. Peripheral Neuropathy Research Registry: A prospective cohort. J Peripher Nerv Syst. 2019 Mar;24(1):39-47. doi: 10.1111/jns.12301. Epub 2019 Jan 29.
[PMID: 30629307] [DOI: 10.1111/jns.12301]
Table of Contents
Peripheral neuropathy
Introduction
Research
The Peripheral Neuropathy Research Registry (PNRR) is a prospective cohort of peripheral neuropathy (PN) patients focused on idiopathic axonal peripheral neuropathy. 1)
Peripheral Neuropathy and Nerve Compression Syndromes in Burns. 2)
B vitamins and chemotherapy-induced peripheral neuropathy. 3)
Evidence of infectious cause
Inflammatory Peripheral Neuropathies Prevalent in Poultry and Swine Farmers
November 18, 2009 (Philadelphia, Pennsylvania) — Symptoms associated with inflammatory peripheral neuropathies are significantly higher in farm workers exposed to poultry and swine, researchers reported here at the American Public Health Association 137th Annual Meeting.
Food-borne infection with Campylobacter jejuni, a common pathogen associated with poultry and swine exposure, is considered a major risk factor for peripheral neuropathies, including Guillain-Barré syndrome, said Meghan F. Davis, DVM, MPH, a PhD student from the Department of Environmental Health Sciences at Johns Hopkins School of Public Health in Baltimore, Maryland.
Campylobacteriosis, the disease produced by bacteria of the genus Campylobacter, affects more than 2.4 million people each year, close to 1% of the population of the United States. Guillain-Barré syndrome is the leading cause of acute peripheral neuropathy worldwide. According to the Centers for Disease Control and Prevention, 3000 to 6000 people in the United States develop Guillain-Barré syndrome each year.
“These are diseases [that farm workers] may develop as a result of their contact with farm birds and animals and the pathogens they carry,” Dr. Davis said in an interview with Medscape Public Health & Prevention. The bacteria are usually found in poultry but have also been isolated in swine, putting farm workers at increased risk of becoming carriers and potentially developing neurologic disease.
Among swine farmers and workers, the risk for numbness was 18% and 23% higher, respectively, than among control subjects. The risk for weakness was 22% and 28% higher, respectively, than among control subjects (P < .05).
Among poultry farmers and workers, the risk for numbness was significantly higher than among control subjects (27% vs 25%; P < .05). No increase in self-reported speech or vision problems was observed, note the investigators.
“Our findings strongly suggest that [farmers and farm workers] are going to be at higher risk,” she cautioned.
“The public health significance is that we need to focus on farm worker safety, potentially using more protective gear and educational programs, and doing more surveillance for diseases that they might develop as a result of their contact with farm animals and birds,” said Dr. Davis.
A total of 52,395 farmers from North Carolina and Iowa were recruited from the Agricultural Health Study between 1993 and 1997. A complete set of data for key symptoms and exposures was available for 20,599 participants. Of these, 15,932 farmers and workers were exposed to swine and poultry.
Swine farmers (n = 7079), swine confinement workers (n = 5930), poultry farmers (n = 784), and poultry workers (n = 713) were evaluated for possible exposure to C jejuni and compared with farmers who reported no occupational animal exposure.
Symptoms relevant to inflammatory peripheral neuropathies, such as numbness, weakness, blurred vision, and night blindness, were examined for the purpose of this retrospective analysis.
Exposure to birds and pigs was used as a surrogate for Campylobacter exposure, explained the investigators, who sought to determine whether exposure increased the prevalence of neurologic symptoms in this cohort.
“What we are going to do as a follow-up is to look more closely at this association, using biomarkers to assess whether the association is very specific to C jejuni and Guillain-Barré syndrome,” Dr. Davis said. They are planning a prospective study of “either established farm workers (or processing plant workers) or [workers] new to these work occupations, and [intend to] follow them over time to see if they have a higher risk for the development of this particular disease.”
“A very well-run study,” said Lee Hurt, MPH, an epidemiologist with the Center for Maternal and Child Health, Maryland Department of Health and Mental Hygiene in Baltimore. Dr. Hurt expressed her interest in “the effects of farm work on public health” in an interview with Medscape Public Health & Prevention.
Controlling pathogens like C jejuni at the farm level might help reduce risks for occupational exposure and address concerns regarding food-borne disease, conclude the investigators.
The work was supported in part by grants from the National Institute of Environmental Health Sciences. Dr. Davis and Ms. Hurt have disclosed no relevant financial relationships.
American Public Health Association (APHA) 137th Annual Meeting: Abstract 213221. Presented November 8, 2009.
Management
A Practical Approach to Diagnosis and Symptom Management. 4)
Caution
“Levofloxacin interacts with a number of other drugs, as well as a number of herbal and natural supplements. Such interactions increase the risk of cardiotoxicity and arrhythmias, anticoagulation, the formation of non-absorbable complexes, as well as increasing the risk of toxicity.[7]
Levofloxacin is associated with a number of serious and life-threatening adverse reactions as well as spontaneous tendon ruptures and irreversible peripheral neuropathy.
