Abstract:Background Cryptococcal meningitis continues to be one of the common causes of chronic central nervous system infection worldwide. Individuals with cryptococcal meningitis can occasionally present with small vessel vasculitis causing infarcts primarily in the basal ganglia, internal capsule, and thalamus. Literature regarding patterns of cerebrovascular injury among patients with cryptococcal meningitis is scanty, and outcome following these vascular involvements is unknown. Aim To study the clinical profile, … Show more
“…24,36,46 Adult studies have found that stroke is not common in HIV without an additional underlying disease state. 47 These disease states include infections including varicella zoster virus, 42 cryptococcus, 48,49 neurocysticercosis, 50 hepatitis B, 51 syphilis, 52 and tuberculosis, 53 as well as neoplastic and prothrombotic states. 47 Immune reconstitution syndrome 54 and ART may also contribute to cerebrovascular disease, with evidence for both protease inhibitors 55 and efavirenz 56 potentially contributing to cerebrovascular disease.…”
Background: Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. Methods: Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. Results: We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P ¼ 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm 3 , P ¼ 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P ¼ 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P ¼ 0.02) of HIV-infected subjects with cognitive impairment. Conclusions: These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.
“…24,36,46 Adult studies have found that stroke is not common in HIV without an additional underlying disease state. 47 These disease states include infections including varicella zoster virus, 42 cryptococcus, 48,49 neurocysticercosis, 50 hepatitis B, 51 syphilis, 52 and tuberculosis, 53 as well as neoplastic and prothrombotic states. 47 Immune reconstitution syndrome 54 and ART may also contribute to cerebrovascular disease, with evidence for both protease inhibitors 55 and efavirenz 56 potentially contributing to cerebrovascular disease.…”
Background: Cognitive impairment is common in children and adolescents with human immunodeficiency virus (HIV). Brain magnetic resonance imaging (MRI) is a potentially useful tool to investigate the pathophysiology of HIV-associated cognitive impairment and may serve as a biomarker in future clinical trials. There are few published data on brain imaging in children with HIV in sub-Saharan Africa. Methods: Thirty-four perinatally infected subjects with HIV and age-matched HIV-exposed uninfected controls between the ages nine and 17 years were recruited from the Pediatric Center of Excellence in Lusaka, Zambia, as part of the HIV-associated Neurocognitive Disorders in Zambia study. Brain MRI sequences were acquired, and clinical and volumetric assessments were performed. Subjects underwent a comprehensive neuropsychologic battery, and cognitive impairment status was classified using a global deficit score approach. Regression models were used to evaluate relationships between MRI findings and cognitive function. Results: We identified cerebrovascular disease in seven of 34 subjects with HIV compared with zero of 17 controls (21% vs 0%, P ¼ 0.04). We also identified decreased total brain volumes (1036 vs 1162 cm 3 , P ¼ 0.03) and decreased cortical thickness in the right temporal lobes (3.12 vs 3.29 mm; P ¼ 0.01) and right fusiform gyri (3.10 vs 3.25 mm; P ¼ 0.02) of HIV-infected subjects with cognitive impairment. Conclusions: These findings support the hypothesis that brain volumes may be useful biomarkers for cognitive outcomes in children with HIV. Further studies are necessary to investigate mechanisms of cerebrovascular disease and volume loss in children with HIV.
“…1 Headache is the most common presenting symptom, although fever, vomiting, and altered mental status can also be observed. 2,3 Immunocompetent patients with cryptococcal meningitis are more likely to have subacute, recurrent episodes of nonspecific symptoms like headache, nausea, and CN palsies. 4 Other signs include meningismus, papilledema, focal deficits, and depressed level of consciousness.…”
A 71-year-old woman with a 4-month history of recurrent headaches refractory to treatment presented to her primary care physician's office with persistent headaches, generalized weakness, and a droopy left eyelid. During initial hospital assessment, she endorsed a 20-pound weight loss. She denied any fever, neck stiffness, or photophobia. Her medical history was significant for type II diabetes mellitus and hypertension (both well-controlled and off medications). On examination, the patient was alert and oriented to person, place, and time. Her speech was dysarthric and she had difficulty with word-finding and following 2-step commands. Pupils were 3 mm and equally reactive to light. She had complete ptosis of the left eyelid, and her left eye was down and out at rest. The left eye was able to abduct and look down, but unable to adduct. The right eye was able to abduct and look down, but unable to go past midline when adducting. Upward gaze was limited in both eyes. Eyelid closure was weak bilaterally, but weaker on the left. Facial sensation to light touch was decreased in the V2 distribution bilaterally, and the patient also exhibited mild left facial droop. Hearing was intact. Shoulder shrug was intact. No palate or tongue weakness/asymmetry was noted. Strength in upper and lower limbs was 5/5 throughout. Deep tendon reflexes were 2+ and symmetric throughout. Toes were downgoing bilaterally. Sensation to light touch, pinprick, and temperature was intact on the right side, but diminished in the left arm and leg throughout and did not fit with a peripheral nerve distribution. Truncal ataxia was noted when sitting up and walking. She had an unsteady, wide-based gait, and her balance did not worsen with eyes closed.
“…Cerebrovascular complications are rare [28]; prognosis is determined by the increase in intracranial pressure and the development of papilledema [29][30][31].…”
Opportunistic infections of the central nervous system (CNS) with bacteria, parasites, fungi or viruses due to iatrogenic immunosuppression are of immense importance because of rising numbers of organ transplantations and immunomodulating treatments. Besides transplantation medicine, the most frequently involved medical subspecialties are dermatology (interferons, rituximab, fingolimod, among others), hematology/oncology (rituximab, among others), neurology (beta-interferon, glatiramer acetate, natalizumab, rituximab, teriflunomide, fingolimod, alemtuzumab, daclizumab, among others) and rheumatology (rituximab).In Europe, typical infections affecting the immunocompromised host are due to herpes viruses and, especially in immunomodulated patients, JC virus (JCV); frequently occurring fungi are Aspergillus fumigatus, Candida albicans and Cryptococcus neoformans. An important parasite is Toxoplasma gondii (TG). Typical bacterial infections of the immunocompromised patient are caused by Nocardia asteroides, Listeria monocytogenes and Mycobacterium tuberculosis.Modern diagnostic and therapeutic procedures will be described.
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