Polirradiculoneurite aguda e vírus da imunodeficiência adquirida

Scaff, Milberto; Rabello, Getúlio D.; Marchiori, Paulo E.

doi:10.1590/S0004-282X1989000100018

Resumos

Polirradiculoneurite aguda possivelmente causada pelo vírus da imunodeficiência humana, tratada com plasmaferese, é relatada em paciente com anticorpos anti-HIV positivos por enzimaimunoensaio, confirmados pelo Western-blot. Este revelou bandas p-24, p-38 (fraca) e p-119. Sem evidências clínicas de AIDS, o paciente desenvolveu manifestações psico-orgânicas e severa neutropenia medicamentosa. São discutidas: a etiologia da manifestação neurológica na ausência de infecções oportunistas, pela ação própria do retrovirus; a patogenia das lesões desmielinizantes pela resposta imune cruzada entre homologias químicas dos epitopes da proteína P2 e o HIV, nas lesões do sistema nervoso periférico, e entre similaridades dos determinantes entre o vírus com proteína de mielina básica, nas agressões ao sistema nervoso central.

A 50-year-old man with positive test for human immunodeficiency virus (HIV) by enzyme-linked-immunoassay and Western-blot, without clinical manifestations of acquired immunodeficiency syndrome (AIDS), developed acute polyradiculoneuritis and was treated by plasmapheresis with improvement. We believe that chemical homologies of antigenic determinants between HIV and P2 protein of peripheral nervous system and myelin basic protein may induce crossed-reaction, thus developing acute polyradiculoneuritis and central nervous system involvement, respectively. The nervous system involvement hy HIV also occur in the HI-viremy, seric conversion alone, and AIDS with or without oportunistic infections.

Polirradiculoneurite aguda e vírus da imunodeficiência adquirida

Acute polyradiculoneuritis and the human immunodeficiency virus

Milberto Scaff^I; Getúlio D. Rabello^II; Paulo E. Marchiori^II

^IDepartamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP): Professor Associado

^IIDepartamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP): Assistente

RESUMO

Polirradiculoneurite aguda possivelmente causada pelo vírus da imunodeficiência humana, tratada com plasmaferese, é relatada em paciente com anticorpos anti-HIV positivos por enzimaimunoensaio, confirmados pelo Western-blot. Este revelou bandas p-24, p-38 (fraca) e p-119. Sem evidências clínicas de AIDS, o paciente desenvolveu manifestações psico-orgânicas e severa neutropenia medicamentosa. São discutidas: a etiologia da manifestação neurológica na ausência de infecções oportunistas, pela ação própria do retrovirus; a patogenia das lesões desmielinizantes pela resposta imune cruzada entre homologias químicas dos epitopes da proteína P2 e o HIV, nas lesões do sistema nervoso periférico, e entre similaridades dos determinantes entre o vírus com proteína de mielina básica, nas agressões ao sistema nervoso central.

SUMMARY

A 50-year-old man with positive test for human immunodeficiency virus (HIV) by enzyme-linked-immunoassay and Western-blot, without clinical manifestations of acquired immunodeficiency syndrome (AIDS), developed acute polyradiculoneuritis and was treated by plasmapheresis with improvement. We believe that chemical homologies of antigenic determinants between HIV and P2 protein of peripheral nervous system and myelin basic protein may induce crossed-reaction, thus developing acute polyradiculoneuritis and central nervous system involvement, respectively. The nervous system involvement hy HIV also occur in the HI-viremy, seric conversion alone, and AIDS with or without oportunistic infections.

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Clínica Neurológica, Hospital das Clínicas, FMUSP - Caixa Postal 3561 - 01051 São Paulo SP -Brasil

