Spirochete infections Boreliosis Lyme disease Borrelia burgdorferi Syphylis
Spirochete infections • Boreliosis (Lyme disease) Borrelia burgdorferi • Syphylis (Lues) Treponema pallidum
Borrelia burgdorferi
Summary of reported cases of Lyme disease in the United States. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
Lyme disease
Lyme disease After tick bite Skin lesion
Erythema migrans rash with the typical target appearance that is virtually diagnostic of Lyme disease. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
Lyme disease
Clinical feature • 10 -15% patients with untreated borreliosis – neuroborelliosis • Primary location – ganglia od posterior roots, nerv roots, leptomeninges (macacus rhesus) • Europe –– B. garinii
Clinical feature Periferal NS • Sensory symptoms • Painful radiculitis • Painful lymphocytic meningoradiculitis – with/without paresis (Garin-Bujadoux. Bannwart syndróm) • Facial palsy • Pain – sharp, during night, weeks – months
Clinical feature Central NS • Subsequent to the tick bite inoculation – B. reach the CNS • Hematogenously or retrogradely via periferal nerves • Encefalitis • Cranial neuritis • Motor or sensitive radikuloneuroitis • Encefalomyelitis - rare
Clinical feature late presentation • Dementia – often in patients with artritis Desorientation, confusion, memory problems, cognitive dysfunction • Chronic radikuloneuropathy – parestesia of acral parts, pain, • EMG – axonal lesion
Diagnosis • EMG – axonal lesion • CSF: • pleocytosis – Ly, proteins intratecal antibodies Ig. M, Ig. G against BB • PCR
Facial neuritis. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
Evolving cranial neuritis. Enhancement n. III, V l. dx. , VII l. sin. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
A 50 -year-old woman with a history of tick bite and erythema migrans rash treated with doxycycline, who had recurrent erythema migrans rash with headache, fever, nausea, and nuchal rigidity. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
A 74 -year-old man with 2 -year cognitive decline and memory loss. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
A 56 -year-old woman with neck, bilateral shoulder, and bilateral arm pain. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
A 17 -year-old boy with right papilledema and orbital pain and rule out pseudotumor. Hildenbrand P et al. AJNR Am J Neuroradiol 2009; 30: 10791087 © 2009 by American Society of Neuroradiology
Boreliosis • Th: Doxycycline (2 x 100 mg/D, 2 T) CSF negat. • i. v. ceftriaxone – likvor pozit.
Syphilis (Lues) • 1/3 nontreated patients – neurovascular complications of syphylis
Neurosyphilis • Patogenesis • Perivascular infiltration of the meninges, focal meningeal inflammation – formation of hypertrophic meninges, or gumma, • Inflammatory cells invide blood vessel wal – arteritis (luminal occlusion) • Parenchymal involvement – gliosis in late stages • Ly infiltration of preganglionic portion of dorsal roots and posterior columns atrophy of posterior columns
Neurosyfilis – meningitis • CSF Ly, ↓ Glu, proteins • Pozit. VDRL test
Neurosyfilis – meningovascular • Endarteritis – small and medium vessels (MCA) – can be stroke etiology in young people !!! • Focal signs • AG: nerrowing of arteries • MRI: multiple infarcts • Spinal artery – transversal myelitis
Demencia paralytica Progressive paralysis • Decreased cognitive functions, memory problems, pupils abnormality
Tabes dorsalis • Paresthesias in root distribution • Decreased proprioception • Spinal ataxia • Argyll-Roberts pupils
Acquired immunodeficiency syndrom (AIDS) Human immunodeficiency virus (HIV) • I. stage • Acute infection - 2. - 3. weeks after infection by HIV • Symptoms like flu, or mononukleosis • Acute retroviral syndrom
Stage II • Period without symptoms – 2 -10 years or more • Decreased imunity in this period
Stage III, IV • III – generalized lymphadenopathy, enlargement of LN • IV- stage of AIDS • Weakened immune system fails • Fewer, lost of weight, weakness, fatigue, muscle atrophy
Acquired immunodeficiency syndrom (AIDS) • IV stage - symptoms of lesion of PNS and CNS • Aseptic meningitis • Cognitive decline • Myelopathy • Neuropathy (inflammatory demyelinating polyneuropathy, mononeuropathy, plexopathy) • Myopathy – myositis
AIDS dementia complex (ADC) • T 2 - MRI: • Enlargement of ventricles • Hyperintensity in subcortical white matter of frontal lobes • Brain atrophy
HIV Opportunistic Infections • People with advanced HIV infection are vulnerable to infections and malignancies that are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system. • Bacterial diseases such as tuberculosis, Mycobacterium avium complex, bacterial pneumonia and septicaemia (blood poisoning) • Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis
HIV Opportunistic Infections • Fungal diseases such as Pneumocystis pneumonia, candidiasis, cryptococcosis and penicilliosis • Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus • HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.
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