Long-term course and outcome in AIDS patients with cerebral toxoplasmosis

Arendt, Gabriele; Giesen, H.‐J. Von; Hefter, Harald; Neuen-Jacob, E.; Roick, H.; Jablonowski, H

doi:10.1111/j.1600-0404.1999.tb00735.x

Cited by 35 publications

(27 citation statements)

References 21 publications

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“…TE thus results in a variety of focal neurological deficits, brain edema, and increased intracranial pressure. Survivors of TE may be afflicted with any number of problems, including hydrocephalus, permanent focal motor and sensory deficits, or seizures (Arendt et al, 1999). PML causes severe demyelination associated with lysis of oligodendrocytes, as well as axonal loss, and focal neurological deficits such as hemiparesis (Roberts, 2005).…”

Section: Discussionmentioning

confidence: 99%

An exploratory study of long-term neurocognitive outcomes following recovery from opportunistic brain infections in HIV+ adults

Levine

Hinkin

Ando

et al. 2008

Journal of Clinical and Experimental Neuropsychology

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Central nervous system opportunistic infections (CNS-OI) are a significant cause of morbidity and mortality in AIDS. While current interventions are increasingly successful in treating CNS-OI, little information exists regarding long-term behavioral outcomes among survivors. In this exploratory study we examined neurocognitive data among three groups of adults with different AIDS-related CNS-OI: 15 with past cryptococcal meningitis (CM), 8 with toxoplasmosis encephalitis (TE), and 8 with progressive multifocal leukoencephalopathy (PML). A group of 61 individuals with AIDS, but without CNS-OI, was used as a comparison group. A battery of standardized neuropsychological tests assessing a variety of cognitive domains was administered upon entry. Results indicate that individuals with a history of CNS-OI were most impaired on measures of cognitive and psychomotor speed relative to the HIV+ comparison group. Among the CNS-OI groups, individuals with history of TE had the most severe and varied deficits. The results are discussed in relation to what is known about the neuropathological consequences of the various CNS-OIs. While this is the first systematic group study of residual CNS-OI effects on neurocognitive function, future studies employing more participants, perhaps focusing on specific CNS-OIs, will further characterize the long-term outcomes in AIDS-related CNS-OI. KeywordsOpportunistic infection; AIDS; Neuropsychological functioning; Toxoplasmosis encephalitis; Progressive multifocal leukoencephalopathy; Cryptococcal meningitis Address correspondence to Andrew Levine, National Neurological AIDS Bank, 11645 Wilshire Blvd., Suite 770, Los Angeles, 90025, CA, USA (ajlevine@mednet.ucla.edu). NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptSince its introduction in 1996, highly active antiretroviral therapy (HAART) has, when used in combination with adjunctive and prophylactic antibiotic therapy, dramatically decreased the incidence of central nervous system opportunistic infections (CNS-OI) and has improved the longevity of people with AIDS (Collier et al., 1999;Neuenburg et al., 2002; San-Andreas et al., 2003). HAART has also contributed to improved survival among those AIDS patients who develop a CNS-OI (Kirk et al., 2002). These conditions, which at one time typically resulted in death, can now be treated. Further, while HIV infection itself may lead to neuropathological changes, the CNS-OIs common among AIDS patients often result in more severe structural brain lesions. Currently, little information exists regarding the long-term cognitive and functional outcomes in individuals who survive AIDS-related CNS-OIs. For example, do most survivors of AIDS-related CNS-OI recover to such a degree that they can return to work or independent living? Examination of the changes in survivors' neuropsychological abilities is necessary to understand the benefits and limitations of current treatments, to identify obstacles in returning affected individuals to independence...

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Section: Discussionmentioning

confidence: 99%

An exploratory study of long-term neurocognitive outcomes following recovery from opportunistic brain infections in HIV+ adults

Levine

Hinkin

Ando

et al. 2008

Journal of Clinical and Experimental Neuropsychology

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“…ausreichend therapierten Residualzuständen persistiert eine intrathekale Antikörpersynthese oft über Jahre. Zur Beurteilung der Krankheitsaktivität und Therapiebedürftigkeit sind daher auch nicht erregerspezifische Kriterien wie die Zellzahl und -differenzierung im Liquor sowie die Schrankenfunktion zu berücksichti-gen. Nach erfolgreicher antibiotischer Therapie sind Zellzahl und Schrankenfunktionsstörung innerhalb von Wochen bis Monaten, der VDRL und das Treponemen-IgM innerhalb eines Jahres rück-läufig [91,92]. Die zerebrale Toxoplasmose ist eine der häufigsten opportunistischen Infektionen bei Patienten mit AIDS und einer CD4 + -T-Zellzahl < 100/µl.…”

Section: Opportunistische Infektionenunclassified

“…Die Toxoplasma-PCR hat nur geringe bis moderate Sensitivität (12 -64 %), wobei die Spezifität bei annähernd 100 % liegt. Ein negativer Befund schließt eine zerebrale Toxoplasmose nicht aus, sodass im Verdachtsfall und passender MRT-Bildgebung eine Therapie eingeleitet werden sollte [91,92].…”

