Small Nerve Fiber Pathology in Critical Illness

Nicola Latronico, Massimiliano Filosto, Nazzareno Fagoni, Laura Gheza, Bruno Guarneri, Alice Todeschini, Raffaella Lombardi, Alessandro Padovani, Giuseppe Lauria

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background:Degeneration of intraepidermal nerve fibers (IENF) is a hallmark of small fiber neuropathy of different etiology, whose clinical picture is dominated by neuropathic pain. It is unknown if critical illness can affect IENF.Methods:We enrolled 14 adult neurocritical care patients with prolonged intensive care unit (ICU) stay and artificial ventilation (≥ 3 days), and no previous history or risk factors for neuromuscular disease. All patients underwent neurological examination including evaluation of consciousness, sensory functions, muscle strength, nerve conduction study and needle electromyography, autonomic dysfunction using the finger wrinkling test, and skin biopsy for quantification of IENF and sweat gland innervation density during ICU stay and at follow-up visit. Development of infection, sepsis and multiple organ failure was recorded throughout the ICU stay.Results:Of the 14 patients recruited, 13 (93%) had infections, sepsis or multiple organ failure. All had severe and non-length dependent loss of IENF. Sweat gland innervation was reduced in all except one patient. Of the 7 patients available for follow-up visit, three complained of diffuse sensory loss and burning pain, and another three showed clinical dysautonomia.Conclusions:Small fiber pathology can develop in the acute phase of critical illness and may explain chronic sensory impairment and pain in neurocritical care survivors. Its impact on long term disability warrants further studies involving also non-neurologic critical care patients.

Original languageEnglish
Article numbere75696
JournalPLoS One
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 30 2013

Fingerprint

nerve fibers
Pathology
Nerve Fibers
Critical Illness
sweat glands
pain
Intensive care units
sepsis (infection)
patient care
Fibers
Intensive Care Units
innervation
Sweat Glands
Multiple Organ Failure
dysautonomia
neuromuscular disorders
Sepsis
muscle strength
electromyography
peripheral nervous system diseases

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Latronico, N., Filosto, M., Fagoni, N., Gheza, L., Guarneri, B., Todeschini, A., ... Lauria, G. (2013). Small Nerve Fiber Pathology in Critical Illness. PLoS One, 8(9), [e75696]. https://doi.org/10.1371/journal.pone.0075696

Small Nerve Fiber Pathology in Critical Illness. / Latronico, Nicola; Filosto, Massimiliano; Fagoni, Nazzareno; Gheza, Laura; Guarneri, Bruno; Todeschini, Alice; Lombardi, Raffaella; Padovani, Alessandro; Lauria, Giuseppe.

In: PLoS One, Vol. 8, No. 9, e75696, 30.09.2013.

Research output: Contribution to journalArticle

Latronico, N, Filosto, M, Fagoni, N, Gheza, L, Guarneri, B, Todeschini, A, Lombardi, R, Padovani, A & Lauria, G 2013, 'Small Nerve Fiber Pathology in Critical Illness', PLoS One, vol. 8, no. 9, e75696. https://doi.org/10.1371/journal.pone.0075696
Latronico N, Filosto M, Fagoni N, Gheza L, Guarneri B, Todeschini A et al. Small Nerve Fiber Pathology in Critical Illness. PLoS One. 2013 Sep 30;8(9). e75696. https://doi.org/10.1371/journal.pone.0075696
Latronico, Nicola ; Filosto, Massimiliano ; Fagoni, Nazzareno ; Gheza, Laura ; Guarneri, Bruno ; Todeschini, Alice ; Lombardi, Raffaella ; Padovani, Alessandro ; Lauria, Giuseppe. / Small Nerve Fiber Pathology in Critical Illness. In: PLoS One. 2013 ; Vol. 8, No. 9.
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