Acute neuropathies in sepsis

  • N. Latronico
  • B. Guarneri
  • A. Candiani
Conference paper


Several infections can cause acute neuropathies. Leprosy is the commonest cause of peripheral neuropathy and is still important in developing countries where the disease is endemic, the Mycobacterium leprae selectively affecting the skin and nerves [1] Peripheral neuropathies may be found in up to 50% of patients infected with HIV [2]. Neuropathies may be related to the immunological reactions against viral antigens, immunodepression, opportunistic infections, and iatrogenic complications of anti-viral drugs [3]. Hepatitis C virus infection has been found in cryoglobulinaemic neuropathies [4]. Poliomyelitis, diphtheria and Lyme disease are other rare causes of neuropathy [3].


Severe Sepsis Lyme Disease Intensive Insulin Therapy Intensive Care Unit Discharge Critical Illness Polyneuropathy 
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  1. 1.
    Haimanot RT, Melaku Z (2000) Leprosy. Curr Opin Neurol 13: 317–322PubMedCrossRefGoogle Scholar
  2. 2.
    Simpson DM (2002) Selected peripheral neuropathies associated with human immunodeficiency virus infection and antiretroviral therapy. J Neurovirol 8 Suppl 2: 33–41Google Scholar
  3. 3.
    Creange A (2000) [Infectious neuropathies]. Rev Prat 50:743–748Google Scholar
  4. 4.
    Mayo MJ (2003) Extrahepatic manifestations of hepatitis C infection. Am J Med Sci 325: 135–148PubMedCrossRefGoogle Scholar
  5. 5.
    Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Commit-tee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101: 1644–1655PubMedCrossRefGoogle Scholar
  6. 6.
    Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29: 530–538Google Scholar
  7. 7.
    Ince C, Sinaasappel M (1999) Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 27: 1369–1377PubMedCrossRefGoogle Scholar
  8. 8.
    Rosser DM, Stidwill RP, Jacobson D. Singer M (1995) Oxygen tension in the bladder epithelium rises in both high and low cardiac output endotoxemic sepsis. J Appl Physiol 79: 1878–1882PubMedGoogle Scholar
  9. 9.
    Boekstegers P, Weidenhofer S. Pilz G, Werdan K (1991) Peripheral oxygen availability within skeletal muscle in sepsis and septic shock: comparison to limited infection and cardiogenic shock. Infection 19: 317–323PubMedCrossRefGoogle Scholar
  10. 10.
    Hotchkiss RS, Swanson PE, Freeman BD et al (1999) Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 27: 1230–1251PubMedCrossRefGoogle Scholar
  11. 11.
    Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348: 138–150PubMedCrossRefGoogle Scholar
  12. 12.
    Latronico N, Fenzi F, Recupero D et al (1996) Critical illness myopathy and neuropathy. Lancet 347: 1579–1582PubMedCrossRefGoogle Scholar
  13. 13.
    Latronico N (2000) Monitoring of peripheral nerves and muscle function in patients with multiple organ dysfunction syndrome. Crit Care Med 28: 3375PubMedCrossRefGoogle Scholar
  14. 14.
    Brealey D, Brand M, Hargreaves I et al (2002) Association between mitochondria] dysfunction and severity and outcome of septic shock. Lancet 360: 219–223PubMedCrossRefGoogle Scholar
  15. 15.
    Astiz ME, Rackow EC (1998) Septic shock. Lancet 351: 1501–1505PubMedCrossRefGoogle Scholar
  16. 16.
    Bochud PY, Calandra T (2003) Pathogenesis of sepsis: new concepts and implications for future treatment. BMJ 326: 262–266PubMedCrossRefGoogle Scholar
  17. 17.
    Fink MP, Evans TW (2002) Mechanisms of organ dysfunction in critical illness: report from a Round Table Conference held in Brussels. Intensive Care Med 28: 369–375PubMedCrossRefGoogle Scholar
  18. 18.
    Adrie C, Pinsky MR (2000) The inflammatory balance in human sepsis. Intensive Care Med 26: 364–375PubMedCrossRefGoogle Scholar
  19. 19.
    Fenzi F, Latronico N, Refatti N, Rizzuto N (2003) Enhanced expression of E-selectin on the vascular endothelium of peripheral nerve in critically ill patients with neuromuscular disorders. Acta Neuropathol (Berl) 106: 75–82Google Scholar
  20. 20.
    Bernard GR. Vincent JL, Laterre PF et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699–709PubMedCrossRefGoogle Scholar
  21. 21.
    Pastorino JG, Simbula G, Yamamoto K et al (1996) The cytotoxicity of tumor necrosis factor depends on induction of the mitochondria] permeability transition. J Biol Chem 271: 29792–29798PubMedCrossRefGoogle Scholar
  22. 22.
    Cuzzocrea S, Costantino G, Mazzon E, Caputi AP (1999) Protective effect of N-acetylcysteine on multiple organ failure induced by zymosan in the rat. Crit Care Med 27: 1524–1532PubMedCrossRefGoogle Scholar
  23. 23.
    Cuzzocrea S, Zingarelli B, Costantino G et al (1999) Protective effect of poly(ADP-ribose) synthetase inhibition on multiple organ failure after zymosan-induced peritonitis in the rat. Crit Care Med 27: 1517–1523PubMedCrossRefGoogle Scholar
  24. 24.
    Chandel NS, Trzyna WC, McClintock DS, Schumacker PT (2000) Role of oxidants in NF-kappa B activation and TNF-alpha gene transcription induced by hypoxia and endotoxin. J Immunol 165: 1013–1021PubMedGoogle Scholar
  25. 25.
