Citation 1 seems extremely important because the researchers documented regional
vasculitis
associated with a pathogen that is challenging to detect (eg, 8). Are these
researchers
illustrating a cause of hypoperfusion (increasingly documented in autism)? I
find myself
wondering if pathogen-induced CNS-vasculitis can occur even when symptoms of
peripheral GBS are
not present. We note that at least one common pathogen (EBV) is associated with
ASD-like traits
(9) and with arthritis (10); and that several MHC alleles are associated with
EBV and with
autism (10-11).
1. Crit Care 2000;4(4):245-248
A case of central nervous system vasculitis related to an episode of
Guillain-Barre syndrome.
Sinardi D et al.
http://www.pubmedcentral.nih.gov/picrender.cgi?artid=14815&pictype=5
The authors report their knowledge about an uncommon case of isolated
vasculitis, restricted to the left sylvian artery during an auto-immune
Guillain-Barre syndrome (GBS), sustained by cytomegalovirus (CMV). An acute
cardiopulmonary failure requiring a ventilator and vasopressor support
manifested, notwithstanding plasma exchanging and immune-modulating therapy. An
IgM-enriched formula administration coincided with a rapid amelioration of GBS
and vasculitis to a complete recovery the next month after her discharge to a
rehabilitation centre.
2. Appl Environ Microbiol 2000 Sep;66(9):3917-23
Amplified fragment length polymorphism analysis of Campylobacter jejuni strains
isolated from chickens and from patients with gastroenteritis or Guillain-Barre
or Miller Fisher syndrome.
Duim B, Ang CW, van Belkum A, Rigter A, van Leeuwen NW, Endtz HP, Wagenaar JA
http://aem.asm.org/cgi/reprint/66/9/3917.pdf
The high-resolution genotyping method of amplified fragment length polymorphism
(AFLP) analysis was used to study the genetic relationships between
Campylobacter jejuni strains infecting chickens (n = 54) and those causing
gastroenteritis in humans (n = 53). In addition, C. jejuni strains associated
with the development of Guillain-Barre syndrome (GBS) (n = 14) and Miller Fisher
syndrome (MFS) (n = 4), two related acute paralytic syndromes in human, were
included. Strains were isolated between 1989 and 1998 in The Netherlands. The
AFLP banding patterns were analyzed with correlation-based and band-based
similarity coefficients and UPGMA (unweighted pair group method using average
linkages) cluster analysis. All C. jejuni strains showed highly heterogeneous
fingerprints, and no fingerprints exclusive for chicken strains or for human
strains were obtained. All strains were separated in two distinct genetic
groups. In group A the percentage of human strains was significantly higher and
may be an indication that genotypes of this group are more frequently associated
with human diseases. We conclude that C. jejuni from chickens cannot be
distinguished from human strains and that GBS or MFS related strains do not
belong to a distinct genetic group.
3. J Neuroimmunol 1999 Dec;100(1-2):74-97
Pathogenesis of Guillain-Barre syndrome.
Hughes RA, Hadden RD, Gregson NA, Smith KJ
Department of Neuroimmunology, Guy's, King's and St. Thomas' School of Medicine,
Guy's Hospital, London, UK. richard.a.hughes@...
http://www.neuroscion.com
Recent neurophysiological and pathological studies have led to a
reclassification of the diseases that underlie Guillain-Barre syndrome (GBS)
into acute inflammatory demyelinating polyradiculoneuropathy (AIDP), acute motor
and sensory axonal neuropathy (AMSAN) and acute motor axonal neuropathy (AMAN).
The Fisher syndrome of ophthalmoplegia, ataxia and areflexia is the most
striking of several related conditions. Significant antecedent events include
Campylobacter jejuni (4-66%), cytomegalovirus (5-15%), Epstein-Barr virus
(2-10%), and Mycoplasma pneumoniae (1-5%) infections. These infections are not
uniquely associated with any clinical subtype but severe axonal degeneration is
more common following C. jejuni and severe sensory impairment following
cytomegalovirus. Strong evidence supports an important role for antibodies to
gangliosides in pathogenesis. In particular antibodies to ganglioside GM1 are
present in 14-50% of patients with GBS, and are more common in cases with severe
axonal degeneration associated with any subtype. Antibodies to ganglioside GQ1b
are very closely associated with Fisher syndrome, its formes frustes and related
syndromes. Ganglioside-like epitopes exist in the bacterial wall of C. jejuni.
