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Jan RL, Ho CH, Sung CH, Wang JJ, Jan HY, Chen WY, Chang YS. Association between Sjögren syndrome, sociodemographic factors, comorbid conditions, and optic neuritis: a Taiwanese population-based study. Front Neurol 2024; 15:1353326. [PMID: 38476197 PMCID: PMC10927792 DOI: 10.3389/fneur.2024.1353326] [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: 12/11/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose Our study aimed to explore the correlation between Sjögren syndrome, sociodemographic factors, comorbid conditions, and optic neuritis. Methods This retrospective, nationwide, population-based, matched case-control investigation involved 33,190 individuals diagnosed with optic neuritis, identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes 377.30 for optic neuritis or 377.32 for retrobulbar neuritis. Patient data were extracted from the Taiwan National Health Insurance Research Database. Demographic characteristics, the presence of Sjögren syndrome, and pre-existing comorbid conditions were analyzed using univariate logistic regression. Continuous variables were assessed with a paired t-test. Adjusted logistic regression was employed to compare the prognosis odds ratio (OR) of patients with optic neuritis to controls. Results After adjusting for confounding variables, individuals with Sjögren syndrome exhibited a significantly higher likelihood of developing optic neuritis compared to controls (adjusted OR, 9.79; 95% confidence interval [CI], 7.28-12.98; p < 0.0001). Other conditions associated with increased odds of optic neuritis included rheumatoid arthritis, ankylosing spondylitis, multiple sclerosis, systemic lupus erythematosus, and granulomatous vasculitis (adjusted OR: 1.57, 95% CI: 1.33-1.86; adjusted OR: 2.02, 95% CI: 1.65-2.48; adjusted OR: 140.77, 95% CI: 35.02-565.85; adjusted OR: 2.38, 95% CI: 1.71-3.30; adjusted OR: 18.28, 95% CI: 2.21-151.45, respectively), as well as systemic infections such as human herpes viral infection and tuberculosis infection (adjusted OR: 1.50, 95% CI: 1.35-1.66; adjusted OR: 4.60, 95% CI: 3.81-5.56, respectively). Discussion Our findings strongly support the existence of an association between Sjögren syndrome, rheumatoid arthritis, ankylosing spondylitis, multiple sclerosis, systemic lupus erythematosus, granulomatous vasculitis, human herpes viral infection, tuberculosis, and optic neuritis.
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Affiliation(s)
- Ren-Long Jan
- Department of Medical Science Industries, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
- Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Hao Sung
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Han-Yi Jan
- College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Yu Chen
- Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Yuh-Shin Chang
- Department of Medical Science Industries, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
- College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
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Frau J, Coghe G, Lorefice L, Fenu G, Cocco E. The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases. Life (Basel) 2023; 13:1309. [PMID: 37374092 DOI: 10.3390/life13061309] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Multiple sclerosis (MS), neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are inflammatory diseases of the central nervous system (CNS) with a multifactorial aetiology. Environmental factors are important for their development and microorganisms could play a determining role. They can directly damage the CNS, but their interaction with the immune system is even more important. The possible mechanisms involved include molecular mimicry, epitope spreading, bystander activation and the dual cell receptor theory. The role of Epstein-Barr virus (EBV) in MS has been definitely established, since being seropositive is a necessary condition for the onset of MS. EBV interacts with genetic and environmental factors, such as low levels of vitamin D and human endogenous retrovirus (HERV), another microorganism implicated in the disease. Many cases of onset or exacerbation of neuromyelitis optica spectrum disorder (NMOSD) have been described after infection with Mycobacterium tuberculosis, EBV and human immunodeficiency virus; however, no definite association with a virus has been found. A possible role has been suggested for Helicobacter pylori, in particular in individuals with aquaporin 4 antibodies. The onset of MOGAD could occur after an infection, mainly in the monophasic course of the disease. A role for the HERV in MOGAD has been hypothesized. In this review, we examined the current understanding of the involvement of infectious factors in MS, NMO and MOGAD. Our objective was to elucidate the roles of each microorganism in initiating the diseases and influencing their clinical progression. We aimed to discuss both the infectious factors that have a well-established role and those that have yielded conflicting results across various studies.
