AIDS-related progressive multifocal leukoencephalopathy

Abstract INTRODUCTION: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by reactivation of JC virus (JCV). METHODS: We described the profile of laboratory-confirmed PML cases among AIDS patients. RESULTS: A total of 43 HIV patients with clinical conditions compatible with PML were obtained; 5 cases were confirmed by JCV testing. The main clinical finding was mental confusion. Median CD4 count was 54 cells/mm³. CONCLUSIONS: Three of the five confirmed PML cases died; the time between diagnosis and death was 2, 5, and 6 months. It is important to consider JCV infection as a differential diagnosis.

AIDS-related progressive multifocal leukoencephalopathy.

INTRODUCTION: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by reactivation of JC virus (JCV). METHODS: We described the profile of laboratory-confirmed PML cases among AIDS patients. RESULTS: A total of 43 HIV patients with clinical conditions compatible with PML were obtained; 5 cases were confirmed by JCV testing. The main clinical finding was mental confusion. Median CD4 count was 54 cells/mm³. CONCLUSIONS: Three of the five confirmed PML cases died; the time between diagnosis and death was 2, 5, and 6 months. It is important to consider JCV infection as a differential diagnosis.

Meningoencephalitis and optical neuritis caused by CRYPTOCOCCUS GATTII in an immunocompetent patient

The following case is of a 59-year-old man, undergoing no medication, with no pathological history or others risk factors, who presented dizziness, fever and asthenia twenty days before admission. The patient was admitted for investigation when the asthenia intensified, followed by seizures. On admission, blood count, biochemical tests and chest computed tomography were normal, a serological test for anti-HIV proved negative, while the magnetic resonance of the brain showed signs suggestive of meningoencephalitis. Cerebrospinal fluid (CSF) analysis suggested bacterial meningitis due to increased leukocytes with a predominance of polymorphonuclear cells, reduced glucose and increased proteins as well as positive Gram cocci in pairs by Gram and negative fungi by India ink test. Treatment with ceftriaxone was started. Since there was no significant improvement, CSF analysis was repeated on the seventh day of treatment. Intracranial pressure was measured by manometry (29 mmHg) and CSF analysis showed the presence of encapsulated yeasts similar to Cryptococcus neoformans by the India ink test. The treatment was modified to liposomal amphotericin B and flucytosine; the intracranial hypertension was controlled by repeated CSF punctures. After fourteen days of antifungal treatment, the patient presented visual turbidity and bilateral papillar edema, so corticosteroid therapy was prescribed. The evolution was favorable, with progressive resolution of symptoms, improvement of CSF parameters and visual acuity. The patient was discharged eight weeks after admission, with outpatient guidance. Corticosteroid therapy associated with antifungal therapy proved to be beneficial in this case, since following the introduction of corticosteroids there was progressive visual improvement.

Distinct inflammatory profiles in HIV-infected individuals under antiretroviral therapy using cannabis, cocaine or cannabis plus cocaine.

OBJECTIVES: To evaluate the effects of cannabis and/or cocaine use on inflammatory, oxidative stress status and circulating monocyte subsets in HIV-infected individuals under antiretroviral therapy. DESIGN: Soluble CD14 (sCD14), intestinal fatty acid-binding protein (IFABP), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP) and oxidative stress markers were examined. The monocyte subsets and their activation and cytokine production by peripheral blood mononuclear cells (PBMCs) of HIV-1 infected individuals upon lipopolysaccharide (LPS)-stimulation were also investigated. METHODS: sCD14, IFABP, TNF-α, IL-6, IL-8 and IL-10 levels were evaluated using ELISA, CRP by turbidimetry; lipid peroxidation (TBARS) spectrofluometrically and total thiol levels by using 5-5'-dithio-bis (2-nitrobenzoic acid) reagent. Monocyte subsets and activation were assessed by flow cytometry. RESULTS: All HIV-infected drug user groups showed higher sCD14 levels compared with HIV+ nondrug users. IFABP was increased in HIV+ drug-users in relation to healthy individuals. Cannabis use lowered the percentages of inflammatory, nonclassical, activated-classic and activated-inflammatory monocytes. Cocaine users showed increased plasmatic TNF-α and TBARS levels, decreased thiols content and lower activated-classic and inflammatory-monocyte percentages. Cannabis-plus-cocaine use increased CRP, IL-8 and IL-6/IL-10 ratio, but decreased thiol content, and inflammatory and activated-classic monocyte percentages. PBMCs of cannabis and cannabis-plus-cocaine users showed low-potential cytokine production either spontaneously or under LPS-stimulation. CONCLUSION: In HIV infection, the use of cannabis induces predominantly an anti-inflammatory profile. The use of cocaine and cannabis-plus-cocaine showed a mixed pro-inflammatory and anti-inflammatory profile, with predominance of inflammatory status. Further studies are required to better understand the action of these drugs in HIV infection.

Potenciais implicaçöes da co-infecçäo HIV e Mycobacterium leprae em saúde pública / Public health implications for the posble interactions between HIV and Mycobaterium leprae infections

Neste trabalho sä revisadas as evidências sobre a interaçäo entre a infecçäo pelo HIV/aids e a hanseníase em consonância com os programas de controle e o desenvolvimento de pesquisas na duas últimas décadas. Säo apresentadas hipóteses e questöes suscitadas pelo possível efeito da co-infecçäo pelo HIV e Mycobacterium leprae alterar o curso de cada infecçäo/doença e desenvolver casos mais graves. Aspectos relacionados à interaçäo adversa entre as terapêuticas pdronizadas, quanto aplicadas simultaneamente para ambas infecçöes/doenças, e as implicaçöes na vacinaçäo BCG nos países em desenvolvimento säo também examinados. A interaçäo entre aids e tuberculose foi usada como exemplo de uma bem conhecida interaçäo biológica entre infecçäo pelo HIV e doenças infecciosas e para traçar um paralelo com outras micobactérias.

Associacao entre AIDS e hanseniase / ?

Neste trabalho sao revisadas as evidencias sobre a interacao entre a infeccao pelo HIV/aids e a hanseniase, nas duas ultimas decadas, em consonancia com os programas de controle. Sao apresentadas hipoteses e questoes suscitadas pelo possivel efeito da co-infeccao pelo HIV e Mycobacterium leprae no curso de cada infeccao/doenca e desenvolvimento de casos mais graves. Aspectos relacionados a interacao adversa entre terapeuticas padronizadas, quando aplicadas simultaneamente para ambas infeccoes/doencas, e as implicacoes no uso da vacinacao BCG nos paises em desenvolvimento sao tambem examinados. O artigo discute a importancia da compreensao das interacoes entre infeccao pelo HIV e M. leprae na implementacao de medidas de prevencao e tratamento com bases cientificas nos programas de saude publica.