Such reactions may manifest long after therapy had been completed and in severe cases may result in life-long disabilities. Hepatoxicity has also been reported with the use of levofloxacin.” Wikipedia
Patient reports
The peripheral neuropathy that hospitalized me back in 2008 has been waxing and waning since I started the MP and is slooooooowwwwwwllly getting better. I still have a ways to go but I have also come a long way. Yomi 2012
Itching much better, but having a lot pf peripheral neuropathy in feet and hands, especially at night, when hands go numb and feet burn and prickle. Most annoying. Not sure if this is IP Kas 2013
Stabbing pains in my eye, various parts of my head, a feeling of an ant crawling over my skin; I never asked the doctor, but guess this is neuropathy. It is much reduced during my continued use of OlmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. , but not completely so. The fleeting stabs have mostly resolved. Sallie
From patient diary
sarc01 19 Feb 2008 The neuro involvement of my disease includes severe neuropathy of both legs starting at the knees and getting progressively worse on down through the toes. This pain is the reason I take the hydrocodone… most of the time all of my daily dose at once to fall asleep. If I accidentally fall asleep with my feet under the covers, I'll wake up about 45 minutes later with both feet on fire (burning sensations… both feet turn beet red) and won't sleep much for the rest of the night. This neuropathy involved all limbs, lower abdomen and even face for about 10 months in 1997… but, it gradually regressed and localized around the shins and feet… and has been there ever since. I mention this because last nights hand experience reminded me of when I had the neuropathy really bad in my hands.
26 Feb 2008 Unusual symptoms: periodic increases in neuropathy pain in the evenings, seem to line up with second day after taking in Mino… hard to truely associate as herx because nerve pain is always worst in the evening and calm when waking up as long as I don't fall asleep with the covers over my legs (then its huge pain). General feeling of well being is just better. Disease related symptoms: SOB (on exertion), skin nodules on shins (resolving), calves (resolving), thighs, hams, glutes, lower abdomen and arms (cutaneous and subcutaneous), neuropathy, fatigue, insomnia.
5 March 2008 Unusual symptoms: heightened neuropathy for three days straight (Thur-Sat) and swelling in feet, toes and ankles… seemed to get better on Sunday and continues to be moderate since Monday when I increased the Mino dose to 50mg. Feeling an increase in SOB and some wheezing. Disease related symptoms: SOB (on exertion), skin nodules on shins (resolving), calves (resolving), thighs, hams, glutes, lower abdomen and arms (cutaneous and subcutaneous), neuropathy, fatigue, insomnia.
18 March Unusual symptoms: continued heightened neuropathy and swelling in feet, toes and ankles… I'm more convinced this is herx because I haven't felt this much pain with it since we went to Disneyworld several years ago and walked around for about 8 hours two days in a row, plus in the heat, and in the sun
3 April 2008 Feet neuropathy is about an 8 on the off day and the night before I take the minocycline. I get the most sleep during the day after I take the mino, benicar and hydrocodone all at once… about 12 hours straight of solid sleep (yay).
26 April 2008 Another interesting symptom is that my leg neuropathy has been its most intense and constant as I can remember… I'd rate it a 9.
6 May 2008 some improvement in neuropathy and swelling in feet, toes and ankles. Night time circulation issues. The benicar really hasn't done much to alleviate the neuropathy symptoms (even when I accidentally took like 4 benicar 40s at once)… so, I've just been dealing with it… it is something I've had to work through for years and years anyway.
11 May 2008 New and unique cold/flu style symptoms over the past 3 days that has exasperated the neuropathy and swelling in feet, toes and ankles. Malaise, blocking sinus congestion, dry cough, and sore throat. Seems this could be a different flavor of herx, but my wife also has the same symptoms, so I think we have picked up another bug… it is also causing the neuropathy in my hands (which, in the past, has been relatively minimal) to become irritating.
January 2009 Neuropathy (shins, feet, toes, hands) - 7
March 2009 Neuropathy (shins, feet, toes, hands) - 6
February 2010 Neuropathy (shins, feet, toes, hands) - 6 rating stays down to 6 but “My peripheral nerve symptoms are still severe enough to keep me disabled and my battle with neuralgia induced insomnia continues”
September 2010
Unfortunately patient reported need to discontinue MP and resume steroids because breathing difficulty prevented sleep
Patient interviews
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chronic borreliosis (“Lyme”), multiple chemical sensitivities, chronic spinal inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue., peripheral neuropathy
Read the interview
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Interviews of patients with other diseases are also available.
2)
. Peripheral Neuropathy and Nerve Compression Syndromes in Burns. Clin Plast Surg. 2017 Oct;44(4):793-803. doi: 10.1016/j.cps.2017.05.010. Epub 2017 Jul 21.
[PMID: 28888304] [PMCID: 5674779] [DOI: 10.1016/j.cps.2017.05.010]
[PMID: 28888304] [PMCID: 5674779] [DOI: 10.1016/j.cps.2017.05.010]
3)
. B Vitamin Complex and Chemotherapy-Induced Peripheral Neuropathy. Curr Oncol Rep. 2017 Oct 5;19(12):76. doi: 10.1007/s11912-017-0636-z.
[PMID: 28983799] [DOI: 10.1007/s11912-017-0636-z]
[PMID: 28983799] [DOI: 10.1007/s11912-017-0636-z]
4)
. Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. Mayo Clin Proc. 2015 Jul;90(7):940-51. doi: 10.1016/j.mayocp.2015.05.004.
[PMID: 26141332] [DOI: 10.1016/j.mayocp.2015.05.004]
[PMID: 26141332] [DOI: 10.1016/j.mayocp.2015.05.004]