1. Alvord EC Jr, Hruby S, Sires LR - Degradation of myelin basic protein by cerebrospinal fluid: preservation of antigenic determinants under physiological conditions. Ann Neurol 6:474, 1979.
2. Alvord EC Jr, Shaw C-M, Hruby S - Myelin basic protein treatment of experimental alergic encephalomyelitis in monkeys. Ann Neurol 6:469, 1979.
3. Alvord EC Jr, Shaw C-M, Hruby S, Kies MW - Has myelin basic protein received a fair trial in the treatment of multiple sclerosis? Ann Neurol 6:461, 1979.
4. Alvord EC Jr, Jahnke TJ, Fischer EH - The causes of the syndrome of Landry (1859) and of Guillain, Barre and Strohl (1916). Rev Neurol 143:571, 1987.
5. Cheng-Mayer C, Levy JA - Distinct biological and serological properties of human immunodeficiency viruses from the brain. Ann Neurol 23 (suppl):S58, 1988.
6. Cornblath DR - Treatment of the neuromuscular complications of human immunodeficiency virus infection. Ann Neurol 23 (suppl):S88, 3988.
7. Drachman DA, Paterson PY, Berlin BS, Roguska J - Immunosuppression and the Guillain-Barre syndrome. Arch Neurol 23:385, 1970.
8. Elder GA, Sever JL - AIDS and neurological disorders: an overview. Ann Neurol 23 (suppl):S4, 1988.
9. Fenichel GM - Neurological complications of immunizations. Ann Neurol 12:119, 1982.
10. Gendelman HE, Leonard JM, Dutko FJ, Koenig S, Khillah JS. Meltzer MS - Immuno-pathogenesis of human immunodeficiency virus infection in the central nervous system. Ann Neurol 23 (suppI):S78, 1988.
11. Jahnke U, Fischer EH, Alvord EC Jr - Hypothesis: certain viral proteins contain encephalitogenic or neuritogenic sequences. J Neuropath Exp Neurol 44:320, 1985.
12. Jahnke TJ, Fischer EH, Alvord EC Jr - Sequence homology between certain viral proteins and proteins related to encephalomyelitis and neuritis. Science 229:282, 1985.
13. Ho DD, Rota TR, Schooley RT, Kaplan JC, Allan JD, Groopman JE, Resnick L, Felsenstein D, Andrews CA, Hirsch MS - Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome. N Engl J Med 313:1493, 1985.
14. Hadlubowski M, Hughes RAC, Gregson NA - Experimental allergic neuritis in the Lewis rat: characterization of the activity of peripheral myelin and its major basic protein P2. Brain Res 184:439, 1980.
15. Kadlubowski M, Hugues RAC, Gregson NA - Spontaneous and experimental neuritis and the distribution of the myelin proteins P2 in the nervous system. J Neurochem 42:123, 1984.
16. Koppel BS, Tuchman AJ, Maayan S, Hewlett D, Daras M - Centrai nervous system involvement in patients with acquired immune deficiency syndrome (AIDS). Acta Neurol Scand 71:337, 1985.
17. Langmuir AD - Guillain-Barre syndrome: the swine influenza virus vaccine incident in the United States of America 1976-1977. Preliminary communication. J Roy Soc Med 72:660, 1979.
18. Lopez-Adaros H, Held JR - Guillain-Barre syndrome associated with immunization against rabies: epidemiological aspects. Res Publ Ass Res Nerv Ment Dis 49:178, 1971.
19. McArthur JC - Neurologic manifestations of AIDS. Medicine (Baltimore) 66:407, 1987.
20. Mclntyre HD, Drouse H - Guillain-Barre syndrome complicating antirabies inoculation. Arch Neurol Psych 62:802, 1949.
21. Moskowitz LB, Hensley GT, Chan JC, Conley FK, Post MJD, Gonzales-Arias SM - Brains biopsies in patients with acquired immune deficiency syndrome. Arch Pathol Lab Med 108:368, 1984.
22. Parry GJ - Peripheral neuropathies associated with human immunodeficiency virus infection. Ann Neurol 23 (suppl):S49, 1988.
23. Perj BC, Smith CC, Ruff MR, Hill JM - AIDS and its dementia as a neuropeptide disorder: role of vip receptor blockade by human immunodeficiency virus envelope. Ann Neurol 23 (suppl):S71, 1988.
24. Persuy P, Arnott G, Fortier B, Ajana F, Blondel M, Fourrier F, Dewilde A, Maniez-Montreuil M - Syndrome de Guillain et Barré d'évolution favorable dans un cas d'infection récente par le virus de l'immunodéficience humaine. Rev Neurol 144:32, 1988.
25. Petito CK, Navia BA, Cho E-S, Jordan BD, George DC, Price RW - Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with acquired immunodeficiency syndrome. N Engl J Med 312:874, 1985.
26. Remlinger P - Les paralysies du traitement antirabique. Ann Inst Pasteur 42:71, 1928.
27. Roue R, Debord T, Denamur E, Ferry M, Dormont D, Barre-Sinoussi F, Rouzioux C - Diagnosis of toxoplasma encephalitis in absence of neurological signs by early computerised tomographic scanning in patients with AIDS. Lancet 2:1472, 1984.
28. Shaw GM, Harper ME, Hahn BH, Epsteins LG, Gajdusek DC, Price RW, Navia BA, Petito CK, O'Hara CJ, Gropman JE, Cho E-S, Oleske JM, Wong-Staal F, Gallo RC - HTLV-III infection in brains of children and adults with AIDS encephalopathy. Science 227:177, 1985 .
29. Snider WD, Simpson DM, Nielsen S, Gold JWM, Metroka CE, Posner JB - Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 14:403, 1983.
30. Spina-França A, Livramento JA, Machado LR, Bacheschi LA, Nobrega JPS - Líqüido cefalorraqueano na síndrome de imunodeficięncia adquirida: análise de 50 casos. Arq. Neuro-Psiquiat (Săo Paulo) 45:412, 1987.
31. Stevenson LD, Alvord EC - Allergy in the nervous system: a review of the literature. Am J Med 3:614, 1947.