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Affiliation(s)
- Jessica Frau
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | | | - Eleonora Cocco
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Garg D, Radhakrishnan DM, Agrawal U, Vanjare HA, Gandham EJ, Manesh A. Tuberculosis of the Spinal Cord. Ann Indian Acad Neurol 2023; 26:112-126. [PMID: 37179681 PMCID: PMC10171010 DOI: 10.4103/aian.aian_578_22] [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: 07/03/2022] [Revised: 08/21/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis involving the spinal cord is associated with high mortality and disabling long-term sequelae. Although tuberculous radiculomyelitis is the most frequent complication, pleomorphic clinical manifestations exist. Diagnosis can be challenging among patients with isolated spinal cord tuberculosis due to diverse clinical and radiological presentations. The principles of management of tuberculosis of the spinal cord are primarily derived from, and dependent upon, trials on tuberculous meningitis (TBM). Although facilitating mycobacterial killing and controlling host inflammatory response within the nervous system remain the primary objectives, several unique features require attention. The paradoxical worsening is more frequent, often with devastating outcomes. The role of anti-inflammatory agents such as steroids in adhesive tuberculous radiculomyelitis remains unclear. Surgical interventions may benefit a small proportion of patients with spinal cord tuberculosis. Currently, the evidence base in the management of spinal cord tuberculosis is limited to uncontrolled small-scale data. Despite the gargantuan burden of tuberculosis, particularly in lower and middle-income countries, large-scale cohesive data are surprisingly sparse. In this review, we highlight the varied clinical and radiological presentations, performance of various diagnostic modalities, summarize data on the efficacy of treatment options, and propose a way forward to improve outcomes in these patients.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Umang Agrawal
- Department of Infectious Diseases, PD Hinduja Hospital and MRC, Mumbai, Maharashtra, India
| | | | | | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
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Fang L, Gong Y, Han K, Lv Y, Li M, Wang J. Longitudinally extensive transverse myelitis with mycobacterium tuberculosis infection. Acta Neurol Belg 2023; 123:243-246. [PMID: 34224079 PMCID: PMC8256407 DOI: 10.1007/s13760-021-01723-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Le Fang
- grid.415954.80000 0004 1771 3349Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, 130031 China
| | - Yushuang Gong
- grid.415954.80000 0004 1771 3349Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, 130031 China
| | - Kai Han
- grid.415954.80000 0004 1771 3349Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, 130031 China
| | - Yalin Lv
- grid.415954.80000 0004 1771 3349Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, 130031 China
| | - Miao Li
- grid.415954.80000 0004 1771 3349Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, 130031 China
| | - Jie Wang
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, 130031, China.
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5
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Carnero Contentti E, Correale J. Association between infections, the microbiome, vaccination, and neuromyelitis optica spectrum disorder. Mult Scler 2022; 29:492-501. [PMID: 35903896 DOI: 10.1177/13524585221113272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a devastating antibody-mediated condition of the central nervous system. As in other autoimmune diseases, there is considerable evidence to suggest that NMOSD arises from complex interactions between genetic susceptibility and environmental factors. However, whether factors like aquaporin-4-Antibody production initiate NMOSD attacks, currently remains unclear, and requires further investigation. Infectious diseases have also been proposed as possible environmental factors associated with NMOSD onset or relapses, some of which are more common in Asia and Latin America than in Europe and North America, in parallel with the higher incidence of NMOSD in these geographic locations. In this review, we examine current evidence on specific infections and vaccines associated with NMOSD onset and/or attacks, as well as the most recent data on gut microbiome composition and SARS-CoV-2 infection in NMOSD patients.
