Cerebro-meningeal infections in HIV-infected patients: a study of 116 cases in Libreville, Gabon

Abstract

Background: Cerebro-meningeal pathology is common in human immunodeficiency virus (HIV) infection and the aetiology is often difficult to ascertain with certainty. Objective: To describe the major suspected and identified causes of meningeal or encephalitic syndromes in HIV infection in Libreville, Gabon. Methods: A descriptive study using clinical records of patients hospitalised in the Department of Medicine in the Military Hospital of Libreville (Gabon) between January 2006 and May 2010. Clinical features were evaluated using multivariable logistic regression to evaluate association with the outcome of a clinical improvement or death. Results:The most frequent neurological symptoms were reduced level of consciousness (54.3%), headache (55.2%), motor deficit (38.7%), and convulsions (36.2%). Cerebral toxoplasmosis represented 64.7% of diagnoses, followed by cryptococcal neuromeningitis in 12.9% of cases. Tuberculoma was diagnosed in 4 cases and lymphoma in 2 cases. In 9.5% of cases, no aetiology was determined. Toxoplasmosis treatment led to clinical improvement in 69.3% of cases with suspected cerebral toxoplasmosis. Overall mortality was 39.7%. Conclusion:The diagnosis of neurological conditions in HIV positive patients is difficult, particularly in a low-resource setting. A trial of treatment for toxoplasmosis should be initiated first line with all signs of neurological pathology in a patient infected with HIV.

Robust Control of a Brain-Persisting Parasite through MHC I Presentation by Infected Neurons

“…In rodents, which are natural hosts of T. gondii, the parasite has been reported to influence the course of neurodegenerative disorders (Cabral et al, 2017;Mö hle et al, 2016) and to cause major behavioral modifications (Vyas, 2015). In case of T cell lymphopenia or suboptimal function (e.g., due to HIV/AIDS or immune suppressive treatment), individuals become at risk of developing T. gondii encephalitis (TE), a fatal neuroinflammatory disease that is still common among HIV-infected people (Ondounda et al, 2016). TE is characterized by high cyst burden, tachyzoite replication foci in the CNS, massive immune cell influx, activation of recruited and local myeloid cells, and cerebral tissue damage (Parlog et al, 2014).…”

Brain opportunistic infections and tumors in people living with HIV — still a challenge in efficient antiretroviral therapy era

“…Numerous studies suggest that the brain is one of the most affected organs in PLWH (Ondounda et al 2016 ; Gray et al 2003 ). Persistence of viral reservoirs in nervous tissue and poor penetration of HIV drugs into the brain are challenging factors in managing patients with neurological complications.…”

From MNHC, NCDs to prevention of infectious diseases and plantibodies: meeting challenges of our times

“…29 The section concludes a much awaited paper from Gabon: Cerebrospinal meningeal infections in HIV-infected patients. 30 We have a paper on upper GIT endoscopy 31 , while the next set of papers is on herbal remedies. 32 …”