Infectious Myelopathies

Abstract

In the setting of both globalization and increasing use of immunosuppressive therapy, infectious myelopathies are an important cause of morbidity worldwide. Clinical spinal cord syndromes related to infection are varied, including transverse myelitis, acute flaccid paralysis related to anterior horn cell involvement, spinal cord compression, chronic spastic paraparesis, and myeloradiculitis. Causative pathogens include viruses, parasites, pyogenic and atypical bacteria, and fungi. The epidemiology, clinical characteristics, diagnosis, and treatment of selected organisms will be discussed in this article.

Infectious Myelopathies

“…EBV DNA PCR is typically positive in the CSF; EBV IgM and IgG should be tested to show intrathecal production. [72][73][74][75] CYTOMEGALOVIRUS AND HUMAN HERPESVIRUS 6 AND 7. CMV, human herpes virus 6 (HHV-6), and human herpes virus 7 (HHV-7) myelopathy are rare and associated with posttransplantation viral activation or immunocompromised patients.…”

“…CSF analysis usually shows mononuclear pleocytosis. EBV DNA PCR is typically positive in the CSF; EBV IgM and IgG should be tested to show intrathecal production 72-75 …”

“…Gram stain and culture may demonstrate the fungi. Testing for fungus-specific antigens and antibodies in body fluids including the CSF, serum, and urine and (1,3)-β- d -glucan assays should be part of the diagnostic evaluation 72 . Fungal myelopathy and myelitis usually present with abnormal imaging.…”

Myelopathy: A Clinical Approach

“…Hyperacute causes typically are due to traumatic cord injury and vascular causes, like hemorrhage or infarction (see articles on Traumatic Spinal Cord Disorders and Vascular Spinal Cord Disorders 9,10 ). Acute and subacute presentations have a broader differential diagnosis, primarily consisting of infectious and inflammatory (rheumatologic, demyelinating diseases, radiation toxicity, or paraneoplastic) etiologies, in addition to progressive structural abnormalities related to a mass or canal stenosis (see articles on Infectious Myelopathies, Immune-Mediated Myelopathies, and Cervical and Thoracic Spondylotic Myelopathies [11][12][13] ). Of the various vascular causes, a spinal dural arteriovenous fistula can present with acute fluctuations over time.…”