Datas de Publicação

Publicação nesta coleção
06 Jun 2011
Data do Fascículo
Mar 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alvord EC Jr, Hruby S, Sires LR - Degradation of myelin basic protein by cerebrospinal fluid: preservation of antigenic determinants under physiological conditions. Ann Neurol 6:474, 1979.

[2] 2. Alvord EC Jr, Shaw C-M, Hruby S - Myelin basic protein treatment of experimental alergic encephalomyelitis in monkeys. Ann Neurol 6:469, 1979.

[3] 3. Alvord EC Jr, Shaw C-M, Hruby S, Kies MW - Has myelin basic protein received a fair trial in the treatment of multiple sclerosis? Ann Neurol 6:461, 1979.

[4] 4. Alvord EC Jr, Jahnke TJ, Fischer EH - The causes of the syndrome of Landry (1859) and of Guillain, Barre and Strohl (1916). Rev Neurol 143:571, 1987.

[5] 5. Cheng-Mayer C, Levy JA - Distinct biological and serological properties of human immunodeficiency viruses from the brain. Ann Neurol 23 (suppl):S58, 1988.

[6] 6. Cornblath DR - Treatment of the neuromuscular complications of human immunodeficiency virus infection. Ann Neurol 23 (suppl):S88, 3988.

[7] 7. Drachman DA, Paterson PY, Berlin BS, Roguska J - Immunosuppression and the Guillain-Barre syndrome. Arch Neurol 23:385, 1970.

[8] 8. Elder GA, Sever JL - AIDS and neurological disorders: an overview. Ann Neurol 23 (suppl):S4, 1988.

[9] 9. Fenichel GM - Neurological complications of immunizations. Ann Neurol 12:119, 1982.

[10] 10. Gendelman HE, Leonard JM, Dutko FJ, Koenig S, Khillah JS. Meltzer MS - Immuno-pathogenesis of human immunodeficiency virus infection in the central nervous system. Ann Neurol 23 (suppI):S78, 1988.

[11] 11. Jahnke U, Fischer EH, Alvord EC Jr - Hypothesis: certain viral proteins contain encephalitogenic or neuritogenic sequences. J Neuropath Exp Neurol 44:320, 1985.

[12] 12. Jahnke TJ, Fischer EH, Alvord EC Jr - Sequence homology between certain viral proteins and proteins related to encephalomyelitis and neuritis. Science 229:282, 1985.

[13] 13. Ho DD, Rota TR, Schooley RT, Kaplan JC, Allan JD, Groopman JE, Resnick L, Felsenstein D, Andrews CA, Hirsch MS - Isolation of HTLV-III from cerebrospinal fluid and neural tissues of patients with neurologic syndromes related to the acquired immunodeficiency syndrome. N Engl J Med 313:1493, 1985.

