Profile of central nervous system pathology in patients with AIDS

Lanjewar, D N; Jain, Paresh P.; Shetty, Chandrashekar R.

doi:10.1097/00002030-199803000-00009

Cited by 63 publications

(42 citation statements)

References 13 publications

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“…However, given that they were all lost to follow-up or died, it is impossible to determine if these were true false positives or due to dual infection (TB and cryptoccocal meningitis). Indeed, our study had seven patients with both cryptococcal and TB meningitis, and dual infection is well described (37,38). There were also five patients, most with very low CD4 counts, with definite TBM who had negative RD-1 ELISOPT assays.…”

Section: Discussionmentioning

confidence: 92%

Cerebrospinal T-Cell Responses Aid in the Diagnosis of Tuberculous Meningitis in a Human Immunodeficiency Virus– and Tuberculosis-Endemic Population

Patel

Singh²,

Connolly³

et al. 2010

Am J Respir Crit Care Med

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Rationale: Current tools for the rapid diagnosis of tuberculous meningitis (TBM) are suboptimal. We evaluated the clinical utility of a quantitative RD-1 IFN-g T-cell enzyme-linked immunospot (ELISPOT) assay (T-SPOT.TB), using cerebrospinal fluid cells for the rapid immunodiagnosis of TBM. Objectives: To evaluate the diagnostic utility of the RD1 antigenspecific ELISPOT assay for the diagnosis of tuberculous meningitis. Methods: The ELISPOT assay was evaluated in 150 patients with suspected TBM who were categorized as definite-TBM, probable-TBM, and non-TBM. Culture or polymerase chain reaction positivity for Mycobacerium tuberculosis served as the reference standard. To determine the diagnostic value of the ELISPOT assay, a clinical prediction rule was derived from baseline clinical and laboratory parameters using a multivariable regression model. Measurements and Main Results: A total of 140 patients (81% HIVinfected; median CD4 count, 160 cells/mm 3 ) were included in the final analysis. When comparing the definite-TBM (n 5 38) and non-TBM groups (n 5 48), the ELISPOT assay (cut point of >228 spot-forming cells per 1 million mononuclear cells) was a useful rule-in test: sensitivity 58% (95% confidence interval [CI], 41-74); specificity 94% (95% CI, 83-99). However, ELISPOT outcomes improved when other rapid tests were concurrently used to exclude bacterial (Gram stain) and cryptococcal meningitis (latex-agglutination test) within the non-TBM group. Using this approach, the ELISPOT assay (cut point of >46 spot-forming cells) was an excellent rule-in test: sensitivity 82% (95% CI, 66-92); specificity 100% (95% CI, 78-100); positive predictive value, 100% (95% CI, 89-100); negative predictive value, 68% (95% CI, 45-86); area under the curve, 0.90. The ELISPOT assay had incremental diagnostic value compared with the clinical prediction rule. Conclusions: The RD-1 ELISPOT assay, using cerebrospinal fluid mononuclear cells and in conjunction with other rapid confirmatory tests (Gram stain and cryptococcal latex-agglutination test), is an accurate rapid rule-in test for TBM in a TB and HIV endemic setting.

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Section: Discussionmentioning

confidence: 92%

Cerebrospinal T-Cell Responses Aid in the Diagnosis of Tuberculous Meningitis in a Human Immunodeficiency Virus– and Tuberculosis-Endemic Population

Patel

Singh²,

Connolly³

et al. 2010

Am J Respir Crit Care Med

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“…Two autopsy studies from India on AIDS patients have also not documented even a single PCNSL case, (Lanjewar et al, 1998;Satishchandra et al, 2000) although autopsy studies in the west have demonstrated that PCNSL occurs frequently (12-40%) in patients with AIDS (Loureiro et al, 1988;Goplen et al, 1997). These facts appear paradoxical because HIV prevalence is quite high in India.…”

Section: Discussionmentioning

confidence: 99%

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

Ambroise

Ghosh²,

Mallikarjuna³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The aim of this study was to analyze the clinicopathological and immunohistochemical features of primary central nervous system lymphoma (PCNSL) cases occurring in Indian patients and also study the utility of the crush smear preparation in intraoperative diagnosis. Materials and Methods: The immune status, clinical, radiological details, immunohistochemical profile, histopathological findings and cytological features in smear preparation of 32 cases of PCNSL were analyzed. Patients with systemic NHL and skull-base lymphomas were excluded. Results: The mean age of our patients was 52 years with a male: female ratio 1:1. A periventricular location was found in 62.5% of patients. None of our PCNSL cases were associated with AIDS. All cases except one were diffuse large B-cell lymphomas. Intraoperative diagnosis using crush smears allowed correct prediction in 93% of cases. Conclusions: Our study shows that PCNSL is seen predominantly in immunocompetent patients in India .The age of presentation is relatively young as compared to the West. Our study also stresses the utility of crush smear preparation in establishing an intraoperative diagnosis.

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“…This may be due to the fact it is not a common practice to conduct an autopsy in HIV/AIDS patients that could give the actual prevalence of AIDS-associated CT being underestimated. CT is one of the most common opportunistic infections of the CNS (Wadia et al, 2001;Nobre et al, 2003) as reported in an autopsy series conducted in India (Lanjewar et al, 1998a;Lanjewar et al, 1998b) and in other clinical settings Souza et al, 2008). The majority of AIDS-related diseases diagnosed at autopsy had not been clinically diagnosed or suspected antemortem (Eza et al, 2006).…”

Section: Neuropathology Of Toxoplasmosis: From Pre To Haart Eramentioning

confidence: 99%