Neuropathies Associated With Infections
HIV Infection
Children with HIV may develop a variety of neurologic sequelae, including encephalopathy, progressive multifocal leukoencephalopathy, myelopathy, intractable seizures, optic neuritis, acute vasculitis, hemiplegia, paraspinal lymphoma, and peripheral nerve disease.
The peripheral nerve dysfunction may present as distal symmetric sensory or sensorimotor polyneuropathy, carpal tunnel syndrome, lumbosacral polyradiculopathy, motor neuronopathy, AIDP and CIDP, autonomic neuropathy, sensory ganglionopathy, and toxic neuropathy (caused by antiretroviral medications) (89). In addition, polyradiculopathy and multiple mononeuropathies may be caused by other infections (eg, cytomegalovirus, hepatitis B or C, and herpes zoster). In one series, one-third of children 5 to 14 years of age had symptoms and signs of peripheral nerve involvement. Distal paresthesia and/or pain plus diminished ankle jerks and/or diminished vibration sense were the most common clinical findings. Symptoms were chronic and fluctuating, and pain was, in general, not severe. Nerve conduction studies primarily revealed axonal changes (90). The issue of peripheral nerve involvement may be multifactorial. Children with HIV-1 infection are exposed to antiretrovirals for an ever-increasing length of time throughout postnatal growth and development, and the cumulative toxici- ties are becoming progressively apparent. Evidence for nucleoside reverse transcriptase inhibitor (NRTI)- associated mitochondrial toxicity is seen in vitro, in animal models, and in NRTI-exposed adults and children (91). Peripheral neuropathy is associated with the chronic use of dual nucleoside reverse-transcriptase inhibitor regimens in HIV-infected children, and regimens containing zidovudine have less toxicity than do those containing d4T (92).Lyme Disease
Lyme disease is the most common tickborne disease in the United States. Children and those spending extended time outdoors in wooded areas are at increased risk. The spectrum of neurologic manifestations and the relative frequencies of different syndromes associated with North American Lyme disease caused by Borrelia burgdorferi infection has been reviewed in a series of 96 children referred for neurologic problems in association with the infection (93). The most frequent neurologic symptom was headache, and the most common sign was facial palsy. Less common manifestations were sleep disturbance and papilledema associated with increased intracranial pressure. Signs and symptoms of peripheral nervous system involvement were infrequent. The most common clinical syndromes were mild encephalopathy, lymphocytic meningitis, and cranial neuropathy (facial nerve palsy). In contrast with adult patients with neurologic Lyme disease, meningoradiculitis (Bannwarth's syndrome) and peripheral neuropathy syndromes were rare in children.