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Immunological disturbance and infectious disease in anorexia nervosa: a review

Published online by Cambridge University Press:  24 June 2014

Rhonda F. Brown ,
Roger Bartrop  and
C. Laird Birmingham
Rhonda F. Brown*
Affiliation:
School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia
Roger Bartrop
Affiliation:
Department of Psychological Medicine, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
C. Laird Birmingham
Affiliation:
Eating Disorders Program, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
*
Dr Rhonda F. Brown, School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale NSW 2351, Australia. Tel: 02-6773 2410; Fax: 02-6773 3820; E-mail: [email protected]
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Abstract

Objective:

Severely malnourished patients with anorexia nervosa (AN) are reported to show fewer symptomatic viral infections and a poorer response to bacterial infection than controls. They are also reported to show mild immune system changes, although the relevance of these to altered infection disease presentation in AN and AN pathophysiology is unknown. Thus, in this paper, we suggest a range of immune system changes that might underpin these altered responses to common pathogens, and review a number of recent infectious disease findings for their utility in explaining the pathophysiology of AN.

Methods:

A systematic review of the literature pertaining to immunity and infectious disease in AN was performed.

Results:

AN is associated with leucopenia, and the increased spontaneous and stimulated levels of proinflammatory cytokines [i.e. interleukin (IL)-1β, IL-6 and tumour necrosis factor α). A range of less consistent findings are also reviewed. Most of these data were not controlled for length of illness, degree of malnutrition, micronutrient or vitamin deficiencies or recent refeeding and starvation.

Conclusion:

Cytokine disturbances have been suggested to be causally related to AN symptomatology and pathophysiology of AN, although the evidence supporting this assertion is lacking. Immune and cytokine changes in AN do, however, occur in association with a decreased incidence of symptomatic viral infection, decreased clinical response to bacterial infection leading to delayed diagnosis and increased morbidity and mortality associated with the infections.

Keywords

anorexia nervosaimmuneinfectious diseaseproinflammatory cytokines
Type
Review article
Information
Acta Neuropsychiatrica , Volume 20 , Issue 3 , June 2008 , pp. 117 - 128
Copyright
Copyright © 2008 Blackwell Munksgaard

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