Service de Neurologie et Laboratoire de Neurochimie, Cliniques universitaires Saint-Luc, Faculté de Médecine, Université catholique de Louvain, Brussels, Belgium.
Curr Opin Neurol. 2013 Oct;26(5):510-5. doi: 10.1097/WCO.0b013e328364c036.
Infectious neuropathies are heterogeneous neuropathies with multiple causes. They still represent an important world health burden and some of them have no current available therapy.
Leprosy incidence has decreased by 50% during the last years, but leprosy-related neuropathies still cause severe disability. The pure neuritic leprosy is a diagnostic challenge that may require nerve biopsy or nerve aspiration cytology. The treatment itself may lead to a 'reversal reaction', which further causes injuries to the nerve. HCV-related neuropathies may be related or not to the presence of cryoglobulins. The absence of vasculitis, the most frequent form is a peripheral sensory neuropathy involving small nerve fibers, and more accurately diagnosed by pain-related evoked potentials. HIV-related neuropathy has become the major neurological complication of HIV infection. Both HIV-induced neuropathy and antiretroviral toxic neuropathy are clinically indistinguishable. The existence of an isolated chronic polyneuropathy due to Borrelia burgdorferi remains highly controversial. Lastly, an active infectious ganglioneuritis caused by varicella zoster virus, producing shingles, is the most frequent infectious neuropathy in the world and may cause various neurological complications. Zoster sine herpete remains frequently undiagnosed.
Recent data have improved our knowledge and diagnostic tools of infectious neuropathies. Treatment of the injured nerves is not yet available, and prevention and rapid diagnosis remain the main priorities for the clinician.
感染性神经病是一种病因多样的异质性神经病。它们仍然是一个重要的全球健康负担，其中一些疾病目前尚无可用的治疗方法。
近年来，麻风病的发病率下降了 50%，但与麻风病相关的神经病仍然导致严重的残疾。单纯神经炎型麻风是一种诊断挑战，可能需要神经活检或神经抽吸细胞学检查。治疗本身可能导致“逆转反应”，进一步对神经造成损伤。丙型肝炎病毒相关的神经病可能与冷球蛋白的存在有关，也可能无关。最常见的形式是非脉管炎性周围感觉神经病，主要影响小神经纤维，通过与疼痛相关的诱发电位可以更准确地诊断。HIV 相关的神经病已成为 HIV 感染的主要神经并发症。HIV 引起的神经病和抗逆转录病毒毒性神经病在临床上难以区分。由于伯氏疏螺旋体引起的孤立性慢性多发性神经病的存在仍然存在很大争议。最后，由水痘带状疱疹病毒引起的活动性感染性节神经节炎，产生带状疱疹，是世界上最常见的感染性神经病，并可能导致各种神经系统并发症。无疱疹性带状疱疹仍然经常被漏诊。
最近的数据提高了我们对感染性神经病的认识和诊断工具。受损神经的治疗方法尚不可用，预防和快速诊断仍然是临床医生的主要重点。
