g(m2)-ganglioside and Cytomegalovirus-Infections

Guillain-Barré syndrome (GBS) is an acute post-infectious inflammatory polyneuropathy of ubiquitous distribution. Cytomegalovirus (CMV) is the virus that is most frequently involved. All ages are affected but rare pediatric cases seem to show some distinctive features in terms of specificity and severity. Specific antibodies that target the peripheral nervous system have been identified in several forms of GBS in adults, such as anti-GM2 ganglioside antibodies in post-CMV GBS, which in most instances present as demyelinating polyneuropathies, with a more favorable progression and fewer complications.. This is a retrospective report on two cases of post-CMV GBS with a demyelinating disorder and positive for anti-GM2 IgM. The review of the literature examines five other cases of children with post-CMV GBS with anti-GM2 IgM.. In terms of progression, our two cases of post-CMV GBS with a demyelinating disorder and anti-GM2 IgM are similar to the five other cases described in the literature. The CMV infection was asymptomatic or paucisymptomatic and involved girls (6/7), often presenting severe motor forms with frequent loss of the ability to walk (4/6), facial involvement (⅗), little respiratory involvement (⅙), and favorable progression with adapted treatment.. Post-CMV GBS with anti-GM2 IgM is a specific clinical spectrum that seems to affect children as it affects adults with a predominance among females, demyelination, and severe motor involvement, but a good prognosis. On the other hand, unlike adults, the use of assisted ventilation does not seem to be more frequent.

Topics: Adult; Child; Cytomegalovirus; Cytomegalovirus Infections; Female; G(M2) Ganglioside; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Retrospective Studies

Topics: Adolescent; Biomarkers; Cytomegalovirus Infections; Female; G(M2) Ganglioside; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Severity of Illness Index

Guillain-Barré syndrome is the most frequent cause of flaccid paresis in Western countries. Moreover, CMV infection is the most common antecedent viral infection in adult patients and the presence of specific IGM antiganglioside antibodies is often identified. Instead, Guillain-Barré syndrome following CMV infections is rarely reported in childhood and often presents severe symptoms at onset and longer recovery times.. One year of clinical, electrophysiological and serological follow-up of a 9-year old child with axonal sensory-motor Guillain-Barré syndrome following CMV infection is reported. Moreover, the literature data on paediatric sensory-motor axonal GBS and GBS secondary to CMV infection and antiganglioside antibodies are reviewed.. Our patient presented with paraesthesias and a pattern of weakness showing proximal predominance and affecting the upper limbs more than the lower limbs. At nadir, unilateral facial palsy was also present and he was unable to walk. Electroneurography showed motor-sensory axonal damage. Both anti-CMV and anti-GM2 IgM were positive. After early treatment with IVIG and IV methylprednisolone the patient recovered deambulation. Six months later, his neurological examination was normal and electroneurography showed normal data.. The sensory-motor axonal form of Guillain-Barré syndrome following CMV infection may present a good prognosis and a prompt full recovery also in children, if adequate treatment is started in time.

Topics: Anti-Inflammatory Agents; Antibodies, Viral; Autoantibodies; Autoantigens; Child; Cytomegalovirus Infections; G(M2) Ganglioside; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Male; Methylprednisolone

We report a 27-year-old man with Guillain-Barré syndrome (GBS) preceded by cytomegalovirus infection. He was admitted to our hospital because of distal dominant weakness and sensory disturbance 5 days after fever. Double filtration plasmapheresis (DFPP) was performed and clinical symptoms temporary but dramatically improved. However facial nerve palsy, difficulty in swallowing food, weakness, dysautonomia and respiratory failure rapidly progressed within 5 days after the onset. Repeated DFPP failed to improve his symptoms. Two months after the onset, he did not improve at all. On T1-weighted MRI, nerve roots were still enhanced with gadolinium, and CSF examination revealed 1,324 mg/dl of protein. These findings suggested us the existence of continuous inflammation on nerve roots. We gave steroid-pulse therapy. He dramatically improved after this treatment. We repeated steroid-pulse therapy for seven times. He was discharged without any major complication 6 months after the onset. Steroid-pulse therapy should be considered in GBS patients associated with CMV infection when other conventional treatments are ineffective.

