Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya9844910.26442/00403660.2021.11.201197Research ArticleUnspecified encephalitis in HIV-infected patients: clinical and postmortem evaluationVoznesenskiySergey L.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0001-5669-1910ShakhgildyanVasiliy I.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0002-8686-0487PetrovaElena V.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0002-6896-6851KozhevnikovaGalina M.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0003-2758-9313ErmakTatiana N.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0001-9490-7129TichkevichOleg A.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0002-0789-7709SamotolkinaElena S.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0002-0533-9412SobolevaZinaida A.voznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0003-3204-9143EmeroleKarl Cvoznesenskiy_sl@pfur.ruhttps://orcid.org/0000-0002-0636-2710People’s Friendship University of Russia (RUDN University)Central Research Institute of EpidemiologyInfectious Clinical Hospital №2151120219311127812822601202226012022Copyright © 2021, Consilium Medicum2021<p><strong>Background. </strong>The search for an aetiology of central nervous system (CNS) lesions In HIV patients can be extremely challenging.</p>
<p><strong>Aim. </strong>To establish the nature and character of CNS lesion according to the data of pathological examination of deceased HIV-patients who had an antemortem clinical diagnosis of unspecified encephalitis.</p>
<p><strong>Materials and methods. </strong>We analysed clinical and laboratory data of 225 HIV-patients admitted to the ICU at the Infectious Clinical Hospital №2 (Moscow, 2018). The principal diagnosis was unspecified encephalitis characterized by cerebral oedema. Had died 183 (67.9%) patients. We conducted pathological examination in 43 (23.5%).</p>
<p><strong>Results. </strong>CNS lesions occurred in 331 patients (58.8% of 563 ICU). The antemortem diagnosis established were as follows: 12.1% toxoplasmosis; 6.6% HIV-encephalitis; 5.1% CNS lymphoma; 3.6% cryptococcal meningoencephalitis; 3.0% cytomegaloviral diseases; 2.1% progressive multifocal leukoencephalopathy. The cause of the pathology remained unidentified in 225 patients (68% with CNS lesions). Majority of patients were ART-naive. Post-mortem verification was conducted in 29 (67.4%) deceased patients, of which HIV-encephalitis 34.5%, toxoplasmosis 10.3%, progressive multifocal leukoencephalopathy 3.4%. The nature of brain damage in the remaining 20.7% cases was not established even after post-mortem investigation. Productive lepto-meningitis 8 (27.6%), indicating a prolonged duration of the inflammatory process. In the brain 48.1% patients with subacute and productive changes, had a pre-hospital time of more than 30 days, in contrast to 11.1% of patients who had acute pathological processes in the CNS (<em>p</em>0.05). Autopsy didnt reveal any inflammatory changes in the brain in 14 (32.6%) patients, though cerebral oedema 93.3%, haemorrhagic syndrome 60% cases.</p>
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