Infections and secondary inflammatory changes play an important role in spine pathology leading to myelopathy or myelitis. To achieve optimal clinical outcomes and accurate prognosis, physicians must promptly recognize these disorders. This review provides a contemporary overview of the major pathogens known to cause myelopathic symptoms and focuses on unique clinical syndromes and signs to aid the differential diagnosis and further workup. This article will help neurologists to consider infectious etiologies during the initial evaluation of patients with myelopathic symptoms.
The spectrum of neurologic infectious diseases is ever evolving because of immigration and travel, aggressive antibiotic use, vaccinations, and effective antiretroviral therapies. One example of this is illustrated by the enteroviruses. Poliovirus is an enterovirus that causes an acute flaccid paralysis but can be prevented by vaccination. A different enterovirus, enterovirus 71, is increasingly reported as the etiologic agent of acute flaccid paralysis similar in presentation to poliomyelitis. This review recognizes the shifting spectrum of infections in immunocompromised hosts, including patients with HIV in the era of effective antiretroviral therapy. It outlines unique features of primary HIV complications as well as closely associated infections, such as tuberculosis, syphilis, and varicella-zoster virus. Finally, each section of this article outlines molecular and immunologic tools that are becoming paramount for effective and rapid diagnosis of the pathogens.
This article offers a basic review and definitions pertinent to myelopathic processes. Parainfectious, viral, bacterial, parasitic, and fungal infections are discussed. Each section offers clinical descriptions, pathophysiologic mechanisms, diagnostic strategies, and an approach to treatment and prognosis. Clinical vignettes describe clinical presentations and imaging findings of prototype disorders leading to myelopathy.
Address correspondence to Dr Tracey Cho, MGH Neurology, 55 Fruit St, Boston, MA 02114, http://ovidsp.tx.ovid.com/sp-3.27.1a/ovidweb.cgi?&S=MADPFPBGABDDEPILNCFKAFJCFCAPAA00&WebLinkReturn=Full+Text%3dL%7cS.sh.20534_1510710796_2.20534_1510710796_14.20534_1510710796_22.20534_1510710796_212.20534_1510710796_215.20534_1510710796_220.20534_1510710796_268%7c0%7c0132979-201212000-00012&Full+Text+External+Link=mailto%3atracey.cho%26%2364%3bpost.harvard.edu.
Relationship Disclosure: Dr Cho serves as a neurology consultant and on a clinical review committee for OptumInsight/UnitedHealth Group for a postmarketing safety study. Dr Cho has served as a guest editor for Seminars in Neurology. Dr Vaitkevicius reports no disclosure.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Cho and Vaitkevicius discuss the unlabeled, anecdotal use of IV immunoglobulin, cyclophosphamide, rituximab, and corticosteroids as potential adjunct treatments for infectious myelopathies.