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Abstract 13. Creutzfeldt-Jakob disease. An interesting clinical report
Viruses,
of affective
disorders
immunity
and mental
299
diseases
in humans.
Abstract ft. Postviral fatigue syndrome P-0. Behan Institute of Neurological Sciences, Glasgow,
Scotland,
U.K.
Fifty patients with postviral fatigue syndrome which has been present from six months to 42 years, were studied. The clinical characteristics were of severe exhaustion and fatigue as the primary symptom occurring in viral infection. Additional secondary symptoms consisted of severe prostration and a plethora of psychiatric symptoms ranging from gross affective disturbances to poor memory and difficulty with concentration. Most patients were diagnosElectrophysioed as severe reactive depression or severe neurotic phobic anxiety states. logical studies using single fibre EMG showed abnormal jitter whilst histopathological studies of muscle biopsy showed muscle fibre necrosis and preponderance of type 2 fibres. Nuclear magnetic resonance in some patients was compatible with a metabolic disturbance There was an apparent increase with a rapid change from aerobic to anaerobic metabolism. in histocompatibility antigens HLA, 88, and lymphocyte subset analysis showed conspicuous disturbances both in suppressor cells and in inducer/helper T cells. Lymphocyte suppressor cell function was abnormal in vitro. There was, particularly in longstanding cases, an inIncreased titres to crease in autoantibody formation and circulating immune complexes. Coxsackie B antibodies were found in patients from some outbreaks and in other sporadic cases. A significant number of patients had persistent specific IgM anti-Coxsackie B antibodies. These data confirm the organic nature of this syndrome and a persistent virus with disturbed immunity, and possible enzyme defect, is suggested as the pathogenesis.
Cognitive dysfunction associated tion A.C. Estes, A.W. Kaszniak, J.F. Jones University of Arizona, Tucson, AZ and National Abstract
12.
with chronic
Epstein
Jewish Hospital,
Barr Virus
Denver,
(EBV) infec-
CO., U.S.A.
Patients with chronic or recurrent illnesses characterized by fever, lymphadenopathy, malaise, fatigue, headaches, arthralgias, myalgias, depressive symptoms and paresthesia and persistently elevated EBV anti-early antigen antibody titers (280) frequently report cognitive dysfunction as a prominent feature of their disease. Ten such patients were evaluated using standard psychometric instruments for general intelligence, concept formation, short- and long-term figural and semantic memory, mental flexibility, concentration, attention, generative naming, fine motor control and voluntary control of the motor act. Four patients demonstrated deficits which varied in type and severity among them. Moderate to severe impair~nt of short- and long-term memory, mild to moderate deficits in flexible memory, severe impairment in conceptual functions and in the ability to benefit from feedback, and moderate impairment in fine motor control. These preliminary findings suggest that this clinical syndrome, currently attributed to a persistent EBV infection, is associated with cerebral dysfunction which has at least a partial organic basis. We are aware of an additional two patients with this illness studied elsewhere who have been found to have "organic brain dysfunction." Studies are underway to further define these observations and delineate the role depression (present in 70% of all such patients) may play in the production of these cognitive deficits.
Abstract 13. Creutzfeldt-Jakob Disease. An interesting E.W. McCrank Department of Psychiatry, University of Western Ontario,
clinical London,
report. Canada.
Creutzfeldt-Jakob Disease is a rare, rapidly progressive and fatal de~nting ved caused by an infectious agent. It has an identifiable neu~pathological sometimes a specific EEG pattern.
illness picture
belieand
This case presented five months prior to her death, a diagnosis of Creutzfeldt-Jakob Disease suggested by EEG at two months and the diagnosis confirmed by neuropathology at autopsy.
300
v‘iruses,
immunity
and mental
diseases
There are three interesting features to this case reported herein. The first is a lengthy prodromal period of six to eight years. The second was the extreme clinical variability and fluctuation and on one lucid period allowed the patient to state that she felt "something is eating my brain". And the third, the variability of the EEG tracing resulting in an initial suggestion of Creutzfeldt-Jakob Disease and at a later stage a less definitive tracing. This clinical report stimulates several questions for discussion.