Infection by this and other organisms triggers an antibody response in patients
with GBS but not in those with uncomplicated enteritis. The development of GBS
is likely to be a consequence of special properties of the infecting organism,
since some strains such as Penner 0:19 and 0:41 are particularly associated with
GBS but not with enteritis. It is also likely to be a consequence of the
immunogenetic background of the patient since few patients develop GBS after
infection even with one of these strains. Attempts to match the subtypes of GBS
to the fine specificity of anti-ganglioside antibodies and to functional effects
in experimental models continue but have not yet fully explained the
pathogenesis. T cells are also involved in the pathogenesis of most or perhaps
all forms of GBS. T cell responses to any of three myelin proteins, P2, PO and
PMP22, are sufficient to induce experimental autoimmune neuritis. Activated T
cells are present in the circulation in the acute stage, up-regulate matrix
metalloproteinases, cross the blood-nerve barrier and encounter their cognate
antigens. Identification of the specificity of these T cell responses is still
at a preliminary stage. The invasion of intact myelin sheaths by activated
macrophages is difficult to explain according to a purely T cell mediated
mechanism. The different patterns of GBS are probably due to the diverse
interplay between antibodies and T cells of differing specificities.
4. J Neurol Neurosurg Psychiatry 1999 Mar;66(3):376-9
Antiganglioside antibodies in Guillain-Barre syndrome after a recent
cytomegalovirus infection.
Khalili-Shirazi A, Gregson N, Gray I, Rees J, Winer J, Hughes R
http://jnnp.bmjjournals.com/cgi/reprint/66/3/376.pdf
OBJECTIVE: To study the association between anti-ganglioside antibody responses
and Guillan-Barre syndrome (GBS) after a recent cytomegalovirus (CMV) infection.
METHODS: Enzyme linked immunosorbant assay (ELISA) was undertaken on serum
samples from 14 patients with GBS with recent cytomegalovirus (CMV) infection
(CMV+GBS) and 12 without (CMV-GBS), 17 patients with other neurological diseases
(OND), 11 patients with a recent CMV infection but without neurological
involvement, 11 patients with recent Epstein-Barr virus (EBV) infection but
without neurological involvement, and 20 normal control (NC) subjects. RESULTS:
IgM antibodies were found at 1:100 serum dilution to gangliosides GM2 (six of 14
patients), GM1 (four of 14), GD1a (three of 14) and GD1b (two of 14) in the
serum samples of the CMV+GBS patients, but not in those of any of the CMV-GBS
patients. IgM antibodies were also found to gangliosides GM1, GD1a, and GD1b in
one of 11 OND patients, to ganglioside GM1 in one of 11 non- neurological CMV
patients, and to ganglioside GD1b in one of 20 NC subjects. Some patients with
EBV infection had IgM antibodies to gangliosides GM1 (five of 11), GM2 (three of
11), and GD1a (two of 11). However, the antibodies to ganglioside GM2 had a low
titre, none being positive at 1:200 dilution, whereas five of the CMV+GBS serum
samples remained positive at this dilution. CONCLUSION: Antibodies to
ganglioside GM2 are often associated with GBS after CMV infection, but their
relevance is not known. It is unlikely that CMV infection and anti-ganglioside
GM2 antibodies are solely responsible and an additional factor is required to
elicit GBS.
5. Ann Neurol 1998 Nov;44(5):815-8
Genetic contribution of the tumor necrosis factor region in Guillain-Barre
syndrome.
Ma JJ et al.
We studied genetic polymorphisms in the tumor necrosis factor (TNF) region
in 81 Japanese patients with Guillain-Barre syndrome (GBS) and 85 controls.
A significantly higher frequency of the 100-base pair (bp) (TNFa2) allele of the
TNFa microsatellite marker, which is associated with high TNF alpha production,
existed in Campylobacter jejuni-positive (Cj+) GBS patients than in controls,
suggesting the involvement of a genetic predisposition to high TNF alpha
secretion in the development of C. jejuni-related GBS.
6. Neurology 1998 Oct;51(4):1110-5
The spectrum of antecedent infections in Guillain-Barre syndrome: a case-control
study.
Jacobs BC et al.
