, magnetic resonance imaging showed mass lesions in bilateral lentiform nuclei in addition to several abscesses in the whole body. The fungal cultures of specimens from abscesses on the anterior chest wall and iliopsoas muscle detected Candida albicans. She was treated with antifungal therapy (fosfluconazole, fluconazole, liposomal amphotericin B, and flucytosine) and two emergent craniotomies for drainage of the intracranial fluid. Thereafter, antifungal medications (voriconazole and flucytosine) were administered for six months as a longterm treatment, which abolished most abscesses. However, severe frontal lobe dysfunction persisted as a residual symptom. This case suggests that AN can mask clinical manifestations of infection. We should always consider the possibility of infectious complications in these patients.
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Affiliation(s)
- Kenji Yoshida
- Department of Neurology, Fukushima Medical University, Fukushima, Japan.
| | - Nozomu Matsuda
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Taku Sato
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Tadashi Watanabe
- Department of Neurosurgery, Aichi Medical University, Nagakute, Japan
| | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University, Fukushima, Japan
| | - Yoshikazu Ugawa
- Department of Human Nuerophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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8
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Auger N, Potter BJ, Ukah UV, Low N, Israël M, Steiger H, Healy‐Profitós J, Paradis G. Anorexia nervosa and the long-term risk of mortality in women. World Psychiatry 2021; 20:448-449. [PMID: 34505367 PMCID: PMC8429328 DOI: 10.1002/wps.20904] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research CentreMontrealQC, Canada,Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada,Department of Social and Preventive MedicineSchool of Public Health, University of MontrealMontrealQC, Canada
| | - Brian J. Potter
- University of Montreal Hospital Research CentreMontrealQC, Canada,Division of Cardiology, Department of MedicineUniversity of Montreal Hospital CenterMontrealQC, Canada
| | - Ugochinyere Vivian Ukah
- Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada
| | - Nancy Low
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Mimi Israël
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island University Integrated Health and Social Service CentreMontrealQC, Canada
| | - Howard Steiger
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island University Integrated Health and Social Service CentreMontrealQC, Canada
| | - Jessica Healy‐Profitós
- University of Montreal Hospital Research CentreMontrealQC, Canada,Institut National de Santé Publique du QuébecMontrealQC, Canada
| | - Gilles Paradis
- Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada
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9
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Butler MJ, Perrini AA, Eckel LA. The Role of the Gut Microbiome, Immunity, and Neuroinflammation in the Pathophysiology of Eating Disorders. Nutrients 2021; 13:nu13020500. [PMID: 33546416 PMCID: PMC7913528 DOI: 10.3390/nu13020500] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 12/23/2022] Open
Abstract
There is a growing recognition that both the gut microbiome and the immune system are involved in a number of psychiatric illnesses, including eating disorders. This should come as no surprise, given the important roles of diet composition, eating patterns, and daily caloric intake in modulating both biological systems. Here, we review the evidence that alterations in the gut microbiome and immune system may serve not only to maintain and exacerbate dysregulated eating behavior, characterized by caloric restriction in anorexia nervosa and binge eating in bulimia nervosa and binge eating disorder, but may also serve as biomarkers of increased risk for developing an eating disorder. We focus on studies examining gut dysbiosis, peripheral inflammation, and neuroinflammation in each of these eating disorders, and explore the available data from preclinical rodent models of anorexia and binge-like eating that may be useful in providing a better understanding of the biological mechanisms underlying eating disorders. Such knowledge is critical to developing novel, highly effective treatments for these often intractable and unremitting eating disorders.
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Affiliation(s)
- Michael J. Butler
- Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Alexis A. Perrini
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA;
| | - Lisa A. Eckel
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL 32306, USA;
- Correspondence: ; Tel.: +1-850-644-3480
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10
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COVID-19, anorexia nervosa and obese patients with an eating disorder - some considerations for practitioners and researchers. J Eat Disord 2021; 9:15. [PMID: 33472682 PMCID: PMC7816735 DOI: 10.1186/s40337-021-00369-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
Since COVID-19 is a global health emergency, there is an urgent need to share experiences on decision-making with regard to safety recommendations and for hypotheses that can inform a more focused prevention and treatment. Moreover, combining research into eating disorders and obesity with research into COVID-19 may provide a unique opportunity to shed light on the susceptibility to COVID-19.
