Neuroinfectious Disease

October 2018, Volume 24, Issue 5
BROWSE ISSUE

Neuroinfectious Disease

October 2018, Vol.24, No.5

Guest Editor:

Joseph R. Zunt, MD, MPH

Editor-in-Chief:

STEVEN L. LEWIS, MD, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
Acute Bacterial Meningitis
Davis, Larry E.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1264-1283
doi: 10.1212/CON.0000000000000660
Viral Meningitis and Encephalitis
Lyons, Jennifer L.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1284-1297
doi: 10.1212/CON.0000000000000650
Chronic Meningitis
Thakur, Kiran T.; Wilson, Michael R.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1298-1326
doi: 10.1212/CON.0000000000000664
Brain and Spinal Epidural Abscess
Chow, Felicia
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1327-1348
doi: 10.1212/CON.0000000000000649
Herpesvirus Infections of the Nervous System
Baldwin, Kelly J.; Cummings, Christopher L.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1349-1369
doi: 10.1212/CON.0000000000000661
Central Nervous System Infections Complicating Immunosuppression and Transplantation
Pruitt, Amy A.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1370-1396
doi: 10.1212/CON.0000000000000653
Neurologic Complications of Human Immunodeficiency Virus Infection
Saylor, Deanna
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1397-1421
doi: 10.1212/CON.0000000000000647
Tuberculosis of the Central Nervous System
Zunt, Joseph R.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1422-1438
doi: 10.1212/CON.0000000000000648
Neuroborreliosis and Neurosyphilis
Halperin, John J.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1439-1458
doi: 10.1212/CON.0000000000000645
Tetanus, Botulism, and Diphtheria
Berkowitz, Aaron L.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1459-1488
doi: 10.1212/CON.0000000000000651
Helminthic Infections of the Central Nervous System
Cho, Tracey A.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1489-1511
doi: 10.1212/CON.0000000000000646
Zika Virus and Other Emerging Arboviral Central Nervous System Infections
Sejvar, James J.
CONTINUUM: Lifelong Learning in Neurology
October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - p 1512-1534
doi: 10.1212/CON.0000000000000652
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology October 2018 - Volume 24 - Issue 5, Neuroinfectious Disease - [no page #] doi: 10.1212/01.CON.0000547180.64440.7a

Issue Overview

Neuroinfectious Disease, Volume 24, Issue 5, October 2018

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Neuroinfectious Disease issue, participants will be able to:

  • Discuss the declining incidence of acute bacterial meningitis in developed and developing countries because of widespread use of certain vaccines; diagnose and manage community-acquired and nosocomial bacterial meningitis at different ages; and review the indications and risks of lumbar puncture
  • Describe the basic pathophysiology and clinical features of common viral causes of encephalitis and meningitis
  • Develop a clinical approach to the diagnosis and management of chronic meningitis and identify the infectious and noninfectious etiologies of chronic meningitis
  • Discuss the clinical presentation, evaluation, and management of brain and spinal epidural abscess
  • Discuss the pathophysiology, epidemiology, clinical presentations, diagnostic investigations, imaging characteristics, and management of herpesvirus infections of the nervous system
  • Describe clinical and imaging patterns of bacterial, viral, and fungal infections specific to patients who are immunocompromised; choose appropriate diagnostic testing for rapid and accurate diagnosis; initiate appropriate management; and differentiate noninfectious conditions that can mimic central nervous system infection
  • Describe common neurologic complications of human immunodeficiency virus (HIV), the clinical scenarios in which they are most likely to occur, and the approach to diagnosis and management of these conditions
  • Develop a diagnostic approach for tuberculosis infection of the central nervous system, identify when to have a high level of suspicion for it, and recognize the importance of working with experts in tuberculosis management to avoid complications and manage coinfections
  • Diagnose and treat neurologic involvement by Lyme disease and syphilis and discuss the similarities and differences between these spirochetal infections
  • Discuss the pathophysiology, epidemiology, clinical manifestations, diagnosis, and management of the bacterial toxin-related neurologic illnesses of tetanus, botulism, and diphtheric neuropathy
  • Order the appropriate diagnostic tests and provide initial treatment for common helminthic infections of the central nervous system
  • Describe the epidemiology, modes of transmission, and neurologic syndromes associated with Zika virus, West Nile virus, and Japanese encephalitis virus
  • Discuss the ethical and legal issues with regard to disclosing a patient’s human immunodeficiency virus (HIV) status to surrogate decision makers

