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Volume 25, Number 5—May 2019
Dispatch

Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans

Matthias Tomschik1Comments to Author , Inga Koneczny1, Anna-Margarita Schötta, Sebastian Scharer, Merima Smajlhodzic, Paloma Fernandes Rosenegger, Martin Blüthner, Romana Höftberger, Fritz Zimprich, Gerold Stanek, and Mateusz Markowicz
Author affiliations: Medical University of Vienna, Vienna, Austria (M. Tomschik, I. Koneczny, A.-M. Schötta, S. Scharer, M. Smajlhodzic, P.F. Rosenegger, R. Höftberger, F. Zimprich, G. Stanek, M. Markowicz); Medizinisches Versorgungszentrum Labor PD Dr. Volkmann und Kollegen GbR, Karlsruhe, Germany (M. Blüthner)

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Figure 2

Timeline of medical history for patient with severe myasthenic manifestation of leptospirosis, including results of relevant neurologic and laboratory investigations. Decrement in repetitive stimulation denotes the maximum decrease in amplitude of the fourth or fifth compound muscle action potential waveform during supramaximal repetitive nerve stimulation at 3 Hz. A decrement >10% is regarded as pathologic (6). Leptospira ELISA cutoff values: IgG, <10 U/mL negative, 15 U/mL positive; IgM,

Figure 2. Timeline of medical history for patient with severe myasthenic manifestation of leptospirosis, including results of relevant neurologic and laboratory investigations. Decrement in repetitive stimulation denotes the maximum decrease in amplitude of the fourth or fifth compound muscle action potential waveform during supramaximal repetitive nerve stimulation at 3 Hz. A decrement >10% is regarded as pathologic (6). Leptospira ELISA cutoff values: IgG, <10 U/mL negative, 15 U/mL positive; IgM, <15 U/mL negative, >20 U/mL positive. CRP, C-reactive protein; LRP4, lipoprotein receptor-related protein 4.

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References
  1. Levett  PN. Leptospirosis. Clin Microbiol Rev. 2001;14:296–326. DOIPubMedGoogle Scholar
  2. Bharucha  NE. Infections of the nervous system. In: Bradley’s neurology in clinical practice. Bradley DR, Fenichel GM, editors. Butterworth Heinemann: Boston; 1991. p. 1074–5.
  3. Panicker  JN, Mammachan  R, Jayakumar  RV. Primary neuroleptospirosis. Postgrad Med J. 2001;77:589–90. DOIPubMedGoogle Scholar
  4. Boonsilp  S, Thaipadungpanit  J, Amornchai  P, Wuthiekanun  V, Bailey  MS, Holden  MT, et al. A single multilocus sequence typing (MLST) scheme for seven pathogenic Leptospira species. PLoS Negl Trop Dis. 2013;7:e1954. DOIPubMedGoogle Scholar
  5. Kumar  S, Stecher  G, Tamura  K. MEGA7: Molecular Evolutionary Genetics Analysis version 7.0 for bigger datasets. Mol Biol Evol. 2016;33:1870–4. DOIPubMedGoogle Scholar
  6. AAEM Quality Assurance Committee. American Association of Electrodiagnostic Medicine. Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome. Muscle Nerve. 2001;24:1239–47. DOIPubMedGoogle Scholar
  7. Vincent  A, Huda  S, Cao  M, Cetin  H, Koneczny  I, Rodriguez-Cruz  P, et al. Serological and experimental studies in different forms of myasthenia gravis. Ann N Y Acad Sci. 2018;1413:143–53. DOIPubMedGoogle Scholar
  8. Yan  M, Xing  GL, Xiong  WC, Mei  L. Agrin and LRP4 antibodies as new biomarkers of myasthenia gravis. Ann N Y Acad Sci. 2018;1413:126–35. DOIPubMedGoogle Scholar
  9. Zisimopoulou  P, Evangelakou  P, Tzartos  J, Lazaridis  K, Zouvelou  V, Mantegazza  R, et al. A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis. J Autoimmun. 2014;52:139–45. DOIPubMedGoogle Scholar
  10. Rodríguez Cruz  PM, Al-Hajjar  M, Huda  S, Jacobson  L, Woodhall  M, Jayawant  S, et al. Clinical features and diagnostic usefulness of antibodies to clustered acetylcholine receptors in the diagnosis of seronegative myasthenia gravis. JAMA Neurol. 2015;72:642–9. DOIPubMedGoogle Scholar
  11. Leis  AA, Szatmary  G, Ross  MA, Stokic  DS. West nile virus infection and myasthenia gravis. Muscle Nerve. 2014;49:26–9. DOIPubMedGoogle Scholar
  12. Molko  N, Simon  O, Guyon  D, Biron  A, Dupont-Rouzeyrol  M, Gourinat  AC. Zika virus infection and myasthenia gravis: report of 2 cases. Neurology. 2017;88:1097–8. DOIPubMedGoogle Scholar
  13. Ramos-Fransi  A, Rojas-García  R, Segovia  S, Márquez-Infante  C, Pardo  J, Coll-Cantí  J, et al.; Myasthenia NMD-ES Study Group. Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry. Eur J Neurol. 2015;22:1056–61. DOIPubMedGoogle Scholar
  14. Pradhan  S, Tandon  R, Kishore  J. Combined involvement of muscle, nerve, and myoneural junction following leptospira infection. Neurol India. 2012;60:514–6. DOIPubMedGoogle Scholar
  15. Makhija  P, Gopinath  S, Kannoth  S, Radhakrishnan  K. A case of post-leptospirosis autoimmune epilepsy presenting with sleep-related hypermotor seizures. Epileptic Disord. 2017;19:456–60.PubMedGoogle Scholar

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1These authors contributed equally to this article.

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