Neuroinfectious Disease, Part 1

Anna M. Cervantes-Arslanian, MD

Neurologists' knowledge and understanding of infectious disease are ever-growing necessity in the modern world. The impact of increasing globalization and expansion into previously undeveloped areas has led to the emergence of several viruses with a predilection for central nervous system (CNS) involvement. Furthermore, many illnesses that were virtually eradicated in upper- and middle-income nations are making a comeback due to voluntary refusal of immunization programs (e.g., measles) and the persistence of illnesses in developing nations (e.g., polio and tuberculosis). Other pathogens are still poorly understood and almost purely manifest as neurologic illness (e.g., prions). Accordingly, there has been growing interest of neurologists in the subspecialty of neuroinfectious disease. This issue is the first part of a two-part series in Seminars in Neurology, dedicated to the practical aspects of diagnosis and management of infectious diseases of the nervous system. The articles are written by a distinguished group of international neurologists with expertise in infectious disease, together with specialists from many other disciplines (infectious disease, internal medicine, cardiology, neurosurgery, radiology, and cardiac surgery). We hope the articles are useful to neurologists and nonneurologists as well.

This issue begins with diagnostic considerations for neurologic infection, with Piantadosi et al providing a deep dive into the newest laboratory testing, while Venkatesan and Jagdish present imaging in encephalitis and AbdalKader et al discuss imaging in other intracranial infections. The following articles provide an overview of CNS infections caused by specific classes of pathogens: bacterial infections (LaPenna and Roos), fungi (Jia and Thakur), parasites (Garcia et al), and viruses (herpes viruses by Bharucha et al). Next, we discuss infections which may afflict immunocompromised patients (Agnihotri) and updates regarding treatment of CNS manifestations of HIV (Handoko and Spudich). Finally, Sharma and Zunt cover considerations for the returning traveler (Sharma and Zunt).

The goal of these issues is to provide a comprehensive review of the current diagnosis, treatment, and management of infectious diseases of the nervous system. We hope that we have reaffirmed the importance of neurologists in the management of infectious disease, and perhaps piqued the interest of trainees who may be considering this subspecialty. Neurologic infectious diseases affect every subspecialty of neurology, causing cerebrovascular disease, epilepsy, movement disorders, and dementia. To steal from the words of Osler, “To know syphilis is to know medicine,” I would like to propose the corollary that to know neuroinfectious disease is to know neurology. With this in mind, I am grateful to the authors for their spectacular work on this issue and to Dr. David Greer for honoring me with the invitation as a guest editor. Dr. Greer's support for my career is the second only, after David in my life (my husband), our beautiful children (Isaac, Jacob, and Abigail), and to our parents Carol, Francisco, Leslie, and Ronald.