Other Infectious Diseases

There are infectious diseases which effect the nervous system which are less common in the UK or a disease that can lead to one stated in the CAL package:

  • Herpes Zoster

  • Poliomyelitis - Poliomyelitis is more commonly known as polio, is a disease caused by the polio virus. It is know a rare disease; however there are still cases in the third world country where sanitation is poor. It is transmitted via water; it enters the body via an intestinal infection. This leads to infection of the motor neurons. This damage to the nervous system can cause paralysis, which can lead to death. Polio can be prevented by simple sanitation including adequate treatment of drinking water and prevention of contamination with sewage. Vaccines are available in oral and injectable form; they are inactivated versions of the virus which induce the production of antibodies.

  • Lyme Disease -

    Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted by a tick endemic in North America and Europe. Most cases occur in summer; the first manifestations are in the skin: a red macule or papule extending outward from the site of the tick bite, with central clearing (erythema chronicum migrans). Fatigue, malaise, and a mild meningoencephalitis may occur in this stage, but the CSF is normal. Within the next 1 to 6 months, 1 in 10 patients develop recurrent or chronic lymphocytic meningitis with cranial and/or peripheral neuropathies or painful radiculopathies. The CSF then contains lymphocytes and plasma cells and the protein level will be high. IgG and oligoclonal bands may be detected. Half of these patients also have mild encephalopathy, but severe focal signs are uncommon.
    Chronic arthropathy is the usual feature of the late stages of the disease, but chronic progressive meningoencephalitis with multifocal signs also occurs at a late stage. A raised ESR, increased serum IgM, and the presence of serum cryoglobulins suggest the diagnosis, which may be confirmed by finding high Borrelial antibody levels in the serum or CSF. Early diagnosis is important because treatment with oral antibiotics may be effective then. When neurologic features are present, high-dose penicillin or ceftriaxone is the treatment of choice.

  • Tetanus - Although Clostridium tetani is not as widespread now as it was in the days of horse-drawn transport, tetanus still constitutes an important disease despite a fairly high level of immunization in Western communities. The organism enters a wound (which may be very small) or follows surgical procedures, otitis media, or puerperal or umbilical sepsis. Its toxin then ascends the peripheral motor nerves to block inhibitory postsynaptic potentials affecting the anterior horn cells.
    After an incubation period of up to 3 weeks, patients develop pain and stiffness of the muscles (especially in the neck, back, and abdominal wall). Trismus, dysphagia, and reflex spasms are common, often beginning in the back, neck, and jaw muscles and lasting up to 30 seconds. The strong muscular contractions may induce hyperpyrexia, and respiratory arrest may occur. Laryngospasm, chest infections, and cardiac arrest are occasional lethal complications. Diagnosis is only achieved early if a high index of suspicion is maintained.
  • Botulism
  • Syphilis

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