Topics: Adult; Cytomegalovirus Infections; Drug Administration Schedule; G(M2) Ganglioside; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Male; Plasmapheresis; Prednisolone; Pulse Therapy, Drug

A 28-year-old man noticed sensory disturbance in the distal parts of his four extremities and muscle weakness of his hands two weeks after cytomegalovirus (CMV) infection. He had splenomegaly, impairment of hepatic function and peripheral neuropathy with decreased tendon reflexes. Protein-cell dissociation was observed in the cerebrospinal fluid, and the nerve conduction study (NCS) showed the changes due to demyelination. Intravenous immunoglobulin therapy was performed for 5 days after the diagnosis of Guillain-Barré syndrome. He did not show any severe symptoms such as bulbar palsy and was discharged on day 16. Anti-GM2 and anti-GalNAc-GD1a IgM antibodies were detected and acute inflammatory demyelinating polyneuropathy following the CMV infection was confirmed. NCS showed the abnormal changes were normalized after 4 months. The levels of antibodies against moesin, which is a protein existing in trace amounts in node of Ranvier, were increased. However, the antibodies were not detected 4 months after therapy. These changes were well correlated to his clinical course.

Topics: Adult; Autoantibodies; Biomarkers; Cytomegalovirus Infections; G(M2) Ganglioside; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Immunoglobulins, Intravenous; Male; Microfilament Proteins; Neural Conduction; Treatment Outcome

We herein present the case of a 38-year-old woman with left-sided oculomotor paralysis with ocular pain that developed after a respiratory infection. Her serum was positive for IgM against GM2 and GalNAc-GD1a gangliosides and cytomegalovirus. Thin-slice magnetic resonance imaging revealed enhanced abnormal tissue located primarily in the superolateral part of the left-sided cavernous sinus, which corticosteroids subsequently obscured with immediate resolution of the patient's ocular symptoms. These clinical features were consistent with those of Tolosa-Hunt syndrome (THS). Our findings in the present patient suggest that cytomegalovirus may provoke granuloma formation in the cavernous sinus, as reported in other various organs, thereby leading to the development of THS.

Topics: Adult; Antibodies, Viral; Autoantibodies; Cavernous Sinus; Cytomegalovirus; Cytomegalovirus Infections; Diplopia; Female; G(M1) Ganglioside; G(M2) Ganglioside; Granuloma; Humans; Imaging, Three-Dimensional; Immunocompetence; Immunoglobulin M; Macrophages; Magnetic Resonance Imaging; Prednisolone; Respiratory Tract Infections; Tolosa-Hunt Syndrome

We analyzed the characteristics of 29 Guillain-Barré syndrome (GBS) patients with IgM anti-GalNAc-GD1a antibodies. Fourteen of them had had an antecedent cytomegalovirus infection (CMV group) and 12 gastrointestinal infection (G-I group). Most of the G-I group patients (nine of 12) were subsequent to Campylobacter jejuni infection. Electrophysiological results in both groups patients predominantly indicated demyelinating neuropathy. The CMV group patients were characterized by slow progression and frequent facial and sensory deficits. IgM antibodies in their sera recognized an epitope shared by GalNAc-GD1a and GM2. The G-I group patients frequently showed motor type of GBS with cranial nerves spared. IgM antibodies specific to GalNAc-GD1a were present in their sera.

Topics: Adult; Antibodies; Campylobacter Infections; Campylobacter jejuni; Cytomegalovirus Infections; Demyelinating Diseases; Electrophysiology; Female; G(M2) Ganglioside; Gangliosides; Gastrointestinal Diseases; Guillain-Barre Syndrome; Humans; Immunoglobulin M; Infections; Male; Middle Aged; Neural Conduction; Prognosis

To investigate whether anti-GM2 antibodies in patients with Guillain-Barré syndrome (GBS) are induced by molecular mimicry with cytomegalovirus (CMV).. Antibodies against ganglioside GM2 are frequently present in the serum from GBS patients with an antecedent infection with CMV.. The authors detected inhibition of anti-GM2 reactivity after incubation of GM2-reactive serum samples with fibroblasts infected with a GBS-associated CMV strain. Control sera consisted of GQ1b-reactive samples, and control antigens included uninfected fibroblasts and fibroblasts that were infected with other herpes viruses.. Serum immunoglobulin M reactivity with GM2 was decreased in a dose-dependent manner after incubation with CMV-infected fibroblasts. Incubation of anti-GM2-positive serum samples with uninfected fibroblasts and fibroblasts infected with varicella zoster virus did not inhibit anti-GM2 reactivity, whereas this reactivity was slightly decreased after incubation with herpes simplex virus type 1 in one patient. Antibodies against ganglioside GQ1b did not react with CMV-infected fibroblasts.. CMV-infected fibroblasts express gangliosidelike epitopes that recognize specifically anti-GM2 antibodies. These results support the hypothesis that antiganglioside antibodies in CMV-infected GBS patients are induced by molecular mimicry between GM2 and antigens that are induced by a CMV infection.