Core Competencies

This Continuum: Lifelong Learning in Neurology Neuroinfectious Disease issue covers the following core competencies:

  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributors

Joseph R. Zunt, MD, MPH, Guest Editor

Professor, Departments of Neurology, Global Health, Epidemiology, and Medicine (Infectious Diseases), University of Washington, Seattle, Washington

Relationship Disclosure: Dr Zunt receives research/grant support from the National Institutes of Health (2D43 TW009345-06, 1D43TW009137-01A1, 1D43TW009375-01A1, 1D43TW009763- 01).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zunt reports no disclosure.

Kelly J. Baldwin, MD

Neurology Residency Program Director, Director Neuroinfectious Disease Program, Assistant Professor, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania

Relationship Disclosure: Dr Baldwin reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Baldwin discusses the unlabeled/investigational use of acyclovir, aloe vera, amitriptyline, controlled-release morphine, controlled-release oxycodone, diazepam, divalproex sodium, ganciclovir, foscarnet, levetiracetam, lidocaine, lorazepam, methylprednisolone, nortriptyline, oxcarbazepine, prednisone, tramadol, and trolamine salicylate for the treatment of herpesvirus infections.

Aaron L. Berkowitz, MD, PhD

Director, Global Neurology Program, Brigham and Women’s Hospital; Associate Professor of Neurology, Harvard Medical School, Boston, Massachusetts

Relationship Disclosure: Dr Berkowitz receives publishing royalties from McGraw-Hill Education, MedMaster Inc, and Oxford University Press.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Berkowitz reports no disclosure.

Tracey A. Cho, MD, FAAN

Clinical Associate Professor of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa

Relationship Disclosure: Dr Cho has received personal compensation as a consultant for Optum, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Cho discusses the unlabeled/investigational use of immunomodulatory medications including corticosteroids and oral steroid-sparing agents for the management of inflammation in neurocysticercosis and neuroschistosomiasis.

Felicia Chow, MD, MAS

Assistant Professor, Weill Institute for Neurosciences, Department of Neurology and Division of Infectious Diseases, University of California, San Francisco at Zuckerberg San Francisco General Hospital, San Francisco, California

Relationship Disclosure: Dr Chow has received personal compensation for speaking engagements from the University of California, San Francisco, for Recent Advances in Neurology and receives research/grant support from the National Institutes of Health (K23NS105575, R21TW010148).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Chow reports no disclosure.

Christopher L. Cummings, MD

Medical Stroke Director; Assistant Professor, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania

Relationship Disclosure: Dr Cummings reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Cummings discusses the unlabeled/investigational use of acyclovir, aloe vera, amitriptyline, controlled-release morphine, controlled-release oxycodone, diazepam, divalproex sodium, ganciclovir, foscarnet, levetiracetam, lidocaine, lorazepam, methylprednisolone, nortriptyline, oxcarbazepine, prednisone, tramadol, and trolamine salicylate for the treatment of herpesvirus infections.

Larry E. Davis, MD

Distinguished Professor of Neurology, University of New Mexico School of Medicine; Chief, Neurology Service, New Mexico VA Medical Center, Albuquerque, New Mexico

Relationship Disclosure: Dr Davis receives publishing royalties from Springer Science+Business Media, LLC.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Davis reports no disclosure.

John J. Halperin, MD, FAAN, FIDSA

Chair, Department of Neurosciences, Overlook Medical Center, Summit, New Jersey; Professor, Neurology and Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania

Relationship Disclosure: Dr Halperin serves on the editorial board of Neurology and has received personal compensation for serving as a section editor for Current Neurology and Neuroscience Reports and as a speaker for the American Academy of Neurology, Infectious Diseases Society of America, and University of Kansas Medical Center. Dr Halperin receives royalties from CABI and UpToDate, Inc and holds stock in Abbott Laboratories, AbbVie Inc, and Johnson & Johnson. Dr Halperin has given expert medical testimony in various medical malpractice cases related to Lyme disease.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Halperin reports no disclosure.

