Abstract
Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.
Highlights
1.1 The Burden of Neurological Diseases and Neuroinfections in AfricaNeurological disorders represent a major cause of disability for patients and an economic burden globally
This review addresses the interplay of the immune system and neuroinfections in the pathogenesis of certain neurological diseases prevalent to the Sub-Saharan Africa (SSA) region such as epilepsy, dementia, motor disorders, headache, sleep disorders, and peripheral neuropathy
These effects of nucleoside reverse transcriptase inhibitors (NRTIs) can augment the effects of human immunodeficiency virus (HIV), as the virus activates p38 mitogen-activated protein kinase (MAPK), Erk1/2 pathways to aid in its replication and proliferation, which is harmful to the host cell as this leads to the release of proinflammatory cytokines and biomarkers that signal apoptosis [307]
Summary
Neurological disorders represent a major cause of disability for patients and an economic burden globally. In SSA, neuroinfections contribute significantly to the diagnosed neurological disorders [10,11,12], in some cases constituting 26.7% to 43% [5, 13]. These neuroinfections include human immunodeficiency virus (HIV), tuberculosis, meningitis, cerebral malaria, rabies, and tetanus [4,5,6,7, 9, 10, 13]. This review addresses the interplay of the immune system and neuroinfections in the pathogenesis of certain neurological diseases prevalent to the SSA region such as epilepsy, dementia, motor disorders, headache, sleep disorders, and peripheral neuropathy
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