Infections And Autoimmune Disorders
Certain viruses and bacteria directly attack nerve tissue.
Viruses such as herpes simplex, varicella-zoster virus , and Epstein-Barr virus damage sensory nerves and cause intense episodes of shooting pain.
Bacterial infections such as Lyme disease can also cause nerve damage and pain if they arent treated. People with HIV or AIDS can also develop peripheral neuropathy.
Autoimmune diseases like rheumatoid arthritis and lupus affect the peripheral nervous system in various ways. Chronic inflammation and damage to tissues throughout the body, as well as pressure caused by inflammation, can all lead to severe nerve pain in the extremities.
Study Setting And Patients
After prior local institutional ethical clearance, we carried out a cross sectional study at the adult HIV outpatient clinic of the Douala General Hospital, a tertiary hospital with a capacity of 320beds, situated in Douala, the economic capital of Cameroon between 1st July and 31st October 2011. Our study population comprised of consenting adults diagnosed with HIV and followed up in this hospital. HIV diagnosis in this institution is made according to Cameroon National AIDS Control Programme guidelines by antibody detection on two successive samples using a third generation ELISA test BIOREX® . If both are positive, a third sample is collected and tested using Genie® III HIV-1/HIV-2 Assay to specify either HIV 1 or HIV 2. A patient is declared positive for HIV if these three tests are positive. In case of any discordance, testing is done with Western blot .
Who Is At Risk Of Developing Pn
There are certain risk factors for PN:
- Feet or hands throbbing or cramping at night
- Sudden sharp shooting pains
It may be easy for you or your health care provider to overlook slight or occasional sensations like the ones listed above. It is important that you not ignore these symptoms, because they may get worse. If you have any of these symptoms, talk to your health care provider right away so that you can be diagnosed and treated early.
Your health care provider will examine you and ask questions about your symptoms, medications and supplements, work environment, exposure to toxic substances, history of alcohol use, and family history of neurological disease. Usually, PN is diagnosed based on signs and symptoms you report as well as your physical exam. However, your health care provider may also order tests to determine the type and extent of nerve damage. Blood tests to rule out other potential causes of PN are very common.
If your symptoms are unusual, your provider may refer you to a neurologist, who may suggest nerve conduction velocity testing or an electromyography test for further evaluation. Nerve conduction velocity looks at the speed of the signals your nerves send, and an EMG looks at whether your muscle can respond normally to an electrical signal from a nerve. Other types of sensory testing and skin biopsies are generally used only in research.
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Magnitude Of Peripheral Sensory Neuropathy And Associated Factors Among Hiv/aids Clients Receiving Care At Public Health Institutions Northwest Ethiopia
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How Is Peripheral Neuropathy Diagnosed
The bewildering array and variability of symptoms that neuropathies can cause often makes diagnosis difficult. A diagnosis of neuropathy typically includes:
- Medical history. A doctor will ask questions about symptoms and any triggers or relieving factors throughout the day, work environment, social habits, exposure to toxins, alcohol use, risk of infectious diseases, and family history of neurological diseases.
- Physical and neurological exams. A doctor will look for any evidence of body-wide diseases that can cause nerve damage, such as diabetes. A neurological exam includes tests that may identify the cause of the neuropathic disorder as well as the extent and type of nerve damage.
- Body fluid tests. Various blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, infections and signs of abnormal immune system activity. Less often other body fluids are tested for abnormal proteins or the abnormal presence of immune cells or proteins associated with some immune-mediated neuropathies.
- Genetic tests. Gene tests are available for some inherited neuropathies.
Additional tests may be ordered to help determine the nature and extent of the neuropathy.
Physiologic tests of nerve function
Neuropathology tests of nerve appearance
Autonomic testing
Radiology imaging tests
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Take Precautions At Home
If you have peripheral neuropathy, youre potentially at greater risk for accidents in the home. You can do the following to improve your safety:
- Use safety guards and other tools for sharp objects like scissors and knives.
- Use thermometers to measure the temperature of bath or tap water.
- Use potholders and gloves when handling hot items.
- Use a walker or cane for added stability.
- Install nightlights to avoid tripping in the dark.
- Carefully wrap your hands and feet when its cold out.
Background On The Spectrum Of Neuropathies Seen In People With Hiv Or In Resource
The peripheral nervous system consists of the nerves connecting the central nervous system to the rest of the body. In a general sense, peripheral neuropathy refers to a dysfunction or damage of one or more peripheral nerves.
In HIV disease, when people say peripheral neuropathy, they are usually referring either to:
- distal symmetrical sensory polyneuropathy , sensory neuropathies starting in the extremities more or less on both sides of the body equally and/or
- antiretroviral toxic neuropathy , which is clinically indistinguishable.
But a host of things can go wrong with the peripheral nervous system ranging from minor transient neuropathies to neurological emergencies that can lead to paralysis, loss of essential bodily functions and then death.
The most common conditions are focal or mononeuropathies and radiculopathies that may cause sensory disturbances and/or weakness in one part or on one side of the body, including injury-related mononeuropathies such as carpal tunnel syndrome .
