Infectious myelopathies

Although infectious myelopathies are rare, timely and accurate diagnosis is essential to improving outcome. There are a number of organisms that may cause infectious myelopathies, including human immunodeficiency virus (HIV), human T-cell lymphotropic virus type I (HTLV-I), herpesviruses, enteroviruses, Treponema pallidum, Mycobacterium tuberculosis, fungi, and parasites. Vacuolar myelopathy, the most common form of spinal cord disease in HIV-infected individuals, is underrecognized clinically. The failure to diagnose this condition is generally a consequence of the attribution of the lower extremity weakness and paresthesias to general debility and concomitant peripheral neuropathy. Tropical spastic paraparesis or HTLV-I-associated myelopathy involves the pyramidal tracts, chiefly at the thoracic level, and results in spastic lower extremity weakness and a spastic bladder. The herpesviruses (varicella-zoster, herpes simplex type 2, cytomegalovirus) and the enteroviruses cause myelitis. Prior to the development of antibiotics, syphilis was the most frequent infectious cause of spinal cord disease. In light of the broad spectrum of pathogens that may affect the spinal cord and the variegate fashion in which these disorders may present, the physician must always consider an infectious etiology in the differential diagnosis for the patient presenting with myelopathy. This review addresses the infectious myelopathies by microorganism.