OBJECTIVE: To determine which antecedent infections are specifically associated
with the Guillain-Barre syndrome (GBS). BACKGROUND: Infections with many agents
have been reported preceding GBS. Some infections are related to specific
clinical and immunologic subgroups in GBS. Most agents were reported in case
reports and uncontrolled small series of GBS patients only, and their relation
to GBS and its subgroups remains unclear. METHOD: A serologic study for 16
infectious agents in 154 GBS patients and 154 sex- and age-matched controls with
other neurologic diseases. Acute phase, pretreatment samples were used from
clinically well-defined GBS patients. The seasonal distribution of serum
sampling in the GBS and control group was the same. RESULTS: Multivariate
analysis showed that in GBS patients, infections with Campylobacter jejuni
(32%), cytomegalovirus (13%), and Epstein-Barr virus (10%) were significantly
more frequent than in controls. Mycoplasma pneumoniae infections occurred more
often in GBS patients (5%) than in controls in univariate analysis. Infections
with Haemophilus influenzae (1%), parainfluenza 1 virus (1%), influenza A virus
(1%), influenza B virus (1%), adenovirus (1%), herpes simplex virus (1%), and
varicella zoster virus (1%) were also demonstrated in GBS patients, but not more
frequently than in controls. C. jejuni infections were associated with
antibodies to the gangliosides GM1 and GD1b and with a severe pure motor form of
GBS. Cytomegalovirus infections were associated with antibodies to the
ganglioside GM2 and with severe motor sensory deficits. Other infections were
not related to specific antiganglioside antibodies and neurologic patterns.
CONCLUSIONS: Recent infections with C. jejuni, cytomegalovirus, Epstein-Barr
virus, and M. pneumoniae are specifically related to GBS. The variety of
infections may contribute to the clinical and immunologic heterogeneity of GBS.
7. Clin Microbiol Rev 1998 Jul;11(3):555-67
Campylobacter species and Guillain-Barre syndrome.
Nachamkin I, Allos BM, Ho T
http://cmr.asm.org/cgi/reprint/11/3/555.pdf
Since the eradication of polio in most parts of the world, Guillain-Barre
syndrome (GBS) has become the most common cause of acute flaccid paralysis. GBS
is an autoimmune disorder of the peripheral nervous system characterized by
weakness, usually symmetrical, evolving over a period of several days or more.
Since laboratories began to isolate Campylobacter species from stool specimens
some 20 years ago, there have been many reports of GBS following Campylobacter
infection. Only during the past few years has strong evidence supporting this
association developed. Campylobacter infection is now known as the single most
identifiable antecedent infection associated with the development of GBS.
Campylobacter is thought to cause this autoimmune disease through a mechanism
called molecular mimicry, whereby Campylobacter contains ganglioside-like
epitopes in the lipopolysaccharide moiety that elicit autoantibodies reacting
with peripheral nerve targets. Campylobacter is associated with several
pathologic forms of GBS, including the demyelinating (acute inflammatory
demyelinating polyneuropathy) and axonal (acute motor axonal neuropathy) forms.
Different strains of Campylobacter as well as host factors likely play an
important role in determining who develops GBS as well as the nerve targets for
the host immune attack of peripheral nerves. The purpose of this review is to
summarize our current knowledge about the clinical, epidemiological,
pathogenetic, and laboratory aspects of campylobacter-associated GBS.
8. Transfusion 1998 Mar;38(3):271-8
Cytomegalovirus DNA can be detected in peripheral blood mononuclear cells from
all seropositive and most seronegative healthy blood donors over time.
Larsson S et al.
BACKGROUND: A poor correlation between cytomegalovirus (CMV) seroreactivity and
the risk of CMV transmission prompted an investigation of the presence of CMV
DNA in peripheral blood mononuclear cells (PBMNCs) from seropositive and
seronegative blood donors. Because latent CMV exists in monocytes,
monocyte-enriched cells were analyzed separately. STUDY DESIGN AND METHODS:
Samples from 270 blood donors were tested with a sensitive polymerase chain
reaction (PCR) test that detects two CMV genes, and the results were correlated
to CMV serology. Cross-reactivity with other herpesvirus genes was not recorded.
