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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The central nervous system was examined in 135 adult AIDS patients who died between August 1982 and December 1990. Twenty two brains showed non-diagnostic changes including microglial nodules, discrete myelin pallor with reactive astrocytosis, mineralization of blood vessels and granular ependymitis. In 105 brains with specific changes, toxoplasmosis was the most frequent finding (55 cases) manifested by multifocal necrotic lesions or diffuse pseudo-encephalitic process. Other opportunists included cytomegalovirus (21 case), progressive multifocal leukoencephalopathy (1 cases), cryptococcosis (6 cases), mycobacterium avium intracellulaire (2 cases), varicella-zoster virus (2 cases), aspergillosis (1 case) and multiple bacterial microabscesses (1 case). Multinucleated giant cells were found in 52 cases. In 40 cases, they were widely disseminated throughout the brain and in 39 cases, they were associated with diffuse or multifocal white matter changes. Fifteen cases had a cerebral lymphoma, 9 hepatic encephalopathy, 1 centropontine myelinolysis and 1 focal pontine leukoencephalopathy. Three cases had a cerebral haemorrhage due to disseminated intravascular coagulation, antithrombin therapy and amyloid angiopathy. Spinal changes in 13 cases included vacuolar myelopathy (7 cases), HIV myelitis (1 case) and ganglio-radiculitis (1 cases), cytomegalovirus myelo-radiculitis (1 case) secondary spread from a lymphoma (1 case) and spinal infarcts due to disseminated intravascular coagulation (1 case). These lesions were frequently atypical and various combinations of all these pathologies were encountered in the same brain, sometimes in the same area and occasionally in the same cell. Chronological variations in the incidence of some complications could be related to changes in treatment.
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PMID:[Neuropathologic study of 135 adult cases of acquired immunodeficiency syndrome (AIDS)]. 195 58

To define the causes, clinical significance and characteristics of headaches in HIV-1-related disorders, we studied 49 consecutive HIV-1 infected patients who presented with headache. Work-up included CT scans, cerebrospinal fluid examinations (in the absence of a contraindication) and serologic studies. Overall, 40 of 49 patients (82 percent) had an identifiable serious cause of headache. Cryptococcal meningitis (39 percent) and CNS toxoplasmosis (16 percent) were the leading headache etiologies. Serious causes were more likely in patients diagnosed with AIDS prior to presentation but also occurred in most patients in early stages of infection. Based on this study, we suggest that patients with HIV-1 infection must be managed with a high index of suspicion when they present with new onset headaches.
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PMID:Headache in HIV-1-related disorders. 196 55

Acquired immunodeficiency syndrome has had a major impact on all aspects of clinical neuroscience in the past few years. Thus understanding acquired immunodeficiency syndrome and its associated complications within the nervous system was a major component of this review of the past year's radiologic literature of infection in the central nervous system. Particular topics discussed include the appearance of primary human immunodeficiency virus infection of the brain as well as toxoplasmosis, cryptococcal infection, and progressive multifocal leukoencephalopathy. In addition, the association of acquired immunodeficiency syndrome with the appearance of lymphoma, myeloradiculopathy, and vascular disease are considered. The remainder of the literature on central nervous system infection in the past year generally concerned the imaging characteristics of unusual infections such as cysticercosis, paragonimiasis, tuberculosis, Lyme disease, viral infection, and nonspecific inflammation of the meninges. The availability of an MR imaging contrast agent (gadolinium) also provided important diagnostic information to the radiologist in the imaging of infection in the central nervous system.
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PMID:Infections of the central nervous system. 202 2

Maccario et al. described, in 1987, the case of an HIV-positive patient whose psychotic symptomatology was the expression of right centrum semi-ovale lesion. We report the case of a patient who suffered a sudden delirium, expression of a probable right lenticular cerebral toxoplasmosis. This 35-year-old male homosexual, who had no psychiatric history, suddenly developed in November 1988 the following psychiatric signs: he started to walk back and forth incessantly, he had the impression that he was the subject of the conversations of the passers-by, that all the posters and notices refer to him, and that he was God. He was admitted in a psychiatric department where the symptoms were progressively curbed by neuroleptics (cyamemazine 75 mg, and haloperidol 15 mg). The episode was not questioned by the patient, but attributed to bad eating habits. HIV-positivity had been discovered a year later (during systematic screening). A computerized tomographic (CT) scan performed subsequently to this delirium was interpreted as normal. Four weeks later the patient was referred to us. The psychiatric condition was stabilized in spite of a certain aggressiveness and the probable persistence of an underlying delirium state. Laboratory examinations showed the following: blood count revealed leukopenia (2.2 G/l) and thrombocytopenia (135 G/l; OKT4/OKT8 ratio was 0.08; CSF: normal; sputum culture evidenced the presence of pneumocystis carinii; EEG were normal. Neuropsychological symptoms concerned in particular a lack of concentration during the different tests with a definitive wavering of attention. Lexical retrieval was poor whatever the topic proposed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute psychiatric pathology disclosing subcortical lesion in neuro-AIDS]. 204 98

