Poliomyelitis and flaviviruses

Johnson, Richard T.; Cornblath, David R.

doi:10.1002/ana.10635

Cited by 16 publications

(15 citation statements)

References 14 publications

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“…Typically the organisms with a predilection for the brainstem are those that also cause meningitis (e. g. Listeria monocytogenes, Brucella, Mycobacterium tuberculosis and HSV type-2). A poliomyelitis-like syndrome can accompany the flavivirus encephalitides (e. g. WNV, JEV, Tick-born encephalitis) leading to peripheral neurological signs [46]. Similarly, radiculitis may accompany EBV encephalitis [60].…”

Section: Acute Infectious Encephalitis ■ Pathology and Aetiologymentioning

confidence: 99%

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

2006

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Reduced level of consciousness is a common clinical finding in acutely sick patients. In the majority of cases a cause for the encephalopathy is readily identifiable,whilst in a minority the aetiology is more difficult to ascertain. Frequently the onset of encephalopathy is associated with, or follows, infection. The mechanisms through which infection leads to encephalopathy are diverse. They range from direct microbial invasion of the brain or its supporting structures, to remote, infection-triggered mechanisms such as acute disseminated encephalomyelitis. Most common however, is the encephalopathy caused through a remote effect of systemic sepsis-septic encephalopathy. This article discusses the clinical presentation and underlying pathogeneses of the acute encephalopathies associated with infection, aiming to aid both their recognition and treatment.

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Section: Acute Infectious Encephalitis ■ Pathology and Aetiologymentioning

confidence: 99%

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

2006

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“…However, several other enteroviruses may result in acute paralytic poliomyelitis that is indistinguishable from the paralysis caused by polio virus. 6,10,12,26 Recent case reports of patients with WNV infection have shown clinical, electrophysiological, and pathological evidence of anterior horn cells damage compatible with acute paralytic poliomyelitis. 7,9,11,16,18 Sequential electrophysiological studies with acute WNV infection, and their correlation with disease progression, were not reported.…”

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confidence: 99%

Electrodiagnostic features of acute paralytic poliomyelitis associated with West Nile virus infection

Alshekhlee

Katirji

2004

Muscle and Nerve

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West Nile virus (WNV) infection is a potentially fatal disease, with meningoencephalitis being its most common neurological manifestation. Guillain-Barré syndrome (GBS) has also been described, but acute paralytic poliomyelitis has only recently been recognized. We report the clinical and electrodiagnostic findings of five patients with WNV infection, who presented with acute paralytic poliomyelitis. Three patients manifested focal asymmetrical weakness, and two had rapid ascending quadriplegia mimicking GBS. Electrodiagnostic studies during the acute illness showed normal sensory nerve action potentials, compound motor action potentials of normal or reduced amplitude, and no slowing of nerve conduction velocities. Depending on the timing of the examination, fibrillation potentials were widespread, including in those with focal weakness. Cervical magnetic resonance imaging in one patient showed abnormal T2-weighted signals in the spinal cord gray matter. On follow-up, signs of clinical improvement were seen in one patient, whereas two remained quadriplegic and ventilator-dependent 5 months after the onset. This report highlights the value of the electrodiagnostic studies in the diagnosis and prognosis of focal or generalized weakness due to acute paralytic poliomyelitis associated with WNV infection.

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“…Within days, a pure motor deficit consisting of flaccid weakness of one or more limbs but without sensory abnormalities or urinary bladder dysfunction emerges. Although preferential involvement of anterior horn cells in gray matter suggests poliovirus infection, infection with other agents, such as coxsackieviruses A and B, enteroviruses-70 and -71, WNV, Japanese encephalitis virus, and tick-borne encephalitis virus, also causes acute flaccid paralysis [5,6]. In contrast, individuals presenting with prominent sensory disturbances, urinary retention, and weakness with either hypo-or hyperreflexia have myelitis due to involvement of the white matter.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In a recent editorial, Johnson and Cornblath [5] emphasized that flaviviruses (WNV, dengue virus, Japanese B encephalitis, and tick-borne encephalitis virus) can produce a poliomyelitis-like syndrome due to preferential, rather than selective, destruction of anterior horn cells and other motor pathways. Although more diffuse spinal cord lesions are observed with flavivirus (and enterovirus) infections, acute transverse myelitis is more typically due to infections with members of the herpes virus family (HSV-2, VZV, EBV, or CMV).…”

Section: Current Issues In Acute Viral Myelitismentioning

confidence: 99%

Viral myelitis: An update

Kincaid¹,

Lipton

2006

Curr Neurol Neurosci Rep

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Viral infections of the central nervous system are uncommon but are important in the differential diagnosis of acute myelopathy. Acute viral myelitis can present as acute flaccid paralysis (poliomyelitis) or neurologic dysfunction due to involvement of the white matter. The latter usually affects only part of the transverse expanse of the spinal cord and manifests as asymmetric motor and sensory symptoms. When both halves of the spinal cord are affected, the entity is referred to as acute transverse myelitis and patients exhibit uniformly symmetric weakness, sensory loss, and urinary bladder involvement. Acute flaccid paralysis is due to cytolytic infection of anterior horn cells. When the involvement is mainly white matter, virus-specific and autoimmune host cellular immune responses are believed to contribute to spinal cord damage. Acute flaccid paralysis is caused by polioviruses-1, -2, and -3; coxsackieviruses A and B; enterovirus-71; and flaviviruses, including West Nile virus. Involvement of spinal cord white matter may be associated with infection by many different viruses; however, in most cases a specific viral cause is never determined. Chronic myelitis may be due to either direct infection of the spinal cord by human T-cell lymphotrophic virus-1 (HTLV-1), or a metabolic disturbance due to HIV-1 infection in AIDS patients; no other human virus is known to chronically infect the spinal cord without involvement of the brain. The principal treatment is antiviral drugs immediately upon virus isolation or the identification of a viral sequence by PCR and, when indicated, high doses of methylprednisolone.

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Poliomyelitis and flaviviruses

Cited by 16 publications

References 14 publications

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

Electrodiagnostic features of acute paralytic poliomyelitis associated with West Nile virus infection

Viral myelitis: An update

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