Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era

Manzardo, Christian; Ortega, M.; Sued, Omar; García, Felipe; Moreno, Asunción; Miró, José M.

doi:10.1080/13550280500513846

Cited by 52 publications

(43 citation statements)

References 33 publications

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“…8,9 In a previous report, we observed that CT accounts for 10% of the admissions at Instituto de Infectologia Emí-lio Ribas, usually occurring as AIDS-defining disease. 2 In addition, similarly to other reports, 10 CT continue to appear in Brazil among patients with late HIV diagnosis, with poor compliance with HAART, or with treatment failure.…”

Section: Discussionmentioning

confidence: 60%

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

Vidal¹,

Díaz²,

Oliveira³

et al. 2011

Braz J Infect Dis

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Background: Cerebral toxoplasmosis (CT) continues to cause significant morbidity and mortality in human immunodeficiency virus (HIV)-infected patients in Brazil. In clinical practice, the initial diagnosis is usually presumptive and alternative diagnosis tools are necessary. Our objective was to evaluate whether the detection of high titers of IgG anti-Toxoplasma gondii and T. gondii DNA in blood samples are associated with the diagnosis of CT. Methods: In this case-control study we included 192 patients with HIV-1 infection: 64 patients with presumptive CT (cases) and 128 patients with other diseases (controls). Blood samples to perform indirect immunofluorescense reaction (IFI) to detect anti-T. gondii IgG antibodies and polymerase chain reaction (PCR) were collected before or within the first three days of anti-Toxoplasma therapy. Two multivariate logistic regression models were performed: one including the variable qualitative serology and another including quantitative serology. Results: In the first model, positive IgG anti-T. gondii (OR 4.7, 95% CI 1.2-18.3; p = 0.027) and a positive T. gondii PCR result (OR 132, 95% CI 35-505; p < 0.001) were associated with the diagnosis. In the second model, IgG anti-T. gondii titres ≥ 1:1024 (OR 7.6, 95% CI 2.3-25.1; p = 0.001) and a positive T. gondii PCR result (OR 147, 95% CI 35-613; p < 0.001) were associated with the diagnosis. Conclusions: Quantitative serology and molecular diagnosis in peripheral blood samples were independently associated with the diagnosis of CT in HIV-infected patients. These diagnostic tools can contribute to a timely diagnosis of CT in settings where Toxoplasma infection is common in the general population.

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Section: Discussionmentioning

confidence: 60%

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

Vidal¹,

Díaz²,

Oliveira³

et al. 2011

Braz J Infect Dis

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“…Es común encontrar enfermedades extraneuronales con afectación de la retina y del tubo digestivo, complicaciones que ocurren con bajos conteos de CD4 (15)(16)(17)(18)(19).…”

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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“…The use of maintenance therapy with foscarnet is feasible but cumbersome since it requires a permanent line for its administration and frequent monitoring of electrolytes and kidney function. Although the optimal time to discontinue maintenance therapy is unknown, some authors suggest that can be safely discontinued in patients with inactive disease and sustained immune reconstitution (CD4+ T cells count > 100 cells/mL for 3-6 months on HAART) 17,20,22 . Three of our patients discontinued maintenance therapy after six months with CD4+T cell count > 100 cells/mL.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors recommend combination therapy in all cases 11,20 or in patients who have received prior antiviral therapy for CMV or in patients with disease progression under monotherapy 22,34 . In the present study we observed that most patients with combination therapy were discharged alive, but it was not significantly higher compared with those receiving monotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Neurologic CMV complications usually occur in patients with very low CD4 cell counts (< 50 cells/µL) and are often simultaneously present at other sites (retina, gastrointestinal tracts, blood, etc) 20 . However, 6/13 patients of the present series did not present extra-neural CMV diseases, except by the presence of pp65 antigenemia in three of them.…”

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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Central nervous system opportunistic infections in developed countries in the highly active antiretroviral therapy era

Cited by 52 publications

References 33 publications

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

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

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

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