This issue of Continuum is devoted to infections of the nervous system, a category of disorders that includes so many illnesses for which neurologists... can provide effective— and many times curative—management to our patients.
This issue of Continuum is devoted to infections of the nervous system, a category of disorders that includes so many illnesses for which neurologists, through fervent and timely recognition and diagnosis, can provide effective—and many times curative—management to our patients. This is why I was so pleased when Dr Avindra Nath, Chief of the Section of Infections of the Nervous System at the National Institute of Neurological Disorders and Stroke of the National Institutes of Health, so kindly accepted my invitation to be guest editor of this issue and brought such expert authors on board.
The issue begins with the article by Dr Nath in which he addresses the modern role of the neurologist in the diagnosis and management of the central and peripheral nervous system complications of human immunodeficiency virus infection, including the neurologic complications of combination antiretroviral therapy and the most up-to-date information about the immune reconstitution inflammatory syndrome of the central nervous system (CNS). Next, Drs Eric M. L. Williamson and Joseph R. Berger review the many CNS infections that can occur with immunomodulatory therapies, including the most current information regarding the incidence, diagnosis, and management of progressive multifocal leukoencephalopathy occurring in association with immunomodulatory therapies for multiple sclerosis.
Drs J. David Beckham and Kenneth L. Tyler review the characteristic clinical features and laboratory diagnosis of the arbovirus infections of the nervous system (including West Nile virus), which are commonly encountered by neurologists and are increasingly important causes of neurologic disease worldwide. Dr Michael D. Geschwind next provides us with the benefit of his extensive experience in diagnosing the prion diseases, whether sporadic, genetic, or acquired (transmitted).
Drs Kiran Thakur and Joseph Zunt review the diagnosis and management of the many neuroinfectious diseases—from a variety of organisms—that are particularly prevalent in tropical and subtropical world regions and that any neurologist may encounter, especially when presented with a patient who has lived in or traveled to an endemic area. Drs Anil A. Panackal and Peter R. Williamson discuss the diagnosis and management of many fungal infections that can affect the CNS, and their wide spectrum of clinical manifestations. Next, Dr Karen L. Roos provides a practical and thoughtful approach to the diagnosis of bacterial infections of the CNS, specifically bacterial meningitis and bacterial spinal epidural abscess, which will be of benefit to us in our next encounters with these important clinical scenarios.
Dr Don Gilden discusses the contemporary diagnosis and management of the remarkably varied clinical and pathologic manifestations that may occur upon reactivation of varicella-zoster virus. Dr Richard J. Whitley next provides us with the most current diagnostic and management recommendations for herpes simplex virus infections of the CNS in older children and adults, as well as in neonates. In the next article, Dr Christina M. Marra discusses the clinical manifestations and diagnosis of neurosyphilis, as well as the most current treatment recommendations for this increasingly common disease. In the final review article of the issue, Dr Adriana R. Marques provides an up-to-date discussion of the epidemiology, clinical manifestations, diagnostic criteria, and treatment recommendations for Lyme neuroborreliosis.
In this issue’s Ethical Perspectives article, Dr Adam Webb carefully analyzes the ethical considerations involved in quarantine and isolation of health care workers who had contact with patients with dangerous communicable diseases. In the Practice Issues article, Dr Raghav Govindarajan discusses the burden of health care–associated infections and reviews common strategies that neurologists can apply in daily practice to help prevent them. Dr Gregory L. Barkley then reviews the many considerations that neurologists need to be aware of with regard to coding for neuroinfectious diseases.
As with every issue of Continuum, a number of opportunities exist for CME. By taking the Postreading Self-Assessment and CME Test, crafted by Drs Douglas Gelb and Joseph Safdieh, after reading the issue, you may earn up to 12 AMA PRA Category 1 CreditsTM toward self-assessment and CME. The Patient Management Problem, written by Drs Arun Venkatesan and Scott D. Newsome, describes the case of an immunosuppressed 48-year-old man who presents to the emergency department for evaluation of confusional episodes. By following his case and answering multiple-choice questions corresponding to diagnostic and management decision points along the course of his complicated illness, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I want to give my sincerest thanks to Dr Nath for so enthusiastically taking on the guest editorship of this issue and for all of the work he and his remarkably expert faculty undertook to bring this volume to fruition and to help us provide the most expert care to our patients with neuroinfectious disease.
—Steven L. Lewis, MD, FAAN