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0840 Immunoglobulins in post-infectious inflammatory disorders
$314
Poster Abstracts
Wednesday, November 9, 2005
Conclusion: DWI may be useful as a non-invasive method for evaluation of bacterial meningitis, especially for assessing the effect of the chosen therapy and the prognosis.
0839 Three interesting cases of multiple tuberculomas of the brain - The paradoxical response Ranganath Pazhani. Apollo Hospitals, Chennai Introduction: The incidence of tuberculosis is common in developing countries. Sometimes patients can develop tuberculoma in the brain while on treatment for tuberculous infection. Three such interesting cases will be discussed in this presentation. Case 1: Fifteen-year-old school going girl was diagnosed to be having miliary tuberculosis of the lung four months back. She was started on four drugs ATT regimen. Her chest X-ray findings improved. But site noticed headache and focal seizure. Her MRI brain showed multiple tuberculomas. She was started on oral steroid and antiepileptic drug in addition to ATT. She improved well and her medications stopped gradually. Case 2: Eighteen year old college going girl was diagnosed to be having tuberculous meningitis. She was treated with ATT and responded well. Two months after discharge site noticed visual blurring and the ophthalmologist felt it is due to ethambutol toxicity. She also complained of urinary incontinence sometimes. Her MRI brain showed tuberculomas in the optic chiasm and brainstem. She responded well to oral steroid in addition to ATT. Case 3: Thirty five year old lady was diagnosed to be having tuberculous meningo encephalitis. She was treated with ATT and responded well. Six months after the treatment she noticed headache, blurring of vision and focal seizure. Her CT scan showed multiple tuberculomas. She was treated with oral steroid in addition to ATT and she recovered fully. Discusion anti contusion: The first patient not had any cranial symptom initially. The second and third patient initial neuroimaging was normal. All these three Patients developed tuberculoma while on treatment with ATT. The tuberculoma formation in these cases is possibly due to immune mediated and that is the reason the patients improved well with steroid in addition to A f T .
0840 Immunoglobulins in post4nfectious inflammatory disorders Ravaglia S. ~, Ceroni M ~, Piccolo G ~, Franciotta D a, Bastianello S. a, Moglia A ~, Marchioni E 1. 1Institute of Neurology IRCCS "C.
Mondino", University of Pavia, Italy; 2 Department of Neurology, Policlinico di Monza, Italy Background: Post-infectious inflanunatory CNS disorders include acute disseminated encephalomyelitis (ADEM) and variants characterized by site-restricted CNS involvement or additional PNS damage. Based on their presumed autoimmune origin, treatment options include high-dose steroids, immunoglobulins, or plasmapheresis, the best of which is not established. We report a series of patients diagnosed as ADEM/post-infectious myelitis, and treated with IVIg. Methods: inpatients of Neurological and Infectious Disease Clinic. consecutively adntitted over five years for post-infectious CNS disorder. Seventeen patients received IVIg after high-dose steroids failure. Five other patients received IVIg as initial treatment, due to: -steroids contraindications (n -- 2); -prominent signs of PNS involvement at onset, that had prompted the diagnosis of AIDP (n -- 3). Results: Steroids failure occurred in 33% of patients, most of which had additional PNS involvement. Among steroids non-responders, 10/17 (59"/0) benefited from IVIg. 3/5 patients receiving IVIg without previous steroids had a good outcome. The improvement began within the end of the five-day IVIg cycle, and no early relapses
occurred. Prominent effects of IVIg were detectable on motor functions. Conclusions; IVIg can be effective in post-infectious CNS disorders, as a first-line treatment or after steroid failure. Though in most cases a syltergistic action of steroids could not be excluded, the clinical nilprovenlent was strictly related to IVIg adnfinistration. The benefit from IVIg in patients with PNS involvement and steroid failure suggests the need of controlled studies in this subgroup. Moreover, IVIg can be considered safer than high-dose steroids when A D E M presents with features mimicking direct CNS infections. 0841 Altered Expression of Costimulatory Molecules in HTLV-1 Assodaled Myelopathy/Tropical Spastic Papaparesis (HAM/TSP) Patients Sabouri, AH 1, Saito, M a, Izumo, S2, Arimura, K 1, Usuku, K 3, Osame M ~. 1Department of Neurology and Geriatrics, Kagoshima