Topics: Adult; Aged; Antibody Specificity; Autoantibodies; Cross Reactions; Cytomegalovirus; Cytomegalovirus Infections; Dose-Response Relationship, Immunologic; Enzyme-Linked Immunosorbent Assay; Female; Fibroblasts; G(M1) Ganglioside; G(M2) Ganglioside; Guillain-Barre Syndrome; Herpesvirus 1, Human; Herpesvirus 3, Human; Humans; Immunosorbent Techniques; Serologic Tests

To study the association between anti-ganglioside antibody responses and Guillan-Barré syndrome (GBS) after a recent cytomegalovirus (CMV) infection.. Enzyme linked immunosorbant assay (ELISA) was undertaken on serum samples from 14 patients with GBS with recent cytomegalovirus (CMV) infection (CMV+GBS) and 12 without (CMV-GBS), 17 patients with other neurological diseases (OND), 11 patients with a recent CMV infection but without neurological involvement, 11 patients with recent Epstein-Barr virus (EBV) infection but without neurological involvement, and 20 normal control (NC) subjects.. IgM antibodies were found at 1:100 serum dilution to gangliosides GM2 (six of 14 patients), GM1 (four of 14), GD1a (three of 14) and GD1b (two of 14) in the serum samples of the CMV+GBS patients, but not in those of any of the CMV-GBS patients. IgM antibodies were also found to gangliosides GM1, GD1a, and GD1b in one of 11 OND patients, to ganglioside GM1 in one of 11 non- neurological CMV patients, and to ganglioside GD1b in one of 20 NC subjects. Some patients with EBV infection had IgM antibodies to gangliosides GM1 (five of 11), GM2 (three of 11), and GD1a (two of 11). However, the antibodies to ganglioside GM2 had a low titre, none being positive at 1:200 dilution, whereas five of the CMV+GBS serum samples remained positive at this dilution.. Antibodies to ganglioside GM2 are often associated with GBS after CMV infection, but their relevance is not known. It is unlikely that CMV infection and anti-ganglioside GM2 antibodies are solely responsible and an additional factor is required to elicit GBS.

Topics: Adolescent; Adult; Autoantibodies; Cytomegalovirus Infections; Enzyme-Linked Immunosorbent Assay; Female; G(M2) Ganglioside; Gangliosides; Humans; Male; Middle Aged; Polyradiculoneuropathy

Guillain-Barré syndrome (GBS) sometimes is preceded by cytomegalovirus (CMV) infection. Irie et al. (J. Neuroimmunol. 1996;68:19-26) reported that three patients with GBS subsequent to CMV infection had IgM and IgG anti-GM2 antibodies. In our larger study, the IgMs from the CMV-associated GBS patients showed significantly higher anti-GM2 antibody titers than anti-GM3, anti-GD1a, anti-GD1b, anti-GD2, anti-GD3, anti-GT1b, anti-GQ1b, and anti-SGPG antibody titers. None of the anti-glycosphingolipid antibody titers differed significantly from the others in the IgGs from the CMV-associated GBS patients. However, IgM anti-GM2 antibody frequently was present in GBS patients who were not preceded by CMV infection and non-GBS patients with acute CMV infection. Our results did not support the conclusion of Irie et al. that anti-GM2 antibodies were closely associated with acute CMV infection in GBS, but acute CMV infection, with and without GBS, was associated with IgM anti-GM2 antibody.

