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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We described an 18 old homosexual man who after 5 days developed a neurologic picture associated with Human Immunodeficiency Viruses (HIV) seroconversion. The patient had developed a dissociative psychiatric disorder 6 months before, and after resolution of the acute neurologic disease a mild neuro-psychiatric disorder remained. After mononucleosis-like syndrome of three weeks, the patient developed a meningo-encephalitic process 48 h post admission. He evolved with tonic seizures and twilight state and was admitted into Intensive Care Unit because of epileptic status and deep coma. Evolution was favourable after 72 h of treatment with acyclovir and antiepileptic drugs. Laboratory data showed an inverted T4/T8 ratio and seroconversion to HIV-antibodies and p24-antigen both in serum and CSF. These observations confirm the existence of psychiatric as well neurological alterations in acute HIV infection, and also the significance of p24-antigen and Western-Blot in serum and CSF in showing the seroconversion profile.
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PMID:[Previous dissociative psychiatric disorder and status epilepticus in a case of acute HIV infection]. 150 7

Involvement of the central nervous system (CNS) is common in patients with advanced disease due to human immunodeficiency virus (HIV). Symptoms range from lethargy and apathy to coma, incoordination and ataxia to hemiparesis, loss of memory to severe dementia, and focal to major motor seizures. Involvement may be closely associated with HIV infection per se, as in the AIDS dementia complex, but is frequently caused by opportunistic pathogens such as Toxoplasma gondii and Cryptococcus neoformans or malignancies such as primary lymphoma of the CNS. The clinical presentations of attendant and direct CNS involvement are remarkably non-specific and overlapping, yet a correct diagnosis is critical to successful intervention. Toxoplasmic encephalitis is one of the most common and most treatable causes of AIDS-associated pathology of the CNS. A great deal has been learned in the last 10 years about its unique presentation in the HIV-infected patient with advanced disease. Drs. Benjamin J. Luft of the State University of New York at Stony Brook and Jack S. Remington of the Stanford University School of Medicine and Palo Alto Medical Foundation's Research Institute have studied T. gondii for many years and are two of the leading experts in the field. This commentary comprises an update of their initial review (J Infect Dis 1988;157:1-6) and a presentation of the current approaches to diagnosing and managing toxoplasmic encephalitis in HIV-infected patients.
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PMID:Toxoplasmic encephalitis in AIDS. 152 Jul 57

A 28-year-old woman presented with progressive coma after being asymptomatic for 1 year after the demonstration of seropositivity for human immunodeficiency virus and high serum immunoglobulin G toxoplasma titers. Computed tomographic scanning showed multiple rounded cerebral hemorrhages and massive cerebral edema. Postmortem examination disclosed Toxoplasma gondii cysts scattered throughout the brain. An overwhelming fatal toxoplasmosis associated with multiple cerebral hemorrhages may be the first presentation of the acquired immunodeficiency syndrome. We raise the possibility that frequent neuroradiological monitoring may be indicated in asymptomatic human immunodeficiency virus-infected patients with high immunoglobulin G toxoplasma titers.
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PMID:Fatal disseminated hemorrhagic toxoplasmic encephalitis as the initial manifestation of AIDS. 189 72

Tuberculosis has now been well documented as a complication of infection with human immunodeficiency virus (HIV), but no studies concern patients requiring admission to the ICU. We report 12 cases of severe disseminated tuberculosis in patients who were seropositive for HIV. Eight patients had diffuse pulmonary involvement responsible for acute respiratory failure, 7 of whom required mechanical ventilation. Four developed septic shock, and in 3 blood cultures were positive for M. tuberculosis. Four patients had central nervous system involvement, with coma requiring mechanical ventilation 3 times. Rapid diagnosis was permitted in 10 patients by acid-fast smears of pulmonary specimens (8 patients) and/or tissue biopsies (4 patients). Seven patients died despite intensive therapy; autopsy was performed in 4 patients, showing disseminated tuberculosis. On the basis of this report, tuberculosis in HIV infection may present as an overwhelming systemic disease and thus requires an aggressive diagnostic and therapeutic approach.
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PMID:Severe tuberculosis in patients with human immunodeficiency virus infection. 228 26

The health condition of man has changed considerably since life insurance companies have been established. The initial problem of the companies was the fact that many young persons died from tuberculosis. For many decades persons from families with tuberculosis cases or with underweight were not accepted for insurance on their lives. Nevertheless companies observed many deaths causes by this disease. Medical directors and actuaries studied these cases in detail (dates and numbers), even of the deceased. The resulting statistics formed the premium calculation basis for persons with an increased risk. Comparative studies allowed acceptance for more people. Within the last decades when sulfonamides, antibiotics and insulin were discovered and produced the mortality ratio decreased. Nowadays, even persons who suffered from tuberculosis do not present an increased risk anymore. The life expectancy has doubled during the last century. This is why degenerative diseases increased, especially the coronary heart diseases. While thirty years ago the mortality ratio stood at about 500%, improved medical and surgical therapy made prognosis easier and when risk factors can be eliminated the mortality ratio tends to be less than 200%. Since insulin is available, patients with type I-diabetes do not die anymore in coma, the remaining risk is the sclerosis of the vessels. Diabetes with adults increases with overweight, high blood pressure and hyperlipemia. The mortality ratio depends on these risk factors. Morbus Crohn, first described in 1932, seems to increase. Life insurance needs more long-term statistical data. For only some years we are confronted with the immunodeficiency "Aids".(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Change in the panorama of chronic diseases and their insurability by life insurance]. 273 88

