Semin Neurol 2019; 39(04): 472-481
DOI: 10.1055/s-0039-1688923
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Infectious Myelitis

Archana Asundi
1   Division of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
2   Boston University School of Medicine, Boston, Massachusetts
,
Anna M. Cervantes-Arslanian
1   Division of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
2   Boston University School of Medicine, Boston, Massachusetts
3   Department of Neurology, Boston Medical Center, Boston, Massachusetts
,
Nina H. Lin
1   Division of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
2   Boston University School of Medicine, Boston, Massachusetts
,
Felipe Barbosa
4   Metro Infectious Disease Consultants, Davenport, Iowa
› Author Affiliations
Further Information

Publication History

Publication Date:
18 September 2019 (online)

Abstract

Myelitis refers to inflammation of the spinal cord which can result in a spectrum of neurologic impairment. Infectious pathogens are an important etiologic category, and can result in myelitis through direct pathogenic effect or through immune-mediated parainfection; this review focuses on the former category. The spectrum of clinical manifestations is summarized and a diagnostic workup provided to aid clinicians in developing an approach to patients presenting with symptoms suggestive of infectious myelitis. This is followed by an overview of the important viral, bacterial, parasitic, and fungal causes of infectious myelitis. The typical presentations, diagnostic modalities, and treatment approaches are outlined for key pathogens culprit in infectious myelitis to allow clinicians to promptly recognize and diagnose specific infectious etiologies of myelitis.

