ALSUntangled #66: antimycobacterial antibiotics

Ellen S Pierce¹, Paul Barkhaus², Morgan Beauchamp³, Mark Bromberg⁴, Gregory T Carter⁵, Jill Goslinga⁶, David Greeley⁷, Sky Kihuwa-Mani⁸, Gleb Levitsky⁹, Isaac Lund¹⁰, Christopher McDermott¹¹, Gary Pattee¹², Kaitlyn Pierce¹³, Meraida Polak¹⁴, Dylan Ratner¹⁵, Paul Wicks¹⁶, Richard Bedlack¹⁷

Affiliations

¹ Spokane Valley, WA, USA.
² Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
³ UNC Neurosciences Clinical Trials Unit, University of North Carolina, Chapel Hill, NC, USA.
⁴ Department of Neurology, University of Utah, Salt Lake City, UT, USA.
⁵ Department of Rehabilitation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
⁶ Department of Neurology, University of California, San Francisco, CA, USA.
⁷ Northwest Neurological Associates, PLLC, Spokane, WA, USA.
⁸ Undergraduate, UNC-Greensboro, Greensboro, NC, USA.
⁹ Real Health Clinic, Moscow, Russia.
¹⁰ Undergraduate, Green Hope High School, Cary, NC, USA.
¹¹ Department of Neuroscience, University of Sheffield, Sheffield, South Yorkshire, UK.
¹² Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA.
¹³ Department of Neuroscience, University of North Carolina, Chapel Hill, NC, USA.
¹⁴ Department of Neurology, Emory University School of Medicine, Emory, GA, USA.
¹⁵ Undergraduate, Longmeadow High School, Longmeadow, MA, USA.
¹⁶ Independent Consultant, Lichfield, England, UK.
¹⁷ Department of Neurology, Duke University, Durham, NC, USA.

PMID: 35913017
DOI: 10.1080/21678421.2022.2104650

Review

ALSUntangled #66: antimycobacterial antibiotics

Ellen S Pierce et al. Amyotroph Lateral Scler Frontotemporal Degener. 2023 Aug.

. 2023 Aug;24(5-6):539-543.

doi: 10.1080/21678421.2022.2104650. Epub 2022 Aug 1.

Authors

Affiliations

¹ Spokane Valley, WA, USA.
² Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
³ UNC Neurosciences Clinical Trials Unit, University of North Carolina, Chapel Hill, NC, USA.
⁴ Department of Neurology, University of Utah, Salt Lake City, UT, USA.
⁵ Department of Rehabilitation, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
⁶ Department of Neurology, University of California, San Francisco, CA, USA.
⁷ Northwest Neurological Associates, PLLC, Spokane, WA, USA.
⁸ Undergraduate, UNC-Greensboro, Greensboro, NC, USA.
⁹ Real Health Clinic, Moscow, Russia.
¹⁰ Undergraduate, Green Hope High School, Cary, NC, USA.
¹¹ Department of Neuroscience, University of Sheffield, Sheffield, South Yorkshire, UK.
¹² Department of Neurology, University of Nebraska Medical Center, Omaha, NE, USA.
¹³ Department of Neuroscience, University of North Carolina, Chapel Hill, NC, USA.
¹⁴ Department of Neurology, Emory University School of Medicine, Emory, GA, USA.
¹⁵ Undergraduate, Longmeadow High School, Longmeadow, MA, USA.
¹⁶ Independent Consultant, Lichfield, England, UK.
¹⁷ Department of Neurology, Duke University, Durham, NC, USA.

PMID: 35913017
DOI: 10.1080/21678421.2022.2104650

Abstract

Several infections have been associated with motor neuron diseases resembling ALS, including species of viruses, bacteria, and parasites. Mycobacterium avium subspecies paratuberculosis (MAP), most known for its probable etiologic association with Crohn's disease, has been suggested as another possible infectious cause of motor neuron disease. Two published case reports describe the successful treatment of ALS-like symptoms with antimycobacterial antibiotics. Both cases had atypical features. Based on these, we believe it would be reasonable to begin performing chest imaging in PALS who have features of their history or exam that are atypical for ALS such as pain, fevers, or eye movement abnormalities. If the chest imaging is abnormal, more specific testing for mycobacteria may be indicated. Until there is more clear evidence of an association between mycobacteria and ALS, we cannot endorse the widespread use of potentially toxic antimycobacterial antibiotics for PALS.

Keywords: Amyotrophic lateral sclerosis; antimycobacterial antibiotic therapy; infectious ALS; motor neurone disease; paratuberculosis.

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ALSUntangled #66: antimycobacterial antibiotics

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ALSUntangled #66: antimycobacterial antibiotics

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