Title: An Interesting Case of Multiple Sclerosis Presenting As Fever

Authors: Dr Aparna Kodre, Dr Anshul Mehta

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.206

Abstract

Introduction

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) which usually begins in early adulthood and is characterized by tissue inflammation, demyelination and gliosis, various degrees of axonal pathology, and episodic or progressive neurological disability. More than 1.5 million people worldwide and at least 400,000 individuals in Europe alone are affected by MS, which is second only to trauma as a cause of acquired disability in young adults in most Caucasian populations1

Genetic and environmental factors jointly determine the susceptibility to develop MS. Collaborative efforts during the past years achieved substantial progress in identifying genetic risk factors that predispose for MS2

The role of environmental as opposed to genetic risk factors in MS is much less well defined, despite the fact that infections have long been thought to critically contribute to disease development. observations led to the development of the field of human genetics of infectious diseases and the identification of genetic traits that predispose to infection and clinical disease development 3.The insight that clinical infectious diseases result from complex interactions between the infectious agent, the environment, and host factors rather than following a simple ‘one organism–one disease paradigm’ has implications for our understanding of how infectious pathogens might trigger complex autoimmune diseases such as MS. Current data suggest that infectious agents that contribute to MS development are most likely ubiquitous and highly prevalent in the general population. Moreover, they require a permissive genetic trait that determines the susceptibility of the host to develop MS. Finally, the distinct conditions, under which primary infection with these pathogens is encountered, might further modulate disease risk. Here, we review new data for an association of certain infectious pathogens with MS and illustrate mechanisms of infection-induced immunopathologies in experimental animal models of autoimmune CNS inflammation.

