The role of brain biopsy in the clinical management of <scp>HIV</scp>‐related focal brain lesions

Acosta, M Carmen; Kundro, M.; Viloria, Guillermo Alberto; Paz, Analía; Morello, Frank A.; Latorre, F. Fernandez; Seoane, Eduardo; Toibaro, J; Losso, MH

doi:10.1111/hiv.12646

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…However, it remains 1 of the most common AIDS-related malignancies, with a prevalence of 20.6% in HIV-positive patients with FBL. [23] EBV infection plays a crucial role in the progression of AR-PCNSL. EBV is a gamma herpesvirus that infects more than 90% of the world's population as a latent asymptomatic infection of B-lymphocytes.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test

et al. 2022

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Background: Epstein-Barr virus (EBV) infection plays a crucial role in the progression of acquired immunodeficiency syndrome related primary central nervous system lymphoma (AR-PCNSL). This study aimed at evaluating the diagnostic value of cerebrospinal spinal fluid (CSF) EBV-deoxyribonucleic acid (DNA) for PCNSL in patients with infection of human immunodeficiency (HIV) virus through a meta-analysis of diagnostic test. Methods: A systematic search in PubMed, Embase, Web of Science, Wanfang, Chinese Biomedical Database and Chinese National Knowledge Infrastructure was conducted before May 10, 2022. Heterogeneity among the studies was assessed using Q test and I2 statistics. Publication bias was assessed using the Deek’s funnel plot asymmetry test. Statistical analyses were performed using Stata 16.0 software. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were caculated to evaluate the diagnostic value. A symmetric receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC) were constructed to evaluate the test-performance. Results: Twelve studies were included in the final analyses, with a total of 141 patients with AR-PCNSL and 590 controls. The pooled diagnostic values were sensitivity of 0.83 (95% CI: 0.73–0.90), specificity of 0.95 (95%CI: 0.89–0.98), PLR of 17.8 (95%CI: 6.8–46.1), NLR of 0.17 (95%CI: 0.10–0.30), DOR of 102 (95%CI: 28–379), and AUC of 0.94 (95%CI: 0.91–0.96). Conclusion: In summary the overall diagnostic value of CSF EBV-DNA is very high and it can be a reliable diagnostic biomarker for AR-PCNSL.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test

et al. 2022

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“…Both the basic CSF profile and microbiological tests for TB are usually normal in the absence of a concurrent tuberculous meningitis, and the only definitive diagnostic test is a brain biopsy. In a retrospective cohort of people with HIV in Argentina presenting with space-occupying lesions, brain biopsy revealed a definitive etiology in 93% of cases and changed management in 75% 70 . However, biopsy is often not possible in resource-limited settings where TB is most common, thus necessitating a presumptive diagnosis based on clinical and radiographic characteristics to initiate empiric antimicrobial therapy.…”

Section: Tuberculomas and Tuberculous Abscessesmentioning

confidence: 99%

Neurologic Complications of Tuberculosis

Saylor¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article describes the current epidemiology, common clinical characteristics, and up-to-date evidence-based approaches to the diagnosis and management of the most common neurologic complications of tuberculosis (TB): tuberculous meningitis, intracranial tuberculoma, and spinal TB.RECENT FINDINGS: Central nervous system (CNS) TB remains common and associated with significant mortality and neurologic sequelae worldwide. Human immunodeficiency virus (HIV) co-infection is strongly associated with both the development of and mortality due to CNS TB. Strongyloides co-infection is associated with reduced CNS inflammation and improved outcomes in the setting of tuberculous meningitis. Stroke remains a common complication of tuberculous meningitis, and emerging evidence suggests aspirin may be used in this context. Although a recent nucleic acid amplification test has demonstrated suboptimal sensitivity in the diagnosis of CNS TB, emerging diagnostic techniques include cell-free DNA, peripheral blood microRNA, metagenomic next-generation sequencing, and advanced imaging techniques, but these are not yet well validated. CNS TB is associated with high mortality even with current treatment regimens, although novel, promising strategies for treatment are under investigation, including a combination of IV isoniazid and ethambutol and high-dose rifampicin.SUMMARY: TB can affect the nervous system in various ways and is associated with high mortality. Diagnosis remains challenging in endemic settings, with empiric treatment often initiated without a definitive diagnosis. Furthermore, optimal treatment regimens remain uncertain because current treatment for all forms of CNS TB is extrapolated from trials of tuberculous meningitis whereas the role of steroids in people with HIV and tuberculous meningitis remains controversial.

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“…Поражение нервной системы у ВИЧ-инфицированных занимает второе место после изменений иммунного статуса и встречается у 40-80% пациентов на стадии СПИДа, что связано как с прямым повреждением вирусом нервных клеток, так и с развитием оппортунистических инфекций [2][3][4]. В 10-20% случаев неврологические нарушенияпервые проявления ВИЧ [5]. Церебральный токсоплазмоз (ЦТ) -наиболее частая оппортунистическая инфекция, поражающая центральную нервную систему (ЦНС) у пациентов со СПИД [1,[5][6][7][8].…”

Section: Introductionunclassified

“…В 10-20% случаев неврологические нарушенияпервые проявления ВИЧ [5]. Церебральный токсоплазмоз (ЦТ) -наиболее частая оппортунистическая инфекция, поражающая центральную нервную систему (ЦНС) у пациентов со СПИД [1,[5][6][7][8].…”

Section: Introductionunclassified

A case series of cerebral toxoplasmosis in the practice of a neurological hospital

Shnyakin

Botov

Rudenko

et al. 2023

Annals of Clinical and Experimental Neurology

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Introduction. Central nervous system is one of the main targets in patients with HIV infection. Neurological complications in AIDS are primarily caused by opportunistic brain infections including toxoplasmosis as the most common one. Patients with cerebral toxoplasmosis are often hospitalized with diagnosed strokes, tumors, or encephalitis. At that, their HIV status may be unknown and their state severity often does not allow conducting the range of required examinations. Materials and methods. We have described our experience in management of 6 patients admitted to the neurosurgery department with single toxoplasmosis foci and diagnosed brain tumors. Results. HIV infection was initially known in 3 patients only. In 2 compensated patients, the diagnosis was confirmed via Toxoplasma IgG blood test. In 2 individuals, negative serological Toxoplasma reactions were followed by neuronavigationally controlled biopsies. A patient with an extensive perifocal edema and, as a result, dislocated midline structures underwent decompressive craniectomy and mass removal. One female patient, with an unclear diagnosis, was operated for a suspected brain tumor. After additional assessments (including 4 histologies to confirm cerebral toxoplasmosis), all the patients were transferred to the infectious disease hospital for specific treatment.

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The role of brain biopsy in the clinical management of HIV‐related focal brain lesions

Abstract: In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients.

Cited by 10 publications

References 24 publications

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test

Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test

Neurologic Complications of Tuberculosis

A case series of cerebral toxoplasmosis in the practice of a neurological hospital

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