The pattern of central nervous system lesion in HIV-infected patients in the specialized unit of an infectious diseases hospital


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Aim. To define the incidence and features of brain lesion (BL) in HIV-infected inpatients.
Subjects and methods. Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out.
Results. In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection.
Conclusion. The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.

作者简介

Alla Peregudova

Vasiliy Shakhgil'dyan

Ol'ga Tsvetkova

Tat'yana Ermak

Boris Gruzdev

Mikhail Yuditskiy

Oleg Tishkevich

Ol'ga Shipulina

Mariya Al'vares Figeroa

Anna Safonova

Ekaterina Dolgova

Dmitriy Goncharov

A Peregudova

Moscow City AIDS Center, Moscow Healthcare Department

Moscow City AIDS Center, Moscow Healthcare Department

V Shakhgildyan

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

O Tsvetkova

Moscow City AIDS Center, Moscow Healthcare Department

Moscow City AIDS Center, Moscow Healthcare Department

T Yermak

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

B Gruzdev

Moscow City AIDS Center, Moscow Healthcare Department

Moscow City AIDS Center, Moscow Healthcare Department

M Yuditsky

G. A. Zakharyin Tuberculosis Hospital Three

G. A. Zakharyin Tuberculosis Hospital Three

O Tishkevich

Infectious Diseases Hospital Two

Infectious Diseases Hospital Two

O Shipulina

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

M Alvares Figeroa

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

A Safonova

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

E Dolgova

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

Central Central Research Institute of Epidemiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare

D Goncharov

N. F. Gamaleya Research Institute of Epidemiology and Microbiology, Russian Academy of Medical Sciences

N. F. Gamaleya Research Institute of Epidemiology and Microbiology, Russian Academy of Medical Sciences

参考

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