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New Interdisciplinary Neuroinfectious Disease Program to Improve Patient Care
Northwestern Medicine is proud to welcome Igor Koralnik MD, FAAN, FANA, as the chief of the new Division of Neuroinfectious Disease and Global Neurology. In this episode, Dr. Koralnik shares his research on the neurologic complications of HIV and JC virus and discusses the new Neuroinfectious Disease Program, a unique program that provides comprehensive care for patients who have acute and chronic neurological infections.
Featured Speaker:
Koralnik also created a global neurology research program in Lusaka, Zambia, where he and his colleagues are studying opportunistic nervous system infections, tuberculous meningitis and new onset seizures in patients with HIV. He previously served as chief of the Section of Neuroinfectious Diseases at Rush University Medical Center and chief of the Neuroimmunology Division at Beth Israel Medical Center at Harvard Medical School.
Learn more about Igor Koralnik, MD
Igor Koralnik, MD
Northwestern Medicine is proud to welcome Igor Koralnik MD, FAAN, FANA, as the chief of the new Division of Neuroinfectious Disease and Global Neurology within the Department of Neurology. Koralnik is an internationally recognized expert in the management of neurological complications of human immunodeficiency virus (HIV) and infections affecting the nervous system. He is a leading researcher in the investigation of polyomavirus JC (JC virus), the causative agent of progressive multifocal leukoencephalopathy (PML).Koralnik also created a global neurology research program in Lusaka, Zambia, where he and his colleagues are studying opportunistic nervous system infections, tuberculous meningitis and new onset seizures in patients with HIV. He previously served as chief of the Section of Neuroinfectious Diseases at Rush University Medical Center and chief of the Neuroimmunology Division at Beth Israel Medical Center at Harvard Medical School.
Learn more about Igor Koralnik, MD
Transcription:
New Interdisciplinary Neuroinfectious Disease Program to Improve Patient Care
Melanie Cole (Host): Northwestern Medicine is proud to welcome Dr. Igor Koralnik as the chief of the new division of Neuroinfectious Disease and Global Neurology. Dr. Koralnik is joining us today to talk about the new Neuroinfectious Disease Program, a unique program that provides comprehensive care for patients who have acute and chronic neurological infections. Dr. Koralnik, it’s such a pleasure to have you with us. You were one of the first physicians to study the neurologic complications of HIV/AIDS. What kind of neurological problems does HIV cause?
Igor Koralnik, MD (Guest): So, Melanie, first, thank you for inviting me on this podcast. I’m thrilled. This is my first week at Northwestern in the Department of Neurology. So, I was interested in neurological complications of HIV since the beginning of the AIDS epidemic when I was a student in medicine. So, HIV can cause complications in the nervous system directly by affecting the brain and cause some cognitive problems that can go all the way to dementia. HIV can affect directly the spinal cord causing a myelopathy, and HIV can also attack the peripheral nerves causing different type of painful neuropathies. In addition, HIV causes AIDS, which leads to profound immunosuppression in patients, and associated with AIDS, you have opportunistic infection or infections that would not occur in healthy people and tumors that can also affect the central and peripheral nervous system. So, it’s a very complex presentation that HIV brings to the nervous system.
Host: Well, it certainly is and thank you for that explanation. Tell us about your research on JC virus and PML.
Dr. Koralnik: Certainly. So, JC virus was named according to the initials of a patient. It’s a benign polyomavirus that affects you and I without causing any disease. It’s latent in the kidney. Doesn’t cause any problem in healthy people, but in the setting of immunosuppression, including patients with HIV and AIDS, but also patients with cancer, transplant recipients, or patients on immunosuppressive medication for autoimmune disease, the virus can reactivate, go to the brain, and destroy cells in the central nervous system called oligodendrocytes, which are responsible to produce the white matter, or myelin. So, it’s a demyelinating disease of the nervous system called Progressive Multifocal Leukoencephalopathy, or PML. So, in addition to PML, our research has shown the JC virus with certain mutation, or variant, can also infect other cells in the nervous system including neurons in the cerebellum, causing cerebellar atrophy or cortical pyramidal neurons in the gray matter causing an encephalopathy, and even infection of the meningeal cells and choroid plexus cells causing meningitis.
Host: Wow, it’s really comprehensive. Dr. Koralnik, tell us a little bit more about the Neuroinfectious Disease Program at Northwestern Medicine. What’s your vision for this new program, and what will it offer as you’re telling us about this amazing research? Tell us what your vision is for this program.
Dr. Koralnik: Sure. So, we are very excited to start this unique clinic in the Neurology Department at Northwestern in close collaboration with [the] Infectious Disease division. So, we will provide comprehensive care for any patients presenting with complication of infectious disease affecting the nervous system. So, these could be caused by viruses, bacteria, fungi, parasites. Peak patients traveling in Africa, for example, could be at risk of developing those complications, but also, patient here in the US, and this would include neurological health complication of Lyme Disease or West Nile Virus or syphilis for example, and so we will be seeing those patients in outpatient clinic at Northwestern and participate to their diagnosis, treatment, and rehabilitation in conjunction with other members of Northwestern Medicine.