Joseph S. Kass, MD, JD, FAAN

Associate Dean, Office of Student Affairs; Professor of Neurology, Psychiatry, and Medical Ethics; Director, Alzheimer’s Disease and Memory Disorders Center, Baylor College of Medicine; Chief of Neurology, Ben Taub General Hospital, Houston, Texas

Relationship Disclosure: Dr Kass serves as associate editor of ethical and medicolegal issues for Continuum, as an associate editor for Continuum Audio, as a neurology section editor of Ferri’s Clinical Advisor for Elsevier, and as co-editor of Neurology Secrets, Sixth Edition. Dr Kass has received personal compensation for CME lectures from Pri-Med Medical Group and has received personal compensation as a medicolegal consultant in legal cases involving criminal proceedings, malpractice, and personal injury.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kass reports no disclosure.

Jennifer L. Lyons, MD

Associate Medical Director, Biogen, Inc, Boston, Massachusetts

Relationship Disclosure: Dr Lyons has provided expert medical testimony on herpes encephalitis.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lyons reports no disclosure.

Amy A. Pruitt, MD

Professor of Neurology, Vice Chair for Education, University of Pennsylvania, Philadelphia, Pennsylvania

Relationship Disclosure: Dr Pruitt serves on the editorial board of Neurology Clinical Practice.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Pruitt discusses therapies for the treatment of lymphoma arising from immunosuppression, none of which are approved by the US Food and Drug Administration.

Rachel V. Rose, JD, MBA

Attorney, Rachel V. Rose Attorney at Law PLLC; Affiliated Faculty, Baylor College of Medicine, Houston, Texas

Relationship Disclosure: Ms Rose serves on the editorial board of BC Advantage and receives book royalties from the American Bar Association.

Unlabeled Use of Products/Investigational Use Disclosure: Ms Rose reports no disclosure.

Deanna Saylor, MD, MHS

Assistant Professor of Neurology, Director, Johns Hopkins Global Neurology Program, Johns Hopkins University School of Medicine, Baltimore, Maryland; Honorary Lecturer, University of Zambia School of Medicine, Lusaka, Zambia

Relationship Disclosure: Dr Saylor receives research/grant support from the National Institutes of Health (P30MH07565673-11A1, R01 MH099733, NS081196091, P30AI094189- 01A1, L30 NS088658, R25 NS065729-05S2, R25 MH080661-08), Sara’s Wish Foundation, and the United States Department of State (Fulbright Scholar Award).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Saylor discusses recent or ongoing clinical trials of intranasal insulin, maraviroc, and paroxetine for treatment of human immunodeficiency virus–associated neurocognitive disorder and the off-label use of interleukin-7, mirtazapine, and topotecan for the treatment of progressive multifocal leukoencephalopathy.

James J. Sejvar, MD

Neuroepidemiologist, Centers for Disease Control and Prevention, Atlanta, Georgia

Relationship Disclosure: Dr Sejvar is an employee of the Centers for Disease Control and Prevention.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Sejvar reports no disclosure.

Kiran T. Thakur, MD

Winifred Mercer Pitkin, MD Assistant Professor of Neurology, Codirector, Community and Global Neurology Program, Columbia University Medical Center, New York, New York

Relationship Disclosure: Dr Thakur receives research/grant support from the National Institutes of Health (K23NS105935).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Thakur reports no disclosure.

Michael R. Wilson, MD, MAS

Assistant Professor, of Neurology, Debbie and Andy Rachleff Distinguished Professor of Neurology, University of California, San Francisco, Weill Institute for Neurosciences, San Francisco California

Relationship Disclosure: Dr Wilson receives research/grant support from Genentech, Inc, and the National Institute of Neurological Disorders and Stroke (K08NS096117).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wilson reports no disclosure.

Self-Assessment and CME Test Writers

Douglas J. Gelb, MD, PhD, FAAN

Professor of Neurology, University of Michigan, Ann Arbor, Michigan

Relationship Disclosure: Dr Gelb receives royalties from MedLink, Oxford University Press, and UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.

Allyson R. Zazulia, MD

Professor of Neurology and Radiology, Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri

Relationship Disclosure: Dr Zazulia reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings. For detailed instructions regarding Continuum CME and self-assessment activities, visit continpub.com/CME.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

© 2018 American Academy of Neurology