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Neurological infections

The 7 most ruthless bacterial infections of the nervous system

This is a follow up to our previous post, the 7 most devastating viral neurological infections. The list of bacteria that invade the nervous system is endless, but some stand out because of the fear they evoke, and the peril they pose. Here then are the 7 most horrifying bacterial infections that threaten the nervous system.

1. Bacterial meningitis

Klebsiella pneumonia bacterium. NIAID on Flikr. https://www.flickr.com/photos/niaid/13383468143

Many bacteria invade the covering of the brain, the meninges, without invading the brain substance. The commonest are Neisseria meningitidis, causing meningococcal meningitis, and Streptococcus pneumoniae, causing pneumococcal meningitis. Other relatively frequent meningeal intruders include Listeria monocytogenes and Haemophilus influenzae. Bacteria may get into the brain following infections elsewhere, such as sinusitis or otitis media (inner ear infection). There are many complications of bacterial meningitis such as cerebral venous thrombosis (CVT) and brain abscess.

2. Tuberculosis

Mycobacterium tuberculosis bacteria, the cause of TB. NIAID on Flikr. https://www.flickr.com/photos/niaid/5149398656

Tuberculosis (TB) is probably as old as history. It is caused by mycobacterium tuberculosis, a slow groing but pernicious organism. TB spares no part of the nervous system, and manifests often as tuberculous meningitis (TBM) or Pott’s disease of the spine. Nervous system TB may also present as an encephalopathy, tuberculoma, brain abscess, vasculopathy, arachnoiditis, radiculomyelitis, and calvarial TB.

3. Neurosyphilis

ff treponema pallidum. isis335 on Flikr. https://www.flickr.com/photos/92708411@N07/8579266595

Treponema pallidum, the bacterium behind the dreaded syphilis, is another ancient bug. It has a variety of ways it terrorises the nervous system, and the longer it inhabits the neurones, the worse the outcome. Typical manifestations of neurosyphilis are tabes dorsalis, general paresis of the insane (GPI), taboparesis, stroke, meningovascular syphilis, optic neuritis (ON), and several movement disorders.

4. Lyme neuroborreliosis

Lyme Disease Bacteria, Borrelia Burgdoferri. NIAID on Flikr. https://www.flickr.com/photos/niaid/5661846104

Lyme disease has acquired an infamy which is probably beyond its real notoriety. It is best known for its tick-borne transmission, and for its classical dermatological feature, erythema chronicum migrans. It affects the nervous system in diverse ways such as encephalomyelitislymphocytic meningitis, cranial neuropathies, spinal radiculitis, stroke, diaphragmatic paralysis, and peripheral neuropathy. Post-Lyme syndrome is a very contentious topic; you may read more on this in a post from our sister blog, The Neurology Lounge, titled ‘Why is chronic Lyme disease so frustrating to neurology.

5. Neurobrucellosis

By This media comes from the Centers for Disease Control and Prevention‘s Public Health Image Library (PHIL), with identification number #1902.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−, Public Domain, Link

Neurobrucellosis is a rarely discussed bacterial infection but it is a significant contributor to neurological morbidity and mortality around the world. It is caused by various brucella species usually grouped under the name Brucella militensis. It has a long reach in the nervous system, causing  a variety of insults such as encephalitis, meningoencephalitis, cranial neuropathies, intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), transverse myelitis, radiculitis, and peripheral neuropathy.

6. Leprosy

Public Domain, Link

This most distasteful of infectious diseases unfortunately has a strong affinity for the nervous system. Unlike its distant cousin, TB, leprosy favours the peripheral over the central nervous system. Its hallmark is thickening of the nerves or nerve hypertrophy. Caused by Mycobacterium leprae, leprosy has a legion of neurological manifestations such as mononeuritis, mononeuritis multiplex, cranial and peripheral neuropathy, myelitis, and leprous ganglionitis.

7. Botulism

Clostridium botulinum. Phil Moyer on Flikr. https://www.flickr.com/photos/hukuzatuna/2537594892

Botulism is the end result of damage by the toxin of Clostridium botulinum. This toxin produces a deadly paralysis by blocking neural transmission across the neuromuscular junction (NMJ). Botulinum toxin respects no borders, able to gain access to the nervous system through the gut, the skin, or the lungs. It paralyses everything, causing acute limb, ocular, and bulbar weakness. Left unchecked, botulism results in autonomic dysfunction and respiratory failure.

 

PS: For Tetanus, check out The Neurology Lounge blog post on The 13 most dreadful neurological disorders

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Explore more neurological infections in neurochecklists!

Bacteria. AJ Cann on Flikr. https://www.flickr.com/photos/ajc1/8975675759
Categories
Neurochecklists updates

40 very handy and practical neurochecklists

Neurochecklists now contains >2000 checklists on all aspects of neurology.
https://pixabay.com/en/brain-anatomy-neurology-medical-1132229/
https://pixabay.com/en/brain-anatomy-neurology-medical-1132229/
Many checklists come to the rescue only to fill a knowledge gap.
By Samurai Gandhi - Own work, CC BY-SA 4.0, Link
By Samurai GandhiOwn work, CC BY-SA 4.0, Link
Most neurochecklists however address important practical questions or outline pragmatic steps in managing neurological disorders.
House of Knowledge. Ian Parkes on Flikr. https://www.flickr.com/photos/parksy/2934000145
House of Knowledge. Ian Parkes on Flikr. https://www.flickr.com/photos/parksy/2934000145
To illustrate, below is a selection of 40 handy neurochecklists

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Anticoagulants: bridging therapy for surgery
Antiepileptic drugs (AEDs): choice with medical conditions
Apomorphine test
Cluster headache (CH): chronic prophylaxis
Cerebral vein thrombosis (CVT): investigations

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Dementia: safety and driving risks
Diaphragmatic paralysis: neurological causes
Drug induced Parkinsonism: risk factors and causes
Epilepsy: patient information
Essential tremor (ET): drug treatment

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Falls: management
Genetic counselling
HyperCKaemia: neurological causes
Lumbar puncture (LP): indications and precautions
Lyme Neuroborreliosis: management

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Migraine prophylaxis: drugs
Mitochondrial diseases: investigations
Motor neurone disease (MND): supportive care
Multiple sclerosis (MS): general investigations
Pregnancy and myasthenia gravis (MG): management

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Myelopathy with normal MRI
Myotonic dystrophy type 1: assessments and monitoring
Neurological complications of liver transplantation
Neurosarcoidosis: treatment
Neurosyphilis: clinical features

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Peripheral neuropathy (PN): red flags for ominous causes
Pineal cysts: monitoring
Psychogenic seizures: management
Subarachnoid haemorrhage (SAH): complications
Sudden unexpected death in epilepsy (SUDEP): management

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Syncope: red flags for admission
Thrombolysis: bleeding risk prediction tools
Trigeminal neuralgia (TN): management
Tic disorders: differential diagnosis and management
Passive tilt table test: indications and contraindications

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Transient loss of consciousness (TLOC): assessment
Vitamin B12 deficiency: tests of B12 metabolites 
Warfarin: switching to new oral anticoagulants
Wernicke’s encephalopathy: risks and clinical features
Young onset dementia

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Explore these and many other practical checklists on Neurochecklists

By Ansonlobo - Own work, CC BY-SA 4.0, Link
By AnsonloboOwn work, CC BY-SA 4.0, Link