Major advances in neuroinfectious diseases in the past two decades

• Published in: Lancet neurology 2022-04, Vol.21 (4), p.308-310
• Main Authors: Nath, Avindra, Smith, Bryan R, Thakur, Kiran T
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; Anniversary Round-up; Antiretroviral therapy; Cerebrovascular diseases; Cognitive ability; Complications; Coronaviruses; COVID-19; Cysticercosis; Dengue fever; Disease prevention; Disease transmission; Epilepsy; Eradication; HIV; Human immunodeficiency virus; Infections; Leukoencephalopathy; Meningitis; Multiple sclerosis; Nervous system; Neurodevelopmental disorders; Pandemics; Paralysis; Pathogens; Poliomyelitis; Progressive multifocal leukoencephalopathy; Public health; Severe acute respiratory syndrome coronavirus 2; Surveillance; Terrorism; Viral infections; West Nile virus; Zika virus
• ISSN: 1474-4422; 1474-4465
• DOI: 10.1016/S1474-4422(22)00093-X

Conditions such as community-acquired bacterial meningitis and tropical neurological infections remain major drivers of death and disability-adjusted life-years (DALYs) worldwide.1 Infections like neurocysticercosis, HIV, and Zika virus not only cause neurological injury in the acute setting, but also contribute substantially to long-term sequelae, such as neurodevelopmental disorders, cerebrovascular disease, epilepsy, or cognitive impairment. With widespread availability of antiretroviral therapy, incidence rates of CNS opportunistic infections for patients with HIV have dropped considerably, by more than 75% of cases in many countries.16 In patients with multiple sclerosis, appropriate risk stratification has led to notable preventive measures for progressive multifocal leukoencephalopathy.17 But perhaps the best example of a prevention and surveillance system for a neuroinfectious disease is the Global Polio Eradication Initiative (GPEI), launched in 1988, which has reduced paralytic poliomyelitis cases by more than 99%.18 High-quality surveillance of acute flaccid paralysis is crucial to detect poliovirus transmission, although complete global eradication has been hampered by several factors in endemic regions, including warfare, terrorism, and inadequate laboratory and environmental surveillance infrastructure. Globally, we are ill prepared to manage major pandemics and our health-care systems are fragile. Since the long-term complications of these infections are largely neurological, policy makers need to take a leadership role in curtailing infections and developing a pandemic preparedness for any future ones.