Neurological manifestation of HIV infection in North-Eastern part of India

Abstract

Background: The nervous system is among the most frequent and serious target of HIV infection, occurring in patients with profound immunosuppression even some time neurological disease is the first manifestation of symptomatic HIV infection in 10-20% of patients. Aims & Objective: (1) To study the clinical, investigation profile and various neurological disorders in HIV positive patients; (2) To correlate neurological manifestations in HIV patients with CD4 Counts. Materials and Methods: 40 HIV positive patients with neurological manifestations were enrolled. Apart from routine investigations, CD4 cell count, MRI brain, CSF, electromyography and nerve conduction study were done whereas required. Results: Meningitis was the commonest diagnosis (52.5%) followed Peripheral neuropathy (20%). Cerebrovascular accident was present in 3 cases. Intracranial space occupying lesion was found in 3 cases. Headache was the commonest neurological symptom seen in 25(62.5%) patients. Altered sensorium was found in 55%. Cranial nerve involvement was seen in 7 (17.5%) patients. Convulsion was reported in 10 (25 %) of the patients. Choreoathetoid movement was present in one patient. CD4 Count was done in 37 patients. In 13 patients it was between 200-500/µl & <200/µl in 24 Patients. CD4 count was <200/ µl in most of the patients having TBM (73%), < 200/ µl in 75% of cryptococcal meningitis. Conclusion: Most of the neurological sign symptoms are due to secondary causes which vary according to the geographical areas. So the knowledge of epidemiology of neurological presentation may help in early diagnosis and treatment of patients.

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

“…10 Shri Ram Sharma et al also found an incidence of 5.49% of CVA in their study. 16 In our study DSPN (13.3%) was the most common primary neurological illness followed by CIDP (6.7%), which is comparable with the study from NIMS 8 in which DSPN (3.13%) was more common than CIDP (1.83%). In our study, we found only 1 patient (2.2%) with CNS lymphoma, which can be compared with other study.…”

“…This finding is in concordance with many other studies. 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%).…”

Clinical Profile of Neurological Manifestations in HIVReactive Patients and Their Relation with CD4 Count

“…Our results are comparable to RANA et al who observed neck rigidity in 76% of TBM and 57% cryptococcal meningitis [11] and Sharma et al who observed that signs of meningeal irritation were present in 50% of the cases. [10] Gait abnormalities were found in 9 (17.54%) out of 57 patients of neurological manifestation, which included spastic 5.26% (3 out if 57) and hemiplegic 10.53% ( 6 out of 57) gaits. Sharma at al observed gait abnormalities in 10% patients 4 had ataxia of which 2 patients had cerebellar ataxia and the other 2 had sensory ataxia.…”

“…Satyendra et al [12] Sharma et al [10] Patel et al [6] Atill et al [9] Sircar at al [22] Headache Atill at al found papilledema in 35.08% [9] sharma et al observed papilledema 3 out of 40 patients (7.5%). [10] Meningeal signs were documented only in 25 out of 57 patients with neurological manifestation (43.86%). Only 62.96% (17 put of 27) of TBM and 62.50% (5 out of 8) of Cryptococcal meningitis had neck rigidity.…”

Cryptococcal meningitis in HIV (AIDS) patients: A Mini Review

“…in Sub-Saharan Africa [3,4]. Though once known to be rare, cryptococcosis has occurred at a high frequency in India in the past two decades [5,6].Furthermore, prevalence of HIV-associated CM is also found to be common in many parts of India including North-eastern and as well as in Southern India [7,8].Cryptococcal meningitis is the fourth most commonly recognized cause of life-threatening infection among AIDS patients [9].Despite availability of antiretroviral therapy, the rise in rate of infections due to HIV/AIDS, suppress the cell mediated immune system and subjects are predisposed for opportunistic infections. Additionally, In AIDS patients, it is characterized by lack of meningeal signs and diminished inflammatory response [10].…”