 
  • References

  • 1 Román GC. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2003; 60 (04) 730-731 , author reply 730–731
  • 2 Beckham JD, Tyler KL. Acute viral myelitis. In: Scheld MW, Whitley RJ, Marra CM. , eds. Infections of the Central Nervous System. 4th ed. Philadelphia: Wolters Kluwer Health; 2014: 315-330
  • 3 DeSanto J, Ross JS. Spine infection/inflammation. Radiol Clin North Am 2011; 49 (01) 105-127
  • 4 Cohen-Gadol AA, Zikel OM, Miller GM, Aksamit AJ, Scheithauer BW, Krauss WE. Spinal cord biopsy: a review of 38 cases. Neurosurgery 2003; 52 (04) 806-815 , discussion 815–816
  • 5 McQuillan G, Kruszon-Moran D, Flagg EW, Paulose-Ram R. Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States, 2015-2016. NCHS Data Brief 2018; (304) 1-8
  • 6 Figueroa D, Isache C, Sands M, Guzman N. An unusual case of acute transverse myelitis caused by HSV-1 infection. IDCases 2016; 5: 29-31
  • 7 Azuma K, Yoshimoto M, Nishimura Y. , et al. Herpes simplex virus type 1 myelitis with a favorable outcome. Intern Med 2001; 40 (10) 1068-1069
  • 8 Nakajima H, Furutama D, Kimura F. , et al. Herpes simplex virus myelitis: clinical manifestations and diagnosis by the polymerase chain reaction method. Eur Neurol 1998; 39 (03) 163-167
  • 9 Nardone R, Versace V, Brigo F. , et al. Herpes simplex virus type 2 myelitis: case report and review of the literature. Front Neurol 2017; 8: 199
  • 10 Gobbi C, Tosi C, Städler C, Merenda C, Bernasconi E. Recurrent myelitis associated with herpes simplex virus type 2. Eur Neurol 2001; 46 (04) 215-218
  • 11 Hung CH, Chang KH, Kuo HC. , et al. Features of varicella zoster virus myelitis and dependence on immune status. J Neurol Sci 2012; 318 (1-2): 19-24
  • 12 Gilden D, Nagel MA, Cohrs RJ, Mahalingam R. The variegate neurological manifestations of varicella zoster virus infection. Curr Neurol Neurosci Rep 2013; 13 (09) 374
  • 13 Gilden DH, Beinlich BR, Rubinstien EM. , et al. Varicella-zoster virus myelitis: an expanding spectrum. Neurology 1994; 44 (10) 1818-1823
  • 14 de Silva SM, Mark AS, Gilden DH. , et al. Zoster myelitis: improvement with antiviral therapy in two cases. Neurology 1996; 47 (04) 929-931
  • 15 Grahn A, Studahl M. Varicella-zoster virus infections of the central nervous system – prognosis, diagnostics and treatment. J Infect 2015; 71 (03) 281-293
  • 16 Wang X, Zhang X, Yu Z, Zhang Q, Huang D, Yu S. Long-term outcomes of varicella zoster virus infection-related myelitis in 10 immunocompetent patients. J Neuroimmunol 2018; 321: 36-40
  • 17 Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N. Varicella zoster virus in the nervous system. F1000 Res 2015; 4: 4
  • 18 Daida K, Ishiguro Y, Eguchi H, Machida Y, Hattori N, Miwa H. Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report. BMC Neurol 2016; 16 (01) 223
  • 19 Fux CA, Pfister S, Nohl F, Zimmerli S. Cytomegalovirus-associated acute transverse myelitis in immunocompetent adults. Clin Microbiol Infect 2003; 9 (12) 1187-1190
  • 20 Kleinschmidt-DeMasters BK, Gilden DH. The expanding spectrum of herpesvirus infections of the nervous system. Brain Pathol 2001; 11 (04) 440-451
  • 21 Majid A, Galetta SL, Sweeney CJ. , et al. Epstein-Barr virus myeloradiculitis and encephalomyeloradiculitis. Brain 2002; 125 (Pt 1): 159-165
  • 22 Bitnun A, Yeh EA. Acute flaccid paralysis and enteroviral infections. Curr Infect Dis Rep 2018; 20 (09) 34
  • 23 Lopalco PL. Wild and vaccine-derived poliovirus circulation, and implications for polio eradication. Epidemiol Infect 2017; 145 (03) 413-419
  • 24 Huang CC, Liu CC, Chang YC, Chen CY, Wang ST, Yeh TF. Neurologic complications in children with enterovirus 71 infection. N Engl J Med 1999; 341 (13) 936-942
  • 25 Hu Y, Jiang L, Peng HL. Clinical analysis of 134 children with nervous system damage caused by enterovirus 71 infection. Pediatr Infect Dis J 2015; 34 (07) 718-723
  • 26 Chen CY, Chang YC, Huang CC, Lui CC, Lee KW, Huang SC. Acute flaccid paralysis in infants and young children with enterovirus 71 infection: MR imaging findings and clinical correlates. AJNR Am J Neuroradiol 2001; 22 (01) 200-205
  • 27 Dyda A, Stelzer-Braid S, Adam D, Chughtai AA, MacIntyre CR. The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) - what is the evidence for causation?. Euro Surveill 2018 23. (03):
  • 28 Greninger AL, Naccache SN, Messacar K. , et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis 2015; 15 (06) 671-682
  • 29 Maloney JA, Mirsky DM, Messacar K, Dominguez SR, Schreiner T, Stence NV. MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014 enterovirus D68 outbreak. AJNR Am J Neuroradiol 2015; 36 (02) 245-250
  • 30 Chancey C, Grinev A, Volkova E, Rios M. The global ecology and epidemiology of West Nile virus. BioMed Res Int 2015; 2015: 376230