[14] 14. Hadlubowski M, Hughes RAC, Gregson NA - Experimental allergic neuritis in the Lewis rat: characterization of the activity of peripheral myelin and its major basic protein P2. Brain Res 184:439, 1980.

[15] 15. Kadlubowski M, Hugues RAC, Gregson NA - Spontaneous and experimental neuritis and the distribution of the myelin proteins P2 in the nervous system. J Neurochem 42:123, 1984.

[16] 16. Koppel BS, Tuchman AJ, Maayan S, Hewlett D, Daras M - Centrai nervous system involvement in patients with acquired immune deficiency syndrome (AIDS). Acta Neurol Scand 71:337, 1985.

[17] 17. Langmuir AD - Guillain-Barre syndrome: the swine influenza virus vaccine incident in the United States of America 1976-1977. Preliminary communication. J Roy Soc Med 72:660, 1979.

[18] 18. Lopez-Adaros H, Held JR - Guillain-Barre syndrome associated with immunization against rabies: epidemiological aspects. Res Publ Ass Res Nerv Ment Dis 49:178, 1971.

[19] 19. McArthur JC - Neurologic manifestations of AIDS. Medicine (Baltimore) 66:407, 1987.

[20] 20. Mclntyre HD, Drouse H - Guillain-Barre syndrome complicating antirabies inoculation. Arch Neurol Psych 62:802, 1949.

[21] 21. Moskowitz LB, Hensley GT, Chan JC, Conley FK, Post MJD, Gonzales-Arias SM - Brains biopsies in patients with acquired immune deficiency syndrome. Arch Pathol Lab Med 108:368, 1984.

[22] 22. Parry GJ - Peripheral neuropathies associated with human immunodeficiency virus infection. Ann Neurol 23 (suppl):S49, 1988.

[23] 23. Perj BC, Smith CC, Ruff MR, Hill JM - AIDS and its dementia as a neuropeptide disorder: role of vip receptor blockade by human immunodeficiency virus envelope. Ann Neurol 23 (suppl):S71, 1988.

[24] 24. Persuy P, Arnott G, Fortier B, Ajana F, Blondel M, Fourrier F, Dewilde A, Maniez-Montreuil M - Syndrome de Guillain et Barré d'évolution favorable dans un cas d'infection récente par le virus de l'immunodéficience humaine. Rev Neurol 144:32, 1988.

[25] 25. Petito CK, Navia BA, Cho E-S, Jordan BD, George DC, Price RW - Vacuolar myelopathy pathologically resembling subacute combined degeneration in patients with acquired immunodeficiency syndrome. N Engl J Med 312:874, 1985.

[26] 26. Remlinger P - Les paralysies du traitement antirabique. Ann Inst Pasteur 42:71, 1928.

[27] 27. Roue R, Debord T, Denamur E, Ferry M, Dormont D, Barre-Sinoussi F, Rouzioux C - Diagnosis of toxoplasma encephalitis in absence of neurological signs by early computerised tomographic scanning in patients with AIDS. Lancet 2:1472, 1984.

[28] 28. Shaw GM, Harper ME, Hahn BH, Epsteins LG, Gajdusek DC, Price RW, Navia BA, Petito CK, O'Hara CJ, Gropman JE, Cho E-S, Oleske JM, Wong-Staal F, Gallo RC - HTLV-III infection in brains of children and adults with AIDS encephalopathy. Science 227:177, 1985 .

[29] 29. Snider WD, Simpson DM, Nielsen S, Gold JWM, Metroka CE, Posner JB - Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients. Ann Neurol 14:403, 1983.

[30] 30. Spina-França A, Livramento JA, Machado LR, Bacheschi LA, Nobrega JPS - Líqüido cefalorraqueano na síndrome de imunodeficięncia adquirida: análise de 50 casos. Arq. Neuro-Psiquiat (Săo Paulo) 45:412, 1987.

[31] 31. Stevenson LD, Alvord EC - Allergy in the nervous system: a review of the literature. Am J Med 3:614, 1947.