University, Kagoshirna, Japan; 2Centerfor Chronic Viral Diseases, Kagoshirna University, Kagoshirna, Kagoshirna, Japan; 3Department of Medical Information, Kagoshima University, Japan Background: HTLV-1 associated myelopathy/tropical spastic papaparesis (HAM/TSP) is a neurological disease that occurs only in 2-3% of HTLV-l-infected people. Our previous study suggested a possible role for IL-10 in the pathogenesis of HAM/TSP. IL-10 induces attergy by inhibiting cell signaling through the costimulatory CD28/CDS0/CD86 pathway. We therefore attempted to characterize the involvement of costimulatory pathway in the pathogenesis of HAM/TSP. Methods: Study population consisted 3 age-matched groups of H A M / TSP patients (in -- 25), HTLV-1 healthy carriers (HCs) 0a -- 27) and normal uninfected controls (NCs) (in -- 16) all residing in Kagoskima, Japan. PBMCs from all subjects were analyzed with antibodies directed against a variety of costimulatory molecules (CD28, CDS0, CD86, CD152) by 4-color flow cytometry staining. HTLV-1 provirus load was measured by quantitative PCR method using ABI prism 7700. Results: Expression of all costimulatory molecules (CD28, CDS0, CD86 and CD152) on CD8 + cells was significantly decreased in HAM/TSP patients in comparison to NCs. CD28 expression on CD8 + cells was also significantly decreased in HAM/TSP patients in comparison to HCs. Costimulatory molecules expression was not changed on CD4 + cells in HAM/TSP patients. There was no Correlation between costinmlatory negative CD8 cells and HTLV-1 provirus load in HAM/TSP patients, HCs or whole cohort. Conclusion: Increased CDS+CD28 T cell population in HAM/TSP patients is an important finding, as CDS+CD28 T cells may function as effector T cells causing hepatocellular damage in HCV infection. Interestingly, in contrast to the observations in HIV-I infection, CDS+CD28 - T cell population was not correlated with HTLV-1 provirus load. Functional studies on CDS+CD28 T cell population in HTLV-1 infection are now underway. 0842 Neurological Maniii~stalions of Dengue Fever
R Sahathevan ~, Norlinah MI a, Hamidon B a, Raymond A A ~.
1Department of Medicine, Faculty of Medicine, National University of Malaysia Background: Dengue is the commonest aborviral infection affecting 50 to 100 million people worldwide, predominantly in the tropics. In recent months Malaysia experienced an increase in the number of reported dengue cases which was reflected in an increase in the number of dengue admissions to our institution. We noted a number of these patients showed evidence of neurological involvement. Methods: We conducted a prospective observational study by identifying all patients with dengue admitted to our institution from
Poster Abstracts
Wednesday, November 9, 2005
Conclusion: DWI may be useful as a non-invasive method for evaluation of bacterial meningitis, especially for assessing the effect of the chosen therapy and the prognosis.
0839 Three interesting cases of multiple tuberculomas of the brain - The paradoxical response Ranganath Pazhani. Apollo Hospitals, Chennai Introduction: The incidence of tuberculosis is common in developing countries. Sometimes patients can develop tuberculoma in the brain while on treatment for tuberculous infection. Three such interesting cases will be discussed in this presentation. Case 1: Fifteen-year-old school going girl was diagnosed to be having miliary tuberculosis of the lung four months back. She was started on four drugs ATT regimen. Her chest X-ray findings improved. But site noticed headache and focal seizure. Her MRI brain showed multiple tuberculomas. She was started on oral steroid and antiepileptic drug in addition to ATT. She improved well and her medications stopped gradually. Case 2: Eighteen year old college going girl was diagnosed to be having tuberculous meningitis. She was treated with ATT and responded well. Two months after discharge site noticed visual blurring and the ophthalmologist felt it is due to ethambutol toxicity. She also complained of urinary incontinence sometimes. Her MRI brain showed tuberculomas in the optic chiasm and brainstem. She responded well to oral steroid in addition to ATT. Case 3: Thirty five year old lady was diagnosed to be having tuberculous meningo encephalitis. She was treated with ATT and responded well. Six months after the treatment she noticed headache, blurring of vision and focal seizure. Her CT scan showed multiple tuberculomas. She was treated with oral steroid in addition to ATT and she recovered fully. Discusion anti contusion: The first patient not had any cranial symptom initially. The second and third patient initial neuroimaging was normal. All these three Patients developed tuberculoma while on treatment with ATT. The tuberculoma formation in these cases is possibly due to immune mediated and that is the reason the patients improved well with steroid in addition to A f T .
0840 Immunoglobulins in post4nfectious inflammatory disorders Ravaglia S. ~, Ceroni M ~, Piccolo G ~, Franciotta D a, Bastianello S. a, Moglia A ~, Marchioni E 1. 1Institute of Neurology IRCCS "C.