Section: Opportunistische Infektionenunclassified

Neues bei HIV und Neuro-Aids

et al. 2015

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Zusammenfassung Trotz sehr effektiver Behandlungsoptionen f?r die systemische HIV-Infektion sind Neuro-Aids und die HIV-assoziierte neurokognitive St?rung ein klinisches und alltagsrelevantes Problem. Man unterscheidet 3 Stufen, das HIV-assoziierte, neuropsychologische Defizit (ANPD), das milde, HIV-assoziierte neurokognitive Defizit (MNCD) und die HIV-assoziierte Demenz (HAD). Die Behandlungsm?glichkeiten HIV-assoziierter neuro-kognitiver St?rungen umfasst die antiretrovirale Therapie (cART), die den CPE-Score zur Penetration der Medikamente ins ZNS ber?cksichtigen sollte. Es ist sinnvoll, bei Auftreten multiresistenter Virusvarianten im Blut auch im Liquor entsprechende Untersuchungen durchzuf?hren. Im peripheren Nervensystems treten neben der klassischen, distal-symmetrischen, HIV-assoziierten Polyneuropathie immunogen vermittelte Neuropathien oder Myopathien auf (CIDP, AIDP). Durch die antiretrovirale Therapie (cART) verursachte Polyneuropathien sind differenzialdiagnostisch zu ber?cksichtigen. Erworbene mitochondrial toxische Myopathien treten h?ufiger auf, da nun eine cART durchaus ?ber 10???20 Jahre durchgef?hrt wird. Bei Patienten mit schweren depressiven Episoden zeigte sich eine 6-mal h?here Wahrscheinlichkeit, die Einnahme der cART mindestens einmal zu vergessen. Depressive Episoden sind oft ein Grund f?r mangelhafte Adh?renz, korrelieren mit einer h?heren Viruslast und sind dringend zu behandeln. In den letzten Jahren kam es infolge der verbesserten cART zu einem R?ckgang der opportunistischen Infektionen (OI) des ZNS. Die h?ufigsten OI stellen die progressive multifokale Leukoenzephalopathie (PML), die Toxoplasma-Enzephalitis und die Kryptokokken-Meningitis dar. Bei rasch progredientem Verlauf einer OI muss an ein Immunrekonstitutionssyndrom (IRIS) gedacht werden. Es gibt momentan keine sichere Methode, z.?B. die Verschlechterung einer PML durch den nat?rlichen Krankheitsverlauf von der Verschlechterung durch ein IRIS zu unterscheiden. Infolge der deutlich zunehmenden Lebenserwartung treten Komorbidit?ten mehr in den Vordergrund. Zu den viralen Biomarkern f?r die Krankheitsaktivit?t im ZNS z?hlen Neopterin als Marker der Makrophagenaktivierung, das Neurofilament-Leichtprotein und das Gesamt-Tau-Protein.

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“…Psychiatric complications due to acute T. gondii infection or secondary reactivation of the disease in immunosuppressed individuals include: disorientation, anxiety, depression, and schizophreniform psychoses [46]. Hydrocephalus, increased ventricular size, and cognitive impairment have also been reported in schizophrenia and other forms of psychosis [45].…”

Section: Toxoplasmosismentioning

confidence: 99%

Psychiatric Aspects of Infectious Diseases

Mufaddel¹,

Omer²,

Salem³

2014

OJPsych

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Psychiatric symptoms can be associated with several systemic and central nervous system infections and they can be the initial presenting symptoms, occurring in the absence of neurological symptoms in some disorders as in some cases of viral encephalitis. They could also be part of the clinical picture in other cases such as psychosis or mood symptoms secondary to brucellosis or toxoplasmosis. Late-onset neuropsychiatric complications may also occur several years following the infection such as in the case of subacute sclerosing panencephalitis due to measles. Some Infectious diseases may have possible etiological role for major psychiatric disorders, based on yet unconfirmed reports for viral infectious diseases (e.g. Influenza virus and HSV-1) which are thought to have risk for developing schizophrenia and psychosis. Neuropsychiatric adverse effects can occur due to drugs (e.g. mefloquine, interferon-alpha) that are used for treatment of infectious diseases. Psychiatric symptoms can also be reactivated resulting from chronic, complicated and serious infections such as HIV that can lead to depression, anxiety or adjustment disorders, although CNS involvement can also be a possible etiological factor. Patients suffering from primary and severe psychiatric disorders are at increased risk of contracting infection; that is mainly related to high risk behaviors in patients with mania or schizophrenia. It is also important to consider that the co-occurrence of psychiatric symptoms and infection can be incidental (i.e. infectious diseases can occur in psychiatric patients regardless of the above mentioned factors). Early identification of the underlying etiology for organic/secondary psychiatric symptoms is essential for appropriate intervention and early treatment of the primary condition that could be the etiology of psychiatric symptoms so as to avoid unnecessary long-term psychiatric treatment and to avoid complications of possible misdiagnosis or delayed diagnosis of the primary condition.

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Long-term course and outcome in AIDS patients with cerebral toxoplasmosis

Cited by 35 publications

References 21 publications

An exploratory study of long-term neurocognitive outcomes following recovery from opportunistic brain infections in HIV+ adults

An exploratory study of long-term neurocognitive outcomes following recovery from opportunistic brain infections in HIV+ adults

Neues bei HIV und Neuro-Aids

Psychiatric Aspects of Infectious Diseases

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