Infectious Polyneuropathy

00:02 So let's talk about some of the infectious polyneuropathies or polyradiculopathies.

00:07 These are polyneuropathies that occur in patients without underlying evidence of inflammation.

00:13 We've ruled out AIDP or CIDP inflammation and we're looking for an alternative etiology.

00:21 We can see both polyradiculopathy presentations, sensory predominant presentations, motor predominant presentations, and others.

00:30 Those infections that present with a polyradiculopathy that means symptoms affecting all of the nerve roots include Lyme, which often causes prominent motor dysfunction, sparing the sensory nerves, CMV as can be seen in patients with HIV and West Nile virus.

00:47 And this is an important mimic of Guillain Barré.

00:49 There we see a lymphocytic pleocytosis In addition to increased protein, as opposed to that classic albuminocytologic dissociation with Guillain Barré.

01:00 There are sensory predominant neuropathies that occur from infections syphilitic neuropathy, herpetic infections can result in severe sensory ganglionopathies And then motor predominant presentations can occur and are seen with diphtheric neuropathy.

01:17 And then other miscellaneous conditions that can affect the nerve include HIV, and HIV has a couple of presentations and acute neuropathy that is very similar to Guillain Barré and seen at seroconversion, the inflammatory demyelinating polyneuropathy associated with HIV, as was present in our case or a chronic form that presents with late polyneuropathy.

01:42 Let's talk a little bit more specifically about polyneuropathies in patients with HIV.

01:46 And I want you to think about the acute form and the chronic form.

01:51 Acute polyneuropathy is present acute or subacutely with symptoms progressively worsening over the course of several weeks.

02:00 This presentation is similar to Guillain Barré or AIDP, EMG shows prolonged F-waves and conduction block as well as delayed conduction velocity.

02:09 These are all findings that we see in the demyelinating or inflammatory neuropathies and this has a prominent inflammatory component.

02:17 CSF shows a lymphocytic pleocytosis as well as elevated protein which is different from AIDP.

02:25 And we see serum elevations in immunoglobulins, which is also different from what we expect in AIDP.

02:31 In addition to this inflammatory presentation, we can also see a CMV-associated polyradiculopathy.

02:40 Patients present with rapidly progressive lower extremity predominant neuropathy with the presence of CMV in the cerebrospinal fluid.

02:49 This acute presentation is different from late onset polyneuropathy that can occur in patients with HIV.

02:55 This is typically a distal symmetric polyneuropathy, a slowly progressive chronic onset condition with weakness and numbness, tingling paraesthesia is initially in the feet and then in the hands in a stocking glove like distribution, similar to what we would see with diabetes or other toxic metabolic polyneuropathies.

03:15 Importantly, HAART or antiretroviral treatment drugs can also be associated with polyneuropathy as well as nutritional deficiencies.

03:23 And so there's a differential diagnosis for this.

03:26 We manage underlying nutritional deficiencies that are observed.

03:32 We remove or adjust antiretroviral treatments to avoid neurotoxic medications and manage HIV aggressively for the late onset distal symmetric polyneuropathy associated with HIV.