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Jiang Y, Xu X, Guo Z, Liu Y, Lin J, Suo L, Jiang Y, Liu B, Lu T. Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome. Front Neurol 2022; 13:830029. [PMID: 35370906 PMCID: PMC8965833 DOI: 10.3389/fneur.2022.830029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMyelitis is an important complication in patients with tuberculous meningitis (TBM). However, a paucity of publications exists on the spectrum of neurological and MRI findings of TBM-related myelitis. The risk factors and prognosis of myelitis in patients with TBM are not fully understood. Therefore, this study aims to identify the risk factors, clinicoradiological features, and prognostic impact of myelitis for patients with TBM.MethodsWe conducted a retrospective study in our institution. Patients with TBM who were consecutively admitted during the period of August 2015 to December 2019 were included. We reviewed the demographic characteristics, clinical, laboratory and MRI findings, and clinical outcomes of all of the included patients. The diagnosis of myelitis was identified by a hyperintensity on T2-weighted images that were associated with cord edema, enlargement, and marginal or no enhancement on contrast-enhanced images.ResultsA total of 114 patients were included. Myelitis occurred in 19 (16.7%) patients, five of whom paradoxically developed myelitis. The common clinical signs of myelitis were paraparesis (738.9%), quadriparesis (844.4%), urinary retention or constipation (1,477.8%), and paresthesias in the lower limbs (1,052.6%). In the MRI findings, the hyperintensities on T2-weighted images involved more than 3 spinal cord segments. Myelitis was often combined with other forms of spinal cord injury, including 10 patients (52.6%) with spinal meningeal enhancement, 7 patients (36.8%) with enlargement of the central canal of the spinal cord, 6 patients (31.6%) with tuberculoma, and 4 patients (21.1%) with arachnoiditis and 1 patient (5.3%) with cerebrospinal fluid (CSF) loculations. None of the 5 patients with paradoxical myelitis were complicated with spinal meningeal enhancement and arachnoiditis, while 4 patients were complicated with enlargements of the central canal of the spinal cord. In multivariable analysis, a grade III disease severity on admission [p = 0.003, odds ratio (OR) = 8.131, 95% CI: 2.080–31.779] and high CSF protein (p = 0.033, OR = 1.698, 95% CI: 1.043–2.763) were independent risk factors for myelitis. After the 6 months follow-up, myelitis (p = 0.030, OR = 13.297, 95% CI: 1.283–137.812) and disturbance of consciousness (p = 0.042, OR = 12.625, 95% CI: 1.092–145.903) were independent risk factors for poor outcomes.ConclusionMyelitis was a common complication of TBM and independently predicted a poor outcome. A grade III disease severity and high CSF protein on admission were independent risk factors for myelitis. Paradoxical myelitis was rarely complicated with spinal meningeal enhancements and arachnoiditis, indicating that the immune reaction may play a dominant role.
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Affiliation(s)
- Yuxuan Jiang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiangqin Xu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuoxin Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiahao Lin
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lijun Suo
- Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Department of Pulmonary and Critical Care Medicine, Zibo City Engineering Technology Research Center of Etiology Molecular Diagnosis, Zibo Municipal Hospital, Zibo, China
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Liu
- Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Department of Pulmonary and Critical Care Medicine, Zibo City Engineering Technology Research Center of Etiology Molecular Diagnosis, Zibo Municipal Hospital, Zibo, China
| | - Tingting Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Tingting Lu
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Saied Z, Nabli F, Rachdi A, Jeridi C, Douma B, Belal S, Ben Sassi S. Neuromyelitis optica and concomitant pulmonary tuberculosis: a case report. J Med Case Rep 2021; 15:391. [PMID: 34353370 PMCID: PMC8344150 DOI: 10.1186/s13256-021-03002-1] [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] [Received: 02/25/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background Concomitant diagnosis of neuromyelitis optica spectrum disease and pulmonary tuberculosis has rarely been reported.
