![]() Other viruses probably invade through peripheral nerves (rabies). Via the vascular route, viral particles pass across the blood–brain barrier, or cross into the brain via infected leukocytes (e.g., mumps, measles, or herpesviruses). Commonly, replication occurs outside the CNS and invasion by hematogenous spread (enterovirus). The penetration of the CNS is achieved by several mechanisms ( Craighead, 2000, Thompson and Green, 2012). Some viruses today only exist in very circumscribed areas due to eradication efforts (e.g., poliomyelitis virus, smallpox) ( Duintjer Tebbens et al., 2013). Viruses transmitted by a vector are usually geographically limited to the vector's host environment: mosquitos or ticks show a clear-cut regional or continental occurrence (e.g., West Nile virus, tick-borne encephalitis virus, Japanese encephalitis virus). Echovirus, enterovirus, measles, mumps, coxsackievirus, herpesvirus, human immunodeficiency virus (HIV), and papovavirus are found in most areas of the world. Alternatively, it may be spread via vehicle transmission through an intermediate, e.g., by food, water, blood, or urine or as in vector-borne infections by mechanical spread. How the virus spreads is another important determinant for its epidemiology: directly by respiratory droplets, kissing, touching, sexual intercourse, or through animal bites. The relationship between the host and the agent is of major importance and factors influencing the spread and epidemiology are listed in Table 12.1 Most viruses involved in acute CNS diseases can be acquired worldwide. ![]() Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. Infections of the nervous system are an important and challenging aspect of clinical neurology.
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