ABSTRACT
The nervous system plays an important role in HIV infection. The purpose of this review is to discuss the indications for cerebrospinal fluid (CSF) analysis in HIV infection in clinical practice. CSF analysis in HIV infection is indicated for the diagnosis of opportunistic infections and co-infections, diagnosis of meningitis caused by HIV, quantification of HIV viral load, and analysis of CNS HIV compartmentalization. Although several CSF biomarkers have been investigated, none are clinically applicable. The capacity of HIV to generate genetic diversity, in association with the constitutional characteristics of the CNS, facilitates the generation of HIV quasispecies in the CNS that are distinct from HIV in the systemic circulation. CSF analysis has a well-defined and valuable role in the diagnosis of CNS infections in HIV/AIDS patients. Further research is necessary to establish a clinically applicable biomarker for the diagnosis of HIV-associated neurocognitive disorders.
O sistema nervoso representa um papel importante na infecção pelo HIV. O objetivo desta revisão é discutir as indicações para análise do líquido cefalorraquidiano (LCR) na infecção pelo HIV na prática clínica. A análise do LCR na infecção pelo HIV é indicada para o diagnóstico de infecções oportunistas e co-infecções, meningite pelo HIV, quantificação da carga viral de HIV e compartimentalização do HIV no SNC. Uma série de biomarcadores no LCR foi investigada, na literatura, porém não apresentam aplicabilidade clínica. A grande capacidade do HIV de gerar diversidade genética, associado a características constitucionais do SNC propicia o desenvolvimento quasiespécies distintas no SNC das circulantes sistemicamente. A análise do LCR na infecção pelo HIV é bem estabelecida no diagnóstico de infecções no CNS, contudo mais pesquisas é necessária para estabelecer a aplicabilidade clínica dos biomarcadores no diagnóstico de desordens cognitivas associadas ao HIV.
Subject(s)
Humans , Central Nervous System Infections/cerebrospinal fluid , HIV Infections/cerebrospinal fluid , Anti-Retroviral Agents/therapeutic use , Central Nervous System Infections/drug therapy , Central Nervous System Infections/virology , Cerebrospinal Fluid/virology , Cognition Disorders/cerebrospinal fluid , HIV Infections/complications , HIV Infections/drug therapy , Reproducibility of Results , Viral LoadABSTRACT
The consequences of inflammatory response are primarily responsible for morbimortality in bacterial meningitis. Early use of steroids in these cases can reduce mortality and hearing loss and improve functional outcome without causing significant side effects. The formal recommendation towards pneumoccocal meningitis is being extended to other forms of Bacterial Meningitis. The same thought can be applied to tuberculous meningitis. In neurocysticercosis and neuroschistosomiasis steroids are more useful than parasiticides in most cases. Despite the evidence favoring the use of steroids in herpes simplex encephalitis, it is not sufficient to definitely support such indication. Among the opportunistic infections that affect AIDS patients, neurotoxoplasmosis and progressive multifocal leukoencephalopaty are those most often considered for the use of steroids; steroids are safe to use, but no definite benefit could be demonstrated in both conditions.
As consequências da resposta inflamatória são as grandes responsáveis pela morbimortalidade das meningites bacterianas. O uso precoce de esteróides nestes casos pode reduzir a mortalidade e a perda auditiva, além de atenuar as consequências a longo prazo deste grupo de doenças, sem causar efeitos colaterais importantes. A recomendação formal de seu uso na meningite pneumocócica tem sido ampliada para outras formas de meningite bacteriana. O mesmo raciocínio pode ser aplicado para a Meningite tuberculosa. Na neurocisticercose e na neuroesquistossomose, os esteróides são mais úteis que as drogas parasiticidas na maior parte dos casos. Apesar de evidências a favor do seu uso na Encefalite Herpética, não existe ainda suporte definitivo para esta recomendação. Entre as infecções oportunísticas que ocorrem nos pacientes com AIDS, a Neurotoxoplasmose e a leucoencefalopatia multifocal progressiva são as mais frequentemente relacionadas com o uso dos esteróides; seu uso tem se mostrado seguro, mas seus benefícios não parecem bem estabelecidos em ambas as condições.
