Acute lumbosacral polyradiculopathy due to cytomegalovirus in advanced HIV disease: CSF findings in 17 patients.

Miller, R F; Fox, Julie D.; Thomas, P K; Waite, James; Sharvell, Y; Gazzard, Brian; Harrison, M. J. G.; Brink, Nicola S.

doi:10.1136/jnnp.61.5.456

Cited by 64 publications

(40 citation statements)

References 29 publications

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“…However, the spectrum of neurologic CMV complications is broad and their diagnosis and treatment is more challenging. In the present study, similar to some reports of the pre HAART period 2,26 , approximately 30% of patients with neurologic CMV complications presented concomitant CMV retinitis. For this reason, routine ophthalmologic evaluation should be performed in all these patients.…”

Section: Discussionsupporting

confidence: 91%

“…Conversely, this figure was only ~ 10% in the pre HAART period 2,26 . This finding suggests that CMV should be included in the differential diagnosis of neurologic complaints in AIDS patients with severe immunosuppression, and without history of previous AIDS-defining conditions.…”

Section: Discussionmentioning

confidence: 92%

“…The differential diagnosis in HIV-infected patients includes other opportunistic infections (tuberculosis, herpes simplex virus -HSV -type 2, varicella-zoster virus, and toxoplasmosis), syphilis, and lymphoma 26 .…”

Section: Discussionmentioning

confidence: 99%

“…In the pre HAART period, the overall prognosis of neurologic CMV complications was poor, independent of treatment, with survival of one to four months 2,3,11,26 . For example, in a retrospective study of 103 cases published with CMV polyradiculopathy, the mean survival time for untreated and treated patients with ganciclovir was 5.4 and 14.6 weeks, respectively 1 .…”

Section: Discussionmentioning

confidence: 99%

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Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Silva

Oliveira

Vilas-Boas

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69%) were men. At admission all patients were aware of their HIV status and only four (31%) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62%) patients. The neurologic syndromes identified were diffuse encephalitis (n = 7; 62%), polyradiculopathy (n = 7; 54%), focal encephalitis (rhombencephalitis) (n = 1; 8%), and ventriculo-encephalitis (n = 1; 8%). Seven (54%) patients presented extra-neural CMV disease and four (31%) had retinitis. The median of CD4+ T-cell count was 13 cells/µL (range: 1-124 cells/µL). Overall in-hospital mortality was 38%. Eight patients used ganciclovir or foscarnet (in-hospital mortality: 50%) and five patients used ganciclovir and foscarnet (in-hospital mortality: 20%). None of the patients fulfilled the diagnosis criteria of immune reconstitution inflammatory syndrome. Four patients were lost to follow-up, and three patients presented immune recovery and discontinued secondary prophylaxis. Although infrequent, distinct neurological syndromes caused by CMV continue to cause high mortality among AIDS patients. Survival depends upon the use of effective antiviral therapy against CMV and the early introduction of HAART.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Silva

Oliveira

Vilas-Boas

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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“…Dado el variado espectro de síntomas neurológicos en la coinfección, entre los diagnósticos diferenciales deben tenerse en cuenta la demencia por HIV, el síndrome de Guillain-Barré, la tuberculosis cerebral, la toxoplasmosis y el linfoma (15,20). Debe señalarse que los diagnósticos no son excluyentes, y que es común el hallazgo de estas enfermedades en el momento en que se detecta la infección por CMV.…”

Section: Discussionunclassified

Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case report

et al. 2017

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: descripción del caso clínico y del marco teórico sustentado durante la discusión Camilo Lara y Natalia Rueda: resumen de presentación del artículo, descripción de los aspectos radiológicos del caso clínico, sustentación de los hallazgos en imágenes descritos en casos previamente publicados Todos los autores contribuyeron a la discusión y la edición del manuscrito. El citomegalovirus (CMV) es uno de los microorganismos oportunistas con mayor prevalencia en pacientes inmunocomprometidos, aunque su reactivación ha descendido después de la introducción de la terapia antirretroviral altamente activa (Highly Active Antiretroviral Therapy, HAART). En las coinfecciones, la encefalitis se ha reportado como una de las condiciones más frecuentes. Se presenta el caso de un paciente adulto joven con infección por virus de la inmunodeficiencia humana (HIV) que tuvo un rápido deterioro neurológico evidenciado en síntomas y signos clínicos clásicos del síndrome de Wernicke-Korsakoff y que no presentaba factores de riesgo para deficiencia de tiamina. En las imágenes de la resonancia magnética cerebral, se detectaron hallazgos típicos del síndrome, y se identificó citomegalovirus (CMV) en el líquido cefalorraquídeo. Con el tratamiento específico para el CMV, se logró el control de los síntomas, aunque hubo secuelas neurológicas que mejoraron. Este es uno de los pocos casos reportados a nivel mundial de síndrome de Wernicke secundario a encefalitis por citomegalovirus. Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case reportCytomegalovirus (CMV) is one of the opportunistic microorganisms with the highest prevalence in immunocompromised patients. Reactivation has decreased after the introduction of highly active antiretroviral therapy (HAART). Encephalitis has been reported in the coinfection as one of the most frequent presentations. We present the case of a young adult patient with HIV infection and rapid neurological deterioration due to classic clinical symptoms and signs of the Wernicke-Korsakoff syndrome, with no risk factors for thiamine deficiency, with images by nuclear magnetic resonance typical of the syndrome, and identification of cytomegalovirus in cerebrospinal fluid. The specific treatment for CMV managed to control the symptoms with neurological sequelae in progression towards improvement. This is one of the few cases reported in the literature of Wernicke syndrome secondary to cytomegalovirus encephalitis. La infección por el virus de la inmunodeficiencia humana (HIV) continúa siendo una de las de mayor trascendencia en el mundo; los informes epidemiológicos internacionales indican que, si bien la incidencia ha disminuido de 2,2 millones de personas infectadas en el 2010 a 2,1 millones en el 2015, la prevalencia ha aumentado de 33,3 millones a 36,7 millones en el mismo periodo. Por otra parte, las muertes relacionadas con el sida se han reducido de 1,5 millones en el 2010 a 1,1 millones en el 2015 (26 %) (1). Ello significa que las tasas de transmisión han disminuido y que la expecta...

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Guidelines for the Treatment of Cytomegalovirus Diseases in Patients With AIDS in the Era of Potent Antiretroviral Therapy<subtitle>Recommendations of an International Panel</subtitle>

Whitley¹

1998

Arch Intern Med

167

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Although the epidemiological features of CMV diseases are changing in the setting of potent, combination antiretroviral therapy, continued attention must be paid to CMV diseases in patients infected with the human immunodeficiency virus to prevent irreversible endorgan dysfunction. The initial and maintenance treatment of CMV retinitis must be individualized based on the characteristics of the lesions, including location and extent, specific patient factors, and characteristics of available therapies among others. Management of relapse or refractory retinitis must be likewise individualized. Ophthalmologic screening for patients at high risk for retinitis or who have a prior diagnosis of extraretinal disease is recommended. Recommendations for gastrointestinal, pulmonary, and neurologic manifestations are included.

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Acute lumbosacral polyradiculopathy due to cytomegalovirus in advanced HIV disease: CSF findings in 17 patients.

Cited by 64 publications

References 29 publications

Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature

Wernicke-Korsakoff syndrome secondary to cytomegalovirus encephalitis: A case report

Guidelines for the Treatment of Cytomegalovirus Diseases in Patients With AIDS in the Era of Potent Antiretroviral Therapy<subtitle>Recommendations of an International Panel</subtitle>

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