RESULTS: PCR testing demonstrated that 71 percent of seropositive donors harbor
CMV in PBMNCs. Thus, not all seropositive donors were CMV DNA positive when
individual samples were tested. Tests repeated over a period of time showed that
all seropositive individuals were positive. Increased sensitivity was obtained
with enriched monocytes. Among seronegative donors, 55 percent harbored CMV DNA
in monocyte-enriched PBMNCs, while 14 percent had CMV DNA in PBMNCs. CONCLUSION:
All seropositive donors harbored latently infected PBMNCs, as demonstrated by
the testing of samples collected over time. In addition, a substantial
proportion of seronegative individuals are CMV carriers and might transfer
infection. The findings concur with clinical evidence of CMV transmission by
blood components from seronegative individuals and with in vitro reactivation of
CMV in PBMNCs from seronegative donors.
9. J Child Neurol 2000 Dec;15(12):791-6
Persistent preceding focal neurologic deficits in children with chronic
Epstein-Barr virus encephalitis.
Caruso JM et al.
Epstein-Barr virus encephalitis is a self-limiting disease with few sequelae.
Persistence of neurologic deficits prior to and after the acute illness has yet
to be described in children. We describe five children with persistent cognitive
and focal neurologic deficits due to chronic Epstein-Barr virus encephalitis
with various T2-weighted magnetic resonance imaging abnormalities. Clinical
features were a 9-year-old boy with aphasia and apraxia, an 11-year-old girl
with impulsivity and inappropriate behavior, a 17-year-old boy with
deterioration of cognitive skills and judgment, a 5-year-old boy with
complex-partial seizures, and a 6-year-old girl with obsessive-compulsive
behavior. All patients had elevated serum Epstein-Barr virus titers for acute
infection, with cerebrospinal fluid polymerase chain reaction positive for
Epstein-Barr virus in four patients. Three children were treated with
methylprednisolone with minimal improvement without changes on magnetic
resonance imaging. Epstein-Barr virus encephalitis can present with chronic and
insidious neurologic symptoms and should be considered in the differential
diagnosis of children with acute or chronic neurologic illness of unknown
etiology.
10. Arthritis Rheum 1999 Jul;42(7):1485-96
Synovial Epstein-Barr virus infection increases the risk of rheumatoid arthritis
in individuals with the shared HLA-DR4 epitope.
Saal JG et al.
OBJECTIVE: To investigate the presence of the Epstein-Barr virus (EBV) in
rheumatoid arthritis (RA) synovium and its correlation with the HLA genotype in
an attempt to elucidate the role of EBV in the pathogenesis of RA. METHODS: EBV
DNA/RNA was investigated by polymerase chain reaction (PCR) analysis of synovial
tissue from 84 patients with RA and from 81 patients with non-RA arthritis
(controls) and was correlated with the patients' HLA genotype. RESULTS: EBV DNA
and EBV-encoded RNA 1 transcripts were significantly more frequently present in
synovial tissue from the RA patients (29 of 84) than in that from the non-RA
patient controls (8 of 81). EBV DNA-positive individuals had a 5.47 times higher
risk of presenting with RA than did EBV DNA-negative individuals. In
HLA-DRB1*0401,0404,0405,0408-positive or shared epitope-positive patients, the
risk was further increased (odds ratio for EBV and HLA-DR4 approximately 41, for
EBV and the shared epitope approximately 15) compared with those who lacked both
EBV DNA and RA-linked HLA genotypes. CONCLUSION: EBV seems to function as an
environmental risk factor for RA, particularly in patients with the RA-linked
HLA-DRB1 alleles.
11. J Neuroimmunol 1996 Jul;67(2):97-102
Strong association of the third hypervariable region of HLA-DR beta 1 with
autism.
Warren RP et al.
We reported that the major histocompatibility complex (MHC) including the null
allele of the C4B gene and the extended haplotype B44-C30-DR4 is associated with
autism. We report now that the third hypervariable region (HVR-3) of certain DR
beta 1 alleles have very strong association with autism. The HVR-3 of DR beta 1*
0401 or the shared HVR-3 alleles DR beta 1* 0404 and DR beta 1* 0404 and DR
*0101, was expressed on extended haplotypes in 23 of 50 (46%) autistic subjects
as compared to only 6 of 79 (7.5%) normal subjects. Another HVR-3 sequence, the
DR beta 1* 0701 allele, was carried on extended haplotypes in 16 (32.0%) of the
autistic subjects as compared to 8 (10.1%) of the normal subjects.