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AIDS-associated Meningoencephalitis

Aids Meningoencephalitis


Presentation

  • It provides a comprehensive review of the epidemiology, diagnosis, and management of opportunistic infections and presents strategies for infection prevention and control.[books.google.com]
  • Images in T2-weighted (center) and FLAIR (right-hand side) reveal regression of the white matter changes; however discrete widening of the right ventricle is still present.[aidsrestherapy.biomedcentral.com]
  • Clinical presentation of meningitis may include: [ 2 ] Fever, headache.[patient.info]
  • […] of recent antibiotic use in patients presenting with meningitis.[infectiousdiseaseadvisor.com]
  • In the present case, the patient was a neurologically impaired woman with HIV/AIDS who was found to have a brain mass in a CT scan of the head.[path.upmc.edu]
Fever
  • Symptoms in mild cases of encephalitis usually include: fever headache poor appetite loss of energy a general sick feeling Serious cases of encephalitis can cause: a high fever severe headache nausea and vomiting stiff neck confusion personality changes[kidshealth.org]
  • Amphotericin B has many side effects including kidney damage, high fever, low blood pressure, decreased numbers of red or white blood cells, nausea, vomiting and chills.[aidsinfo.nih.gov]
  • The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes.[mayoclinic.org]
  • Clinical presentation of meningitis may include: [ 2 ] Fever, headache.[patient.info]
  • The classic symptoms of meningitis are fever, headache and neck stiffness. Prompt diagnosis and treatment of bacterial meningitis and the associated condition of meningococcal septicaemia are vital for a good outcome and recovery.[health24.com]
Weight Loss
  • If you have a low CD4 count, keep eep a record of your symptoms, and pay attention to: Fever for more than 2 days Weight loss A change in vision Problems with your mouth, skin, or breathing Call your doctor when you have new or unusual symptoms.[webmd.com]
  • loss) PML Rapid neurologic decline (hemiplegia, visual field defects, ataxia, aphasia) HIV Encephalopathy Progressive memory loss, depression, movement disorders CMV encephalitis Confusion, focal deficits Laboratory tests Blood : Anti-toxoplasma IgG[learningradiology.com]
  • loss) and management of insulin resistance and hyperlipidemia.[aafp.org]
  • At admission, physical examination revealed fever (38 C), tachycardia (102 beats/min) and weight loss (approximately 10 kg in the last three months). Respiratory and cardiovascular systems were normal. Abdomen examination was also normal.[elsevier.es]
  • Majority of patients have a general signs of TB infection (night sweat seen in 80%, weight loss in 76%). Pulmonary symptoms were rarely presenting the symptoms (30%) of cases.[elynsgroup.com]
Burkina Faso
  • While in Africa the range of frequency varies between 13 and 35% [5,8,11], 5.4% in Tunisia [18,19], 3,25% in Burkina Faso [21] and 5,4% in Ivory Coast [3].[ajns.paans.org]
  • [Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso Bull Soc Pathol Exot Jul 16, 2004 ... year-period. During this period, cryptococcal meningo-encephalitis was diagnosed in ... /36).[aidshivresearch.com]
Plethora
  • The emerging new fields of genomics andproteomics have begun to better define the host factors that permit active viral production in the brain as well as lead to a secretion of a plethora of inflammatory and cytotoxic factors that lead to neuronal injury[books.google.com]
Myopathy
  • Human immunodeficiency virus, type 1 (HIV-1) infection can often lead to a number of neurological events including peripheral neuropathy, myopathy, vacuolar myelopathy; and cognitive, motor and behavior abnormalities.[books.google.com]
  • The cause of the myopathies unassociated with AZT are unknown, but pathologic findings include rod body myopathy, both necrotizing and nonnecrotizing inflammatory myopathy, and type 2 muscle fiber atrophy found in HIV-1-associated muscle wasting syndrome[hivinsite.ucsf.edu]
  • Acta myologica : myopathies and cardiomyopathies : official journal of the Mediterranean Society of Myology / edited by the Gaetano Conte Academy for the study of striated muscle diseases 27 19-24 Nov 2008 Tongue fasciculations in chronic inflammatory[researchmap.jp]
  • Myopathy from older nucleoside analogues may now be less common because of the availability of newer agents. HIV also causes an autoimmune-mediated myopathy.[aafp.org]
Confusion
  • Primary CNS Lymphoma (EBV) 30% of all brain lesions in AIDS patients (PML, HIV-associated encephalopathy, and CMV encephalitis usually do not cause mass lesions) History Toxo Headache, confusion, /- fever; focal weakness, seizures; if advanced, dull affect[learningradiology.com]
  • The first signs of meningitis include fever, fatigue, a stiff neck, headache, nausea and vomiting, confusion, blurred vision or sensitivity to bright light. The symptoms may come on slowly.[aidsinfonet.org]