    Witt NJ, Zochodne DW, Bolton CF et al (1991) Peripheral nerve function in sepsis and multiple organ failure. Chest 99: 176–184PubMedCrossRefGoogle Scholar
  26. 26.
    van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345: 1359–1367PubMedCrossRefGoogle Scholar
  27. 27.
    Gao F, Gao E, Yue TL et al (2002) Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemia-reperfusion: the roles of PI3-kinase, Akt, and endothelial nitric oxide synthase phosphorylation. Circulation 105: 1497–1502PubMedCrossRefGoogle Scholar
  28. 28.
    Singleton JR, Baker BL, Thorburn A (2000) Dexamethasone inhibits insulin-like growth factor signaling and potentiates myoblast apoptosis. Endocrinology 141: 2945–2950PubMedCrossRefGoogle Scholar
  29. 29.
    Van den Berghe G, Wouters PJ, Bouillon R et al (2003) Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 31: 359–366PubMedCrossRefGoogle Scholar
  30. 30.
    Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ (1984) Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry 47: 1223–1231PubMedCrossRefGoogle Scholar
  31. 31.
    Bolton CF, Laverty DA, Brown JD et al (1986) Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barré syndrome. J Neurol Neurosurg Psychiatry 49: 563–573PubMedCrossRefGoogle Scholar
  32. 32.
    Zochodne DW, Bolton CF, Wells GA et al (1987) Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain 110 (Pt 4): 819–841PubMedCrossRefGoogle Scholar
  33. 33.
    Latronico N, Candiani A (1999) Neuromuscular disorders acquired in the ICU. Intensive Care Med 25: 645CrossRefGoogle Scholar
  34. 34.
    Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de Weerd AW (1995) The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA 274: 1221–1225PubMedCrossRefGoogle Scholar
  35. 35.
    Garnacho-Montero J, Madrazo-Osuna J, Garcia-Garmendia JL et al (2001) Critical illness polyneuropathy: risk factors and clinical consequences. A cohort study in septic patients. Intensive Care Med 27: 1288–1296PubMedCrossRefGoogle Scholar
  36. 36.
    Tepper M, Rakic S, Haas JA, Woittiez AJ (2000) Incidence and onset of critical illness polyneuropathy in patients with septic shock. Neth J Med 56: 211–214PubMedCrossRefGoogle Scholar
  37. 37.
    Berek K, Margreiter J, Willeit J et al (1996) Polyneuropathies in critically ill patients: a prospective evaluation. Intensive Care Med 22: 849–855PubMedCrossRefGoogle Scholar
  38. 38.
    De Jonghe B, Sharshar T, Lefaucheur JP et al (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288: 2859–2867PubMedCrossRefGoogle Scholar
  39. 39.
    Zochodne DW, Bolton CF (1996) Neuromuscular disorders in critical illness. Baillieres Clin Neurol 5: 645–671PubMedGoogle Scholar
  40. 40.
    Tennila A, Salmi T, Pettila V et al (2000) Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med 26: 1360–1363PubMedCrossRefGoogle Scholar
  41. 41.
    Latronico N, Rasulo FA, Recupero D et al (1998) Acute quadriplegia with delayed onset and rapid recovery. Case report. J Neurosurg 88: 769–772PubMedCrossRefGoogle Scholar
  42. 42.
    Maher J, Rutledge F, Remtulla H et al (1995) Neuromuscular disorders associated with failure to wean from the ventilator. Intensive Care Med 21: 737–743PubMedCrossRefGoogle Scholar
  43. 43.
    Sander HW, Saadeh PB, Chandswang N et al (1999) Diaphragmatic denervation in intensive care unit patients. Electromyogr Clin Neurophysiol 39: 3–5PubMedGoogle Scholar
  44. 44.
    van Mook WN, Hulsewe-Evers RP (2002) Critical illness polyneuropathy. Curr Opin Crit Care 8: 302–310PubMedCrossRefGoogle Scholar
  45. 45.
    Latronico N, Guarneri B, Alongi S et al (1999) Acute neuromuscular respiratory failure after ICU discharge. Report of five patients. Intensive Care Med 25: 1302–1306PubMedCrossRefGoogle Scholar
  46. 46.
    de Seze M, Petit H, Wiart L et al (2000) Critical illness polyneuropathy. A 2-year follow-up study in 19 severe cases. Eur Neurol 43: 61–69PubMedCrossRefGoogle Scholar
  47. 47.
    Herridge MS, Cheung AM, Tansey CM et al (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348: 683–693PubMedCrossRefGoogle Scholar
  48. 48.
    Bolton CF (1996) Sepsis and the systemic inflammatory response syndrome: neuromuscular manifestations. Crit Care Med 24: 1408–1416PubMedCrossRefGoogle Scholar
  49. 49.
    Bolton CF, Young GB (1997) Critical illness polyneuropathy due to parenteral nutrition. Intensive Care Med 23: 924–925PubMedGoogle Scholar
  50. 50.
    Coakley JH, Nagendran K, Yarwood GD et al (1998) Patterns of neurophysiological abnormality in prolonged critical illness. Intensive Care Med 24: 801–807PubMedCrossRefGoogle Scholar
  51. 51.
    Latronico N, Fenzi F. Boniotti C et al (1993) Acute reversible paralysis in critically ill patients. Acta Anaestesiol Ital 44: 157–171Google Scholar
  52. 52.
    Morris C, Trinder JT (2002) Electrophysiology adds little to clinical signs in critical illness polyneuropathy and myopathy. Crit Care Med 30: 2612PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • N. Latronico
  • B. Guarneri
  • A. Candiani

There are no affiliations available

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