  • 31 Jeha LE, Sila CA, Lederman RJ, Prayson RA, Isada CM, Gordon SM. West Nile virus infection: a new acute paralytic illness. Neurology 2003; 61 (01) 55-59
  • 32 Centers for Disease Control and Prevention (CDC). Acute flaccid paralysis syndrome associated with West Nile virus infection--Mississippi and Louisiana, July-August 2002. MMWR Morb Mortal Wkly Rep 2002; 51 (37) 825-828
  • 33 Sejvar JJ. Clinical manifestations and outcomes of West Nile virus infection. Viruses 2014; 6 (02) 606-623
  • 34 Blakely PK, Kleinschmidt-DeMasters BK, Tyler KL, Irani DN. Disrupted glutamate transporter expression in the spinal cord with acute flaccid paralysis caused by West Nile virus infection. J Neuropathol Exp Neurol 2009; 68 (10) 1061-1072
  • 35 Yun SI, Lee YM. Zika virus: an emerging flavivirus. J Microbiol 2017; 55 (03) 204-219
  • 36 Muñoz LS, Barreras P, Pardo CA. Zika virus-associated neurological disease in the adult: Guillain-Barré syndrome, encephalitis, and myelitis. Semin Reprod Med 2016; 34 (05) 273-279
  • 37 Mécharles S, Herrmann C, Poullain P. , et al. Acute myelitis due to Zika virus infection. Lancet 2016; 387 (10026): 1481
  • 38 Di Rocco A, Simpson DM. AIDS-associated vacuolar myelopathy. AIDS Patient Care STDS 1998; 12 (06) 457-461
  • 39 Chong J, Di Rocco A, Tagliati M, Danisi F, Simpson DM, Atlas SW. MR findings in AIDS-associated myelopathy. AJNR Am J Neuroradiol 1999; 20 (08) 1412-1416
  • 40 Gessain A, Cassar O. Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol 2012; 3: 388
  • 41 Lezin A, Olindo S, Oliere S. , et al. Human T lymphotropic virus type I (HTLV-I) proviral load in cerebrospinal fluid: a new criterion for the diagnosis of HTLV-I-associated myelopathy/tropical spastic paraparesis?. J Infect Dis 2005; 191 (11) 1830-1834
  • 42 Yukitake M, Takase Y, Nanri Y. , et al. Incidence and clinical significances of human T-cell lymphotropic virus type I-associated myelopathy with T2 hyperintensity on spinal magnetic resonance images. Intern Med 2008; 47 (21) 1881-1886
  • 43 Croda MG, de Oliveira AC, Vergara MP. , et al. Corticosteroid therapy in TSP/HAM patients: the results from a 10 years open cohort. J Neurol Sci 2008; 269 (1–2): 133-137
  • 44 Buell KG, Puri A, Demontis MA. , et al. Effect of pulsed methylprednisolone on pain, in patients with HTLV-1-associated myelopathy. PLoS One 2016; 11 (04) e0152557
  • 45 Hill SA, Lloyd PA, McDonald S, Wykoff J, Derse D. Susceptibility of human T cell leukemia virus type I to nucleoside reverse transcriptase inhibitors. J Infect Dis 2003; 188 (03) 424-427
  • 46 Isono T, Ogawa K, Seto A. Antiviral effect of zidovudine in the experimental model of adult T cell leukemia in rabbits. Leuk Res 1990; 14 (10) 841-847
  • 47 Taylor GP, Goon P, Furukawa Y. , et al. Zidovudine plus lamivudine in human T-lymphotropic virus type-I-associated myelopathy: a randomised trial. Retrovirology 2006; 3: 63
  • 48 Yamauchi J, Coler-Reilly A, Sato T. , et al. Mogamulizumab, an anti-CCR4 antibody, targets human T-lymphotropic virus type 1-infected CD8+ and CD4+ T cells to treat associated myelopathy. J Infect Dis 2015; 211 (02) 238-248
  • 49 Chan CT, Gold WL. Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 1998; 27 (03) 619-626
  • 50 Candon E, Frerebeau P. Bacterial abscesses of the spinal cord. Review of the literature (73 cases) [in French]. Rev Neurol (Paris) 1994; 150 (05) 370-376
  • 51 Tali ET, Oner AY, Koc AM. Pyogenic spinal infections. Neuroimaging Clin N Am 2015; 25 (02) 193-208
  • 52 Lu C-H, Chang W-N, Lui C-C. Strategies for the management of bacterial brain abscess. J Clin Neurosci 2006; 13 (10) 979-985
  • 53 Smith R, Eviatar L. Neurologic manifestations of Mycoplasma pneumoniae infections: diverse spectrum of diseases. A report of six cases and review of the literature. Clin Pediatr (Phila) 2000; 39 (04) 195-201
  • 54 Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis 1993; 17 (Suppl. 01) S52-S57
  • 55 Csábi G, Komáromy H, Hollódy K. Transverse myelitis as a rare, serious complication of Mycoplasma pneumoniae infection. Pediatr Neurol 2009; 41 (04) 312-313
  • 56 Weng W-C, Peng SS-F, Wang S-B, Chou Y-T, Lee W-T. Mycoplasma pneumoniae--associated transverse myelitis and rhabdomyolysis. Pediatr Neurol 2009; 40 (02) 128-130
  • 57 Tsiodras S, Kelesidis T, Kelesidis I, Voumbourakis K, Giamarellou H. Mycoplasma pneumoniae-associated myelitis: a comprehensive review. Eur J Neurol 2006; 13 (02) 112-124
  • 58 Berger JR, Sabet A. Infectious myelopathies. Semin Neurol 2002; 22 (02) 133-142
  • 59 Adams RD, Houston Merritt H. Meningeal and vascular syphilis of the spinal cord. Medicine (Baltimore) 1944; 23 (02) 181-214
  • 60 Tsui EYK, Ng SH, Chow L, Lai KF, Fong D, Chan JHM. Syphilitic myelitis with diffuse spinal cord abnormality on MR imaging. Eur Radiol 2002; 12 (12) 2973-2976