  • Cryptococcal meningitis may cause a person to become confused and have memory loss. Family members or friends may note small changes in personality or behavior.[aidsinfo.nih.gov]
  • Possible signs and symptoms in anyone older than the age of 2 include: Sudden high fever Stiff neck Severe headache that seems different than normal Headache with nausea or vomiting Confusion or difficulty concentrating Seizures Sleepiness or difficulty[mayoclinic.org]
  • Within a few days to a few weeks of contact, an infected person may develop the following symptoms: headache nausea vomiting mental changes, including confusion, hallucinations, and personality changes lethargy sensitivity to light In some cases, the[healthline.com]
Seizure
  • Seizures: occur more commonly during the acute stage of the disease.[patient.info]
  • Anticonvulsants might be given to a child having seizures. Over-the-counter (OTC) medicines, like acetaminophen, can help with fever and headaches. Antibiotics don't work against viruses, so aren't used to treat most forms of encephalitis.[kidshealth.org]
  • The clinical course in both cases was most consistent with Alpers-Huttenlocher syndrome, given the intractable seizures, developmental regression, and, ultimately, death due to liver and renal failure.[hhv-6foundation.org]
  • The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including: Hearing loss Memory difficulty Learning disabilities Brain damage Gait problems Seizures Kidney failure Shock[mayoclinic.org]
  • Flucytosine also may cause serious side effects, including decreased numbers of red or white blood cells, liver damage, nausea, diarrhea, seizures, abdominal discomfort or rash.[aidsinfo.nih.gov]
Neck Stiffness
  • However, 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status. [ 12 ] Most patients with viral meningitis present with subacute neurological symptoms developing over 1-7 days.[patient.info]
  • Case Presentation A 34 year-old Indonesian female with a known history of Acquired Immunodeficiency Syndrome (AIDS) presented with frontal headache, high grade fever, vomiting, and neck stiffness for four days associated with poor oral intake.[pubs.sciepub.com]
  • The classic symptoms of meningitis are fever, headache and neck stiffness. Prompt diagnosis and treatment of bacterial meningitis and the associated condition of meningococcal septicaemia are vital for a good outcome and recovery.[health24.com]
  • The key physical exam findings of aseptic meningitis may include fever, nuchal rigidity (neck stiffness) and photophobia. Altered mental status is rare and if present should increase suspicion for acute purulent meningitis or encephalitis.[infectiousdiseaseadvisor.com]
  • Patients with CM may present with fever as well as symptoms and signs related to inflamed meninges (including neck stiffness), raised intracranial pressure (including headache, confusion, altered level of consciousness, sixth cranial nerve palsies with[sajhivmed.org.za]
Altered Mental Status
  • Meningitis is distinct from encephalitis, which is inflammation of the brain parenchyma and is strongly associated with altered mental status.[infectiousdiseaseadvisor.com]
  • In investigating symptoms such as headache, altered mental status, and cranial neuropathy, aseptic meningitis must be a diagnosis of exclusion.[hivinsite.ucsf.edu]
  • During the hospitalization he presented symptoms consistent with gradually increasing intracranial pressure such as headache and altered mental status that required multiple lumbar punctures to reduce intracranial hypertension (30–45 cm H 2 O).[elsevier.es]
  • However, 95% had at least two of the four symptoms of headache, fever, neck stiffness and altered mental status. [ 12 ] Most patients with viral meningitis present with subacute neurological symptoms developing over 1-7 days.[patient.info]
  • Patients with meningitis or encephalitis generally present with one or more of the following: fever, headache, neck pain or stiffness, altered mental status, or seizure.[aafp.org]
Neurologic Manifestation
  • Neuropsychological methods to monitor cognitive impairments are more precise, and as patients live longer withdisease more subtle neurological manifestations of disease have emerged.[books.google.com]
  • manifestations [ 13 ].[cid.oxfordjournals.org]
  • In conclusion, our report demonstrates that BKV might be the causative agent of meningoencephalitis in AIDS patients, and that this virus must be investigated in higher frequencies in HIV-1 positive patients with neurological manifestations now that its[aidsrestherapy.biomedcentral.com]
  • Clinical and laboratory characteristics of hospitalised patients with neurological manifestations of HIV/AIDS at the Nairobi hospital. Afr Med J;84(2):67-76, 2007. Matee MI, Matre R.[aidsmap.com]
  • Levy RM, Bredesen DE, Rosenblum ML (1985) Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): Experience at UCSF and review of literature. J Neurosurg 62: 475-495. Casadevall A, Perfect JR (1998) Cryptococcus neoformans.[omicsonline.org]