Case report We report a case involving a young Tunisian male patient who developed dry cough followed, 2 months later, by weakness in the lower limbs. The findings of central nervous system imaging and anti-aquaporin-4 antibody positivity were compatible with the diagnosis of neuromyelitis optica spectrum disease. Constellation of the clinical and the typical radiological pulmonary findings in our patient, coming from an endemic region, allowed the diagnosis of pulmonary tuberculosis, although sputum smear examination for acid-fast bacilli and cultures was negative. The patient received anti-tuberculous polytherapy associated with immunomodulation, consisting of methylprednisolone and intravenous immunoglobulins. Pulmonary infection symptoms initially improved but with no motor recovery. The patient suddenly died at home 4 months after the onset of the first symptoms. Current data regarding the clinical presentation of this underreported concomitant or associated condition, the possible pathophysiological mechanisms, and the therapeutic options were reviewed. Conclusions This case underscores the necessity to understand the exact mechanism of these coincident entities and to clarify the best immunomodulatory choice since immunosuppression targeting neuromyelitis optica spectrum disease can lead to dissemination of pulmonary tuberculosis.
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Affiliation(s)
- Zakaria Saied
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
| | - Fatma Nabli
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
| | - Amine Rachdi
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia.
| | - Cyrine Jeridi
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
| | - Bissene Douma
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
| | - Samir Belal
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
| | - Samia Ben Sassi
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, University of Tunis El Manar, Jbel Lakhdhar Street 1007, LaRabta Bab Saâdoun, Tunis, Tunisia
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Saylor D. Neurologic Complications of Tuberculosis. Continuum (Minneap Minn) 2021; 27:992-1017. [PMID: 34623101 DOI: 10.1212/con.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes the current epidemiology, common clinical characteristics, and up-to-date evidence-based approaches to the diagnosis and management of the most common neurologic complications of tuberculosis (TB): tuberculous meningitis, intracranial tuberculoma, and spinal TB. RECENT FINDINGS Central nervous system (CNS) TB remains common and associated with significant mortality and neurologic sequelae worldwide. Human immunodeficiency virus (HIV) co-infection is strongly associated with both the development of and mortality due to CNS TB. Strongyloides co-infection is associated with reduced CNS inflammation and improved outcomes in the setting of tuberculous meningitis. Stroke remains a common complication of tuberculous meningitis, and emerging evidence suggests aspirin may be used in this context. Although a recent nucleic acid amplification test has demonstrated suboptimal sensitivity in the diagnosis of CNS TB, emerging diagnostic techniques include cell-free DNA, peripheral blood microRNA, metagenomic next-generation sequencing, and advanced imaging techniques, but these are not yet well validated. CNS TB is associated with high mortality even with current treatment regimens, although novel, promising strategies for treatment are under investigation, including a combination of IV isoniazid and ethambutol and high-dose rifampicin. SUMMARY TB can affect the nervous system in various ways and is associated with high mortality. Diagnosis remains challenging in endemic settings, with empiric treatment often initiated without a definitive diagnosis. Furthermore, optimal treatment regimens remain uncertain because current treatment for all forms of CNS TB is extrapolated from trials of tuberculous meningitis whereas the role of steroids in people with HIV and tuberculous meningitis remains controversial.
