Journal of Neuroinfectious Diseases
Open Access

Infectious myelitis is a neurological condition characterized by inflammation of the spinal cord due to infectious agents such as viruses, bacteria, fungi, or parasites. The spinal cord serves as the main communication pathway between the brain and the rest of the body; hence, damage to this structure can cause significant motor, sensory, and autonomic dysfunction. Although relatively rare, infectious myelitis poses serious health challenges because of its potential to cause paralysis, chronic disability, or even death. The clinical presentation and severity of disease vary depending on the causative organism, host immune status, and timeliness of medical intervention [1,2].

Discussion

The causes of infectious myelitis are diverse, with viral infections being the most common. Viruses such as herpes simplex, varicella-zoster, enteroviruses, West Nile virus, and HIV can directly infect the spinal cord or trigger immune-mediated inflammation. Bacterial pathogens, including Mycobacterium tuberculosis, Treponema pallidum, and Borrelia burgdorferi, may also lead to spinal cord involvement. In immunocompromised individuals, fungi like Cryptococcus or parasites such as Schistosoma are additional concerns [3,4].

Patients typically present with acute or subacute onset of neurological symptoms. These include weakness of the limbs, sensory disturbances, and bladder or bowel dysfunction. Some individuals may also experience systemic signs such as fever or malaise, which help differentiate infectious causes from autoimmune or idiopathic transverse myelitis. Neurological examination often reveals spasticity, hyperreflexia, or a sensory level consistent with spinal cord involvement [5-8].

Diagnosis requires a careful combination of clinical evaluation, imaging, and laboratory investigations. Magnetic resonance imaging (MRI) is the most reliable imaging tool, demonstrating inflammatory lesions within the cord. Cerebrospinal fluid (CSF) analysis is essential, often revealing increased white cell counts, elevated protein levels, or specific microbial markers. Polymerase chain reaction (PCR) testing has greatly enhanced the ability to detect viral DNA and RNA, improving diagnostic accuracy. Additional studies, such as blood cultures or serological tests, may further confirm the infectious etiology [9].

Treatment strategies depend on the underlying cause. For viral myelitis, antivirals such as acyclovir are commonly used, while bacterial infections require targeted antibiotics. Fungal and parasitic infections necessitate specific antifungal or antiparasitic agents. In selected cases, corticosteroids may be added to reduce spinal cord inflammation, though this remains a debated practice depending on the type of infection. Supportive care, including pain management and physical rehabilitation, is vital to optimize recovery and long-term function [10].

Conclusion

Infectious myelitis represents a serious neurological disorder with potentially devastating consequences. Its diverse causes demand careful diagnostic evaluation to ensure appropriate, targeted therapy. Advances in imaging and molecular diagnostics have improved the ability to identify causative pathogens and guide treatment decisions. Nevertheless, prevention through vaccination, timely treatment of systemic infections, and strengthening infection control measures remains the most effective strategy to reduce disease burden. Continued research and awareness are essential to improve outcomes and minimize the disability associated with this condition.

References

1. Fauci AS, Marston HD (2015) Ending the HIV-AIDS pandemic-follow the science. N Engl J Med 373: 2197- 2199.

   Indexed at, Google Scholar, Cross Ref

2. Maschke M, Kastrup O, Esser S, Ross B, Hengge U, et al. (2000) Incidence and prevalence of neurological disorders associated with HIV since the introduction of highly active antiretroviral therapy (HAART). J Neurol Neurosurg Psychiatry 69: 376- 380.

   Indexed at, Google Scholar, Cross Ref

3. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. AIDS info.

   Google Scholar

4. The INSIGHT START study group (2015) Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 373: 795- 807.

   Indexed at, Google Scholar, Cross Ref

5. Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, et al. (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69: 1789-1799.

   Indexed at, Google Scholar, Cross Ref

6. Heaton R (1994) Neuropsychological impairment in human immunodeficiency virus-infection: implications for employment. HNRC Group HIV Neurobehavioral Research Center. Psychosom Med 56 : 8-17.

   Indexed at, Google Scholar

7. Heaton R, Velin R A, McCutchan J A, Gulevich S J, Atkinson J H, et al. (2010) HIV-associated neurocognitive disorders (HAND) persist in the era of potent antiretroviral therapy: The CHARTER Study. Neurology 75: 2087-2096.

   Indexed at, Google Scholar, Cross Ref

8. Tozzi V (2007) Persistence of neuropsychologic deficits despite long-term highly active antiretroviral therapy in patients with HIV-related neurocognitive impairment: prevalence and risk factors. J Acquir Immune Defic Syndr 45: 174-182.

   Indexed at, Google Scholar, Cross Ref

9. Fois AF, Brew BJ (2015) The potential of the CNS as a reservoir for HIV-1 infection: implications for HIV eradication. Curr HIV/AIDS Rep 12: 299-303.

   Indexed at, Google Scholar, Cross Ref

10. McArthur JC, Brew BJ (2010) HIV-associated neurocognitive disorders: is there a hidden epidemic? AIDS 24: 1367-1370.

    Indexed at, Google Scholar, Cross Ref