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11
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Antimicrobial peptides in patients with anorexia nervosa: comparison with healthy controls and the impact of weight gain. Sci Rep 2020; 10:22223. [PMID: 33335229 PMCID: PMC7746688 DOI: 10.1038/s41598-020-79302-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
Clinical observations show that patients with anorexia nervosa (AN) are surprisingly free from infectious diseases. There is evidence from studies in Drosophila melanogaster that starvation leads to an increased expression of antimicrobial peptides (AMPs). AMPs are part of the innate immune system and protect human surfaces from colonization with pathogenic bacteria, viruses and fungi. We compared the expression of AMPs between patients with AN and healthy controls (HC) and investigated the influence of weight gain. Using a standardized skin rinsing method, quantitative determination of the AMPs psoriasin and RNase 7 was carried out by ELISA. Even though non-significant, effect sizes revealed slightly higher AMP concentrations in HC. After a mean weight gain of 2.0 body mass index points, the concentration of psoriasin on the forehead of patients with AN increased significantly. We could not confirm our hypotheses of higher AMP concentrations in patients with AN that decrease after weight gain. On the contrary, weight gain seems to be associated with increasing AMP concentrations.
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12
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Severe bronchiectasis and inflammatory lung disease in a patient with anorexia nervosa and severe and enduring malnutrition - a case report. J Eat Disord 2020; 8:72. [PMID: 33292553 PMCID: PMC7672942 DOI: 10.1186/s40337-020-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent structural changes of the lungs in anorexia nervosa (AN) patients are rarely described in contemporary medical literature. The objective of our paper is to report a rare case of severe bronchiectasis and inflammatory changes to the lungs resulting from chronic malnutrition in a AN patient. CASE PRESENTATION We describe a patient with severe inflammatory lung disease caused by malnutrition, resulting in persistent bronchiectasis accompanying AN. We performed an analysis of the patient's medical records including radiological findings and laboratory results. A review of available literature shows very little data available on this topic. CONCLUSION Bronchiectasis and other structural changes of the lungs are rare, but severe complications of severe, chronic malnutrition. As exemplified by our case report, they may require extensive differential diagnosis and pose a significant clinical challenge due to their non-reversible character. A successful treatment relies heavily on the patient's compliance and may be hard to achieve. Clinicians managing patients with anorexia nervosa should be wary of early respiratory tract dysfunction-related symptoms and always consider malnutrition bronchiectasis as a differential diagnosis option.
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13
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Guinhut M, Melchior JC, Godart N, Hanachi M. Extremely severe anorexia nervosa: Hospital course of 354 adult patients in a clinical nutrition-eating disorders-unit. Clin Nutr 2020; 40:1954-1965. [PMID: 33023762 DOI: 10.1016/j.clnu.2020.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The clinical nutrition-eating disorders-unit in Raymond Poincaré Hospital is a reference center for the management of severe malnutrition and its complications in patients with anorexia nervosa (AN). The purpose of this study is to specify socio-demographic, anamnesic and clinical characteristics of AN patients hospitalized for extreme malnutrition, to identify types and prevalence of medical complications presented during their hospitalization for refeeding and the evolution of patients nutritional status. METHODS Demographic, clinical and paraclinical data of 354 severely malnourished AN patients were collected, during their first hospitalization in the unit, between November 1997 and January 2014, through medical records. The prevalence of medical complications was compared between the 2 AN subtypes (restricting and binging-purging). RESULTS 339 patients were female and mean age was 28.7 ± 10.7 years old. Duration of AN was 9.5 ± 9 years, 173 (48.9%) patients had a restricting AN subtype. BMI at admission was 12.2 ± 1.6 kg/m2, 280 (79.3%) patients had already been hospitalized for AN in other hospitals before. Psychiatric comorbidities were present in 168 (47.5%) patients. Associated somatic comorbidities concerned 70 (19.8%) patients. Outcomes during hospitalization were marked by 4.1 ± 3.9 kg weight gain on 36.9 ± 30.5 days. Enteral nutrition was provided in 304 (85.9%) patients. Main medical complications during hospitalization were: anemia (79%), neutropenia (53.9%), hypertransaminasemia (53.7%), osteoporosis (46.3%), hypokalemia (39.5%), hypophosphatemia (26%), hypoglycemia (13.8%), infectious complications (24.3%), cardiac dysfunction (7.1%), and proven gelatinous bone marrow transformation (6.5%). Hypokalemia was more frequent in binging-purging subtype. Lympho-neutropenia and hypertransaminasemia were more frequent in restricting subtype. During their hospitalization, 35 (10%) patients were referred to medical intensive care unit and 5 patients died. CONCLUSIONS AN patients hospitalized for severe malnutrition in a specialized clinical nutrition unit have severe and frequent medical complications. Psychiatric comorbidities are also frequent and could complicate medical care. A specialized and multidisciplinary management of these patients is therefore essential.
