Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Front Immunol. 2022 Mar 9;13:833548. doi: 10.3389/fimmu.2022.833548. eCollection 2022.
The direct impact and sequelae of infections in children and adults result in significant morbidity and mortality especially when they involve the central (CNS) or peripheral nervous system (PNS). The historical understanding of the pathophysiology has been mostly focused on the direct impact of the various pathogens through neural tissue invasion. However, with the better understanding of neuroimmunology, there is a rapidly growing realization of the contribution of the innate and adaptive host immune responses in the pathogenesis of many CNS and PNS diseases. The balance between the protective and pathologic sequelae of immunity is fragile and can easily be tipped towards harm for the host. The matter of immune privilege and surveillance of the CNS/PNS compartments and the role of the blood-brain barrier (BBB) and blood nerve barrier (BNB) makes this even more complex. Our understanding of the pathogenesis of many post-infectious manifestations of various microbial agents remains elusive, especially in the diverse African setting. Our exploration and better understanding of the neuroimmunology of some of the infectious diseases that we encounter in the continent will go a long way into helping us to improve their management and therefore lessen the burden. Africa is diverse and uniquely poised because of the mix of the classic, well described, autoimmune disease entities and the specifically "tropical" conditions. This review explores the current understanding of some of the para- and post-infectious autoimmune manifestations of CNS and PNS diseases in the African context. We highlight the clinical presentations, diagnosis and treatment of these neurological disorders and underscore the knowledge gaps and perspectives for future research using disease models of conditions that we see in the continent, some of which are not uniquely African and, where relevant, include discussion of the proposed mechanisms underlying pathogen-induced autoimmunity. This review covers the following conditions as models and highlight those in which a relationship with COVID-19 infection has been reported: a) Acute Necrotizing Encephalopathy; b) Measles-associated encephalopathies; c) Human Immunodeficiency Virus (HIV) neuroimmune disorders, and particularly the difficulties associated with classical post-infectious autoimmune disorders such as the Guillain-Barré syndrome in the context of HIV and other infections. Finally, we describe NMDA-R encephalitis, which can be post-HSV encephalitis, summarise other antibody-mediated CNS diseases and describe myasthenia gravis as the classic antibody-mediated disease but with special features in Africa.
儿童和成人的感染的直接影响和后遗症会导致严重的发病率和死亡率，尤其是当感染涉及中枢神经系统 (CNS) 或周围神经系统 (PNS) 时。历史上对发病机制的理解主要集中在各种病原体通过神经组织侵袭的直接影响上。然而，随着对神经免疫学的更好理解，人们越来越认识到固有和适应性宿主免疫反应在许多 CNS 和 PNS 疾病的发病机制中的作用。免疫的保护和病理后果之间的平衡很脆弱，很容易对宿主造成伤害。CNS/PNS 隔室的免疫特权和监视以及血脑屏障 (BBB) 和血神经屏障 (BNB) 的作用使情况更加复杂。我们对许多不同微生物病原体感染后的表现的发病机制的理解仍然难以捉摸，尤其是在多样化的非洲环境中。我们对我们在非洲大陆遇到的一些传染病的神经免疫学的探索和更好理解将有助于我们改善其管理，从而减轻负担。非洲是多样化的，由于经典的、描述明确的自身免疫性疾病实体与特定的“热带”疾病的混合，它具有独特的优势。本综述探讨了目前在非洲背景下对一些 CNS 和 PNS 疾病的感染后和感染相关自身免疫表现的理解。我们强调了这些神经疾病的临床表现、诊断和治疗，并强调了知识空白和未来研究的观点，使用我们在非洲大陆看到的疾病模型，其中一些疾病并非独特的非洲疾病，并且在相关情况下，包括讨论病原体诱导自身免疫的潜在机制。本综述涵盖了以下疾病模型，并强调了与 COVID-19 感染相关的疾病：a）急性坏死性脑病；b）麻疹相关脑病；c）人类免疫缺陷病毒 (HIV) 神经免疫障碍，特别是与 HIV 和其他感染相关的经典感染后自身免疫性疾病（如格林-巴利综合征）相关的困难。最后，我们描述了 NMDA-R 脑炎，它可以是单纯疱疹病毒脑炎后，总结了其他抗体介导的中枢神经系统疾病，并描述了重症肌无力作为经典的抗体介导疾病，但在非洲有特殊特征。
