Highlights
- •West Nile virus (WNV) infection has been reported to promote myasthenia gravis (MG) and other autoimmune diseases.
- •Molecular mimicry between WNV proteins and host proteins is postulated as the major mechanism for WNV-triggered autoimmunity.
- •We present a patient with stable ocular MG who progressed to myasthenic crisis after WNV neuroinvasive disease.
- •In stable ocular MG with proven autoantibodies, transformation to generalized MG cannot be attributed to molecular mimicry.
- •Evidence implicates a WNV-induced post-infectious pro-inflammatory state that may amplify and promote autoimmune disease.
Abstract
West Nile virus (WNV) infection has been reported to promote myasthenia gravis (MG)
and various other diseases that have a presumed autoimmune pathogenesis. Molecular
mimicry between WNV proteins and host proteins has been postulated as the major mechanism
for WNV-triggered breaking of immunological self-tolerance. We present a patient with
stable ocular MG and positive anti-acetylcholine receptor antibodies who progressed
to myasthenic crisis after WNV neuroinvasive disease. In this case of stable autoimmune
disease with proven auto-antibodies, transformation to generalized disease cannot
be attributed to molecular mimicry, which requires that an immune response first be
generated against an infectious agent. Rather, the evidence supports the concept of
a post-infectious pro-inflammatory state that may contribute to the amplification
and promotion of autoimmune disease in some WNV survivors.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Zika virus infection and myasthenia gravis: report of 2 cases.Neurology United States. 2017; 88: 1097-1098
- West nile virus infection and myasthenia gravis.Muscle Nerve. United States. 2014; 49: 26-29
- Postinfectious myasthenia gravis: report of two children.J. Child Neurol. United States. 2005; 20: 441-444
- Stiff-person syndrome following West Nile fever.Arch. Neurol. United States. 2004; 61: 938-941
Sumner N, Jones L. Multifocal neuropathy associated with West Nile virus infection. Neurology. United States; 2008;71:1123.
- West Nile virus infection in 2002: morbidity and mortality among patients admitted to hospital in southcentral Ontario.CMAJ. Canada. 2003; 168: 1399-1405
- Guillain-Barre syndrome: an unusual presentation of West Nile virus infection.Neurology. United States. 2000; 55: 144-146
- Myasthenia gravis: a comprehensive review of immune dysregulation and etiological mechanisms.J. Autoimmun. England. 2014; 52: 90-100
- Molecular mimicry and myasthenia gravis. An autoantigenic site of the acetylcholine receptor alpha-subunit that has biologic activity and reacts immunochemically with herpes simplex virus.J. Clin. Invest. United States. 1989; 84: 1174-1180
- Prognosis of ocular myasthenia gravis: retrospective multicenter analysis.Ophthalmology. 2015 Jul; 122: 1517-1521https://doi.org/10.1016/j.ophtha.2015.03.010
- Prognosis of ocular myasthenia in Korea: a retrospective multicenter analysis of 202 patients.J. Neurol. Sci. 2008 Oct 15; 273: 10-14https://doi.org/10.1016/j.jns.2008.05.023
- Neuromuscular Home Page.(updated 4/21/2018)
- Development of Generalized Disease at 2 years in patients with Ocular Myasthenia Gravis.Arch. Neurol. 2003; 60: 243-248https://doi.org/10.1001/archneur.60.2.243
- Seropositivity for West Nile virus antibodies in patients affected by myasthenia gravis.J. Clin. Med. Res. Canada. 2016; 8: 196-201
- Unresolved issues in theories of autoimmune disease using myocarditis as a framework.J. Theor. Biol. 2015 June 21; 375: 101-123https://doi.org/10.1016/j.jtbi.2014.11.022
- Unilateral brachial plexopathy associated with West Nile virus meningoencephalitis.Clin. Infect. Dis. 2003 Jun 15; 36: 1629-1630
- Myocarditis in West Nile Virus infection.Am. J. Trop. Med. Hyg. 2006; 75: 1232-1233
- Neuronal and glial cerebrospinal fluid protein biomarkers are elevated after West Nile virus infection.Muscle Nerve. United States. 2010; 41: 42-49
- Glial S100B is elevated in serum across the spectrum of West Nile virus infection.Muscle Nerve. United States. 2012; 45: 826-830
- Does astroglial protein S100B contribute to West Nile neuro-invasive syndrome?.J. Neurol. Sci. Netherlands. 2015; 358: 243-252
- High-mobility group box-1, promising serological biomarker for the distinction of human WNV disease severity.Virus Res. Netherlands. 2015; 195: 9-12
- Receptor for advanced glycation end-products in neurodegenerative.Dis. Rev. Neurosci. 2015; https://doi.org/10.1515/revneuro-2015-0003
- Activation of the receptor for advanced glycation end products (RAGE) exacerbates experimental autoimmune myasthenia gravis symptoms.Clin. Immunol. United States. 2011; 141: 36-48
- The receptor for advanced glycation endproducts and its ligands in patients with myasthenia gravis.Biochem. Biophys Res. Commun. United States. 2012; 420: 96-101
- Interleukin-17A Promotes CD8+ T Cell Cytotoxicity to Facilitate West Nile Virus Clearance.J. Virol. United States. 2017; 91https://doi.org/10.1128/JVI.01529-16
- Elevated plasma interleukin-17A in a subgroup of Myasthenia Gravis patients.Cytokine. England. 2016; 78: 44-46
- IL-17-producing CD4(+) T cells contribute to the loss of B-cell tolerance in experimental autoimmune myasthenia gravis.Eur J Immunol. Germany. 2015; 45: 1339-1347
- Evaluation of prolonged fatigue post-West Nile virus infection and association of fatigue with elevated antiviral and proinflammatory cytokines.Viral Immunol. United States. 2014; 27: 327-333
- West Nile virus induces a prolonged pro-inflammatory state that may promote myasthenia gravis.in: Poster Abstracts. 13th International Conference on Myasthenia Gravis and Related Disorders. NYAS. May 15–17. 2017
- A Cross-Sectional Study of Neurocognitive Outcomes in Post-West Nile Virus Infection.Am Soc Trop Med Hyg. ASTMH. November 7 2017; (Abstract 1310)
Article info
Publication history
Published online: September 13, 2018
Accepted:
September 12,
2018
Received in revised form:
August 5,
2018
Received:
April 23,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