Abstract 14. HTLV-III and acquired immune deficiency syndrome M. Sarngadharan, L. Bruch, J, Schuepbach, A. Device, M. Popovic and R. Gallo Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes Bethesda, Maryland, U.S.A.
of Health,
The human T-cell leukemia virus, HTLV-III, isolated from T-cell cultures of patients with acquired i~unodeficiency syndrome is a T-4 lymphotropic retrovirus with a Mg2+- dependent high mol. wt. reverse transcriptase. It shares some antigenic similarities with HTLV-I and HTLV-II, but is clearly distinct from them in biological and biochemical properties. Antibodies reactive with HTLV-III are found in the sera of nearly all patients with AIDS and about 90% of patients with AIDS related complex (ARC). About 40% of homosexual men at increased risk of AIDS were also positive for anti-HTLV-III antibodies. In a collaborative study with J. Groopman of New England Deaconess Hospital, Boston, MA, and scientists at the Centers for Disease Control, Atlanta, GA, all of a group of 19 patients with no traditional risk factors for AIDS, who developed AIDS subsequent to receiving blood transfusions, and 31 of 35 high risk blood donors surveyed, had antibodies to HTLV-III. In all donor sets in which "high risk" donors were identified, at least one of them was antibody positive. Such antibodies were absent in the sera of several hundred control subjects, including These results show a close etiologia number of patients with non-AIDS related diseases. cal association between HTLV-III and AIDS. They further demonstrate that HTLV-III is transmissible via blood products, and may be a singular sufficient viral agent in the pathogenesis of AIDS, and is associated with a broad clinical spectrum, including an asymptomatic, but probably contagious, carrier state.
Abstract
15.
The relationship with AIDS
C. Britton Columbia University,
of psychiatric
New York, N.Y.,
complications
to viral infection
in patients
U.S.A.
Mental abnormalities, common in patients with AIDS and opportunistic infections other than Pneumocystis carinii pneumonia (PCP), include dementia with or without psychiatric features, psychiatric disorders with or without cognitive impairment and a confusional state. A group of patients has been identified in whom psychiatric symptoms are dominant, related to sysPsychotic temic viral infection and in some cases, are the initial symptoms of disease. behavior with paranoid features, severe anxiety state and depression are most common. Twenty-five patients with AIDS or AIDS prodrome were evaluated for mental change. Of thirteen patients with the primary diagnosis of PCP, mild situational depression and signifiExacerbation cant exacerbation of a pro-existing depression occurred in one patient each. of chronic depression occurred in one of two patients with AIDS prodrome. Of ten patients with opportunistic infections other than PCP, five had significant psychiaIn three of these, psychiatric tric symptoms not attributable to proven brain infection. All five had cytomegalovirus (CMV) infection symptoms preceded the diagnosis of AIDS. with viremia. Post-mortem brains showed microglial nodules and astrocytosis. Rare incluImmune stains of glial nodules for CMV antigen were negative. sions were seen in one case. Pathologic abnormalities did not correlate with the severity of clinical symptoms. Psychiatric symptoms in this subgroup of patients are related to viremia and may be the earliest sign of systemic infection but are not necessary caused by brain infection.
of affective
disorders
immunity
and mental
299
diseases
in humans.
Abstract ft. Postviral fatigue syndrome P-0. Behan Institute of Neurological Sciences, Glasgow,
Scotland,
U.K.
Fifty patients with postviral fatigue syndrome which has been present from six months to 42 years, were studied. The clinical characteristics were of severe exhaustion and fatigue as the primary symptom occurring in viral infection. Additional secondary symptoms consisted of severe prostration and a plethora of psychiatric symptoms ranging from gross affective disturbances to poor memory and difficulty with concentration. Most patients were diagnosElectrophysioed as severe reactive depression or severe neurotic phobic anxiety states. logical studies using single fibre EMG showed abnormal jitter whilst histopathological studies of muscle biopsy showed muscle fibre necrosis and preponderance of type 2 fibres. Nuclear magnetic resonance in some patients was compatible with a metabolic disturbance There was an apparent increase with a rapid change from aerobic to anaerobic metabolism. in histocompatibility antigens HLA, 88, and lymphocyte subset analysis showed conspicuous disturbances both in suppressor cells and in inducer/helper T cells. Lymphocyte suppressor cell function was abnormal in vitro. There was, particularly in longstanding cases, an inIncreased titres to crease in autoantibody formation and circulating immune complexes. Coxsackie B antibodies were found in patients from some outbreaks and in other sporadic cases. A significant number of patients had persistent specific IgM anti-Coxsackie B antibodies. These data confirm the organic nature of this syndrome and a persistent virus with disturbed immunity, and possible enzyme defect, is suggested as the pathogenesis.
Cognitive dysfunction associated tion A.C. Estes, A.W. Kaszniak, J.F. Jones University of Arizona, Tucson, AZ and National Abstract
12.
with chronic
Epstein
Jewish Hospital,
Barr Virus
Denver,
(EBV) infec-
CO., U.S.A.