Workup

  • DISCUSSION Patients with HIV/AIDS frequently present with neurological signs and symptoms and require neuroimaging studies as part of their diagnostic workup.[path.upmc.edu]
  • So,it seems that in patients with HIV infection, a high index of suspicion with full laboratory workup and early institution of treatment is required to improve survival.[ijmm.org]
Toxoplasma Gondii
  • .- ) Protozoal diseases B58 ICD-10-CM Diagnosis Code B58 Toxoplasmosis 2016 2017 2018 2019 Non-Billable/Non-Specific Code Includes infection due to Toxoplasma gondii Type 1 Excludes congenital toxoplasmosis ( P37.1 ) Toxoplasmosis Approximate Synonyms[icd10data.com]
  • The major diagnoses in these patients include Toxoplasma gondii infection, primary CNS lymphoma, progressive multifocal leukoencephalopathy (PML) and focal HIV encephalopathy, with some variation seen in the frequency of these entities with the advent[path.upmc.edu]
  • After a week on this therapeutic regime, the patient's neurological status remained unaltered, and PCR analysis of CSF was performed, resulting negative for all human herpes viruses, JCV, and for Toxoplasma gondii .[aidsrestherapy.biomedcentral.com]
  • Well-known pathogens include Toxoplasma gondii ( Figure 1 ) , Cryptococcus neoformans, and JC virus. Primary central nervous system lymphoma may also affect severely immunocompromised patients ( Figure 2 ) .[aafp.org]
  • Intracranial Opportunistic Infections Toxoplasma gondii Incidence and Presentation CNS toxoplasmosis has been the most common cause of intracerebral mass lesion in HIV-infected patients.[hivinsite.ucsf.edu]
White Matter Lesions
  • ., cognitive decline, cranial nerve palsy, aphasia, ataxia, weakness or sensory loss, seizure); may progress to coma 200 per mm 3 Single or multiple white matter lesions with little to no enhancement and no edema or mass effect (MRI more sensitive than[aafp.org]
  • ., retinitis, GI), lapsed maintenance therapy, advanced HIV w/ low CD4, ventricular/white matter lesions on MRI, and ( ) CSF CMV PCR studies.[hopkinsguides.com]
Brain Edema
  • edema without any true reduction in severity of infection) If it’s Toxo, should see radiographic improvement within 2 weeks Toxoplasmosis.[learningradiology.com]
Lymphocytic Infiltrate

Treatment

  • However, the lack of response to treatment and the presence of BKV DNA in CSF samples and brain tissue led us to reclassify the patient as with BKV meningoencephalitis.[aidsrestherapy.biomedcentral.com]
  • Twelve patients (40%) died while undergoing treatment in the hospital; six during first week of treatment, three each during the second and third weeks of treatment.[omicsonline.org]
  • Treatment of cryptococcal meningitis in KwaZulu-Natal, South Africa.[aidshivresearch.com]
  • The risks, benefits and alternative to fluconazole treatment (i.e.[sajhivmed.org.za]
  • […] a paucity of diagnostic and treatment tools.[edctp.org]