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Anand KA, Bhowmik KK, Sarkar A, Ghosh R, Mandal A, Swaika B, Ray BK. Tubercular longitudinally extensive transverse myelitis (LETM): An enigma for primary care physicians. J Family Med Prim Care 2021; 10:1057-1060. [PMID: 34041124 PMCID: PMC8138341 DOI: 10.4103/jfmpc.jfmpc_2101_20] [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] [Received: 10/11/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022] Open
Abstract
Albeit, all forms of tuberculosis (TB) are endemic in India, spinal intramedullary TB and tubercular longitudinally extensive transverse myelitis (LETM) is deemed extremely rare. With recent advances in the field of neurology, autoimmune astrocytopathy (neuromyelitis optica spectrum disorders, NMOSD), myelin-oligodendrocyte glycoprotein associated encephalomyelitis (MOG-EM), metabolic myelopathy, connective tissue diseases and viral infections have gained considerable focus in the list of differentials of LETM whereas tubercular association is often forgotten. This report presents a rare case of acute transverse myelopathy which unveiled previously undiagnosed pulmonary tuberculosis in an adult rural Indian male. The patient responded well to anti-tubercular therapy and corticosteroids. Exact pathogenesis of LETM in TB remains elusive. Association of TB with MOG-EM has been one of the recent hot-cakes. However, an ill-defined immune-inflammatory response to the infectious agent is the likely cause of tubercular LETM. Hence, the primary care physicians who are the first medical contacts of acute LETM cases and in most cases due to diagnostic dilemma there is an unavoidable delay in accurate diagnosis and initiation of therapy. Primary care doctors should nurture a high index of suspicion to diagnose this potentially lifetime-debilitating yet absolutely treatable clinical condition i.e. tubercular LETM.
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Affiliation(s)
- Kumar Abhishek Anand
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Kalyan Kumar Bhowmik
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Amit Sarkar
- Assistant Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Ritwik Ghosh
- Resident, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Arpan Mandal
- Associate Professor, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Bikash Swaika
- Professor and Head of the Department, Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Biman Kanti Ray
- Professor, Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
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Zayet S, Zaghdoudi A, Harrabi H, Goubantini A, Tiouiri Benaissa H. Devic's neuromyelitis optica associated with active pulmonary tuberculosis, Tunisia. New Microbes New Infect 2020; 39:100828. [PMID: 33425364 PMCID: PMC7777500 DOI: 10.1016/j.nmni.2020.100828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022] Open
Abstract
Devic's Optic neuromyelitis (OND) is a very rare disease defined as a central nervous system (CNS) inflammation resulting in optic neuritis and/or myelitis. The discovery of a highly specific serum autoantibody biomarker for the diagnosis has triggered a great interest in conducting further research into this disease. The association of OND with Tuberculosis (TB) is even rarer and could be an entirely random conjunction. To our knowledge, we reported the first case of Neuromyelitis Optica associated with pulmonary TB in Tunisia.
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Affiliation(s)
- S Zayet
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia
| | - A Zaghdoudi
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia
| | - H Harrabi
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - A Goubantini
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - H Tiouiri Benaissa
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Jorge de Saráchaga A, Rivera-Chávez LF, López-Martínez MS. Neuromyelitis optica spectrum disorder (NMOSD) with hypothalamic involvement and central nervous system tuberculosis: A case report. Clin Neurol Neurosurg 2020; 193:105751. [PMID: 32163749 DOI: 10.1016/j.clineuro.2020.105751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Adib Jorge de Saráchaga
- Neurology Department, National Institute of Neurology and Neurosurgery "MVS", Mexico City, Mexico.
| | - Luis F Rivera-Chávez
- Psychiatry Department, National Institute of Neurology and Neurosurgery "MVS", Mexico City, Mexico
| | - Manuel S López-Martínez
- Neurologic Emergencies Department, National Institute of Neurology and Neurosurgery "MVS", Mexico City, Mexico
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12
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Naser Moghadasi A. Environmental and genetic risk factors in the development of neuromyelitis optica. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1723416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Grieve JK, Day S, Connell D, O'Riordan J. Neuromyelitis optica spectrum disorder and active tuberculosis. BMJ Case Rep 2020; 13:13/1/e231524. [PMID: 31900293 DOI: 10.1136/bcr-2019-231524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis is on the rise again. It brings with it potential for neurological involvement both as a direct infection and as a parainfectious process. Accordingly we report the development of neurological problems affecting a 48-year-old patient's vision and sensation while being treated for active tuberculosis. At its nadir her vision deteriorated to nil perception of light and she had a sensory level to T10. Neuromyelitis optica spectrum disorder was diagnosed. We discuss our management strategy with neuromodulation in the context of active tuberculosis infection.
