Management of HIV-associated focal brain lesions in developing countries

Modi, Mala; Mochan, Andre; Modi, Girish

doi:10.1093/qjmed/hch080

Cited by 70 publications

(48 citation statements)

References 7 publications

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“…In a study conducted in Mexico only 1.1% of NCC has been reported in HIV positive cases, compared with 2.4% in control autopsies 15 . In South Africa, co-infections by HIV, M. tuberculosis, and T. solium are relatively common in densely populated area where the parasite is widely distributed 18 . NCC has been reported in HIV cases traveling to areas with high intensity of cysticercosis 29 In the present study EITB and ELISA were used to detect anti-T. solium larval stage antibody in patients with HIV.…”

Section: Discussionmentioning

confidence: 99%

A serological study of cysticercosis in patients with HIV

Parija

Gireesh

2009

Rev. Inst. Med. trop. S. Paulo

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Neurocysticercosis (NCC) has attained the importance of one of the most common cause of focal brain lesions in patients infected with HIV (human immunodeficiency virus). Adequate data regarding the rate of this co-infection is lacking. Therefore, the present study was carried out to determine the prevalence of cysticercosis among HIV patients residing in Puducherry or its neighboring districts of Tamil Nadu State, India. A total of one hundred blood samples were collected from HIV seropositive cases visiting JIPMER hospital, Puducherry, between June 2007 and May 2008. Enzyme immunotransfer blot (EITB) and enzyme linked immunosorbent assay (ELISA) were used to demonstrate anti- T. solium larval stage antibodies and Co-agglutination (Co-A) test was used to detect T. solium larval stage antigens in sera. Two HIV seropositive cases were found positive for anti-T. solium larval stage antibody by EITB and four were positive by ELISA. Only one sample was positive by both EITB and ELISA. No serum sample was found positive for T. solium larval stage antigen by Co-A test. The overall seropositivity detected by all the methods was 5% in this study group. The accurate clinical diagnosis of NCC in HIV is difficult due to deranged immunological parameters in the HIV infected patients. The results of this study provides important data on the prevalence of cysticercosis in HIV positive patients in Puducherry and neighboring areas which was previously unknown. This study will also increase awareness among physicians and public health agencies about T. solium cysticercosis in the selected group.

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Section: Discussionmentioning

confidence: 99%

A serological study of cysticercosis in patients with HIV

Parija

Gireesh

2009

Rev. Inst. Med. trop. S. Paulo

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“…An early SPECT study by Rosci et al [89] revealed perfusion abnormalities in the majority of their HIV-infected cohort, but these findings were not correlated to immunological status or predictive of a patient being symptomatic. More recently, Modi et al [90] used SPECT to implicate decreased temporal lobe perfusion in HIV patients who presented with seizures as their first neurological complication. However, comparisons of SPECT to MRS [91] and SPECT findings in nondemented versus demented patients [92] or HAARTtreated versus nontreated patients [93] have led to the conclusion that SPECT is less sensitive in HIV-infected cohorts than other imaging modalities and is of little value in identifying the neuropathology underlying HIVassociated neurocognitive dysfunction.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections

et al. 2011

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Summary:In this review of the current literature, we examine the role of medical imaging in providing new and relevant information on central nervous system (CNS) injury associated with human immunodeficiency virus (HIV) infection and various clinical manifestations of this injury. Common imaging modalities used to examine CNS injury in HIV infection include structural magnetic resonance imaging, magnetic resonance spectroscopy, diffusion tensor imaging, functional MRI, and positron emissions tomography. Clinical implications for the findings are discussed for each of these modalities individually and collectively. In addition, the direction for future studies is suggested in an attempt to provide possible methods that might answer the many questions that remain to be answered on the evolution and progression of CNS injury in the context of HIV infection.

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“…Studies at autopsy have shown that the brain is the second most affected organ after the lungs in patients infected with HIV 3 . The most frequent cause of neurological disease in HIV seropositive patients is an infectious agent, principally Toxoplasma gondii, Cryptococcus neoformans and Mycobacterium tuberculosis in endemic areas 4,5 . These may present as a neuromeningitis syndrome with or without cerebral lesions visible on brain imaging.…”

Section: Introductionmentioning

confidence: 99%

“…Toxoplasmosis is common with seroprevalence reaching over 70% in some areas 7 . The accurate diagnosis of these neurological conditions is difficult due to the variation in clinical features and this is even more challenging in a setting with limited technical diagnostic capabilities, notably a lack of cerebral biopsy 2,4 . The diagnostic approach is presumptive, despite evidence that there is poor accuracy of diagnosis without the gold standard of brain biopsy…”

Section: Introductionmentioning

confidence: 99%

“…Diagnostic guidelines for the industrialised countries of Europe and the USA may not be appropriate for developing countries as the aetiologies of brain lesions differ. Thus the clinical evolution is often the cornerstone for assessing diagnostic accuracy 4 . The objective of this study was to describe the principal diagnoses of neurological diseases in adult patients infected with HIV at the military hospital of Libreville, Gabon.…”

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confidence: 99%

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

Ondounda¹,

Ilozue²,

Magne³

2016

Afr H. Sci.

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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.

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Management of HIV-associated focal brain lesions in developing countries

Cited by 70 publications

References 7 publications

A serological study of cysticercosis in patients with HIV

A serological study of cysticercosis in patients with HIV

The Role of Medical Imaging in Defining CNS Abnormalities Associated with HIV-Infection and Opportunistic Infections

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

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