Infections of the Peripheral Nervous System

LoRusso, Samantha

doi:10.1212/con.0000000000000981

Cited by 2 publications

(2 citation statements)

References 98 publications

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“…Several infectious pathogens have a particular predilection for the spinal cord and nerve roots and should be considered in the differential diagnosis for a patient who is immunocompromised and presenting with new-onset numbness or weakness. For additional considerations in patients who are immunocompetent, refer to the articles “Infections of the Spine and Spinal Cord” by Shamik Bhattacharyya, MD, MS, and Michael J. Bradshaw, MD, 126 and “Infections of the Peripheral Nervous System” by Samantha LoRusso, MD, 127 in this issue of Continuum .…”

Section: Myelopathy and Radiculopathymentioning

confidence: 99%

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

Anand¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWBoth broadly immunosuppressive medications and selective immunomodulatory agents that act on particular components of the immune system are increasingly used in the treatment of neurologic and non-neurologic diseases. These therapies predispose patients to particular infections, some of which may affect the nervous system. Therefore, familiarity with the clinical and radiologic features of neurologic infections associated with specific immunomodulatory therapies is of importance for the practicing neurologist. This article reviews these neuroinfectious conditions, as well as other neurologic complications unique to transplant recipients and other patients who are immunocompromised.RECENT FINDINGSDiagnosis of infectious pathogens in patients who are immunocompromised may be particularly challenging because a decreased immune response can lead to atypical imaging or laboratory findings. Next-generation sequencing and other novel diagnostic modalities may improve the rate of early identification of neurologic infections in patients who are immunocompromised and ultimately ameliorate outcomes in this vulnerable population.SUMMARYA broad range of bacterial, viral, fungal, and parasitic infections of the nervous system can complicate solid organ and hematopoietic cell transplantation as well as other forms of immunocompromise. In addition to neurologic infections, such patients are at risk of neurotoxic and neuroinflammatory complications related to immunomodulatory and immunosuppressive therapies. Early recognition of infectious and noninfectious complications of immunocompromise is essential to guide appropriate treatment, which can include antimicrobial therapy and, in some cases, withdrawal of the predisposing medication with a transition to an alternative regimen.

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Section: Myelopathy and Radiculopathymentioning

confidence: 99%

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

Anand¹

2021

CONTINUUM: Lifelong Learning in Neurology

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“…For further discussion of infections of the nerve roots, nerves, neuromuscular junction, and muscles, refer to “Infections of the Peripheral Nervous System” by Samantha LoRusso, MD, 23 in this issue of Continuum.…”

Section: Clinical Approachmentioning

confidence: 99%

Approach to Neurologic Infections

Berkowitz¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEWThis article provides an overview of the clinical approach to the diagnosis of neurologic infections, focusing on the symptoms, signs, imaging features, and laboratory findings of the major categories of neuroinfectious diseases.RECENT FINDINGSThe increased use of immunosuppressive and immunomodulatory therapy to treat autoimmune diseases has led to an increase in opportunistic neurologic infections. The description of numerous causes of autoimmune antibody–mediated encephalitis over the past decade has expanded the differential diagnosis of encephalitis beyond infection. The emergence of metagenomic next-generation sequencing has led to diagnoses of rare or unexpected causes of neurologic infections and has the potential to enhance diagnostic precision in neuroinfectious diseases.SUMMARYInfections of the nervous system can affect any level of the neuraxis and present over any time course. Neurologic infections may present atypically with respect to clinical, radiologic, and CSF analysis features in immunocompromised patients or older adults. A thorough evaluation including systemic features, past medical history, travel, exposures, detailed examination, neuroimaging, and CSF analysis is often necessary to make a definitive diagnosis. It is important to be aware of the test characteristics and limitations of microbiological tests on CSF for neurologic infections to avoid being misled by false positives or false negatives.

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Infections of the Peripheral Nervous System

Cited by 2 publications

References 98 publications

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies

Approach to Neurologic Infections

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