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Infection-Associated Peripheral Nerve Hyperexcitability: An Under-Recognized Entity.

Ajith Sivadasan1, Aditya Nair1, Angel Miraclin1

  • 1Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.

Annals of Indian Academy of Neurology
|July 5, 2021
PubMed
Summary

Staphylococcal infections, particularly methicillin-resistant Staphylococcus aureus (MRSA), may trigger peripheral nerve hyperexcitability (PNH). Treatment of MRSA infections led to neuromyotonia resolution in most patients.

Keywords:
Methicillin-resistant Staphylococcus aureusStaphylococcus aureusneuromyotoniaperipheral nerve hyperexcitabilitysuperantigenvoltage-gated potassium channel

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Area of Science:

  • Neurology
  • Infectious Disease
  • Immunology

Background:

  • Peripheral nerve hyperexcitability (PNH) and neuromyotonia are typically linked to anti-voltage-gated potassium channel (VGKC) antibodies.
  • Infections are rarely considered triggers for PNH, with no prior reports implicating Staphylococcus aureus.

Observation:

  • Four patients presented with PNH and concurrent staphylococcal skin infections (three confirmed MRSA).
  • Two patients had positive anti-VGKC antibodies.
  • Neuromyotonia symptoms significantly improved in three patients after antibiotic treatment for their infections.

Findings:

  • A strong association was observed between Staphylococcus aureus infection (especially MRSA) and the development of PNH.
  • The resolution of PNH symptoms following infection treatment suggests a causal link.

Implications:

  • Staphylococcal enterotoxins may act as superantigens, initiating inflammation and cross-reactive antibodies against VGKCs.
  • Further research, potentially using animal models, is warranted to elucidate the pathogenic mechanisms.