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Affiliation(s)
- Marie Guinhut
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Descartes University, Paris, France.
| | - Jean-Claude Melchior
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Saclay University, France
| | - Nathalie Godart
- Fondation de Santé des Etudiants de France, Paris, France; CESP, INSERM, UMR 1018, UVSQ, Université Paris-Saclay, Paris, France
| | - Mouna Hanachi
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Saclay University, France
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14
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Dalton B, Whitmore V, Patsalos O, Ibrahim MAA, Schmidt U, Himmerich H. A systematic review of in vitro cytokine production in eating disorders. Mol Cell Endocrinol 2019; 497:110308. [PMID: 30296466 DOI: 10.1016/j.mce.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Eating disorders (EDs) have been associated with alterations in cytokine concentrations and production. This review examines whether in vitro cytokine production (i) is altered in people with EDs compared to healthy participants; and (ii) changes in response to treatment? METHODS Using PRISMA guidelines, we systematically reviewed articles reporting group comparisons or longitudinal assessments of spontaneous and/or stimulated cytokine production in vitro in people with EDs. RESULTS Twelve studies were included. Cross-sectional results were mixed in anorexia nervosa. Only one study measured cytokine production in bulimia nervosa. Two longitudinal studies showed that daily yoghurt consumption increases phytohemagglutinin-stimulated interferon-γ production in anorexia nervosa. CONCLUSION The mixed results could be accounted for by variations in experimental design. Our findings suggest that cytokine production could possibly be modulated through dietary interventions. However, due to the methodological heterogeneity and shortcomings of the included studies, it seems unreasonable to draw further conclusions.
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Affiliation(s)
- Bethan Dalton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Victoria Whitmore
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Faculty of Life Sciences and Medicine, King's College London, UK
| | - Olivia Patsalos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mohammad A A Ibrahim
- Department of Clinical Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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15
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Gabriel T, Paul S, Berger A, Massoubre C. Anorexia Nervosa and Autism Spectrum Disorders: Future Hopes Linked to Mucosal Immunity. Neuroimmunomodulation 2019; 26:265-275. [PMID: 31715599 DOI: 10.1159/000502997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
Mental health is becoming a public health priority worldwide. Anorexia nervosa and autism spectrum disorders are 2 important types of childhood disorders with a bad prognosis. They share cognitive impairments and, in both cases, the microbiota appears to be a crucial factor. Alteration of the microbiota-gut-brain axis is an appealing hypothesis to define new pathophysiological mechanisms. Mucosal immunity plays a key role between the microbiota and the brain. The mucosal immune system receives and integrates messages from the intestinal microenvironment and the microbiota and then transmits the information to the nervous system. Abnormalities in this sensorial system may be involved in the natural history of mental diseases and might play a role in their maintenance. This review aims to highlight data about the relationship between intestinal mucosal immunity and these disorders. We show that shared cognitive impairments could be found in these 2 disorders, which both present dysbiosis. This literature review provides details on the immune status of anorexic and autistic patients, with a focus on intestinal mucosal factors. Finally, we suggest future research hypotheses that seem important for understanding the implication of the gut-brain-axis in psychiatric diseases.
