Neurological syndromes driven by postinfectious processes or unrecognized persistent infections, Avindra Nath et al, 2018

Forbin

Forbin

Senior Member (Voting Rights)
I ran across this 2018 article by Drs. Nath and Johnson while googling "postinfectious process," because that's the term that I was diagnosed with back in the 1980's. [I was just curious if the term was still used.]

It's behind a wall, but there's an abstract here:

Neurological syndromes driven by postinfectious processes or unrecognized persistent infections, Avindra Nath et al, 2018
https://journals.lww.com/co-neurolo...al_syndromes_driven_by_postinfectious.16.aspx

Recent findings
Some pathogens endure longer than previously thought. Persistent infections may continue to drive immune responses resulting in chronic inflammation or development of autoimmune processes, resulting in damage to the nervous system. Patients with genetic susceptibilities in immune regulation may be particularly vulnerable to pathogen driven autoimmune responses.
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I'm posting this because the article certainly sounds like it might relate to ME/CFS and because one of the authors is Dr. Nath.

There's more to the abstract, but I didn't want to cut and paste it in its entirety.
 
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Full abstract
Purpose of review
The immune system serves a critical role in protecting the host against various pathogens. However, under circumstances, once triggered by the infectious process, it may be detrimental to the host. This may be as a result of nonspecific immune activation or due to a targeted immune response to a specific host antigen. In this opinion piece, we discuss the underlying mechanisms that lead to such an inflammatory or autoimmune syndrome affecting the nervous system. We examine these hypotheses in the context of recent emerging infections to provide mechanistic insight into the clinical manifestations and rationale for immunomodulatory therapy.

Recent findings
Some pathogens endure longer than previously thought. Persistent infections may continue to drive immune responses resulting in chronic inflammation or development of autoimmune processes, resulting in damage to the nervous system. Patients with genetic susceptibilities in immune regulation may be particularly vulnerable to pathogen driven autoimmune responses.

Summary
The presence of prolonged pathogens may result in chronic immune stimulations that drives immune-mediated neurologic complications. Understanding the burden and mechanisms of these processes is challenging but important.
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I've just skimmed it, but I didn't see any reference to CFS or ME/CFS. This is despite it mentioning chronic fatigue lasting more than 6 months and things like post-Ebola symptoms. I think that's rather remarkable.

Elucidating the mechanisms behind the neurological complications of infectious agents is challenging for multiple reasons. First, although potentially devastating, these are fairly uncommon complications. Only during large out- breaks, such as the recent Zika virus epidemics, do patterns of neurologic diseases emerge.
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Ditto, remarkable.
From whence does cerebral damage, such as restricted diffusion come for those post EBV pwME?
 
Elucidating the mechanisms behind the neurological complications of infectious agents is challenging for multiple reasons. First, although potentially devastating, these are fairly uncommon complications. Only during large out- breaks, such as the recent Zika virus epidemics, do patterns of neurologic diseases emerge.
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Wow. I mean. The logic behind this is... wow. It only emerges when we look, because outside of epidemics and large outbreaks nobody looks (so how could anyone know?). Therefore it only happens when we look. And since we only look when it's very large then it only happens when it's very large. Obviously this means people should look beyond but no, the conclusion is the opposite, that it must only happen then. One step removed from: if we didn't look for it it wouldn't exist. If you don't test for Covid you have zero cases and the pandemic is over.

And it didn't happen following SARS. Because nobody looked. Confirming it didn't happen. Same with swine flu. Same with, I guess, Incline village and RFH and on and on. And again with Long Covid most research ignores neurological symptoms so do they even exist if no one checks?

Literally failing at object permanence. I personally prefer science that respects object permanence. I personally require science to respect object permanence, but maybe I'm just very weird.
 
rvallee said:
Wow. I mean. The logic behind this is... wow. It only emerges when we look, because outside of epidemics and large outbreaks nobody looks (so how could anyone know?).
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I think a big part of the problem is that (so far as I know) ME/CFS is not reportable (at least not in the US). Another factor is that, technically, according to the definition, you can't be diagnosed for six months. Even if it were reportable, I wonder how many doctors would remember to report after 6 months later.

Is "long covid" is even reportable? I guess there have been estimates of the percentage of patients who go on to develop "long covid," but I wonder how accurate those would be.
 
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