In people with HIV, a number of PNS disorders seem to be either caused by the virus, opportunistic infections or neoplasms, by commonly used medications, or by the immune systems reaction to infection. These can be roughly distinguished by how the condition is localised , and whether it is primarily sensory versus whether it also causes weakness and loss of motor/autonomic functions though there can be some overlap in some situations.
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What Are The Symptoms Of Peripheral Nerve Damage
Symptoms are related to the type of nerves affected.
Motor nerve damage is most commonly associated with muscle weakness. Other symptoms include painful cramps, fasciculations and muscle shrinking.
Sensory nerve damage causes various symptoms because sensory nerves have a broad range of functions.
- Damage to large sensory fibers harms the ability to feel vibrations and touch, especially in the hands and feet. You may feel as if you are wearing gloves and stockings even when you are not. This damage may contribute to the loss of reflexes . Loss of position sense often makes people unable to coordinate complex movements like walking or fastening buttons or maintaining their balance when their eyes are shut.
- The small fibers without myelin sheaths include fiber extensions called axons that transmit pain and temperature sensations. Small-fiber polyneuropathy can interfere with the ability to feel pain or changes in temperature. It is often difficult for medical caregivers to control, which can seriously affect a patients emotional well-being and overall quality of life. Neuropathic pain is sometimes worse at night, disrupting sleep. It can be caused by pain receptors firing spontaneously without any known trigger, or by difficulties with signal processing in the spinal cord that may cause you to feel severe pain from a light touch that is normally painless. For example, you might experience pain from the touch of your bedsheets, even when draped lightly over the body.
Hiv/aids Drugs That Can Cause Neuropathy
Peripheral neuropathy is a potential side effect of certain medications used to treat HIV/AIDS. Nucleoside reverse transcriptase inhibitors , or d-drugs, are most frequently associated with peripheral neuropathy.
This group of drugs includes:
- ddI: Didanosine, Videx®
- ddC: Zalcitabine, Hivid®
- d4T: Stavudine, Zerit®
Other forms of NRTIs and protease inhibitors, are not generally associated with peripheral neuropathy.
Hydroxyurea , a drug used to treat cancer that may also help certain anti-HIV drugs work better, appears to increase the risk of peripheral neuropathy
Other drugs used in the treatment of HIV-related disorders that can increase the chance of developing peripheral neuropathy include:
- Dapsone, used for pneumocystis pneumonia
- Isoniazid, , used to treat tuberculosis
- Metronidazole , used to treat amoebic dysentery and microsporidiosis
- Vincristine , used for Kaposis sarcoma and non-Hodgkins lymphoma
- Thalidomide, used to treat cancers, wasting syndrome and severe mouth ulcers
- Ethambutol , used to treat Mycobacterium avium complex and other bacterial infections
Peripheral neuropathy caused by these medications can often be treated by reducing the dosage or withdrawing the drug. Although it can take several months for the nerves to completely heal after discontinuing these treatments, the patient may start to feel better within a few weeks. In extreme cases, the nerve damage may be permanent.
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Measurement Of Cellular Immune Activation
Multiparameter flow cytometry was used to measure the percentage of CD38and HLA-DR double positive CD8+ and CD4+ T lymphocytes in asubset of CSF and whole blood samples using previously describedmethods20,21. Lymphocyte activation antibody-dyepanels were switched halfway through the study, though the two panels werecompared in analysis and confirmed to have consistent T lymphocyte activationmeasures. A further subset of samples was analyzed by flow cytometry formonocyte activation, identifying CD3 negative cells with aCD14+CD16+ phenotype. Blood samples were stained withfluorescence minus one controls in which one antibody was omitted. Anunstained control and single stained samples were also prepared as compensationcontrols. Samples were run on a FACS DIVA and analyzed withFlowJo .
What Are The Symptoms Of Hiv
Medically reviewed by
Last reviewed: 17 Mar 2019
The different stages of HIV
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HIV progresses in three distinct phases, each with very different symptoms
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Acute HIV Symptoms appear flu-like
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Early HIV Symptoms can include slightly swollen lymph nodes
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Late-Stage Symptoms of HIV include weight loss, dry cough, night sweats, cold sores, weakness and confusion or difficulty concentrating
Human immunodeficiency virus is a retrovirus that causes acquired immune deficiency syndrome . It is an incurable disease that leads to progressive failure of the immune system. With a failed immune system, it leaves you susceptible to other illnesses like pneumonia or cancer.
Signs and symptoms of HIV depend on the stage of infection, and can range from flu-like symptoms early on, to depression, weight loss and fatigue if left untreated.
Early treatment allows HIV patients to lead a normal life. If you have had unprotected sex with a partner who could have HIV, you should get tested. You can use a home HIV test or visit your local doctor.
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Early Hiv Symptoms: Rash
An important symptom of HIV is a dark skin rash that may develop on the face, hands, feet and/or torso. Learn more about HIV rashes.
After the acute illness has passed, HIV often doesn’t cause any major symptoms for the following 10 years or longer.
You may feel perfectly healthy, with slightly swollen lymph nodes being one of the only signs of HIV during this stage of the infection.
