ABSTRACT
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.
Subject(s)
Humans , HIV Infections , Acquired Immunodeficiency Syndrome , Leukoencephalopathy, Progressive Multifocal/diagnosis , JC Virus/genetics , DNA, Viral , CD4 Lymphocyte CountABSTRACT
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.
Subject(s)
Humans , Visual Acuity , Optic Neuritis , Meningitis, Bacterial , Adrenal Cortex Hormones , Cryptococcus gattiiABSTRACT
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.
Subject(s)
Humans , Mycobacterium leprae , Leprosy/etiology , HIV Infections/epidemiology , Nontuberculous Mycobacteria , Acquired Immunodeficiency Syndrome/complications , Brazil/epidemiology , Leprosy/epidemiology , Leprosy/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/drug therapyABSTRACT
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.