A study of clinical profile of HIV positive patients with neurological manifestations

Abstract

a b s t r a c tBackground: Central nervous system (CNS) is among the most frequent and serious target of HIV infection in patients with profound immunosuppression. CNS problems occur mainly due to either primary pathologic process of HIV or secondary to opportunistic infection and neoplasm. Aims and objectives: To study the clinical and investigation profile in diagnosis of HIV patients with CNS manifestation. To correlate CD 4 levels with CNS opportunistic infections. Materials and methods: A prospective observational non-randomized clinical study of 50 HIV infected patients, showing clinical evidence of CNS involvement, admitted in tertiary care centre was done. Detail clinical history and CNS examination was carried out. CD 4 count was measured using standard flowcytometry. Investigations like MRI brain/electromyography-nerve conduction studies/cerebrospinal fluid (CSF) examination were done as and when required for diagnosis. Results: HIV induced primary CNS illness was present in 30% while 70% cases were due to secondary CNS manifestation mainly due to opportunistic infection. Most common primary illness was distal symmetric polyneuropathy (DSPN) (22%), followed by Aids dementia complex (ADC) (4%) and acute inflammatory demyelinating polyneuropathy (AIDP)(4%). tuberculous meningitis (TBM) was the most common presentation as secondary CNS illness (34%), followed by cryptococcal meningitis (14%), toxoplasmosis (10%), progressive multifocal leucoencephalopathy (PML) (8%) and neurosyphilis (4%). Meningitis was presenting CNS manifestation in majority of patients. The commonest presentation of TBM was fever (64%), while headache for cryptococcal meningitis (71%) and seizures was that of toxoplasmosis (80%). Mean CD 4 count was 170 ± 80.1 in patients of DSPN, 131 ± 85.75 for TBM, 47.5 ± 36.8 for cryptococcal, 160 ± 77.4 for toxoplasmosis and 93 ± 65 for ADC. Conclusion: High degree of clinical suspicion of nervous involvement in HIV patients at all stages help in early diagnosis and institution of specific therapeutic measures which in turn decrease mortality and morbidity.

Neurological Manifestations in Hiv Patients- A Hospital-Based Study of Jawaharlal Nehru Institute of Medical Sciences (Jnims), Imphal, Manipur

“…This is similar to the findings of other studies by Shripad R Kausadikar et al, 13 MD Solu et al 14 and Himanshu M Rana. 15 In our study tuberculous meningitis was the most common infection with 16 patients (35.6%), out of which 4 patients also had intracranial tuberculoma. Next common infections was cryptococcal meningitis in 9 patients (20%) and toxoplasmosis in 6 patients (13.3%).…”

“…In a study from NEIGRIHMS, Shillong, Shri Ram Sharma et al 16 found Tuberculous meningitis (43.95%) to be more common than cryptococcal meningitis (14.2%) followed by toxoplasmosis (2.19%). Similarly, Himanshu M Rana et al 15 found tuberculous meningitis (34%) more common than Cryptococcal meningitis (14%) and cerebral toxoplasmosis (10%). Attili Venkata Satya et al 17 also found the same pattern.…”

“…This is similar with the findings of MD Solu et al 14 who found fever (64%), headache (56%), altered consciousness (52%) and convulsion (32%) to be the most common symptoms in their study. Himanshu M Rana et al 15 also found fever as the most common symptoms (88%) followed by headache (82%), altered consciousness (64%) and convulsion (35%). In this study fever, headache, altered consciousness were the most common symptoms in TBM and Cryptococcal meningitis, while convulsion and headache were the most common symptoms of Cerebral Toxoplasmosis.…”

Radiological Abnormalities in HIV Infected Patients with Neurologic Symptoms and Diagnostic Accuracy of CT and MRI Scans of Brain

“…NORMAL ATROPHY HIVE TOXO PML CNS LYM TB CRYPTO INFARCT HYDROC VASCU CMV HSV BAC PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT PRESENT ABSENT CT POSITIVE 13 0 2 6 4 1 5 2 3 0 2 1 3 2 0 0 5 3 1 0 0 0 0 0 1 0 0 0 CT NEGATIVE 0 41 0 46 4 45 1 46 1 50 0 51 2 47 2 52 0 46 0 53 1 53 2 52 1 52 2 The most common neurological abnormality in patients imaged with CT scan and MRI in our study was HIV encephalopathy (n=8) and the most common opportunistic infections were toxoplasmosis (n=6) and tuberculosis (n=5). In studies by Patel ML et al, Kausadikar SR et al, Rana HM et al [10] , Mahajan et al [11] and Lanjewar DN et al [12] , tuberculosis was the most common cause of opportunistic infections. Normally, when tubercle bacilli reach lung alveoli, alveolar macrophages ingests them.…”

Clinical manifestations and outcome of patients with human immunodeficiency virus infection at tertiary care teaching hospital

“…[5] Cryptococcus neoformans being an important cause among etiologies causing fungal meningitis. [6] With the availability of antiretroviral therapy (ART) at lower cost, the clinical profile of HIV disease in India is now changing to include drug-related toxicities and immune reconstitution syndrome.…”