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Chronic Infectious Inflammatory Diseases of the Central Nervous System

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Cerebrospinal Fluid in Clinical Neurology

Abstract

Chronic infections of the central nervous system (CNS) tend to progress over months or years. The incubation period is usually considerably longer than that of acute infections. Chronic infections of the CNS could be triggered by persistence of infecting organisms in the brain or spinal cord causing direct tissue damage (e.g. neurosyphilis, CNS tuberculosis) or by the host immunological response in the absence of continuing infection. Often both factors are involved. Onset of symptoms is usually subacute, and CSF findings include predominantly lymphocytic pleocytosis and elevated protein and sometimes decreased glucose level. Several CNS-prone microorganisms are difficult to eradicate from CNS, and confirmation of diagnosis may be challenging, but it is critical for prognosis. Infecting organisms are rarely detected in the CSF by classical culture methods. The methods used for diagnosis are either serological tests of blood or CSF (e.g. HIV, Lyme borreliosis, syphilis) or detection of nucleic acids in the CSF (Table 15.1). CNS inflammation is confirmed by the CSF examination that may need repeated examinations. In infections associated with the persistence of microorganisms, long-term antibacterial therapy is recommended (syphilis, TBE, toxoplasmosis, Lyme borreliosis). In diseases in which host immunological response plays a predominant role, the treatment of chronic CNS infection is usually symptomatic.

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Abbreviations

ADA:

Adenosine deaminase

AIDS:

Acquired immunodeficiency syndrome

CATT:

Card agglutination test for trypanosomiasis

CJD:

Creutzfeldt–Jakob disease

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CXCL:

Chemokine ligand

DNA:

Deoxyribonucleic acid

EIA:

Treponemal enzyme immunoassay

ELISA:

Enzyme-linked immunosorbent assay

FTA:

Fluorescent treponemal antibody

FTA-abs:

Fluorescent treponemal antibody absorption

HIV:

Human immunodeficiency virus

IgG:

Immunoglobulin G

IgM:

Immunoglobulin M

IGRA:

Interferon-gamma release assays

IP-10:

Interferon protein 10

ITPA:

Intrathecal Treponema pallidum antibody

JCV:

JC virus/John Cunningham virus

MCP-1:

Monocyte chemokine protein 1

MHA-TP:

Microhaemagglutination for Treponema pallidum

MMP-9:

Matrix metallopeptidase 9

MODS:

Microscopic observation drug susceptibility

MRI:

Magnetic resonance imaging

NAAT:

Nucleic acid amplification tests

NFL:

Neuronal injury neurofilament

NSE:

Neuron-specific enolase

PCR:

Polymerase chain reaction

PML:

Progressive multifocal leucoencephalopathy

PrP:

Prion protein

RNA:

Ribonucleic acid

RPR:

Rapid plasma regain

RT-PCR:

Real-time polymerase chain reaction

SSPE:

Subacute sclerosing panencephalitis

sVCAM-1:

Soluble vascular adhesion molecule 1

TBE:

Tick-borne encephalitis

TBEV:

Tick-borne encephalitis virus

TIMP-1:

Tissue inhibitor of metalloproteinases 1

TNFα:

Tumour necrosis factor alpha

TPHA:

Treponema pallidum haemagglutination

TPPA:

Treponema pallidum particle agglutination

VDRL:

Venereal disease research laboratory

WBC:

White blood cell

WHO:

World Health Organisation

β2M:

Beta-2-microglobulin

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, University of Tartu, Puusepa 8 – H452, Tartu, 51014, Estonia

    Pille Taba MD, PhD

  2. Department of Microbiology, University of Tartu, Tartu, Estonia

    Irja Lutsar MD, PhD

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  1. Pille Taba MD, PhD
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  2. Irja Lutsar MD, PhD
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Correspondence to Pille Taba MD, PhD .

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  1. Department of Neurology, Innsbruck Medical University, Innsbruck, Austria

    Florian Deisenhammer

  2. Department of Neurology, Danish Multiple Sclerosis Center Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Finn Sellebjerg

  3. Department of Clinical Chemistry, VU University Medical Center Amsterdam Neurochemistry Laboratory and Biobank, Amsterdam, The Netherlands

    Charlotte E Teunissen

  4. Department of Neurology, University of Ulm, Ulm, Germany

    Hayrettin Tumani

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Taba, P., Lutsar, I. (2015). Chronic Infectious Inflammatory Diseases of the Central Nervous System. In: Deisenhammer, F., Sellebjerg, F., Teunissen, C., Tumani, H. (eds) Cerebrospinal Fluid in Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-01225-4_15

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