Epidemics and outbreaks of peripheral nervous system disorders: I. infectious and immune-mediated causes

Abstract

The history of mankind is marked by numerous epidemics, some of which involved diseases of the peripheral nervous system, either infectious or otherwise. We describe here the three main infectious causes of epidemics that affect the peripheral nervous system: leprosy, poliomyelitis and diphtheria. We then discuss the main epidemics of immune-mediated origin.

Keywords: Diphtheria; Guillain–Barré syndrome; HIV; Leprosy; Lyme; Poliomyelitis.

Fig. 1

Main clinical and pathological characteristics of leprosy, poliomyelitis and diphtheria. a Table summarizing the main clinical characteristics of leprosy, poliomyelitis and diphtheria. b Leprosy. nerve biopsy (personal case; transverse section; light microscopy, hematoxylin–eosin) showing tuberculoid leprosy; in this nerve fascicle, granulomatous lesions heavily infiltrate the endoneurium: macrophages, histiocytes, lymphocytes and giant cells (Langerhans cells) (arrow). c Leprosy. nerve biopsy (personal case; transverse section; electron microscopy) showing the presence of four Hansen bacilli (arrows) in a Schwann cell (SC) cytoplasm. d Poliomyelitis. Drawing of the paper of Charcot and Joffroy (1870; Figure V.2; with the permission of the “Bibliothèque de France”) showing atrophy of the anterior horns (A and A’’) in a case of ‘infantile spinal atrophy’—transverse section of the spinal cord at the level of the dorsal part of the spine). e Diphtheria. Drawing of the paper of Dejerine (1878; Fig. XVII.1; with the permission of the “Bibliothèque de France”) showing severe axonal lesions (with ovoids) in a case of diphtheritic paralysis (picrocarmin staining)

Fig. 2

Schematic chronological representation of the main infectious epidemics affecting the peripheral nervous system (poliomyelitis, leprosy and diphtheria)

Fig. 3

Main steps in the history and emergence of Zika virus (ZIKV) and Guillain–Barré syndrome (GBS); ZIKV+ serum positivity to ZIKV; ZIKVi:ZIKV infection

Fig. 4

Paraffin-embedded transverse section of one fascicle of the nerve biopsy of a patient with neuroborreliosis (hematein-eosin staining) showing infiltrations of lymphocytes and plasma cells, sometimes forming thick pericapillary cuffs with no accompanying necrosis of vessel walls; many capillaries of the endoneurium, perineurium, and epineurium are affected in this way