Patients with chronic or recurrent illnesses characterized by fever, lymphadenopathy, malaise, fatigue, headaches, arthralgias, myalgias, depressive symptoms and paresthesia and persistently elevated EBV anti-early antigen antibody titers (280) frequently report cognitive dysfunction as a prominent feature of their disease. Ten such patients were evaluated using standard psychometric instruments for general intelligence, concept formation, short- and long-term figural and semantic memory, mental flexibility, concentration, attention, generative naming, fine motor control and voluntary control of the motor act. Four patients demonstrated deficits which varied in type and severity among them. Moderate to severe impair~nt of short- and long-term memory, mild to moderate deficits in flexible memory, severe impairment in conceptual functions and in the ability to benefit from feedback, and moderate impairment in fine motor control. These preliminary findings suggest that this clinical syndrome, currently attributed to a persistent EBV infection, is associated with cerebral dysfunction which has at least a partial organic basis. We are aware of an additional two patients with this illness studied elsewhere who have been found to have "organic brain dysfunction." Studies are underway to further define these observations and delineate the role depression (present in 70% of all such patients) may play in the production of these cognitive deficits.
Abstract 13. Creutzfeldt-Jakob Disease. An interesting E.W. McCrank Department of Psychiatry, University of Western Ontario,
clinical London,
report. Canada.
Creutzfeldt-Jakob Disease is a rare, rapidly progressive and fatal de~nting ved caused by an infectious agent. It has an identifiable neu~pathological sometimes a specific EEG pattern.
illness picture
belieand
This case presented five months prior to her death, a diagnosis of Creutzfeldt-Jakob Disease suggested by EEG at two months and the diagnosis confirmed by neuropathology at autopsy.
300
v‘iruses,
immunity
and mental
diseases
There are three interesting features to this case reported herein. The first is a lengthy prodromal period of six to eight years. The second was the extreme clinical variability and fluctuation and on one lucid period allowed the patient to state that she felt "something is eating my brain". And the third, the variability of the EEG tracing resulting in an initial suggestion of Creutzfeldt-Jakob Disease and at a later stage a less definitive tracing. This clinical report stimulates several questions for discussion.
Abstract 14. HTLV-III and acquired immune deficiency syndrome M. Sarngadharan, L. Bruch, J, Schuepbach, A. Device, M. Popovic and R. Gallo Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes Bethesda, Maryland, U.S.A.
of Health,
The human T-cell leukemia virus, HTLV-III, isolated from T-cell cultures of patients with acquired i~unodeficiency syndrome is a T-4 lymphotropic retrovirus with a Mg2+- dependent high mol. wt. reverse transcriptase. It shares some antigenic similarities with HTLV-I and HTLV-II, but is clearly distinct from them in biological and biochemical properties. Antibodies reactive with HTLV-III are found in the sera of nearly all patients with AIDS and about 90% of patients with AIDS related complex (ARC). About 40% of homosexual men at increased risk of AIDS were also positive for anti-HTLV-III antibodies. In a collaborative study with J. Groopman of New England Deaconess Hospital, Boston, MA, and scientists at the Centers for Disease Control, Atlanta, GA, all of a group of 19 patients with no traditional risk factors for AIDS, who developed AIDS subsequent to receiving blood transfusions, and 31 of 35 high risk blood donors surveyed, had antibodies to HTLV-III. In all donor sets in which "high risk" donors were identified, at least one of them was antibody positive. Such antibodies were absent in the sera of several hundred control subjects, including These results show a close etiologia number of patients with non-AIDS related diseases. cal association between HTLV-III and AIDS. They further demonstrate that HTLV-III is transmissible via blood products, and may be a singular sufficient viral agent in the pathogenesis of AIDS, and is associated with a broad clinical spectrum, including an asymptomatic, but probably contagious, carrier state.
Abstract
15.
The relationship with AIDS
C. Britton Columbia University,
of psychiatric
New York, N.Y.,
complications
to viral infection
in patients
U.S.A.
Mental abnormalities, common in patients with AIDS and opportunistic infections other than Pneumocystis carinii pneumonia (PCP), include dementia with or without psychiatric features, psychiatric disorders with or without cognitive impairment and a confusional state. A group of patients has been identified in whom psychiatric symptoms are dominant, related to sysPsychotic temic viral infection and in some cases, are the initial symptoms of disease. behavior with paranoid features, severe anxiety state and depression are most common. Twenty-five patients with AIDS or AIDS prodrome were evaluated for mental change. Of thirteen patients with the primary diagnosis of PCP, mild situational depression and signifiExacerbation cant exacerbation of a pro-existing depression occurred in one patient each. of chronic depression occurred in one of two patients with AIDS prodrome. Of ten patients with opportunistic infections other than PCP, five had significant psychiaIn three of these, psychiatric tric symptoms not attributable to proven brain infection. All five had cytomegalovirus (CMV) infection symptoms preceded the diagnosis of AIDS. with viremia. Post-mortem brains showed microglial nodules and astrocytosis. Rare incluImmune stains of glial nodules for CMV antigen were negative. sions were seen in one case. Pathologic abnormalities did not correlate with the severity of clinical symptoms. Psychiatric symptoms in this subgroup of patients are related to viremia and may be the earliest sign of systemic infection but are not necessary caused by brain infection.