Host: Well, as you’ve described this program, what makes it so unique, and how will it change the way patients receive care for neuroinfectious diseases, and tell us a little bit about the multidisciplinary aspect of the program?
Dr. Koralnik: Sure. So, at this point in time, I have been in this field for the past 20 some years and developed collaborations with other fields that have taken care of those patients including the cancer providers, rheumatologists, and the transplant surgeons, for example, and so we will be able to take care of these patients in conjunction with their primary providers.
Host: You’re heavily involved, Dr. Koralnik, in global health initiatives. In fact, just last year, you helped launch the first Neurology training program in Zambia. Tell us more about the need for programs like this and your goals.
Dr. Koralnik: Sure. So, today is actually the Global Health Day at Northwestern, and we have recently started a new Global Health Institute at Northwestern as well. So, we have been active in Lusaka, Zambia’s capital since 2010, when some of my mentees have been there living full-time on the ground providing care—neurological care—for Zambian patients. Prior to that, there was only one neurologist for the entire country of Zambia. It is the size of Texas, and so we are doing also research on those neurological complications of HIV infection, including new-onset seizures, TB meningitis, opportunistic infections of the brain, and in 2018, a group of young US faculty who are now forming a consortium of neurologists in Zambia have started the first residency training program, and the current class of three adult and two pediatric neurologists in Zambia are being trained and will graduate in two years.
Host: Well, that is amazing. What a great global health initiative that you’re involved in, Dr. Koralnik. Why for neuroinfectious diseases is a continuum of care so important for success as you are embarking on this program and following patients? Tell us a little bit about that continuum of care—why it’s so important.
Dr. Koralnik: It’s important because infectious disease affect the nervous system in ways that are very debilitating, and so, for example, if patients have infection—meningitis, encephalitis—and then they are completely impaired, they are not able to function in their work situation. They’re not able to take their other medications. It unravels the social fabric of the family, and it is very important to take care of those patients, in that sense. In countries like Africa, there’s a certain—I mean in certain countries in Africa there is this stigma, for example, in patients developing seizures and that prevents also their access to care. So, I think that the continuum of care is extremely important in that setting both in the global sphere and in the US.
Host: Well, thank you for that answer. So, what’s next when it comes to this area of study, doctor? What would you like other providers to know about your research or referring patients to Northwestern, engaging in global health activities? Give us a wrap up or a summary.
Dr. Koralnik: Sure. So, we are delighted to be part of the Northwestern community. In addition to taking care of patients in the clinic, I have an active basic science laboratory here at Northwestern. We are conducting studies on the entire virome—all species of virus known to infect humans. We have developed as assay called a Viral Find to find those viruses—561 species of virus—can be detected in one clinical sample with a single assay, and we’re interested to understand the implication of the entire virome in neurological disease, not only in infectious disease such as meningitis, encephalitis, but also in inflammatory disease or common disease like multiple sclerosis as well as in degenerative disease, such as Alzheimer’s, ALS, Parkinson’s, and others. So, we’re happy to bring cutting-edge science together with our clinical abilities to the service of [the] Northwestern community and all the patients in the Chicago area.
Host: Well, that’s truly a far-reaching effect when you mention all of those different conditions and disease states that can be affected neurologically and how the research can really affect them all. Thank you so much for all the great work that you’re doing, Dr. Koralnik, and thank you so much for joining us today on this podcast. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates, please follow us on your social channels. I’m Melanie Cole.
New Interdisciplinary Neuroinfectious Disease Program to Improve Patient Care
Melanie Cole (Host): Northwestern Medicine is proud to welcome Dr. Igor Koralnik as the chief of the new division of Neuroinfectious Disease and Global Neurology. Dr. Koralnik is joining us today to talk about the new Neuroinfectious Disease Program, a unique program that provides comprehensive care for patients who have acute and chronic neurological infections. Dr. Koralnik, it’s such a pleasure to have you with us. You were one of the first physicians to study the neurologic complications of HIV/AIDS. What kind of neurological problems does HIV cause?
Igor Koralnik, MD (Guest): So, Melanie, first, thank you for inviting me on this podcast. I’m thrilled. This is my first week at Northwestern in the Department of Neurology. So, I was interested in neurological complications of HIV since the beginning of the AIDS epidemic when I was a student in medicine. So, HIV can cause complications in the nervous system directly by affecting the brain and cause some cognitive problems that can go all the way to dementia. HIV can affect directly the spinal cord causing a myelopathy, and HIV can also attack the peripheral nerves causing different type of painful neuropathies. In addition, HIV causes AIDS, which leads to profound immunosuppression in patients, and associated with AIDS, you have opportunistic infection or infections that would not occur in healthy people and tumors that can also affect the central and peripheral nervous system. So, it’s a very complex presentation that HIV brings to the nervous system.
Host: Well, it certainly is and thank you for that explanation. Tell us about your research on JC virus and PML.
