Infections of the spinal cord

Abstract

Infectious myelopathies can be caused by viral, bacterial, fungal, and parasitic agents. In this chapter, the most common causes of infectious and tropical myelopathies will be reviewed. HIV and HTLV-1 retroviruses have been associated with subacute and chronic myelopathy; herpesviruses may cause radiculomyelitis and transverse myelitis; enterovirus and flavivirus seem to have a tropism for the anterior horns of the spinal cord. Paralytic poliomyelitis can occur as a complication of poliovirus infection in around 1-2% of cases. Enterovirus D68 and 71 have been identified as the etiologic agent of a poliomyelitis-like syndrome. The Flaviviridae family includes some mosquito-borne virus such as dengue, chikungunya, Zika, Japanese encephalitis, West Nile and Murray Valley viruses, and tick-borne virus and has also been associated with a flaccid poliomyelitis-like syndrome. Tuberculous myelopathy may develop as a secondary extension of vertebral body tuberculosis (Pott's disease), as a downward extension of tuberculous meningitis, and even as a primary tuberculous lesion. Spinal schistosomiasis is a common cause of acute myelopathy in tropical regions, and acute transverse myelitis, conus medullaris syndrome, and lower limb myeloradiculopathy are the most common schistosomal spinal syndromes. Other parasitary diseases that may affect the spinal cord are gnathostomiasis, cysticercosis, hydatid disease, and paragonimiasis. Invasive fungus may provoke a spinal cord compression syndrome from osteomyelitis, epidural abscess, or paravertebral lesions.