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Affiliation(s)
- Tristan Gabriel
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France
| | - Stéphane Paul
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Anne Berger
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Catherine Massoubre
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France,
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Dalton B, Bartholdy S, Robinson L, Solmi M, Ibrahim MAA, Breen G, Schmidt U, Himmerich H. A meta-analysis of cytokine concentrations in eating disorders. J Psychiatr Res 2018; 103:252-264. [PMID: 29906710 DOI: 10.1016/j.jpsychires.2018.06.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/16/2018] [Accepted: 06/01/2018] [Indexed: 01/02/2023]
Abstract
Cytokines are signalling molecules, which play an important role in both immune system function and brain development and function, and subsequently mental states and behaviour. Cytokines have been implicated in eating disorders (EDs) due to their role in psychological health, body weight and appetite regulation. This meta-analysis examined cross-sectional and longitudinal studies measuring concentrations of cytokines in individuals with EDs. Using PRISMA guidelines, we systematically reviewed relevant articles in PubMed, Web of Science, and MEDLINE. Random-effects meta-analyses were conducted for interleukin (IL)-1β, IL-6, transforming growth factor (TGF)-β, and tumor necrosis factor (TNF)-α, independently, firstly with all EDs combined and then stratified by ED diagnosis. Twenty-five studies were included: serum/plasma cytokine concentrations were measured in people with anorexia nervosa (AN) in 23 studies and bulimia nervosa (BN) in 4 studies. TNF-α and IL-6 were elevated in ED participants compared to healthy controls (HCs). Specifically, this pattern was seen only when comparing AN participants to HCs. Concentrations of these cytokines did not differ between people with BN and HCs. IL-1β and TGF-β did not differ between HCs and any ED group. Therefore, AN seems to be associated with elevated concentrations of TNF-α and IL-6. Considering the role of cytokines in appetite, mood regulation, and anxiety, these pro-inflammatory cytokines could be a potential future drug target to help people with AN, not only with weight gain, but also with various coexisting psychological problems. Future studies should consider confounding factors that affect cytokine concentrations and report ED-relevant clinical characteristics.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Marco Solmi
- Department of Neurosciences, Psychiatry Unit, University of Padua, Padua, Italy; Cognitive Neuroscience Center, University of Padua, Padua, Italy; University Hospital Padua, Padua, Italy
| | - Mohammad A A Ibrahim
- Department of Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London SE5 9RS, UK
| | - Gerome Breen
- MRC Social, Genetic, and Developmental Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Suda M, Nagamitsu S, Kinosita M, Matsuoka M, Ozono S, Otsu Y, Yamashita Y, Matsuishi T. A child with anorexia nervosa presenting with severe infection with cytopenia and hemophagocytosis: a case report. Biopsychosoc Med 2017; 11:24. [PMID: 28878816 PMCID: PMC5583750 DOI: 10.1186/s13030-017-0108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Patients with anorexia nervosa in the acute phase have physical complications, such as infectious disease. Although hemophagocytic syndrome due to infection is a rare complication in anorexia nervosa, early identification for hemophagocytosis is important for avoiding a life-threatening condition. Case presentation We report a case of a 12-year-old girl with anorexia nervosa presenting with infection with cytopenia and hemophagocytosis during initial nutritional therapy. She developed pyrexia, abdominal pain, and diarrhea during inpatient treatment. Although intravenous antibiotics were administered, the symptoms persisted. Acinetobacter baumannii was detected in blood culture. Hemophagocytosis was present in the bone marrow. Gamma globulin therapy was effective, with improvement in symptoms and cytopenia. Conclusions Although our case did not fulfill the criteria of hemophagocytic syndrome, clinicians should consider severe infection in anorexia nervosa with cytopenia and hemophagocytosis.
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Affiliation(s)
- Masao Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Masahiro Kinosita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Michiko Matsuoka
- Department of Psychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Shuichi Ozono
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Yasushi Otsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi Kurume City, Fukuoka, 830-0011 Japan
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Mizuhara Y, Choi H, Kohigashi M, Hata Y, Nishizawa S, Fujimori A, Wada Y, Yamashita T, Fukui K. A Case of Anorexia Nervosa Complicated by Brain Abscess due to Sepsis After Pneumonia. PSYCHOSOMATICS 2011; 52:478-81. [DOI: 10.1016/j.psym.2011.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/09/2010] [Accepted: 09/17/2010] [Indexed: 11/27/2022]
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Malhi GS. An emphasis on stress. Acta Neuropsychiatr 2008; 20:111. [PMID: 26951033 DOI: 10.1111/j.1601-5215.2008.00308.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gin S Malhi
- 1Discipline of Psychological Medicine, University of Sydney
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