Introduction

The aim of this chapter is to describe movement disorders associated with infections that do not involve invasion of the central nervous system (CNS) by the etiologic agent. The prototype of condition where a systemic infection causes a movement disorder is rheumatic fever (RF). Already in the seventeenth century in England, Thomas Sydenham provided a detailed clinical description which would be named after him. However, its causal relationship with streptococcal infection was only firmly established in the middle of the twentieth century (Taranta and Stollerman 1956). The incidence of Sydenham’s chorea (SC) has markedly decreased in North America and Western Europe since 1960. Nevertheless, it remains the most common of acute choreas in children worldwide. Interest in this condition has been fueled by the hypothesis that Streptococcus-induced antibodies targeted at basal ganglia neurons might account for tics and behavioral abnormalities among children (Cardoso 2002a). In the last two decades of the twentieth century, acquired immune deficiency syndrome (AIDS) was the infectious disease to receive the largest scientific and public attention. Soon after its discovery, movement disorders became recognized among the neurologic complications in patients with AIDS due to the HIV virus (Nath et al. 1987; Brew 2001). The introduction of highly active antiretroviral therapy has led to a remarkable decline in the frequency of occurrence of HIV-related neurologic disorders (Maschke et al. 2000; Cardoso 2002b). Table 6.1 summarizes the most common movement disorders associated with infectious agents.