[Rapidly progressive dementia as the initial presentation of human immunodeficiency virus infection].

Dementia associated with human immunodeficiency virus (HIV) is currently a rare cause of rapidly progressive dementia. Its appearance is not only limited to the late phases of the disease, but can sometimes be the presenting symptom. We present the case of a patient who debuted with anxious-depressive symptoms and rapid cognitive deteri-oration with early repercussions on his daily functionality. HIV was detected in the study, with a higher viral load in cerebrospinal fluid than in plasma. Despite a torpid course at the beginning, antiretroviral therapy brought about a progressive improvement in the cognitive sphere, consistent with the decrease in the viral load. Although rare, HIV continues to be a cause of dementia that primary care and hospital care professionals should not forget. The relevance of its early diagnosis lies in its potentially reversible nature.

Demencia rápidamente progresiva como forma de presentación de infección por el virus de la inmunodeficiencia humana / Rapidly progressive dementia as the initial presentation of human immunodeficiency virus infection

La demencia asociada a virus de la inmunodeficiencia humana (VIH) es una causa de demencia rápidamente progresiva poco frecuente en la actualidad. Su aparición no se limita a las fases tardías de la enfermedad, sino que en ocasiones puede ser el síntoma de presentación. Presentamos el caso de un paciente que debutó con síntomas ansioso-depresivos y un rápido deterioro cognitivo con repercusión precoz en su funcionalidad diaria. En el estudio se detectó VIH con mayor carga viral en líquido cefalorraquídeo que en plasma. La terapia antirretroviral logró, a pesar de la tórpida evolución inicial, una mejora progresiva en la esfera cognitiva, congruente con la disminución de la carga viral. Aunque poco frecuente, el VIH sigue siendo una causa de demencia que los profesionales de atención primaria y hospitalaria no debemos olvidar. La importancia de su diagnóstico precoz radica en su carácter potencialmente reversible.(AU)

Dementia associated with human immunodeficiency virus (HIV) is currently a rare cause of rapidly progressive dementia. Its appearance is not only limited to the late phases of the disease, but can sometimes be the presenting symptom. We present the case of a patient who debuted with anxious-depressive symptoms and rapid cognitive deterioration with early repercussions on his daily functionality. HIV was detected in the study, with a higher viral load in cerebrospinal fluid than in plasma. Despite a torpid course at the beginning, antiretroviral therapy brought about a progressive improvement in the cognitive sphere, consistent with the decrease in the viral load. Although rare, HIV continues to be a cause of dementia that primary care and hospital care professionals should not forget. The relevance of its early diagnosis lies in its potentially reversible nature.(AU)

[Neurocognitive screening in a population with acquired immunodeficiency virus]. / Cribado neurocognitivo en población con virus de inmunodeficiencia adquirida.

INTRODUCTION: Neurocognitive impairment associated to human immunodeficiency virus (HIV) is a current problem despite the effectiveness of antiretroviral treatment. The screening tests which best suit to Spanish population are Brief Neuro-cognitive Scale (BNCS) and Neu Screening. We are unaware of our HIV population' neurocognitive impairment magnitude. AIMS: To verify if association between HIV and neurocognitive impairment does exist and to know its prevalence. SUBJECTS AND METHODS: An observational, descriptive and transversal study comparing 24 HIV-outpatients and 21 non-HIV-healthy control matched by age, gender and educational level. Hospital Anxiety and Depression Scale, Neu Screening and BNCS were used as neurocognitive impairment screening. Positive screening was considered with one or more abnormal test. RESULTS: 33.3% of VIH+ and 33.3% of healthy controls had positive screening without significant difference between both populations. Positive screening was significantly associated with anxiety-punctuation and depression-punctuation. A lineal correlation between CD4-nadir-levels and Digit Symbol and between CD4-nadir-levels and verbal fluency results were found. There was no significant relationship between HIV serology and screening result. CONCLUSIONS: HIV-patients clinically controlled had no significantly different neurocognitive profile compared to control population. CD4-nadir levels may be a predictor variable in terms of neurocognitive impairment development. BNCS and Neu Screening are reasonable alternatives for neurocognitive impairment screening. A concomitant psychiatric and neuro-psychological assessment is necessary. Further studies with bigger samples are necessary in order to confirm the alternative hypothesis.

TITLE: Cribado neurocognitivo en población con virus de inmunodeficiencia adquirida.Introducción. El trastorno neurocognitivo asociado al virus de la inmunodeficiencia humana (VIH) es un problema emergente a pesar del tratamiento antirretroviral. Los test de cribado que mejor se adaptan a la población española son la Brief Neurocognitive Scale (BNCS) y el Neu Screening. Desconocemos la magnitud del trastorno neurocognitivo en la población con VIH. Objetivos. Comprobar si existe asociación entre la infección por el VIH y el trastorno neurocognitivo, y conocer su prevalencia. Sujetos y métodos. Estudio observacional, descriptivo y transversal que compara a 24 pacientes con VIH y a 21 controles sanos, pareados por sexo, edad y nivel de estudios. Se utilizó la Hospital Anxiety and Depression Scale, el Neu Screening y la BNCS para el cribado neuropsicológico. Se consideró positivo un cribado con una alteración en uno o más test. Resultados. Un 33,3% de los pacientes con VIH y un 33,3% de los controles sanos tuvieron un cribado positivo, sin diferencias significativas entre ambos grupos. El cribado positivo presentó una relación significativa con ansiedad y depresión. Existe una correlación lineal positiva entre niveles nadir de CD4 y resultados del Digit Symbol, y entre nadir de CD4 y fluencia verbal. No hubo relación significativa entre VIH positivo y cribado positivo. Conclusiones. Los pacientes con VIH con buen control clínico presentan un perfil neurocognitivo sin diferencias significativas frente a la población control. Los niveles de CD4 son posiblemente una variable predictora para el desarrollo de trastorno neurocognitivo. La BNCS y el Neu Screening son buenas alternativas, pero resulta necesario un abordaje neuropsiquiátrico concomitante. Se precisan estudios con muestras mayores para confirmar la hipótesis alternativa.

Debut de linfoma Hodgkin con clínica de compresión medular / Spinal involvement as first presentation of Hodgkin´s disease

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[Adult respiratory distress syndrome secondary to varicella pneumonia in an immunocompetent male]. / Síndrome de distress respiratorio del adulto secundario a neumonía varicelosa en varón inmunocompetente.

We present a case of varicellous pneumonia in a 40-year-old patient without immunitary compromise, who quickly evolved to respiratory distress in the adult and required sustained ventilatory support. We review the literature, with special mention to the indications of the antivirical treatment with Aciclovir.