Chorea associated with infections: A narrative review

In tropical countries like India, infections of the central nervous system (CNS) and their varied complications are often encountered. Movement disorders (MDs) are reported to be a complication of infectious diseases, and the spectrum of MDs differs in tropical countries from other developed countries. We screened three electronic databases to search for cases of chorea as a presenting feature of infections, collected cases, and series describing chorea associated with infections. The studies were identified later and data were extracted regarding study design, sample size, neurological assessment, and diagnostic workup including brain imaging and cerebrospinal fluid analysis. After a detailed review of 283 different articles in the selection, a total of 33 articles were included in the final manuscript. In this narrative review, we review the important contributions in the field of chorea related to infections and discuss the salient features of infections of the CNS which can present with chorea. The infections presenting with chorea include streptococcal infections, tuberculosis, neurosyphilis, Japanese encephalitis, herpes simplex encephalitis, and neurocysticercosis. The hypothesized mechanisms of infection-related dystonia are vasculopathy, space-occupying lesions, autoimmune reaction, and inflammation. Although chorea is considered to be a result of heredodegenerative, metabolic, or autoimmune disorders lesions, infections may also present with chorea, especially in tropical and developing countries.