Infectious diseases causing autonomic dysfunction.

Review article

Carod-Artal FJ. Clin Auton Res. 2018.


OBJECTIVES: To review infectious diseases that may cause autonomic dysfunction.

METHODS: Review of published papers indexed in medline/embase.

RESULTS: Autonomic dysfunction has been reported in retrovirus (human immunodeficiency virus (HIV), human T-lymphotropic virus), herpes viruses, flavivirus, enterovirus 71 and lyssavirus infections. Autonomic dysfunction is relatively common in HIV-infected patients and heart rate variability is reduced even in early stages of infection. Orthostatic hypotension, urinary dysfunction and hypohidrosis have been described in tropical spastic paraparesis patients. Varicella zoster reactivation from autonomic ganglia may be involved in visceral disease and chronic intestinal pseudo-obstruction. Autonomic and peripheral nervous system dysfunction may happen in acute tick-borne encephalitis virus infections. Hydrophobia, hypersalivation, dyspnea, photophobia, and piloerection are frequently observed in human rabies. Autonomic dysfunction and vagal denervation is common in Chagas disease. Neuronal depopulation occurs mainly in chagasic heart disease and myenteric plexus, and megacolon, megaesophagus and cardiomyopathy are common complications in the chronic stage of Chagas disease. Parasympathetic autonomic dysfunction precedes left ventricle systolic dysfunction in Chagas disease. A high prevalence of subclinical autonomic neuropathy in leprosy patients has been reported, and autonomic nerve dysfunction may be an early manifestation of the disease. Autonomic dysfunction features in leprosy include anhidrosis, impaired sweating function, localised alopecia ,and reduced heart rate variability. Urinary retention and intestinal pseudo-obstruction have been described in Lyme disease. Diphtheritic polyneuropathy, tetanus and botulism are examples of bacterial infections releasing toxins that affect the autonomic nervous system.

CONCLUSIONS: Autonomic dysfunction may be responsible for additional morbidity in some infectious diseases.



Autonomic nervous system dysfunction or dysautonomia is when the autonomic nervous system does not work properly and may affect the the heart, bladder, intestines, sweat glands, pupils, and blood vessels.  (Go here for a full explanation)

Some symptoms include: 

  • dizziness and fainting upon standing up, or orthostatic hypotension (POTS)
  • an inability to alter heart rate with exercise, or exercise intolerance
  • sweating abnormalities, which could alternate between sweating too much and not sweating enough
  • digestive difficulties, such as a loss of appetite, bloating, diarrhea, constipation, or difficulty swallowing
  • urinary problems, such as difficulty starting urination, incontinence, and incomplete emptying of the bladder
  • sexual problems in men, such as difficulty with ejaculation or maintaining an erection
  • sexual problems in women, such as vaginal dryness or difficulty having an orgasm
  • vision problems, such as blurry vision or an inability of the pupils to react to light quickly

Peripheral nervous system dysfunction is when the nerves outside of the brain and spine do not react properly to signals from the brain which can cause the following symptoms:

  • Numbness
  • Pain
  • Burning or tingling
  • Muscle weakness (things slip through your hands)
  • Sensitivity to touch
  • loss of balance and coordination (not knowing where your feet are)
  • muscle cramping/twitching
  • difficulty walking or moving the arms
  • Unusual sweating
  • Abnormalities in blood pressure or pulse

Urinary retention is the inability to empty the bladder completely.

Intestinal pseudo-obstruction is a clinical syndrome caused by severe impairment in the ability of the intestines to push food through.  Some call it “palsy of the gut.” Great article here:

Please see this case report of a poor woman suffering with both urinary and intestinal symptoms with Lyme: The patient’s gastrointestinal function recovered and the pain subsided significantly following treatment with antibiotics.

As I look at these symptoms, they are a literal rap sheet for tick borne illness. The symptoms are widely variable and involve nearly every organ of the body. While you may hear about the digestive, vision, urinary, and burning pain and numbness symptoms, you will only hear about the sexual dysfunction in close circles, but it is real and it can be devastating if you don’t understand it.  Word needs to get out.

Most doctors are clueless so print this out so you can talk about it with them.