References

  1. E. McFarlin, H.F. McFarlandMultiple sclerosis (first of two parts).The New England Journal of Medicine, 307 (1982), pp. 1183-1188 .Cross RefView Record in Scopus Google Scholar
  2. L. De Jager, X. Jia, J. Wang, P.I. de Bakker, L. Ottoboni, N.T. Aggarwal, L. Piccio, S. Raychaudhuri, D.Tran, C. Aubin, R. Briskin, S. Romano, International MS Genetics Consortium, S.E. Baranzini, J.L.McCauley, M.A. Pericak-Vance, J.L. Haines, R.A. Gibson, Y. Naeglin, B. Uitdehaag, P.M. Matthews, L.Kappos, C. Polman, W.L. McArdle, D.P. Strachan, D. Evans, A.H. Cross, M.J. Daly, A. Compston, S.J.Sawcer, H.L. Weiner, S.L. Hauser, D.A. Hafler, J.R. Oksenberg. Meta-analysis of genome scans and replication identify CD6, IRF8 and TNFRSF1A as new multiple sclerosis susceptibility loci Nature Genetics, 41 (7) (2009), pp. 776-782 (Epub 2009 Jun .CrossRefView Record in Scopus Google Scholar.
  3. Quintana-Murci, A. Alcaïs, L. Abel, J.L. Casanova Immunology in nature: clinical, epidemiological and evolutionary genetics of infectious disease. Nature Immunology, 8 (2007), pp. 1165-117 Cross Ref View Record in Scopus Google Scholar
  4. Brocke, A. Gaur, C. Piercy, A. Gautam, K. Gijbels, C.G. Fathman, L. SteinmanInduction of relapsing paralysis in experimental autoimmune encephalo-myelitis by bacterial superantigen Nature, 365 (1993), pp. 642-644 Cross Ref View Record in Scopus Google Scholar
  5. K. Olson, J.L. Croxford, S.D. MillerInnate and adaptive immune requirements for induction of autoimmune demyelinating disease by molecular mimicry Molecular Immunology, 40 (2004), pp. 1103-1108. Article Download PDF View Record in Scopus Google Scholar
  6. P. Pender Infection of autoreactive B lymphocytes with EBV, causing chronic autoimmune diseases Trends in Immunology, 24 (2003), pp. 584-588 Article Download PDF View Record in Scopus Google Scholar
  7. S. Kim, K.S. Lee, J.H. Park, M.Y. Kim, W.S. Shin Detection of human herpesvirus 6 variant A in peripheral blood mononuclear cells from multiple sclerosis patients European Neurology, 43 (2000), pp. 170-173 Cross Ref View Record in Scopus Google Scholar
  8. Chapenko, A. Millers, Z. Nora, I. Logina, R. Kukaine, M. MurovskaCorrelation between HHV-6 reactivation and multiple sclerosis disease activity Journal of Medical Virology, 69 (2003), pp. 111-117 Cross Ref View Record in Scopus Google Scholar
  9. Martin, M. Enbom, M. Söderström, S. Fredrikson, H. Dahl, J. Lycke, T. Bergströ, A. LindeAbsence of seven human herpesviruses, including HHV-6, by polymerase chain reaction in CSF and blood from patients with multiple sclerosis and optic neuritis Acta Neurologica Scandinavica, 95 (1997), pp. 280-283 Cross Ref View Record in ScopusGoogle Scholar
  10. Mirandola, A. Stefan, E. Brambilla, G. Campadelli-Fiume, L.M. GrimaldiAbsence of human herpesvirus 6 and 7 from spinal fluid and serum of multiple sclerosis patients Neurology, 53 (1999), pp. 1367-1368 .View Record in ScopusGoogle Scholar
  11. B. Challoner, K.T. Smith, J.D. Parker, D.L. MacLeod, S.N. Coulter, T.M. Rose, E.R. Schultz, J.L.Bennett, R.L. Garber, M. ChangPlaque-associated expression of human herpesvirus 6 in multiple sclerosis Proceedings of the National Academy of Sciences of the United States of America, 92 (1995), pp. 7440-7444 .Cross Ref View Record in Scopus Google Scholar.
  12. Berti, M.B. Brennan, S.S. Soldan, J.M. Ohayon, L. Casareto, H.F. McFarland, S. JacobsonIncreased detection of serum HHV-6 DNA sequences during multiple sclerosis (MS) exacerbations and correlation with parameters of MS disease progression Journal of Neurovirology 8 (2002), pp. 250-256 .Cross Ref View Record in Scopus Google Scholar
  13. Alvarez-Lafuente, V. De Test Relapsing–remitting multiple sclerosis and human herpesvirus 6 active infection Archives of Neurology, 61 (2004), pp. 1523-1527. Cross Ref View Record in Scopus Google Scholar
  14. A. Operskalski, B.R. Visscher, R.M. Malmgren, R. DetelsA case–control study of multiple sclerosis Neurology, 39 (1989), pp. 825-829 View Record in Scopus Google Scholar.
  15. Lindberg, O. Andersen, A. Vahlne, M. Dalton, B. RunmarkerEpidemiological investigation of the association between infectious mononucleosis and multiple sclerosis  Neuroepidemiology, 10 (1991), pp. 62-65 .Cross Ref View Record in Scopus Google Scholar
  16. R. Nielsen, K. Rostgaard, N.M. Nielsen, N. Koch-Henriksen, S. Haahr, P.S. Sørensen, H. Hjalgrim Multiple sclerosis after infectious mononucleosis .Archives of Neurology  64 (2007), pp. 72-75 .Cross Ref View Record in Scopus Google Scholar
  17. R. Nielsen, K. Rostgaard, J. Askling, R. Steffensen, A. Oturai, C. Jersild, N. Koch-Henriksen, P.S.Sørensen, H. HjalgrimEffects of infectious mononucleosis and HLA-DRB1*15 in multiple sclerosis Multiple Sclerosis (Houndmills, Basingstoke, England), 15 (2009), pp. 431-436 .Cross Ref View Record in Scopus
  18. L. Thacker, F. Mirzaei, A. AscherioInfectious mononucleosis and risk for multiple sclerosis: a meta-analysis .Annals of Neurology, 59 (2006), pp. 499-503.CrossRefView Record in Scopus
  19. H, G. C, L. A, M. C, P. J, S. Jm, Leptomeningeal cell line from multiple sclerosis with reverse transcriptase activity and viral particles, (1989). Google Scholar
  20. Komurian-Pradel, G. Paranhos-Baccala, F. Bedin, A. Ounanian-Paraz, M. Sodoyer, C. Ott, A.Rajoharison, E. Garcia, F. Malle, B. Mandrand, H. PerronMolecular cloning and characterization of MSRV-related sequences associated with retrovirus-like particles .Virology, 260 (1999), pp. 1-9. Article Download PDF View Record in Scopus Google Scholar.
  21. Perron, J.A. Garson, F. Bedin, F. Beseme, G. Paranhos-Baccala, F. Komurian-Pradel, F. Mallet, P.W.Tuke, C. Voisset, J.L. Blond, B. Lalande, J.M. Seigneurin, B. MandrandMolecular identification of a novel retrovirus repeatedly isolated from patients with multiple sclerosis. The Collaborative Research Group on Multiple Sclerosis .Proceedings of the National Academy of Sciences of the United States of America, 94 (1997), pp. 7583-7588. Cross Ref View Record in Scopus Google Scholar
  22. Perron, J.A. Garson, F. Bedin, F. Beseme, G. Paranhos-Baccala, F. Komurian-Pradel, F. Mallet, P.W.Tuke, C. Voisset, J.L. Blond, B. Lalande, J.M. Seigneurin, B. MandrandMolecular identification of a novel retrovirus repeatedly isolated from patients with multiple sclerosis. The Collaborative Research Group on Multiple Sclerosis .Proceedings of the National Academy of Sciences of the United States of America, 94 (1997), pp. 7583-7588. Cross Ref View Record in Scopus Google Scholar.
  23. A. Garson, P.W. Tuke, P. Giraud, G. Paranhos-Baccala, H. PerronDetection of virion-associated MSRV-RNA in serum of patients with multipl sclerosis. Lancet, 351 (1998), p. 33. Article Download PDF View Record in Scopus Google Scholar.
  24. Nowak, D. Januszkiewicz, M. Pernak, I. Liweń, M. Zawada, J. Rembowska, K. Nowicka, K.Lewandowski, H. Hertmanowsk, M. WenderMultiple sclerosis-associated virus-related pol sequences found both in multiple sclerosis and healthy donors are more frequently expressed in multiple sclerosis patients. Journal of Neurovirology, 9 (2003), pp. 112-117. Cross Ref View Record in ScopusGoogle Scholar.
  25. Traggiai, L. Chicha, L. Mazzucchelli, L. Bronz, J.C. Piffaretti, A. Lanzavecchia, M.G. Manz Development of a human adaptive immune system in cord blood cell-transplanted mice .Science, 304 (2004), pp. 104-107 .Cross Ref View Record in Scopus Google Scholar
  26. Strowig, C. Gurer, A. Ploss, Y.F. Liu, F. Arrey, J. Sashihara, G. Koo, C.M. Rice, J.W. Young, A.Chadburn, J.I. Cohen, C. MünzPriming of protective T cell responses against virus-induced tumors in mice with human immune system components. The Journal of Experimental Medicine, 206 (2009), pp. 1423-1434.CrossRefView Record in Scopus Google Scholar
  27. J.R. Weaver, S.N. IsaacsMonkeypox virus and insights into its immunomodulatory proteins. Immunological Reviews, 225 (2008), pp. 96-113. Cross Ref View Record in Scopus Google Scholar

Corresponding Author

Dr Anshul Mehta

Department of Internal Medicine, Noble Hospital, Pune, India