Neuroinfectious Diseases

Abstract

Despite significant advancements in the management of infectious diseases, central nervous system (CNS) infections remain a major challenge. They are often difficult to diagnose, and treatments are inadequate or nonexistent. Not surprisingly, encephalitis has been the subject of several recent movies and of fiction and nonfiction books, and outbreaks have received wide attention by the popular media. For example, bovine spongiform encephalopathy (mad cow disease) continues to get wide media coverage despite the absence of human cases in United States. Emergence of New InfectionsWith the globalization of human travel, new infections can spread worldwide in record time. Recent examples include the West Nile, chikungunya, dengue, Hanta, Marburg, and influenza viruses; severe acute respiratory syndrome; and now the Ebola virus and enterovirus D68. There is the reemergence of meningococcal meningitis, poliomyelitis, and measles. Bioterrorism is another threat because CNS pathogens can be weaponized. Human and animal products for treatment also pose a risk.

Metagenomics for neurological infections — expanding our imagination

“…Immunocompromised patients present particular challenges because they are susceptible to unusual neuroinvasive pathogens that might not be part of a neurologist’s standard diagnostic algorithm 2 , 10 , 17 , 23 – 26 . In addition, many emerging and re-emerging pathogens have neuroinvasive potential, including Ebola, measles, mumps, Nipah, Hendra, Chikungunya, Zika and Powassan viruses 4 , 23 , 24 , 27 – 29 . Zika virus had been circulating in Brazil for 18 months before it was identified and for 24 months before it was determined that it was responsible for a spike in cases of microcephaly and Guillain–Barré syndrome 30 .…”

“…Indeed, many epidemiological studies have shown that an aetiological diagnosis is not obtained in ~50% of patients with encephalitis 2 , 3 . Improved diagnostic testing modalities are urgently needed to enhance individual patient care and to expand our understanding of the full spectrum of clinical phenotypes with which neurological infections can manifest 4 .…”

Emerging Diagnostic and Therapeutic Tools for Central Nervous System Infections

“…2 Fueled by globalization and climate change, we will continue to experience a changing landscape of neurological infections. The technologies described earlier have already affected improved diagnosis of novel and unusual pathogens, and may eventually lead to dramatic new therapies.…”

“…2 This commentary highlights 2 important “next-generation” approaches to diagnosis and therapy that are either already clinically relevant or likely to be tested in central nervous system (CNS) neurotropic viral infections in the near future.…”

Disentangling etiologies of CNS infections in Singapore using multiple correspondence analysis and random forest

“…Concern is growing about novel neurologic infections 6 , due to the emergence of new pathogens, the spread of existing pathogens to new regions as a consequence of globalization, climate change, increased virulence of existing pathogens and increasing numbers of immunocompromised patients [7][8][9] . This is particularly true for Southeast Asia, a focal point for zoonotic and vector-borne diseases emergence 10,11 .…”