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Affiliation(s)
| | - Scott Day
- General Medicine, Ninewells Hospital, Dundee, Tayside, UK
| | - David Connell
- Respiratory, Ninewells Hospital, Dundee, Tayside, UK
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14
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Zhang Y, Wang D, Yin Y, Wang Y, Fan H, Zhang W, Zeng X. Tuberculosis Infection in Chinese Patients with Giant Cell Arteritis. Sci Rep 2019; 9:14364. [PMID: 31591421 PMCID: PMC6779871 DOI: 10.1038/s41598-019-50892-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022] Open
Abstract
Giant cell arteritis (GCA) is a medium- and large-vessel vasculitis with an onset age after 50 years. Takayasu arteritis (TA), which is also a large-vessel vasculitis with an onset age earlier than 40 years, was suggested to be associated with tuberculosis (TB). However, the association between GCA and TB was rarely reported. This study was to retrospectively analyze clinical data of GCA patients at Peking Union Medical College Hospital and elucidate the association between GCA and TB. Ninety-one patients diagnosed with GCA were included in the study. A total of 20 patients (22.0%) had a history of active tuberculosis and received anti-tuberculosis therapy. On comparing the clinical features of patients with GCA and concomitant TB and those without TB, obvious weight loss (P = 0.011), lower percentage of dyslipidemia (P = 0.042), higher percentage of anti-phospholipid antibodies (P = 0.010), and lower white blood cells (P = 0.006) were noted in the TB group. In conclusion, this study demonstrated the percentage of TB history in patients with GCA was higher than that in the Chinese general population. Clinicians should recognize the possibility of comorbid TB in patients with obvious weight loss and relatively lower white blood cell count.
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Affiliation(s)
- Yun Zhang
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yue Yin
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
| | - Yu Wang
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China
| | - Hongwei Fan
- Department of Infectious Disease of PUMCH, CAMS & PUMC, Beijing, 100730, China
| | - Wen Zhang
- Department of Rheumatology of PUMCH, CAMS & PUMC, Beijing, 100730, China
| | - Xuejun Zeng
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, 100730, China.
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15
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Bennis A, El Otmani H, Benkirane N, Harrizi I, El Moutawakil B, Rafai MA, Slassi I. Clinical course of neuromyelitis optica spectrum disorder in a moroccan cohort. Mult Scler Relat Disord 2019; 30:141-148. [DOI: 10.1016/j.msard.2019.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/30/2022]
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16
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Zhong X, Zhou Y, Lu T, Wang Z, Fang L, Peng L, Kermode AG, Qiu W. Infections in neuromyelitis optica spectrum disorder. J Clin Neurosci 2017; 47:14-19. [PMID: 29066232 DOI: 10.1016/j.jocn.2017.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory astrocytopathy that has both genetic and environmental causes. A growing body of evidence suggests that the presence of several infectious agents correlates with the development of NMOSD. In this review, we summarize studies that either support or present evidence against the hypothesized association between infection and NMOSD. We will also present an overview of potential mechanisms underlying the pathogenesis of NMOSD. Finally, we provide some beneficial properties that infectious elements may have based on "hygiene hypothesis". It is of great clinical significance to further investigate the complex mechanisms by which infections may affect autoimmune diseases to develop better strategies to prevent and treat them, although so far no causal link between infectious agents and NMOSD has been established.
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Affiliation(s)
- Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yifan Zhou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tingting Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhanhang Wang
- Department of Neurology, Guangdong 999 Brain Hospital, China
| | - Ling Fang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Allan G Kermode
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, Australia
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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17
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Alkan G, Emiroğlu M, Kartal A, Peru H, Koplay M. Occult Disseminated Tuberculosis with Holocord Longitudinally Extensive Transverse Myelitis: A Rare Phenomenon in a Child. J Pediatr Neurosci 2017; 12:259-261. [PMID: 29204202 PMCID: PMC5696664 DOI: 10.4103/jpn.jpn_14_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Longitudinally extensive transverse myelitis (LETM) is defined as an inflammatory lesion of the spinal cord that extends to three or more segments. LETM is a commonly characteristic feature of neuromyelitis optica (NMO) or various autoimmune diseases. Manifestation of Mycobacterium tuberculosis (MTB) infection with LETM are rare and usually in the cervicothoracic spinal cord. Our patient presented with holocord LETM, so NMO was considered initially diagnosis. After in further research, MTB was diagnosed and treated successfully. The current case underscores that tuberculosis must be keep in mind when undertaking differential diagnosis of demyelinating diseases even in the absence of symptoms of infection, and especially in endemic regions.
