Grill Marie F
Continuum (Minneap Minn). 2018 Apr;24(2, Spinal Cord Disorders):441-473. doi: 10.1212/CON.0000000000000597.
This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or parainfectious autoimmune-mediated mechanisms; this article focuses primarily on the former.
Some microorganisms exhibit neurotropism for the spinal cord (eg, enteroviruses such as poliovirus and flaviviruses such as West Nile virus), while others are more protean in neurologic manifestations (eg, herpesviruses such as varicella-zoster virus), and others are only rarely reported to cause myelopathy (eg, certain fungal and parasitic infections). Individuals who are immunocompromised are at increased risk of disseminated infection to the central nervous system. Within the last few years, an enterovirus D68 outbreak has been associated with cases of acute flaccid paralysis in children, and emerging Zika virus infection has been concurrent with cases of acute flaccid paralysis due to Guillain-Barré syndrome, although cases of myelitis have also been reported. Associated pathogens differ by geographic distribution, with myelopathies related to Borrelia burgdorferi (Lyme disease) and West Nile virus more commonly seen in the United States and parasitic infections encountered more often in Latin America, Southeast Asia, and Africa. Characteristic CSF and MRI patterns have been identified with many of these infections.
A myriad of pathogens are associated with infectious myelopathies. Host factors, geographic distribution, clinical features, CSF profiles, and MRI findings can assist in formulating the differential diagnosis and ultimately guide management.
本文综述与脊髓病相关的细菌、病毒、真菌和寄生虫病原体。感染性脊髓病可能由直接感染或感染后自身免疫介导机制引起；本文主要关注前者。
一些微生物对脊髓具有嗜神经性（例如脊髓灰质炎病毒等肠道病毒和西尼罗河病毒等黄病毒），而其他微生物在神经表现上更为多变（例如水痘 - 带状疱疹病毒等疱疹病毒），还有一些仅很少被报道可引起脊髓病（例如某些真菌和寄生虫感染）。免疫功能低下的个体发生中枢神经系统播散性感染的风险增加。在过去几年中，肠道病毒D68爆发与儿童急性弛缓性麻痹病例相关，新兴的寨卡病毒感染与吉兰 - 巴雷综合征所致急性弛缓性麻痹病例同时出现，尽管也有脊髓炎病例的报道。相关病原体因地理分布而异，与伯氏疏螺旋体（莱姆病）和西尼罗河病毒相关的脊髓病在美国更常见，而寄生虫感染在拉丁美洲、东南亚和非洲更常遇到。已确定许多此类感染的特征性脑脊液和磁共振成像模式。
多种病原体与感染性脊髓病相关。宿主因素、地理分布、临床特征、脑脊液检查结果和磁共振成像表现有助于进行鉴别诊断并最终指导治疗。
