BRAIN ABSCESS DUE TO Staphylococcus aureus OF CRYPTOGENIC SOURCE IN AN HIV-1 INFECTED PATIENT IN USE OF ANTIRETROVIRAL THERAPY

Oliveira, Anna Paula Romero de; Pappalardo, Mara C. S. M.; Dantas, Daniel Soares de Sousa; Lins, Diogo L.M.; Vidal, José Ernesto

doi:10.1590/s1678-9946201658034

Cited by 5 publications

(9 citation statements)

References 15 publications

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“…A myriad of etiologies may occasionally present with expansive brain lesions in PLWHA: Nocardia species, varicella zoster virus, Aspergillus species, Listeria monocytogenes , Treponema pallidum , Histoplasma capsulatum , and Cryptococcus neoformans . Eventually, bacterial, 52,143 mycobacterial, 144 or fungal 145 abscesses, particularly in early stages of evolution in CT scan, may be misdiagnosed as cerebral toxoplasmosis. However, neuroradiological features of brain abscess are usually well characterized, and immediate neurosurgical evaluation is imperative.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…Finally, focal brain lesions may or may not show expansive effect. [49][50][51][52] Complementary to the syndromic diagnosis, 3 aspects are relevant to establish the most probable etiologies of expansive focal brain lesions in PLWHA: (1) local neuroepidemiology (ie, tuberculomas is usually more common than primary central nervous system lymphoma [PCNSL] in low-and middleincome countries) [53][54][55][56] ; (2) degree of immunosuppression (ie, lymphocyte CD4 count <200 cells/mm 3 suggests opportunistic diseases; PCNSL usually occurs with lymphocyte CD4 count <50 cells/mm 3 ) 57,58 ; and (3) individual clinical, laboratorial, and neuroradiological features. 51 The management of expansive focal brain lesions in PLWHA in high-income countries and in some middleincome countries has undergone several changes in approaches throughout the AIDS epidemic.…”

Section: Syndromic Approachmentioning

confidence: 99%

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HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

Vidal

2019

J Int Assoc Provid AIDS Care

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Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.

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Section: Differential Diagnosismentioning

confidence: 99%

Section: Syndromic Approachmentioning

confidence: 99%

HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

Vidal

2019

J Int Assoc Provid AIDS Care

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“…The frequency of pyogenic brain abscesses in patients with well-controlled HIV and high CD4 cell counts is unknown. The literature is very limited in this regard, with only a few cases reported [ 7 , 8 ]. It is unclear if HIV infection by itself increases the risk of brain abscesses.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike immunocompetent hosts, the microbiology of pyogenic brain abscesses in HIV patients with CD4 count >200 cells/uL has not been well defined. The literature is very limited, with only anecdotal reports of Staphylococcus , Propionibacterium , and Streptococcus as some of the pathogens isolated [ 7 , 8 ]. In the setting of HIV, Peptostreptococcus has been associated with skin abscesses, periodontitis, and pneumonia, but no cases of pyogenic brain abscess have been reported [ 11 , 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Brain Abscess Caused by Peptostreptococcus in a Patient with HIV-1 Infection

Zamora

Espinoza

2017

Diseases

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In the setting of HIV, cerebral lesions are usually secondary to lymphoma and opportunistic infections; however, in patients with CD4 counts above 200 cells/uL, other pathologies such as pyogenic brain abscess could gain importance. The microbiology of pyogenic brain abscess has Staphylococcus and Streptococcus as the leading etiologic pathogens in immunocompetent individuals. Peptostreptococcus is also recognized as a common cause of brain abscess in this patient population. In HIV-infected individuals, there have been sporadic reports of Peptostreptococcus infections but none of brain abscess. We describe the case of a 43-years-old HIV-infected patient with a CD4 count of 350 cells/uL that developed a Peptostreptococcus brain abscess presumably from hematogenous spread of an odontogenic source. Treatment with stereotactic needle aspiration in two opportunities and four weeks of intravenous antibiotics led to a complete resolution of this infection. This case highlights the importance of a multidisciplinary approach for an effective treatment of pyogenic brain abscess in HIV-1 patients.

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“…The origin of brain abscess formation remains unknown (cryptogenic brain abscess) in 20% to 30% of cases. 7 …”

Section: Discussionmentioning

confidence: 99%

Multiple Brain Abscesses in an Immunocompetent Patient With Factor V Leiden Mutation

Zafar

Pervin

Manthri

et al. 2016

Journal of Investigative Medicine High Impact Case Reports

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Multiple brain abscesses in an immunocompetent patient is a challenging clinical problem in the medical world despite advances in imaging techniques, laboratory diagnostics, surgical interventions, and antimicrobial treatment. It is a clinical entity that typically tends to occur in the presence of known predisposing factors. Clinicians seek to determine the potential risk factors responsible for the development of brain abscess because it is very crucial for management of this life-threatening condition. At times, like in our case, there are clinical situations where it is difficult to reveal any traditional risk factors. We report a case of multiple brain abscesses in a 51-year-old female with a past medical history significant only for factor V Leiden mutation, and deep vein thrombosis on chronic anticoagulation. She underwent thorough evaluation but no predisposing factors were found. Based on our extensive literature review, this is the index case of multiple brain abscesses in a patient with history of factor V Leiden mutation and the absence of any conventional risk factors. We also postulate a possible mechanism of infection in such patients.

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BRAIN ABSCESS DUE TO Staphylococcus aureus OF CRYPTOGENIC SOURCE IN AN HIV-1 INFECTED PATIENT IN USE OF ANTIRETROVIRAL THERAPY

Cited by 5 publications

References 15 publications

HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease

Pyogenic Brain Abscess Caused by Peptostreptococcus in a Patient with HIV-1 Infection

Multiple Brain Abscesses in an Immunocompetent Patient With Factor V Leiden Mutation

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