Neurological lesions are frequent complications of human immunodeficiency virus (HIV) infections. Organs involved include the brain, peripheral nerves and muscles. Since the widespread use of immunodepressive agents, spinal cord complications have also appeared although poorly documented in the literature. We observed six cases of spinal cord involvement which help indicate the modalities of practical management. In the first case, a 45-year old HIV1 + male presented dysesthesia evolving progressively over the T10 to L2 zones leading to the diagnosis of spinal cord toxoplasmosis. A gait disorder was the first sign in the second case, a 60-year old HIV1 + male. Neurological involvement progressed and the patient developed paraparesia, decreased muscular force with hypoesthesia and impaired proprioception of the lower limbs. Further complications led to coma and death and on autopsy, the patient was found to have cytomegalovirus myeloencephalitis. A 21 HIV1 + haemophiliac was our third case. Here paraplegia resulted from epidural compression due to Burkitt malignant lymphocytosis. The aggravation of paresthesia of the lower limbs, complicated by painful dysesthesia and proximal motor deficiency led to the suspected diagnosis of HIV-related myelitis in a particularly complicated case in a 52-year old seropositive male. In the fifth case, HIV infection led to major demelinization of the cervical and dorsal spinal cord due to toxoplasmosis and vacuolar myelopathy. In the sixth case, acute myelitis in an HIV2 positive male regressed spontaneously in 15 days. In clinical practice, spinal cord complications would appear to be frequent but less so than brain involvement. In the future, a better understanding of these complications should lead to specific identification of spinal cord signs in the neurological symptomatology of patients with HIV infection and allow adapted specific management.
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PMID:[Lesions of the spinal cord in HIV infection]. 789 90

Trichosanthin is a ribosome-inactivating protein that is being studied as a possible treatment for patients infected with human immunodeficiency virus (HIV). We report the clinical and pathological features in two patients who experienced neurological reactions to trichosanthin. Both patients were neurologically asymptomatic prior to treatment but developed coma and multifocal neurological deficits after treatment. Neuropathological examination revealed regions of severe, multifocal necrosis with histiocytic infiltrates. These reactions to trichosanthin may be mediated by soluble factors released by HIV-infected macrophages.
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PMID:Neurological reactions in HIV-infected patients treated with trichosanthin. 827 23

The authors report a case and treatment of multiple brain abscesses located in the cerebrum and cerebellum combined with subdural empyema. In conjunction with the case report, the authors review the literature on the pathogenesis of brain abscesses and discuss therapeutic strategies concerning the topic. In the case presented, the primary infection persisted in the lung causing subclinical bronchitis. The hemoculture showed evidence of Streptococcus mitis infection. Although the etiological role of this bacterium in meningitis is known, it rarely causes bacterial meningitis without underlying predisposing factors. In their case, the patient was free of the most common predisposing factors such as congenital heart disease or immunodeficiency. Following the 2 month period of latency, a rapid onset of the symptoms of intracranial inflammation could be observed: fever, headache, meningeal symptoms, focal neurological symptoms and coma. They were not able to identify any bacteria in the cerebrospinal fluid; the Streptocossus mitis could be cultivated only from the haemoculture. The cytological analysis of the cerebrospinal fluid showed typical signs of bacterial infection and the cranial Computed Tomography revealed multiple cerebral abscesses. Neurosurgical intervention was not recommended because of the number, localization and size of the focal lesions. The therapy consisted of intravenous administration of 24 x 10(6) IU/die Penicillin and 4 g/die ceftriaxon. For supportive therapy, Mannitol B, 3 mg/die clonazepam and 300 mg/die phenytoin were administered. Corticosteroids were not used during the course of therapy. Two years later the 55 year old female is symptom free and doing well.
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PMID:[Non-invasive management of multiple brain abscesses. Case report and review of the literature]. 1053 93

Although most children with human immunodeficiency virus (HIV) infection have neurological dysfunction, in childhood the incidence of symptomatic cerebrovascular disease is low. Cerebral aneurysmal arteriopathy in childhood AIDS has been reported in the past and considered to have a relatively long latency following the primary infection. We report a 1 month-old infant with congenitally acquired HIV infection, and herpes encephalitis; she presented a sudden cardiorespiratory arrest followed by coma and was found to have a giant saccular aneurysm of the left basilar artery. Literature review showed that cerebral aneurysmal artheriopathy is an unusual manifestation in newborns and infants and this case is possibly the youngest patient reported with aneurysma, herpes encephalitis and AIDS. The role of HIV and herpes simplex infections in the pathogenesis of this lesion is discussed.
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PMID:Cerebral aneurysmal dilatation in an infant with perinatally acquired HIV infection and HSV encephalitis. 1160 32

Medications that act on the central nervous system are frequently used in people infected with human immunodeficiency virus (HIV). Actually, drug interactions are an important factor in the treatment of patients with (HIV) infection and because of the complexity of the current drug regimens, clinicians should be trained in order to recognize and manage drug interactions. Herein, we present an HIV infected male admitted for manic behavior and treated with risperidone who developed a profound coma secondary to increased levels of risperidone because of a possible drug interaction with ritonavir and indinavir. Subsequently, we discuss this interaction, rarely described in the literature. Risperidone is a cytochrome P450 (CYP2D6) enzyme substrate and weak inhibitor and a CYP3A4 substrate. Possible interactions with CYP2D6 inhibitors (amiodarone, fluoxetine or ritonavir) and CYP3A4 inhibitors (indinavir and ritonavir) can increase its serum concentrations and produce significant adverse effects. In conclusion, this drug combination should be administered with caution and routinely examined for signs and symptoms of risperidone toxicity. Dosages should be reduced as needed. Finally, we think that in patients taking multiple medications, plasma levels of risperidone should be monitored especially if drug interactions are possible.
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PMID:Reversible coma caused by risperidone-ritonavir interaction. 1241 55


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