Mondino", University of Pavia, Italy; 2 Department of Neurology, Policlinico di Monza, Italy Background: Post-infectious inflanunatory CNS disorders include acute disseminated encephalomyelitis (ADEM) and variants characterized by site-restricted CNS involvement or additional PNS damage. Based on their presumed autoimmune origin, treatment options include high-dose steroids, immunoglobulins, or plasmapheresis, the best of which is not established. We report a series of patients diagnosed as ADEM/post-infectious myelitis, and treated with IVIg. Methods: inpatients of Neurological and Infectious Disease Clinic. consecutively adntitted over five years for post-infectious CNS disorder. Seventeen patients received IVIg after high-dose steroids failure. Five other patients received IVIg as initial treatment, due to: -steroids contraindications (n -- 2); -prominent signs of PNS involvement at onset, that had prompted the diagnosis of AIDP (n -- 3). Results: Steroids failure occurred in 33% of patients, most of which had additional PNS involvement. Among steroids non-responders, 10/17 (59"/0) benefited from IVIg. 3/5 patients receiving IVIg without previous steroids had a good outcome. The improvement began within the end of the five-day IVIg cycle, and no early relapses
occurred. Prominent effects of IVIg were detectable on motor functions. Conclusions; IVIg can be effective in post-infectious CNS disorders, as a first-line treatment or after steroid failure. Though in most cases a syltergistic action of steroids could not be excluded, the clinical nilprovenlent was strictly related to IVIg adnfinistration. The benefit from IVIg in patients with PNS involvement and steroid failure suggests the need of controlled studies in this subgroup. Moreover, IVIg can be considered safer than high-dose steroids when A D E M presents with features mimicking direct CNS infections. 0841 Altered Expression of Costimulatory Molecules in HTLV-1 Assodaled Myelopathy/Tropical Spastic Papaparesis (HAM/TSP) Patients Sabouri, AH 1, Saito, M a, Izumo, S2, Arimura, K 1, Usuku, K 3, Osame M ~. 1Department of Neurology and Geriatrics, Kagoshima
University, Kagoshirna, Japan; 2Centerfor Chronic Viral Diseases, Kagoshirna University, Kagoshirna, Kagoshirna, Japan; 3Department of Medical Information, Kagoshima University, Japan Background: HTLV-1 associated myelopathy/tropical spastic papaparesis (HAM/TSP) is a neurological disease that occurs only in 2-3% of HTLV-l-infected people. Our previous study suggested a possible role for IL-10 in the pathogenesis of HAM/TSP. IL-10 induces attergy by inhibiting cell signaling through the costimulatory CD28/CDS0/CD86 pathway. We therefore attempted to characterize the involvement of costimulatory pathway in the pathogenesis of HAM/TSP. Methods: Study population consisted 3 age-matched groups of H A M / TSP patients (in -- 25), HTLV-1 healthy carriers (HCs) 0a -- 27) and normal uninfected controls (NCs) (in -- 16) all residing in Kagoskima, Japan. PBMCs from all subjects were analyzed with antibodies directed against a variety of costimulatory molecules (CD28, CDS0, CD86, CD152) by 4-color flow cytometry staining. HTLV-1 provirus load was measured by quantitative PCR method using ABI prism 7700. Results: Expression of all costimulatory molecules (CD28, CDS0, CD86 and CD152) on CD8 + cells was significantly decreased in HAM/TSP patients in comparison to NCs. CD28 expression on CD8 + cells was also significantly decreased in HAM/TSP patients in comparison to HCs. Costimulatory molecules expression was not changed on CD4 + cells in HAM/TSP patients. There was no Correlation between costinmlatory negative CD8 cells and HTLV-1 provirus load in HAM/TSP patients, HCs or whole cohort. Conclusion: Increased CDS+CD28 T cell population in HAM/TSP patients is an important finding, as CDS+CD28 T cells may function as effector T cells causing hepatocellular damage in HCV infection. Interestingly, in contrast to the observations in HIV-I infection, CDS+CD28 - T cell population was not correlated with HTLV-1 provirus load. Functional studies on CDS+CD28 T cell population in HTLV-1 infection are now underway. 0842 Neurological Maniii~stalions of Dengue Fever
R Sahathevan ~, Norlinah MI a, Hamidon B a, Raymond A A ~.
1Department of Medicine, Faculty of Medicine, National University of Malaysia Background: Dengue is the commonest aborviral infection affecting 50 to 100 million people worldwide, predominantly in the tropics. In recent months Malaysia experienced an increase in the number of reported dengue cases which was reflected in an increase in the number of dengue admissions to our institution. We noted a number of these patients showed evidence of neurological involvement. Methods: We conducted a prospective observational study by identifying all patients with dengue admitted to our institution from