The objectives of this study were to evaluate the efficacy of a sulphadiazine desensitization protocol to treat patients with AIDS and cerebral toxoplasmosis (CT) and known sulphonamide allergy, to ensure that an adequate dose of sulphadiazine (2-4 g/day) was achieved rapidly (within 4-5 days), and to assess the effect of concurrent corticosteroid (CS) administration on the success rate of the regimen. Sixteen patients with CT and a past history or current manifestations of sulphonamide allergy were desensitized to sulphadiazine from October 1988 to December 1989. The protocol employed the oral administration of gradually increasing increments of sulphadiazine 3-hourly over 5 days. Success was defined as tolerance of 2-4 g oral sulphadiazine per day for at least 7 days until death or the present time without any allergic reactions. Our success rated overall was 10 out of 16 patients (62%). Seven patients achieved a final dose of 4 g/day and three a dose of 2 g/day. Concurrent CS administration did not appear to affect the outcome in the small number of patients studied. Our sulphadiazine regimen rapidly, successfully and safely desensitized patients with CT and sulphonamide allergy, allowing the optimal first-line treatment to continue. The aetiology of allergy in HIV-infected patients and the mechanisms by which desensitization works are unknown.
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PMID:Sulphadiazine desensitization in patients with AIDS and cerebral toxoplasmosis. 205 71

Antibody titers to Toxoplasma gondii were studied in 62 AIDS patients with active toxoplasmosis (cerebral in 42, pulmonary in 10 and ocular in 10), confirmed by biopsy or by imaging techniques with a therapeutic test, and in 1,499 HIV-positive patients. The purpose of this study was to evaluate the value of antibody assays for the diagnosis of active infection and the prevalence of toxoplasmosis in HIV-positive individuals. IgG antibodies to Toxoplasma were found in 61 of the 62 AIDS patients, but not in one patient with pulmonary toxoplasmosis, with no significant differences in mean titers obtained by dye test, indirect immunofluorescence and sensitized agglutination. Twenty patients (31.7%) had dye test titers of 400 IU/ml or more; three patients had IgM antibodies. Thirteen (38%) of the 34 patients who had serial antibody assays exhibited a rise in IgG titers with no detectable production of IgM antibodies. Antibodies to Toxoplasma were found in 75% of the 1,499 HIV-positive subjects, a proportion which is not significantly different from that seen in HIV-negative controls; however, HIV-positive subjects were significantly more likely than controls to have high titers (greater than or equal to 500 IU in 18.7% of patients versus 9.2% of controls, p less than 0.001). A follow-up study in 177 HIV-positive patients with antibodies to Toxoplasma showed an annual reactivation rate of 12%; in five of 30 patients, the rise in antibody titers occurred concomitantly with or a few months before clinical toxoplasmosis; 25 patients remained asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Value and limitations of toxoplasmosis serology in HIV patients]. 206 48

Recently published encouraging data concerning the value of anticardiolipin antibody assays in patients with HIV infection, both for prognostic purposes and to diagnose pneumocystosis, have prompted us to evaluate these assays in a series of 116 patients. We were unable to demonstrate any correlation between the levels of these antibodies and the clinical stage of the infection or the presence of thrombocytopenia. Varying levels of anticardiolipin antibodies were found in 29.3 percent of our patients. More frequent positivity and higher levels seemed to be associated only with the development of cerebral toxoplasmosis. The value and the possible physiopathological role of these antibodies in patients with HIV infection should be reconsidered.
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PMID:[Value of anticardiolipin antibody assay in human immunodeficiency virus infection]. 214 72

Toxoplasmosis should be considered as a potential pathogen in cancer patients who have clinical syndromes, especially lymphadenopathy, for which the cause is not clear. Patients with reticuloendothelial malignancies or solid cancers treated with systemic chemotherapy or with progressive disease appear to be at particular risk for life-threatening toxoplasmosis. There has also been an explosion in the number of cases of toxoplasmic encephalitis in patients infected with HIV. Diagnosis rests on demonstration of trophozoites in tissue or body fluids, demonstration of characteristic serologic test results, and, in cases of lymphadenopathy, characteristic histologic features.
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PMID:Current diagnosis and management of toxoplasmosis in cancer patients. 214 27

A 20-year-old male AIDS patient developed rapidly progressive dementia for more than 3 months prior to death. Autopsy showed, in addition to adrenal cytomegalovirus (CMV) infection and focal cerebral necrosis due to toxoplasmosis, multifocal subcortical white matter lesions of the brain which were strikingly similar to the histopathology of vacuolar myelopathy in AIDS. These distinct lesions contained macrophages which were rarely multinucleated and expressed HIV antigens by immunocytochemistry. The distribution of lesions mimics extrapontine myelinolysis and progressive multifocal leucoencephalopathy (PML); PML was excluded by the absence of papovaviruses by immunocytochemistry and by in situ DNA hybridization. Tissue damage in multifocal vacuolar leucoencephalopathy is different from hitherto characterized HIV-specific neuropathology such as HIV encephalitis and HIV leucoencephalopathy, and should be included in the list of conditions with damage of the brain white matter in AIDS.
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PMID:Multifocal vacuolar leucoencephalopathy: a distinct HIV-associated lesion of the brain. 217 48

A 42 year old male Spanish patient who presented since one year a symptomatic stage IV C1,C2,D HIV infection (Pneumocystis carinii pneumonia, cerebral toxoplasmosis, esophageal candidiasis, Kaposi's sarcoma) became progressively asthenic with weight loss, diarrhea, fever and complained about bone pain. These symptoms could be attributed to visceral leishmaniasis. This novel opportunistic infection should be considered in the differential diagnosis of fever of unknown origin in HIV+ patients coming from or having travelled in endemic areas.
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PMID:[Visceral leishmaniasis (kala-azar) and HIV infection. Apropos of a case and literature review]. 218 45


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