Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy

Wang, Yihong; Qian, Qingli

doi:10.1099/jmm.0.004432-0

Cited by 27 publications

(22 citation statements)

References 15 publications

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“…As expected, CSF analysis, when performed, did not reveal any specific characteristics [25, 26]. JCV DNA determination by PCR was done in 7 patients, being positive in three of them (42.9%).…”

Section: Discussionsupporting

confidence: 53%

From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

et al. 2011

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BackgroundProgressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system, associated with immunosuppression states. As there are only some non-published documents concerning PML in HIV infected patients in Portugal, we pretend to characterize natural history of PML infection in a population of HIV patients.MethodsWe retrospectively reviewed, from 1992 to 2009, PML cases in a population of 724 HIV infected patients followed in our institution. Clinical, biological, imagery features and outcomes were characterized.ResultsTwenty-five (3.45%) patients were identified as having PML. The mean time between HIV and PML diagnosis was 20.4 months. PML was the presentation of HIV infection in 40% of the patients, and 92% had CD4 T cell count lower than 200/mm3. Paresis was the most common clinical presentation. No specific characteristics were found in cerebrospinal fluid and JCV DNA was positive in 3 of 7 patients. MRI revealed characteristic findings. Combined antiretroviral therapy was started or changed in 96% of the patients. Neurological condition got worse in 12 patients. From the 14 deaths, 5 were directly attributed to PML progression. Follow-up was lost in 8 patients.ConclusionsPML was the presentation of HIV infection in more than 1/3 of patients, frequently associated with advanced immunocompromise. MRI sensitivity to PML is high, and JCV DNA determination in CSF was not revealed to be sensible. PML diagnosis should be taken into account in HIV patients presenting any neurological symptoms, and HIV infection should be suspected when radiological findings suggest PML lesions even in previously healthy individuals.KeywordsProgressive multifocal leukoencephalopathy; JC virus; Human immunodeficiency virus; Demyelinating disease

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Section: Discussionsupporting

confidence: 53%

From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

et al. 2011

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“…Viruses like Epstein-Barr virus (EBV), cytomegalovirus (CMV), and JC virus (JCV) can result in life-threatening infections in the central nervous system (CNS) of immunodeficient individuals (3,4). The clinical conditions include primary CNS lymphoma, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy (PML) (5)(6)(7). To compound the clinical problem, viral infections can coexist with bacterial and fungal infections.…”

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confidence: 99%

Association of Neurotropic Viruses in HIV-Infected Individuals Who Died of Secondary Complications of Tuberculosis, Cryptococcosis, or Toxoplasmosis in South India

Kannangai¹,

Sachithanandham²,

Mahadevan³

et al. 2013

J Clin Microbiol

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The frequencies of 10 opportunistic DNA viruses were determined by multiplex real-time PCR in paired cerebrospinal fluid (CSF) and brain tissue of HIV-infected individuals. In the CSF, viruses were detectable in 45/55 cases: JC virus (JCV) in 62%, Epstein-Barr virus (EBV) in 44%, cytomegalovirus (CMV) in 25%, varicella-zoster virus (VZV) in 3.6%, herpes simplex virus 1 (HSV-1) in 1.8%, and human herpesvirus 6 (HHV-6) in 1.8% of cases. A single virus was detectable in 20 cases, 19 cases had coinfection with two viruses, and 6 cases were positive for three viruses. JCV was detectable in the CSF of 62% of cases and in 42% of brain tissues, with higher loads in progressive multifocal leukoencephalopathy (PML) (P < 0.05). Several viruses can cause opportunistic infections in HIV-infected individuals, with high morbidity and mortality in HIVinfected individuals (1). These infections are more frequently reactivation of the latent viruses in the host. It is essential to identify the causative agent of these opportunistic infections to initiate therapy or prophylactic treatment. As the clinical pictures caused by different viruses often overlap and multiple infections are also frequent in immunocompromised hosts, simultaneous screening of a wide range of viruses would be cost-effective management (2). Viruses like Epstein-Barr virus (EBV), cytomegalovirus (CMV), and JC virus (JCV) can result in life-threatening infections in the central nervous system (CNS) of immunodeficient individuals (3, 4). The clinical conditions include primary CNS lymphoma, cytomegalovirus encephalitis, and progressive multifocal leukoencephalopathy (PML) (5-7). To compound the clinical problem, viral infections can coexist with bacterial and fungal infections. Currently, there are no reports from India on the frequency of CNS viral infections among HIV-1-infected individuals. The aim of this study was to develop a real-time multiplex PCR for the simultaneous detection of DNA viruses in paired CSF and brain tissue samples of HIV-infected individuals.The study was carried out in the Departments of Clinical Virology (site 1) and Neuropathology (site 2) of two tertiary care centers in south India. The study was approved by the institutional review boards of both institutions. Brain tissues and CSF samples of histopathologically well-characterized HIV-associated opportunistic infections collected at autopsy and archived in the Human Brain Tissue Repository of Neuropathology were utilized for the study. All the samples archived were collected at autopsy following written informed consent from the legal close relative(s) of the deceased to use the biological material for research.A total of 55 archived paired CSF and brain tissue samples collected from HIV-positive individuals who had died with confirmed bacterial or fungal infections were investigated. These diagnoses were confirmed by histopathology, immunohistochemistry, and/or microbiological methods (culture, serology). The study also included 20 CSF samples collected from patients who died of non...

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“…34, 44 Among the reported cases in HIV-infected children, none had pleocytosis and all had a normal glucose (48-92 mg/dL) and a normal to slightly elevated protein (12-76 mg/dL). 6, 10, 11, 13-16, 19, 20, 23, 34 Among case reports in children without HIV, the CSF profiles, including cell count, glucose, and protein, were also within normal limits.…”

Section: Reviewmentioning

confidence: 99%

Progressive Multifocal Leukoencephalopathy in Pediatric Patients

Schwenk

Ramirez-Avila

Sheu

et al. 2014

Pediatric Infectious Disease Journal

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Progressive multifocal leukoencephalopathy (PML) is a rare, demyelinating disease of the central nervous system caused by JC virus. Fewer than 30 cases have been reported in HIV-infected and non-infected children. We report the case of a 15 year-old girl with PML and AIDS who presented with nystagmus, dysarthria, and ataxia. Following combined antiretroviral therapy, she developed immune reconstitution inflammatory syndrome, which proved fatal.

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Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy

Cited by 27 publications

References 15 publications

From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

From Clinical Presentation to the Outcome: the Natural History of PML in a Portuguese Population of HIV Infected Patients

Association of Neurotropic Viruses in HIV-Infected Individuals Who Died of Secondary Complications of Tuberculosis, Cryptococcosis, or Toxoplasmosis in South India

Progressive Multifocal Leukoencephalopathy in Pediatric Patients

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