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Neurologic cytomegalovirus complications in patients with AIDS: retrospective review of 13 cases and review of the literature Complicações neurológicas causadas pelo citomegalovírus em pacientes com AIDS: estudo retrospectivo de 13 casos e revisão da literatura

By Camila Almeida Silva, Augusto C. Penalva de Oliveira, Lucy Vilas-Boas, Maria Cristina D.S. Fink, Cláudio S. Pannuti and José E. Vidal

Abstract

Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69%) were men. At admission all patients were aware of their HIV status and only four (31%) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62%) patients. The neurologic syndromes identified were diffuse encephalitis (n = 7; 62%), polyradiculopathy (n = 7; 54%), focal encephalitis (rhombencephalitis) (n = 1; 8%), and ventriculo-encephalitis (n = 1; 8%). Seven (54%) patients presented extra-neural CMV disease and four (31%) had retinitis. The median of CD4+ T-cell count was 13 cells/µL (range: 1-124 cells/µL). Overall in-hospital mortality was 38%. Eight patients used ganciclovir or foscarnet (in-hospital mortality: 50%) and five patients used ganciclovir and foscarnet (in-hospital mortality: 20%). None of the patients fulfilled the diagnosis criteria of immune reconstitution inflammatory syndrome. Four patients were lost to follow-up, and three patients presented immune recovery and discontinued secondary prophylaxis. Although infrequent, distinct neurological syndromes caused by CMV continue to cause high mortality among AIDS patients. Survival depends upon the use of effective antiviral therapy against CMV and the early introduction of HAART.<br>As complicações neurológicas causadas pelo Citomegalovírus (CMV) em pacientes com aids são raramente relatadas na era HAART. O objetivo deste estudo foi descrever as principais características clínicas e laboratoriais de pacientes com complicações neurológicas associadas ao CMV em pacientes com aids admitidos em centro de referência em Sao Paulo, Brasil. A doença citomegálica precisou da identificação do vírus no líquor mediante a reação em cadeia da polimerase (PCR). Treze casos foram identificados entre janeiro de 2004 e dezembro de 2008. A mediana da idade foi 38 anos e nove (69%) eram homens. Na admissão, todos os pacientes sabiam do seu status sorológico para o HIV e apenas quatro (31%) pacientes usavam HAART. A doença citomegálica foi a primeira doença definidora de aids em oito (62%) pacientes. As síndromes neurológicas identificadas foram: encefalite difusa (n = 7; 62%), polirradiculopatia (n = 7; 54%), encefalite focal (romboencefalite) (n = 1; 8%), e ventrículo-encefalite (n = 1; 8%). Sete (54%) pacientes apresentaram doença citomegálica fora do sistema nervoso e quatro (31%) tiveram retinite. A mediana da contagem de células CD4+ foi 13 células/µL. A mortalidade global durante a internação foi 38%. Oito pacientes usaram ganciclovir ou foscarnet (mortalidade: 50%) e cinco pacientes usaram ganciclovir e foscarnet (mortalidade: 20%). Nenhum paciente apresentou critérios diagnósticos da síndrome inflamatória de reconstituição imunológica. Quatro pacientes foram perdidos do acompanhamento ambulatorial e três pacientes apresentaram reconstituição imunológica e descontinuaram as profilaxias secundárias. Embora raras, as particulares síndromes neurológicas causadas pelo CMV continuam causando elevada mortalidade em pacientes com aids. A sobrevida depende do uso de terapia antiviral efetiva contra o CMV e a introdução oportuna do HAART

Topics: Human immunodeficiency virus, AIDS, Cytomegalovirus, Encephalitis, Polyradiculopathy, LCC:Medicine (General), LCC:R5-920, LCC:Medicine, LCC:R, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Instituto de Medicina Tropical
Year: 2010
DOI identifier: 10.1590/S0036-46652010000600004
OAI identifier: oai:doaj.org/article:daa6672cd47e491aa46e7ed95cad2fe5
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