Topics: Acute Disease; Adolescent; Adult; Antibodies, Viral; Chromatography, Thin Layer; Cytomegalovirus; Cytomegalovirus Infections; Enzyme-Linked Immunosorbent Assay; Female; G(M2) Ganglioside; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Polyradiculoneuropathy

Topics: Antibodies, Monoclonal; Autoantibodies; Cross Reactions; Cytomegalovirus Infections; G(M2) Ganglioside; Humans; Polyradiculoneuropathy

Topics: Acetylgalactosamine; Adult; Autoantibodies; Cross Reactions; Cytomegalovirus Infections; G(M2) Ganglioside; Hepatitis, Viral, Human; Humans; Immunoglobulin M; Male; Polyradiculoneuropathy; Receptors, Immunologic

A 28-year-old housewife developed motor and sensory neuropathy in both limbs with facial nerve paralysis and decreased taste sensation, two weeks after cough and sore throat with slight fever. On laboratory examination, mild increase of transaminases was found. Enzyme-linked immunosorbent assay showed that the serum had markedly high titers of IgG antibodies to GM2 (1:3,200) and Ga1NAc-GD1a (1:1,600). Serum IgM-EIA index and CF titer of cytomegalovirus were markedly high. In cerebrospinal fluid examination, protein was increased (110 mg/dl). Blink reflex indicated involvement of bilateral facial nerves. In limb motor and sensory nerves, conduction studies revealed the presence of both axonal degeneration and segmental demyelination. The diagnosis of Guillain-Barré syndrome (GBS) with facial nerve paralysis, relatively unique to CMV infection, was made. In the fourth week following the initial neurologic symptom, weakness in facial and limb muscles and sensory disturbances in both limbs were gradually improved. In about three months, conduction studies of limb nerves and CSF protein were normalized. During the clinical course above, the titers of antibodies to GM2 and Ga1NAc-GD1a, IgM-EIA index and the titer of CF of CMV were significantly decreased. Anti-GM2 antibody was reported to be found in the sera from the patient of GBS associated with CMV infection. However, there is no report of GBS patient with CMV infection whose serum showed the presence of both anti-GM2 and anti-Ga1NAc-GD1a antibodies. In this patient, antibodies to CMV, GM2 and Ga1NAc-GD1a epitopes and other unexamined or/and unknown epitopes may be related to the neuropathy. The studies of the specific antibody to react with facial nerve in the serum from GBS patients with facial nerve paralysis and the molecular mimicry between the specific ganglioside and the structure of CMV are warranted in future.

Topics: Acetylgalactosamine; Adult; Antibodies, Viral; Autoantibodies; Biomarkers; Cytomegalovirus; Cytomegalovirus Infections; Facial Paralysis; Female; G(M1) Ganglioside; G(M2) Ganglioside; Hepatitis, Viral, Human; Humans; Immunoglobulin G; Immunoglobulin M; Polyradiculoneuropathy

To investigate whether antecedent cytomegalovirus (CMV) infections in patients with Guillain-Barré syndrome are associated with the presence of specific antiganglioside antibodies, acute phase serum samples from 130 patients with Guillain-Barré syndrome and 200 controls were tested. Anti-GM2 IgM antibodies were found more often in patients with Guillain-Barré syndrome with CMV infection (22%) than in patients without the infection (2%) (P = 0.003). CMV infections may elicit anti-GM2 antibodies in susceptible patients, which may contribute to the pathogenesis of Guillain-Barré syndrome associated with CMV.

Topics: Chromatography, Thin Layer; Cytomegalovirus Infections; Enzyme-Linked Immunosorbent Assay; G(M2) Ganglioside; Humans; Immunoglobulin G; Immunoglobulin M; Polyradiculoneuropathy

We examined serum anti-cytomegalovirus (CMV) and anti-ganglioside antibodies by ELISA in 51 patients with Guillain-Barré syndrome (GBS), and titers were compared with those from 47 normal and 74 disease controls. Three GBS patients with IgM anti-CMV antibodies had high titers of IgM and IgG anti-GM2 antibodies. The other GBS patients without IgM anti-CMV antibodies, and the normal and disease controls except one of 6 non-GBS patients with acute CMV infections had no anti-GM2 antibodies. The titers of anti-GM2 antibodies decreased on absorption with CMV-infected cells. These findings suggest that anti-GM2 antibodies are associated with acute CMV infections in GBS patients.

Topics: Adult; Antibodies, Viral; Antibody Specificity; Carbohydrate Sequence; Chromatography, Thin Layer; Cytomegalovirus; Cytomegalovirus Infections; Enzyme-Linked Immunosorbent Assay; Female; G(M2) Ganglioside; Humans; Immunoblotting; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Molecular Sequence Data; Polyradiculoneuropathy