Diagnosis of AIDS-related focal brain lesions

Antinori, Andrea; Ammassari, Adriana; Luca, Andrea De; Cingolani, Antonella; Murri, Rita; Scoppettuolo, Giancarlo; Fortini, Marco; Tartaglione, Tommaso; Larocca, Luigi Maria; Zannoni, GF; Cattani, Paola; Grillo, R; Roselli, R.; Iacoangeli, Maurizio; Scerrati, Massimo; Ortona, L

doi:10.1212/wnl.48.3.687

Cited by 200 publications

(123 citation statements)

References 14 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…In HIV-positive patients with cerebral toxoplasmosis, PCR amplification in CSF or blood has a high specificity (100%) but a low sensitivity (30-50%). 59,60 In BMT patients, we do not have data concerning sensitivity or specificity, although Johnson et al 52 reported one false-negative result. However, many authors consider that PCR testing contributes to a rapid diagnosis and potentially improves outcome, and also allows monitoring of efficacy of treatment.…”

Section: Discussionmentioning

confidence: 85%

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature

Mele

Paterson

et al. 2002

Bone Marrow Transplant

169

154

View full text Add to dashboard Cite

Summary:Toxoplasma infection represents a rare but often fatal complication in bone marrow transplant (BMT) recipients. We report two cases of toxoplasmosis: one of successfully treated cerebral toxoplasmosis after peripheral blood stem cell transplantation, and a fatal case of pulmonary toxoplasmosis in a BMT recipient. We have systematically reviewed the 110 published cases of toxoplasmosis following BMT. We analyzed the pretransplant and clinical features of BMT recipients developing toxoplasmosis, together with the diagnostic procedures used and treatment given. By univariate and multivariate statistical analysis we analyzed the risk factors for diagnosis (during life vs post-mortem) and Toxoplasma-related mortality. Ante-mortem diagnosis was made in 47% of cases. Site of infection (P = 0.02; odds ratio 10.8), presence of symptoms at onset (P = 0.01) and conditioning regimen (P = 0.04) were factors influencing whether the diagnosis was made before or after death. Overall mortality rate was 80% and that attributed to toxoplasmosis was 66%. Variables influencing outcome were: site of infection (P = 0.02; odds ratio 5.28), day of onset (P = 0.04) and conditioning regimen (P = 0.04). Underlying disease (P = 0.02; odds ratio 9.45), among patients diagnosed before death, was the most significant factor influencing outcome.

show abstract

Section: Discussionmentioning

confidence: 85%

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature

Mele

Paterson

et al. 2002

Bone Marrow Transplant

169

154

View full text Add to dashboard Cite

show abstract

“…However, surprisingly, JCV PCR was positive in only 24 % of patients with radiology findings suggestive of PML (Table 1). This low detection rate may be due to non-specificity of radiological findings (Antinori et al, 1997) or insensitivity of PCR, or perhaps due to highly active antiretroviral therapy (HAART) re-establishing host immune function and reducing JCV below detectable levels (Koralnik, 2006). These possibilities are supported by the findings that PML is often difficult to distinguish radiographically from lesions caused by HIV encephalopathy (Olsen et al, 1988;Koralnik et al, 1999) and that the sensitivity of JCV PCR dropped from 89.5 % in the pre-HAART era (1992)(1993)(1994)(1995) to 57.5 % in the HAART era (1996)(1997)(1998)(1999)(2000)(2001)(2002) (Marzocchetti et al, 2005).…”

Section: Resultsmentioning

confidence: 99%

Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy

Wang

Qian

2009

Journal of Medical Microbiology

View full text Add to dashboard Cite

In a retrospective review of data from 168 patients with suspected progressive multifocal leukoencephalopathy (PML) between 1996 and 2006, JC virus (JCV) PCR on cerebrospinal fluid (CSF) samples was positive only in human immunodeficiency virus (HIV)-infected patients with low CD4 cell counts and in severely immunocompromised patients with radiographic lesions consistent with PML or infectious processes generally. Of note, one HIV patient with a very low CD4 cell count had a positive JCV PCR despite a normal magnetic resonance imaging exam. We concluded that JCV PCR testing on CSF specimens should therefore be targeted to these high-risk patients.

show abstract

“…Neurological examination on presentation was unremarkable, without any focal abnormalities. Laboratory revealed moderate anemia (hemoglobin of 10 g/dL), with leukopenia (white blood cell count of 1900 cells/mm 3 ), and lymphopenia (260 cells/mm 3 ). Chest radiograph was normal.…”

Section: Case Reportmentioning

confidence: 99%

Tuberculous brain abscess in a patient with AIDS: case report and literature review

Vidal

Cimerman

Silva

et al. 2003

Rev. Inst. Med. trop. S. Paulo

View full text Add to dashboard Cite

SUMMARYTuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. Brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.

show abstract

Diagnosis of AIDS-related focal brain lesions

Cited by 200 publications

References 14 publications

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature

Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy

Tuberculous brain abscess in a patient with AIDS: case report and literature review

Contact Info

Product

Resources

About