ABSTRACT
Guillain Barre Syndrome [GBS] is an inflammatory, usually demyelinating, polyneuropathy where autoantibodies have been detected. It is usually preceded by various bacterial and viral infections including cytomegalo virus [CMV]. Cytomegalo virus infection has been associated with the production of autoantibodies and autoimmune reactions. The aim of this study was to investigate the possible association between CMV infection and GBS. Twenty five patients with GBS were recruited from the paediatric intensive care unit at Mansoura University Children's Hospital. As a control group 25 age and sex matched children with other diseases admitted to the same hospital at the same time, were included in our study. Serum samples were collected before treatment from each patient [within 4 weeks after the disease onset] and controls, and stored frozen at -20?C until PCR and serologic assays were done. Serologic testing and PCR of pre-treatment serum were performed in all patients. Positive titer of virus specific IgM antibody against cytomegalovirus [CMV] was found in 11 cases [44%] which was statistically significant when compared to the control group [4%] p=.001, PCR was found positive for CMV DNA in 12 [48%] patients and 1 control [4%]. We hereby report a significant association between positive CMV infection and GBS. Our results provide further evidence that CMV can be associated with GBS
ABSTRACT
Childhood diseases such as bronchial asthma and acute bronchiolitis have both been linked to lower airway obstruction with the possibility of developing acute lung injury. Management usually necessitates the intervention of mechanical ventilation with its risks and complications. In addition, serum levels of lnterleukin-4 [IL-4] and Interleukin-5 [IL-5] have been found to be associated in the pathogenesis of this condition and are known to be elevated in these patients. This study was designed to evaluate the use of IL-4 and IL-5 as predictive factors and markers of inflammation for a successful response to non-invasive ventilation [NIV] in children with acute severe lower airway obstruction. This iia prospective study that included 40 cases presented with acute respiratory distress secondary to lower airway obstruction including acute exacerbations of asthma and acute bronchiolitis. Cases were classified randomly into two groups; Group A: patients who received NIV plus standard conventional therapy if needed, and Group B: control patients who received only standard conventional therapy without NIV. Serum IL-4 and IL-5 were measured in all patients on admission and after treatment. We have found that there was significant improvement of all the clinical parameters in addition to a reduction in the need of invasive ventilation. There were also a significant reduction in the serum levels of the studied interleukins 4 and 5 after the completion of therapy as indicated by p<.001 in both cytokines. This may give a key for the importance of the early use of NIV as a first line of treatment of severe cases of lower airway obstruction and highlights the importance of using serum IL-4 and IL-5 as parameters of improvement