Abstract Body

The clinical presentations of infectious neuropathies are wide and varied and include generalized polyneuropathy, pure sensory or motor neuropathy, focal mononeuropathies including cranial neuropathies, mononeuritis multiplex and autonomic neuropathy. Human immunodeficiency virus 1 (HIV) most frequently presents as sensory predominant painful neuropathy followed by a generalized polyneuropathy. Prevalence estimates vary between 20 to 60%, and of those with neuropathy, neuropathic pain is present in at least half of all afflicted individuals. Older individuals with comorbidities, including diabetes or malnutrition, are more likely to develop HIV neuropathy, which does not correlate with CD4 counts or total viral load. First generation dideoxynucleotide antiretroviral agents used to treat HIV result in a similar neuropathy, making the drug-induced neuropathy indistinguishable from the HIV neuropathy itself. Less commonly, HIV can present as an acute or chronic inflammatory demyelinating polyradiculopathy (AIDP, CIDP), or as a mononeuritis multiplex in patients with advanced disease. Other infectious neuropathies include herpes simplex virus type 2 (HSV-2) and varicella-zoster virus (VZV). 90% of humans harbor latent Herpes virus, and reactivation can result in VZV painful mononeuropathies of a single dermatome (shingles) while HSV-2 most commonly presents as a lumbosacral radiculomyelitis. Hepatitis C infects one percent of the world’s population, and among those with the disorder, 10% develop a neuropathy, most commonly a painful sensory predominant followed by a generalized polyneuropathy. There are 250,000 new cases of leprosy secondary to infection with Mycobacterium Leprae each year and the disorder remains a common cause of infectious neuropathy in India and Africa. Because the bacterium prefers cool environments, sensory loss can be widespread, and not in the typical stocking glove pattern seen in length dependent neuropathies. Lyme disease is secondary to a spirochete, Borrelia burgdorfei, and is prevalent in the Northeast USA. Afflicted individuals can present early with cranial mononeuropathies or polyradiculopathies, and a more generalized polyneuropathy is only seen in late stages of untreated disease. Other less common infectious disorders that mediate neuropathy include diphtheria, botulism, West Nile Virus, and parasites (Chagas disease). In summary, a number of infections can underlie neuropathy, and in the correct clinical context, diagnosis can lead to treatment which in turn can improve neurologic function.