  • 61 He D, Jiang B. Syphilitic myelitis: magnetic resonance imaging features. Neurol India 2014; 62 (01) 89-91
  • 62 Workowski KA, Bolan GA. ; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64 (RR-03): 1-137
  • 63 Schwartz AM, Hinckley AF, Mead PS, Hook SA, Kugeler KJ. Surveillance for Lyme disease - United States, 2008-2015. MMWR Surveill Summ 2017; 66 (22) 1-12
  • 64 Schwenkenbecher P, Pul R, Wurster U. , et al. Common and uncommon neurological manifestations of neuroborreliosis leading to hospitalization. BMC Infect Dis 2017; 17 (01) 90
  • 65 Mygland A, Ljøstad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. ; European Federation of Neurological Societies. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. Eur J Neurol 2010; 17 (01) 8-16 , e1–e4
  • 66 Wasay M, Arif H, Khealani B, Ahsan H. Neuroimaging of tuberculous myelitis: analysis of ten cases and review of literature. J Neuroimaging 2006; 16 (03) 197-205
  • 67 Nahid P, Dorman SE, Alipanah N. , et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis 2016; 63 (07) e147-e195
  • 68 Ferrari TC, Moreira PR. Neuroschistosomiasis: clinical symptoms and pathogenesis. Lancet Neurol 2011; 10 (09) 853-864
  • 69 Ferrari TC, Moreira PR, Cunha AS. Spinal cord schistosomiasis: a prospective study of 63 cases emphasizing clinical and therapeutic aspects. J Clin Neurosci 2004; 11 (03) 246-253
  • 70 Moreno-Carvalho OA, Nascimento-Carvalho CM, Bacelar AL. , et al. Clinical and cerebrospinal fluid (CSF) profile and CSF criteria for the diagnosis of spinal cord schistosomiasis. Arq Neuropsiquiatr 2003; 61 (2B): 353-358
  • 71 Boongird P, Phuapradit P, Siridej N, Chirachariyavej T, Chuahirun S, Vejjajiva A. Neurological manifestations of gnathostomiasis. J Neurol Sci 1977; 31 (02) 279-291
  • 72 Sawanyawisuth K, Tiamkao S, Kanpittaya J, Dekumyoy P, Jitpimolmard S. MR imaging findings in cerebrospinal gnathostomiasis. AJNR Am J Neuroradiol 2004; 25 (03) 446-449
  • 73 Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis 2011; 17 (07) 1174-1180
  • 74 Crete RN, Gallmann W, Karis JP, Ross J. Spinal coccidioidomycosis: MR imaging findings in 41 patients. AJNR Am J Neuroradiol 2018; 39 (11) 2148-2153
  • 75 Adam RD, Elliott SP, Taljanovic MS. The spectrum and presentation of disseminated coccidioidomycosis. Am J Med 2009; 122 (08) 770-777
  • 76 Martinez-Del-Campo E, Kalb S, Rangel-Castilla L. , et al. Spinal coccidioidomycosis: a current review of diagnosis and management. World Neurosurg 2017; 108: 69-75
  • 77 Standaert SM, Schaffner W, Galgiani JN. , et al. Coccidioidomycosis among visitors to a Coccidioides immitis-endemic area: an outbreak in a military reserve unit. J Infect Dis 1995; 171 (06) 1672-1675
  • 78 Bajema KL, Dalesandro MF, Fredricks DN, Ramchandani M. Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges. Med Mycol Case Rep 2016; 15: 1-4
  • 79 Lammering JC, Iv M, Gupta N, Pandit R, Patel MR. Imaging spectrum of CNS coccidioidomycosis: prevalence and significance of concurrent brain and spinal disease. AJR Am J Roentgenol 2013; 200 (06) 1334-1346
  • 80 Galgiani JN, Ampel NM, Blair JE. , et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis 2016; 63 (06) e112-e146
  • 81 Rivierez M, Heyman D, Brebion A, Landau-Ossondo M, Desbois N, Vally P. Spinal cord histoplasmoma. A case report [in French]. Neurochirurgie 2002; 48 (01) 44-48
  • 82 Wheat J, Myint T, Guo Y. , et al. Central nervous system histoplasmosis: multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine (Baltimore) 2018; 97 (13) e0245
  • 83 Wheat LJ, Freifeld AG, Kleiman MB. , et al; Infectious Diseases Society of America. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007; 45 (07) 807-825
  • 84 Bush JW, Wuerz T, Embil JM, Del Bigio MR, McDonald PJ, Krawitz S. Outcomes of persons with blastomycosis involving the central nervous system. Diagn Microbiol Infect Dis 2013; 76 (02) 175-181
  • 85 Parr AM, Fewer D. Intramedullary blastomycosis in a child: case report. Can J Neurol Sci 2004; 31 (02) 282-285
  • 86 Chapman SW, Dismukes WE, Proia LA. , et al; Infectious Diseases Society of America. Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2008; 46 (12) 1801-1812
  • 87 Dromer F, Moulignier A, Dupont B. , et al. Myeloradiculitis due to Cryptococcus curvatus in AIDS. AIDS 1995; 9 (04) 395-396
  • 88 Rai AK, Synmon B, Basumatary LJ, Das M, Goswami M, Kayal AK. Cryptococcal myelitis: a rare manifestation in immunocompetent patients. Neurol India 2014; 62 (03) 321-322
  • 89 Perfect JR, Dismukes WE, Dromer F. , et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society Of America. Clin Infect Dis 2010; 50 (03) 291-322
  • 90 Centers for Disease Control and Prevention. Acute flaccid myelitis. 2018 . Available at: https://www.cdc.gov/acute-flaccid-myelitis/about-afm.html . Accessed November 1, 2018