The postpolio syndrome: No evidence for poliovirus persistence

Abstract

To investigate the possibility of poliovirus persistence in patients with the postpolio syndrome, we examined skeletal muscle biopsy specimens, cerebrospinal fluid specimens, and sera for the presence of poliovirus RNA by the polymerase chain reaction, and for IgM antibodies by a poliovirus type-specific IgM antibody-capture enzyme-linked immunosorbent assay. In none of these specimens was poliovirus RNA or a poliovirus type-specific IgM response detected. These results argue against the hypothesis that poliovirus persists in patients with the postpolio syndrome and plays a role in the pathogenesis of the postpolio syndrome.

Enterovirus infection of the central nervous system of humans: lack of association with chronic neurological disease

“…However, the serotype of viruses detected cannot be conclusively identified on the basis of nucleotide sequencing, due to the high genetic homology between different serotypes within the genomic region studied (Klump et al, 1990;Diedrich et al, 1995), and also because nucleotide sequence information is not yet available for all enterovirus serotypes. In contrast to our findings, an earlier study failed to detect enterovirus RNA by RT-PCR in CSF, skeletal muscle biopsies or serum from patients with a diagnosis of PPS (Melchers et al, 1992). However, the number of patients studied was small, and the difference between their findings and those presented here are not statistically significant.…”

Elevated serum inflammatory markers in post-poliomyelitis syndrome

“…While not active or having a direct ability to cause PPS symptoms due to restrained RNA synthesis and lack of evidence for direct toxicity, these poliovirus genomic particles have the potential to induce the production of cytokines, such as TNFα, and thereby contribute to gradually worsening chronic inflammation [35]. Other groups have not found evidence for poliovirus persistence [36,37]. This has led to other hypotheses for persistently elevated cytokines to include a poliovirus-induced autoimmune response directed against as of yet unknown neuronal or non-neuronal autoantigens, or an immune response that is completely secondary to CNS damage [10].…”

Late Post-Polio Functional Deterioration

“…There is undoubtedly an ongoing intrathecal antibody response to poliomyelitis -oligoclonal IgM bands specifi c to polio virus were detected in the CSF of 21/36 (58%) patients with postpolio syndrome but none of 67 controls (Sharief et al 1991). Once again the signifi cance of this fi nding is uncertain (Melchers et al 1992;Muir et al 1996).…”