Prognosis

  • Treatment and prognosis Severity is related to the patient's viral load, and can regress with highly active antiretroviral therapy (HAART). Superimposed infection may lead to fulminant disease.[radiopaedia.org]
  • Prognosis Meningitis kills more UK children under the age of 5 than any other infectious disease. [ 2 ] Prognosis depends on the pathogen, the patient's age and condition and the severity of acute illness.[patient.info]
  • Favorable prognosis of purulent meningitis in patients infected with human immunodeficiency virus. Clin Infect Dis;27:176-180, 1998. Molyneux EM et al. The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi. Arch. Dis.[aidsmap.com]
  • With effective antiretroviral therapy, the prognosis for those who develop PML has improved dramatically, with long-term remission being fairly common.[hivinsite.ucsf.edu]
  • Generally poor prognosis for pts w/ AIDS and clinical CNS CMV. Neurological sequelae common, and existing deficits at time of treatment initiation may not reverse. Radiculopathy tends to improve within 2-3 wks.[hopkinsguides.com]

Etiology

  • Other well known infectious etiologies of focal brain lesions in HIV/AIDS patients are fungal organisms, CNS tuberculosis and neurosyphilis (12).[path.upmc.edu]
  • Aseptic Meningitis Clinical Trial The main objective of this study is: - to establish etiology of acute aseptic meningitis/meningoencephalitis in Slovenia - to assess the clinical course and outcome of tick-born...[patientwing.com]
  • CSF analysis facilitates the diagnosis of specific HIV-related etiologies and the assessment of other non–HIV-associated causes.[emedicine.medscape.com]
  • A NINDS study found HHV-6 DNA in the CSF of 40% of 35 immunocompetent patients with encephalitis of unknown etiology ( Yao 2009 ). HHV-6 encephalitis/encephalopathy associated with primary infection in infants has an unexpectedly poor outcome.[hhv-6foundation.org]
  • Besides HIV, other etiologies of mononeuropathy multiplex include hepatitis B infection, diabetes, herpes zoster, and neoplastic infiltration of nerve.[hivinsite.ucsf.edu]

Epidemiology

  • The work includes considerable emphasis onthe epidemiology, psychological and psychiatric aspects of the disease complex.[books.google.com]
  • AIDS-associated cryptococcal meningitis in Rwanda (1983–1992): epidemiologic and diagnostic features. J Infect; 39:32–37, 1999. Békondi C et al.[aidsmap.com]
  • Article Access Statistics Viewed 4718 Printed 190 Emailed 4 PDF Downloaded 529 Comments 2008 2 Cryptococcal Meningitis in Senegal: Epidemiology, Laboratory Findings, Therapeutic and Outcome of Cases Diagnosed from 2004 to 2011 Doudou Sow,Roger Clément[neurologyindia.com]
  • […] of Cryptococcal Meningitis Associated with HIV in an Indian Hospital .Epidemiology (Sunnyvale) 4:166. doi:10.4172/2161-1165.1000166 Copyright: 2014 Duggal S, et al.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • 2012;7:e46178, J Infect Dis 2008;197:S294 Sites Although HIV encephalitis may occur anywhere within the nervous system, there is a distinct predilection for pathologic changes to be found predominantly within subcortical white matter and basal ganglia Pathophysiology[pathologyoutlines.com]
  • Its pathophysiology, although not yet well characterized, is thought to be due to "indirect" effects of HIV-1 infection. HIV-1 virions are rarely detected in peripheral nerve tissue, even in patients with severe neuropathy.[hivinsite.ucsf.edu]
  • Except for C. gattii outbreaks in immunocompetent hosts, most patients have immune dysfunction related to the pathophysiology or treatment of an underlying autoimmune disease, malignancy, or innate immunological disorder.[dovepress.com]

Prevention

  • It provides a comprehensive review of the epidemiology, diagnosis, and management of opportunistic infections and presents strategies for infection prevention and control.[books.google.com]
  • Prevention Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. These steps can help prevent meningitis: Wash your hands.[mayoclinic.org]
  • CAN MENINGITIS BE PREVENTED? Taking fluconazole when your CD4 count is below 50 can help prevent cryptococcal meningitis. But there are several reasons why most health care providers don’t use it: Most fungal infections are easy to treat.[aidsinfonet.org]
  • To prevent relapses, most doctors recommend that people who have had cryptococcal meningitis take fluconazole daily. Other drugs used include intravenous amphotericin B taken weekly or biweekly.[aidsinfo.nih.gov]
  • Can Encephalitis Be Prevented? Encephalitis can't be prevented, but you can avoid the illnesses that may lead to it. Immunizations protect kids from many common childhood illnesses. So follow the immunization schedule recommended by your doctor.[kidshealth.org]

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