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Affiliation(s)
- Gülsüm Alkan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Melike Emiroğlu
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Ayşe Kartal
- Department of Pediatric Neurology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Harun Peru
- Department of Pediatric Nephrology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Faculty of Medicine, Selcuk University, Konya, Turkey
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18
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Kasundra GM, Sood I, Bhushan B, Bhargava AN, Shubhkaran K. Distal cord-predominant longitudinally extensive myelitis with diffuse spinal meningitis and dural abscesses due to occult tuberculosis: A rare occurrence. J Pediatr Neurosci 2016; 11:77-9. [PMID: 27195042 PMCID: PMC4862298 DOI: 10.4103/1817-1745.181268] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Tuberculous myelitis usually involves thoracic and only rarely, distal cord. Longitudinal lesions more than three spinal segments long in tuberculosis (TB) are usually due to intramedullary tuberculomas and not infectious myelitis. We report a 17-year-old male with acute myelitis from D7 to conus medullaris, diffuse spinal meningitis, subdural and epidural abscesses, normal vertebrae, intervertebral discs, and brain imaging. Cerebrospinal fluid (CSF) showed raised proteins, lymphocytosis, hypoglycorrhagia, and positive TB-polymerase chain reaction. Chest X-ray was normal, and sputum was negative for acid-fast Bacilli. Chest computed tomography (CT) revealed endobronchial TB. The patient was successfully treated with antitubercular drugs and steroids. In endemic areas, a high index of suspicion should be kept for TB in patients with myelitis, especially those with spinal abscesses and a suggestive CSF report. In selected cases, there may be a role of CT scan inspite of normal X-ray.
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Affiliation(s)
- Gaurav M Kasundra
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Isha Sood
- Department of Medicine, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Bharat Bhushan
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Amita Narendra Bhargava
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
| | - Khichar Shubhkaran
- Department of Neurology, Dr. S. N. Medical College, M. G. Hospital, Jodhpur, Rajasthan, India
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19
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Sridhar S, Chan JFW, Yuen KY. Fatal anti-aquaporin-4 seropositive neuromyelitis optica spectrum disorder in tuberculosis. BMC Infect Dis 2014; 14:470. [PMID: 25169022 PMCID: PMC4158048 DOI: 10.1186/1471-2334-14-470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is an autoimmune inflammatory condition of the central nervous system that is characterized by circulating anti-aquaporin-4 antibodies, transverse myelitis and optic neuritis. NMO spectrum disorders are rarely reported in patients with active pulmonary tuberculosis (TB). We report a fatal case of anti-aquaporin-4 antibody positive NMO spectrum disorder in a patient who was receiving treatment for pulmonary tuberculosis. Case presentation A previously healthy 42-year-old Chinese man was diagnosed with smear positive pulmonary tuberculosis. After one month of anti-tuberculosis treatment, he presented with acute generalized weakness and rapid neurological deterioration. Spinal imaging and anti-aquaporin-4 antibody positivity established a diagnosis of neuromyelitis optica spectrum disorder. Conclusion This is the first reported case of anti-aquaporin-4 antibody-positive NMO spectrum disorder in a patient with active tuberculosis. It shows the usefulness of testing for anti-aquaporin-4 antibodies while evaluating neurological deterioration in patients with tuberculosis. The literature on the rare association between NMO spectrum disorders and TB is reviewed. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-470) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
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