Dr. Koralnik: Certainly. So, JC virus was named according to the initials of a patient. It’s a benign polyomavirus that affects you and I without causing any disease. It’s latent in the kidney. Doesn’t cause any problem in healthy people, but in the setting of immunosuppression, including patients with HIV and AIDS, but also patients with cancer, transplant recipients, or patients on immunosuppressive medication for autoimmune disease, the virus can reactivate, go to the brain, and destroy cells in the central nervous system called oligodendrocytes, which are responsible to produce the white matter, or myelin. So, it’s a demyelinating disease of the nervous system called Progressive Multifocal Leukoencephalopathy, or PML. So, in addition to PML, our research has shown the JC virus with certain mutation, or variant, can also infect other cells in the nervous system including neurons in the cerebellum, causing cerebellar atrophy or cortical pyramidal neurons in the gray matter causing an encephalopathy, and even infection of the meningeal cells and choroid plexus cells causing meningitis.
Host: Wow, it’s really comprehensive. Dr. Koralnik, tell us a little bit more about the Neuroinfectious Disease Program at Northwestern Medicine. What’s your vision for this new program, and what will it offer as you’re telling us about this amazing research? Tell us what your vision is for this program.
Dr. Koralnik: Sure. So, we are very excited to start this unique clinic in the Neurology Department at Northwestern in close collaboration with [the] Infectious Disease division. So, we will provide comprehensive care for any patients presenting with complication of infectious disease affecting the nervous system. So, these could be caused by viruses, bacteria, fungi, parasites. Peak patients traveling in Africa, for example, could be at risk of developing those complications, but also, patient here in the US, and this would include neurological health complication of Lyme Disease or West Nile Virus or syphilis for example, and so we will be seeing those patients in outpatient clinic at Northwestern and participate to their diagnosis, treatment, and rehabilitation in conjunction with other members of Northwestern Medicine.
Host: Well, as you’ve described this program, what makes it so unique, and how will it change the way patients receive care for neuroinfectious diseases, and tell us a little bit about the multidisciplinary aspect of the program?
Dr. Koralnik: Sure. So, at this point in time, I have been in this field for the past 20 some years and developed collaborations with other fields that have taken care of those patients including the cancer providers, rheumatologists, and the transplant surgeons, for example, and so we will be able to take care of these patients in conjunction with their primary providers.
Host: You’re heavily involved, Dr. Koralnik, in global health initiatives. In fact, just last year, you helped launch the first Neurology training program in Zambia. Tell us more about the need for programs like this and your goals.
Dr. Koralnik: Sure. So, today is actually the Global Health Day at Northwestern, and we have recently started a new Global Health Institute at Northwestern as well. So, we have been active in Lusaka, Zambia’s capital since 2010, when some of my mentees have been there living full-time on the ground providing care—neurological care—for Zambian patients. Prior to that, there was only one neurologist for the entire country of Zambia. It is the size of Texas, and so we are doing also research on those neurological complications of HIV infection, including new-onset seizures, TB meningitis, opportunistic infections of the brain, and in 2018, a group of young US faculty who are now forming a consortium of neurologists in Zambia have started the first residency training program, and the current class of three adult and two pediatric neurologists in Zambia are being trained and will graduate in two years.
Host: Well, that is amazing. What a great global health initiative that you’re involved in, Dr. Koralnik. Why for neuroinfectious diseases is a continuum of care so important for success as you are embarking on this program and following patients? Tell us a little bit about that continuum of care—why it’s so important.
Dr. Koralnik: It’s important because infectious disease affect the nervous system in ways that are very debilitating, and so, for example, if patients have infection—meningitis, encephalitis—and then they are completely impaired, they are not able to function in their work situation. They’re not able to take their other medications. It unravels the social fabric of the family, and it is very important to take care of those patients, in that sense. In countries like Africa, there’s a certain—I mean in certain countries in Africa there is this stigma, for example, in patients developing seizures and that prevents also their access to care. So, I think that the continuum of care is extremely important in that setting both in the global sphere and in the US.
Host: Well, thank you for that answer. So, what’s next when it comes to this area of study, doctor? What would you like other providers to know about your research or referring patients to Northwestern, engaging in global health activities? Give us a wrap up or a summary.
Dr. Koralnik: Sure. So, we are delighted to be part of the Northwestern community. In addition to taking care of patients in the clinic, I have an active basic science laboratory here at Northwestern. We are conducting studies on the entire virome—all species of virus known to infect humans. We have developed as assay called a Viral Find to find those viruses—561 species of virus—can be detected in one clinical sample with a single assay, and we’re interested to understand the implication of the entire virome in neurological disease, not only in infectious disease such as meningitis, encephalitis, but also in inflammatory disease or common disease like multiple sclerosis as well as in degenerative disease, such as Alzheimer’s, ALS, Parkinson’s, and others. So, we’re happy to bring cutting-edge science together with our clinical abilities to the service of [the] Northwestern community and all the patients in the Chicago area.
Host: Well, that’s truly a far-reaching effect when you mention all of those different conditions and disease states that can be affected neurologically and how the research can really affect them all. Thank you so much for all the great work that you’re doing, Dr. Koralnik, and thank you so much for joining us today on this podcast. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates, please follow us on your social channels. I’m Melanie Cole.