Meningoencephalitis due to varicella zoster virus in AIDS patients. Report of eleven cases and review of the literature



Document title: Meningoencephalitis due to varicella zoster virus in AIDS patients. Report of eleven cases and review of the literature
Journal: Revista do Instituto de Medicina Tropical de Sao Paulo
Database: PERIÓDICA
System number: 000387769
ISSN: 0036-4665
Authors: 1
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Institutions: 1Hospital General de Infecciosas F.J. Muñiz, División HIV/AIDS, Buenos Aires. Argentina
2Hospital General de Infecciosas F.J. Muñiz, Laboratorio de Virología, Buenos Aires. Argentina
3Sociedad Iberoamericana de Información Científica, Buenos Aires. Argentina
Year:
Season: Nov-Dic
Volumen: 57
Number: 6
Pages: 505-508
Country: Brasil
Language: Inglés
Document type: Revisión bibliográfica
Approach: Aplicado, descriptivo
English abstract Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease
Portuguese abstract As complicações neurológicas do vírus varicela-zoster (VVZ) são pouco frequentes e incluem vários quadros clínicos. A reativação do VVZ em pacientes com AIDS é geralmente associada com meningoencefalite aguda e grave. Nós relatamos os dados epidemiológicos, clínicos e virológicos de onze pacientes consecutivos com diagnóstico de HIV/AIDS e comprometimento do sistema nervoso central (SNC) devido ao VVZ. Todos os pacientes eram do sexo masculino e soropositivos para HIV. O principal fator de risco para a infecção pelo HIV foi o contato sexual sem proteção. A mediana da contagem de células CD4 T foi de 142 cel/µL. Todos apresentavam sinais e sintomas devido à meningoencefalite. Seis pacientes (54,5%) apresentaram pleiocitose; todos apresentaram hiperproteinorraquia com mediana de 2,1 g/dL. A reação em cadeia da polimerase de amostra do líquido cefalorraquidiano foi positiva para VVZ em todos eles. Todos os pacientes foram tratados com aciclovir por via intravenosa em doses de 30 mg/kg/dia durante 21 dias. A sobrevida global foi de 63% (sete de 11 pacientes). Os quatro pacientes mortos tiveram uma escassa resposta celular no LCR abaixo da mediana para este parâmetro. O VVZ deve ser incluído entre os patógenos oportunistas que podem comprometer o SNC com meningoencefalite difusa e grave em pacientes com doença avançada por HIV/SIDA
Disciplines: Medicina
Keyword: Microbiología,
Neurología,
Inmunología,
VIH,
SIDA,
Infecciones oportunistas,
Virus,
Varicela zoster,
Meningoencefalitis
Keyword: Medicine,
Microbiology,
Neurology,
Immunology,
HIV,
AIDS,
Opportunistic infections,
Varicella zoster,
Virus,
Meningoencephalitis
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