Subject(s)
Humans , Central Nervous System Infections/drug therapy , Steroids/therapeutic use , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Central Nervous System Infections/diagnosis , Magnetic Resonance ImagingABSTRACT
BK virus, a double-stranded DNA virus, is a member of the Polyomaviridae family which is known to infect humans. Clinical evidence of disease is mostly encountered in immunosuppressed individuals such as AIDS patients or those who undergo renal or bone marrow transplantation where complications associated with BKV infection manifest commonly as a polyomavirus nephropathy or hemorrhagic cystitis, respectively. Recent evidence suggests that in addition to the JC virus (the other member of the same family known to be strongly neurotropic and responsible for the progressive multifocal leukoencephalopathy), BK virus can infect and cause clinically relevant disease in the human central nervous system. In this mini-review, an analysis of the literature is made. A special focus is given to alert clinicians to the possibility of this association during the differential diagnosis of infections of the central nervous system in the immunocompromised host.
Subject(s)
Humans , BK Virus , Central Nervous System Infections/virology , Communicable Diseases, Emerging/virology , Opportunistic Infections/virology , Polyomavirus Infections/virology , Tumor Virus Infections/virology , Central Nervous System Infections/diagnosis , Central Nervous System Infections/drug therapy , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , Immunocompromised Host , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Polyomavirus Infections/diagnosis , Polyomavirus Infections/drug therapy , Tumor Virus Infections/diagnosis , Tumor Virus Infections/drug therapyABSTRACT
A esquistossomose do Sistema Nervoso Central é relativamente pouco diagnosticada. Relatamos o caso de um paciente procedente de área näo endêmica, com manifestaçöes meningorradiculares da esquistosomose mansônica, comprovada por reaçäo de imunofluorescência no líquido cefalorraquidiano, tratado com praziquantel associado à corticoterapia. Ressaltamos a necessidade do diagnóstico etiológico específico e a instituiçäo precoce do tratamento com drogas antiinflamatórias e drogas específicas para a melhor recuperaçäo do paciente.
Subject(s)
Humans , Male , Adult , Anthelmintics/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Central Nervous System Infections/diagnosis , Central Nervous System Infections/drug therapy , Neuroschistosomiasis/diagnosis , Neuroschistosomiasis/drug therapy , Neuroschistosomiasis/etiology , Praziquantel/therapeutic use , Prednisone/therapeutic use , Schistosomiasis mansoni/complicationsABSTRACT
En la infección por el virus de la inmunodeficiencia humana (VIH), la afección del sistema nervioso central (SNC) es muy común. El compromiso neurológico observado con mayor frecuencia es el complejo cognoscitivo motor, también llamado demencia asociada al SIDA. Este es provocado directamente por la infección del VIH y la respuesta secundaria del sistema inmune, específicamente del sistema monocito-macrofágico. Revisamos la patogénesis y presentamos las posibilidades terapéuticas actuales en el manejo de esta compleja enfermedad, dividiéndola en terapia antirretroviral, control de la inflamación asociada a la infección y fármacos protectores del SNC. El pilar fundamental del tratamiento son las drogas antirretrovirales. Dentro de éstas, la zidovudina (AZT) ha demostrado hasta ahora la mayor efectividad. Actualmente se emplean terapias combinadas, utilizando inhibidores de la transcriptasa reversa e inhibidores de proteasas. Dentro de estas asociaciones, la terapia triasociada es la de elección, ya que permite cambiar la condición de la enfermedad, desde un problema mortal, al de una situación crónica controlable. Se revisa la terapéutica enfocada a frenar la reacción inflamatoria nociva, producida por macrófagos y microglia infectados y las drogas utilizadas en la protección del sistema nervioso central
Subject(s)
Humans , AIDS Dementia Complex/drug therapy , Central Nervous System Infections/etiology , HIV Infections/complications , Central Nervous System Infections/drug therapy , Drug Combinations , Drug Interactions , Protease Inhibitors/administration & dosage , Reverse Transcriptase Inhibitors/administration & dosage , Zidovudine/administration & dosageABSTRACT
Se hace una revisión y actualización de los antibióticos del grupo de los carbapenémicos y monobactámicos, se hace énfasis en algunos aspectos como espectro antibacteriano, utilidad clínica, estructura química y otros. Se señalan las diferencias entre los diversos fármacos que conforman estos grupos