Clinical And Demographic Associations With Peripheral Neuropathy In Primaryinfection
20 of 58 PHI subjects had signs of peripheral neuropathy upon neurologic examination. Therewas a trend towards PN subjects being older with a median age of 40 yearscompared to 34 years in subjects with no peripheral neuropathy . There was no significant relationship between history ofalcohol abuse and signs of peripheral neuropathy . Of the 20 PNsubjects, 6 subjects had bilateral findings, 7 subjects had unilateral findings,and in the remaining 7 subjects, laterality was not specified.Neuropsychological performance was not different between the PN and NPNgroups . There was no difference in dptbetween the two groups. The PN group showed no significant difference comparedto the NPN group in absolute blood CD4+ and CD8+ T cell counts . 13 of the 20 PNsubjects also had symptoms ofperipheral neuropathy . Typical symptoms included foot tinglingand numbness. There were no demographic differences identified betweenNPN and SPN subjects.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by NINDS, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Lesions In Somatosensory Ganglia Of Simian Immunodeficiency Virus
Trigeminal ganglionitis in SIV-infected pigtailed macaques. Hematoxylin and eosin-stained sections of trigeminal ganglia from an uninfected control macaque and a SIV-infected macaque . TG showed evidence of neuronophagia, characterized by macrophages within the neuronal compartment of degenerate neurons , and nodules of Nageotte, with neuron cell bodies replaced by aggregates of satellite glial cells and macrophages . Sections of TG from control animals showed scattered CD68-immunopositive resident macrophages . The TG of SIV-infected animals had increased immunostaining for CD68, likely reflecting a combination of resident macrophage activation and infiltration of circulating macrophages . Similar changes were also observed in the DRG . Scale bars = 100 µm 50 µm. Reprinted with permission from .
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Specimen Sampling And Processing
Laboratory assessments included blood testing and lumbar puncture. CSFtotal white blood cell , protein, albumin, blood albumin, CD4+ andCD8+ counts by flow cytometry were measured on fresh samples. Cell-freeCSF and blood plasma were also aliquoted and stored within 6 hours of collectionin 70°C freezers monitored daily for temperature usingNIST-certified thermometers.
Are Short People Better Off
But perhaps the difference isnt genetic. Perhaps it is something much more basic, like height.
Another study presented at CROI reported that, along with age and increasing treatment exposure, being taller puts one at increased risk of developing ATN whether you are from Australia, Indonesia or Malaysia .84
Dr Catherine Cherry of Monash University in Melbourne, Australia, presented findings from the study, which sought to identify risk factors associated with sensory neuropathy amongst HIV patients in the Asia-Pacific region and to assess whether these risk factors could be used to predict sensory neuropathy in patients who were asymptomatic before d4T exposure. The idea being that, if there is no choice but to use d4T in most patients, those who are most likely develop sensory neuropathy can be offered an alternative regimen if they can be identified in advance.
So screening programmes for sensory neuropathy were set up in Melbourne , Kuala Lumpur , and Jakarta . The ACTG Brief Peripheral Neuropathy Screen was used to look for the presence of symptoms and signs of sensory neuropathy, and the participants height, age, and weight were recorded along with demographic, laboratory, and treatment data obtained from the medical file. Close to 100 participants were enrolled at each site.
These observations were consistent across sites neither weight nor ethnicity affected the risk.
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Causal And Symptomatic Treatments
There are no FDA-approved treatments. Treatment options fall into 2 groups: causal and symptomatic. In causal treatment, avoid neurotoxic medications, if possible. Carnitine supplementation may be effective in antiretroviral toxic neuropathy. Correct vitamin B-12 and folate deficiency. Consider thiamine replacement if the patient is malnourished.
Treatment of HIV-associated distal painful sensorimotor polyneuropathy currently focuses on pain management. As in other painful neuropathies drugs from several classes can be used alone or in combination.
Unfortunately, evidence supporting the use of these agents in HIV-related cases is limited. With several of these agents, controlled studies have found them to be well tolerated but not significantly more effective than placebo.
What Is Peripheral Neuropathy
Peripheral neuropathy refers to the many conditions that involve damage to the peripheral nervous system, the vast communication network that sends signals between the central nervous system and all other parts of the body. Peripheral nerves send many types of sensory information to the central nervous system , such as a message that the feet are cold. They also carry signals from the CNS to the rest of the body. Best known are the signals to the muscles that tell them to contract, which is how we move, but there are different types of signals that help control everything from our heart and blood vessels, digestion, urination, sexual function, to our bones and immune system. The peripheral nerves are like the cables that connect the different parts of a computer or connect the Internet. When they malfunction, complex functions can grind to a halt.
Nerve signaling in neuropathy is disrupted in three ways:
- loss of signals normally sent
- inappropriate signaling when there shouldnt be any
- errors that distort the messages being sent
Symptoms can range from mild to disabling and are rarely life-threatening. The symptoms depend on the type of nerve fibers affected and the type and severity of damage. Symptoms may develop over days, weeks, or years. In some cases, the symptoms improve on their own and may not require advanced care. Unlike nerve cells in the central nervous system, peripheral nerve cells continue to grow throughout life.
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