Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 4, Number 1—March 1998
Letter

Infectious Diseases and Mental Illness: Is There a Link?

On This Page
Article Metrics
7
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: The report by Hatalski et al. (1) on Borna virus as a probable human pathogen provides yet another example of an infectious agent being tentatively associated with neuropsychiatric disorders. Earlier this year, researchers at Rockefeller University and the National Institute of Mental Health suggested that after streptococcal infection, some children may be at increased risk for obsessive-compulsive disorders and Tourette syndrome (2). The human B-cell antigen D8/17, believed to be a marker for increased susceptibility to poststreptococcal rheumatic heart disease, has been tentatively linked to this increased risk for psychiatric illness in children. Other reports of patients with complicated Lyme borreliosis, including some whose infections have progressed to encephalopathies, describe persistent verbal and memory deficits among these patients (3). In a few Lyme disease patients, the only overt symptoms of disease at the time of initial diagnosis and treatment were classified as mental confusion (4). Two newly emergent infectious diseases in the United States, leptospirosis and neurocysticercosis, have been found among inner city residents and poor immigrants, respectively. Occasionally leptospirosis has been associated with a variety of postinfectious psychiatric symptoms, including depression, dementia, and psychosis (5). Neurocysticercosis, a tropical parasitic infection, is increasingly associated with emergency room admissions for seizures and epilepsy (6). Still other infectious diseases are being examined for links with cognitive symptoms and emotional disorders.

The primary cause of many common psychiatric disorders, including depression, manic depression, anxiety, and schizophrenia, remains a mystery. The World Health Organization estimates that 1.5 billion people worldwide suffer from a neuropsychiatric disorder. Of the 10 leading causes of disability in 1990, four were psychiatric disorders: unipolar depression, manic depression, schizophrenia, and obsessive-compulsive disorders (7). The National Institute of Mental Health recently estimated that as many as 20% of young Americans ages 7 to 14 approximately 10 million children have mental health problems severe enough to compromise their ability to function (8). Infectious agents may play a role in some of these diseases to some unknown degree. A better understanding of the role of infection may speed treatment and prevention efforts and reduce the degree of disability and stigma associated with mental illness.

Vaccines and antimicrobial agents might enhance current therapeutic options for mental illnesses. Even if infectious diseases were a primary factor in only 1% of neuropsychiatric illnesses, some 10 million persons might benefit from antimicrobial therapies. Identifying those susceptible to neuropsychiatric illnesses (because of environmental factors or genetic predisposition) may also permit vaccination or antimicrobial prophylaxis and a subsequent lowering of disease incidence.

Physicians and federal agencies addressing the problems of emerging infectious diseases should examine the possibility of infection as a cause of mental illness. Better communication among infectious disease and mental health experts, as well as additional training, will be needed to shed light on the growing phenomenon of infectious diseases manifesting themselves as neuropsychiatric disorders.

Top

Edward McSweegan
Author affiliation: National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA

Top

References

  1. Hatalski  CG, Lewis  AJ, Lipkin  WI. Borna disease. Emerg Infect Dis. 1997;3:12935. DOIPubMedGoogle Scholar
  2. Swedo  SE, Leonard  HL, Mittleman  BB, Allen  AJ, Rapoport  JL, Dow  SP, Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry. 1997;154:1102.PubMedGoogle Scholar
  3. Benke  T, Gasse  T, Hittmair-Delazer  M, Schmutzhard  E. Lyme encephalopathy: long-term neuropsychological deficits years after acute neuroborreliosis. Acta Neurol Scand. 1995;91:3537. DOIPubMedGoogle Scholar
  4. Fallon  BA, Nields  JA. Lyme disease: a neuropsychiatric illness. Am J Psychiatry. 1994;151:157183.PubMedGoogle Scholar
  5. Mumford  C, Dudley  N, Terry  H. Leptospirosis presenting as a flaccid paraplegia. Postgrad Med J. 1990;66:21820. DOIPubMedGoogle Scholar
  6. Garcia  H, Tsang  V, Gonzalez  A, Gilman  R. Cysticercosis in the U.S. and Peru. Presented at the 6th Annual National Institutes of Health International Centers for Tropical Disease Research Meeting; 1997 May 5-7; Bethesda, Maryland.
  7. World Health Organization. The global burden of disease [cited 1998 Jan 5]; [2 screens]. Available from URL: http://www.who.ch/programmes/mnh/msamain.htm
  8. Children's mental health research severely neglected, says National Institute of Mental Health Director. Washington Fax [serial online] 1997 Apr 8 [cited 1998 Jan 5]. Available from URL: http://www.washington-fax.com

Top

Cite This Article

DOI: 10.3201/eid0401.980118

CrossRef reports the first page should be "139" not "129" in the reference 1 "Hatalski, Lewis, Lipkin, 1997".

Related Links

Top

Table of Contents – Volume 4, Number 1—March 1998

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Page created: December 13, 2010
Page updated: December 13, 2010
Page reviewed: December 13, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external