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PubMed1989

[Polyneuropathies in HIV infection].

In approximately 10-16% of the cases, diseases of the peripheral nerves occur in the fully developed stage of AIDS, more seldom, however, in the stage of ARC. Some cases have been described in the stage of seroconversion or lymphadenopathy. At this stage cranial neuropathies can show up in connection with aseptic meningitis. The peripheral nerve diseases are present as distal symmetric sensomotory neuropathy, as chronic demyelinating polyradiculoneuropathy, as acute polyradiculoneuritis and as mononeuropathy multiplex. Frequently Varicella-zoster-radiculitis is observed. Cranial neuropathies are noted especially together with atypical aseptic meningitis, as a syndrome of the above mentioned polyneuropathies, with intracranial lymphomas and meningitides and meningoencephalitides caused by opportunistic infections. The morphological findings of the roots and nerves are variable: axonal degeneration and/or demyelination, infiltration of lymphocytes and microvasculitis. The pathogenesis varies: amongst others, direct infection by HIV, immunopathological changes and opportunistic infections are considered. The spontaneous development frequently leads to a remission. Treatment with corticosteroids and/or plasma exchange is only partially successful.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Sensory and sympathetic ganglia in HIV-1 infection: immunocytochemical demonstration of HIV-1 viral antigens, increased MHC class II antigen expression and mild reactive inflammation.

Sensory and sympathetic ganglia from 12 cases of human immunodeficiency virus type 1 (HIV-1) infection, all but one without clinical evidence of peripheral nerve disease, were studied immunocytochemically for their content of lymphocytes, macrophages, MHC Class II antigens and HIV-1 and cytomegalovirus antigens. They were compared with ganglia from 7 normal and peripheral nerve disease control cases. Compared with normal controls, many of the ganglia from the majority of HIV-1-infected subjects contained more T lymphocytes and macrophages and enhanced MHC class II expression. A few also showed occasional neuronal degeneration which was not present in the normal controls. In 7 cases HIV-1 gp41 envelope protein and/or p24 core protein antigens were detected in intraganglionic macrophages. Sensory ganglia contained more gp41 HIV-1 antigen than sympathetic ganglia. There was no clear correlation between detection of HIV-1 antigens in ganglia and in the CNS. Detection of HIV-1 antigens in ganglia was more common in cases of HIV-1 infection that had progressed to clinical AIDS by the time of death (71%) than in those that had not done so (40%). It is concluded that there is commonly a mild ganglionitis which is asymptomatic in the absence of detailed clinical testing and frequently associated with local presence of HIV-1 antigens in sensory and sympathetic ganglia in AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Neuro-muscular biopsy in Churg-Strauss syndrome: 24 cases.

Churg-Strauss syndrome (CSS) is a distinctive clinical entity in which systemic vasculitis, associated with eosinophilia, occurs almost exclusively in individuals with adult-onset asthma. The major complications of the condition result from damage to the lungs, heart, and peripheral nerves. Necrotizing vasculitis with eosinophils in the cellular infiltrate, vascular or perivascular infiltration by eosinophils in absence of vessel wall necrosis, extra-vascular eosinophil infiltrates, and vascular or extra-vascular granuloma are histopathological features supportive of CSS. As the peripheral nerve disease often dominates the clinical picture, the peripheral nerve biopsy may be decisive in establishing the diagnosis. In this retrospective study of neuro-muscular biopsies in 24 CSS cases, the authors give an extensive description of neuropathological lesions associated with this disorder. Fifteen patients (62.5%) exhibited eosinophils either in extra-vascular infiltrates or in vessel walls, and 6 of them (25%) had an associated necrotizing vasculitis. Granulomas were found in only 3 cases (12.5%). The clinical diagnosis of CSS was supported in 15 out of the 24 patients (62.5%), in the nerve in 2 cases (8.3%), in the muscle in 8 cases (33.3%), and in both nerve and muscle in 5 others (20.8%).

Adult↗
PubMed2002

Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study.

OBJECTIVE: To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women's Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures. RESULTS: Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree. CONCLUSIONS: Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

Age of Onset↗
PubMed1990

Infectious agents and disease of peripheral nerve.

An organism by organism review is presented of infectious agents that may result in focal, multifocal, or diffuse peripheral neuropathy by either direct or, more often, indirect means. Therapy is discussed and is directed at the primary infection as well as at the indirect cause if possible (for example, replacement therapy in vitamin deficiency).

Anti-Infective Agents↗
PubMedDate not supplied

[Neurologic syndromes in patients with HIV infections. I. Diseases of peripheral nerves and skeletal muscles associated with HIV infection].

It is a review of the most common neuropathies observed in HIV infected people. The authors present the basic clinical and neuropathological features of the: distal peripheral neuropathy, chronic inflammatory, demyelinating polyneuropathy, progressive ascending polyradiculopathy-myelopathy, mononeuropathy multiplex, and autonomic neuropathy. Mentioned are neuropathies observed as adverse reactions to drugs used for people with AIDS. HIV related myopathy is included in the review.

Anti-HIV Agents↗
PubMed1989

Macrophages, lymphocytes and major histocompatibility complex (HLA) class II antigens in adult human sensory and sympathetic ganglia.

We report an immunocytochemical study of sensory and autonomic ganglia from ten adult human subjects aged 18-83 years without peripheral nerve disease using monoclonal antibodies to macrophages, lymphocytes and human leukocyte (HLA) class II antigens. All ganglia and their associated nerve roots were found to contain a population of resident macrophages which accounted for 5-20% of the cells present. These macrophages and, in addition, many Schwann cells and satellite cells, gave reactions for HLA class II antigens in all cases. Very low numbers of CD3 and CD8 lymphocytes were also regularly detectable in sensory and autonomic ganglia. The resident macrophages may have important immunological and trophic functions. Their possible role in the development of immune-mediated peripheral nerve disease deserves further study.

Adolescent↗