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Dumonceau AG, Ameli R, Rogemond V, Ruiz A, Joubert B, Muñiz-Castrillo S, Vogrig A, Picard G, Ambati A, Benaiteau M, Rulquin F, Ciron J, Deiva K, de Broucker T, Kremer L, Kerschen P, Sellal F, Bouldoires B, Genet R, Biberon J, Bigot A, Duval F, Issa N, Rusu EC, Goudot M, Dutray A, Devoize JL, Hopes L, Kaminsky AL, Philbert M, Chanson E, Leblanc A, Morvan E, Andriuta D, Diraison P, Mirebeau G, Derollez C, Bourg V, Bodard Q, Fort C, Grigorashvili-Coin I, Rieul G, Molinier-Tiganas D, Bonnan M, Tchoumi T, Honnorat J, Marignier R. Glial Fibrillary Acidic Protein Autoimmunity: A French Cohort Study. Neurology 2021; 98:e653-e668. [PMID: 34799461 PMCID: PMC8829963 DOI: 10.1212/wnl.0000000000013087] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives To report the clinical, biological, and imaging features and clinical course of a French cohort of patients with glial fibrillary acidic protein (GFAP) autoantibodies. Methods We retrospectively included all patients who tested positive for GFAP antibodies in the CSF by immunohistochemistry and confirmed by cell-based assay using cells expressing human GFAPα since 2017 from 2 French referral centers. Results We identified 46 patients with GFAP antibodies. Median age at onset was 43 years, and 65% were men. Infectious prodromal symptoms were found in 82%. Other autoimmune diseases were found in 22% of patients, and coexisting neural autoantibodies in 11%. Tumors were present in 24%, and T-cell dysfunction in 23%. The most frequent presentation was subacute meningoencephalitis (85%), with cerebellar dysfunction in 57% of cases. Other clinical presentations included myelitis (30%) and visual (35%) and peripheral nervous system involvement (24%). MRI showed perivascular radial enhancement in 32%, periventricular T2 hyperintensity in 41%, brainstem involvement in 31%, leptomeningeal enhancement in 26%, and reversible splenial lesions in 4 cases. A total of 33 of 40 patients had a monophasic course, associated with a good outcome at last follow-up (Rankin Score ≤2: 89%), despite a severe clinical presentation. Adult and pediatric features are similar. Thirty-two patients were treated with immunotherapy. A total of 11/22 patients showed negative conversion of GFAP antibodies. Discussion GFAP autoimmunity is mainly associated with acute/subacute meningoencephalomyelitis with prodromal symptoms, for which tumors and T-cell dysfunction are frequent triggers. The majority of patients followed a monophasic course with a good outcome.
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Affiliation(s)
- Alice Gravier Dumonceau
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | - Roxana Ameli
- Service d'imagerie médicale, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | - Veronique Rogemond
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Anne Ruiz
- Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, 69003 Lyon, France
| | - Bastien Joubert
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Sergio Muñiz-Castrillo
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Alberto Vogrig
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Geraldine Picard
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Aditya Ambati
- Stanford University Center for Sleep Sciences and Medecine, Palo Alto, CA, USA
| | - Marie Benaiteau
- Service de neurologie cognitive, épilepsie, sommeil et mouvements anormaux, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Florence Rulquin
- Service de neurologie inflammatoire et neuro-oncologie, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Jonathan Ciron
- Service de neurologie inflammatoire et neuro-oncologie, Hôpital Pierre-Paul Riquet, Hôpitaux de Toulouse, 31059 Toulouse, France
| | - Kumaran Deiva
- Service de neuropédiatrie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94270 Le Kremlin-Bicêtre, France
| | - Thomas de Broucker
- Service de neurologie, Hôpital Delafontaine, Centre Hospitalier de Saint-Denis, 93205 Saint-Denis, France
| | - Laurent Kremer
- Service de neurologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Philippe Kerschen
- Service de neurologie, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg
| | - François Sellal
- Service de neurologie, Hôpitaux Civils de Colmar, 68000 Colmar, France ; Unité INSERM U-1118, Faculté de Médecine, Université de Strasbourg
| | - Bastien Bouldoires
- Service de médecine interne, Hôpitaux civils de Colmar, 68000 Colmar, France
| | - Roxana Genet
- Service de médecine interne, Hôpital d'Instruction des Armées Legouest, 57000 Metz, France
| | - Jonathan Biberon
- Service de neurologie, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France
| | - Adrien Bigot
- Service de médecine interne et immunologie clinique, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France
| | - Fanny Duval
- Service de neurologie et maladies neuromusculaires, Groupe Hospitalier Pellegrin, Hôpitaux de Bordeaux, 33000 Bordeaux, France
| | - Nahema Issa
- Service de médecine intensive et réanimation, Hôpital Saint André, 33000 Bordeaux, France
| | - Elena-Camelia Rusu
- Service de neurologie, Hôpital Sainte Musse, Centre Hospitalier Intercommunal de Toulon, 83056 Toulon, France
| | - Mathilde Goudot
- Service de neurologie, Hôpital Emile Muller, 68100 Mulhouse, France
| | - Anais Dutray
- Service de neurologie, Centre Hospitalier de Perpignan, 66046 Perpignan, France
| | - Jean Louis Devoize
- Pôle Cardio-vasculaire et métabolique, Centre hospitalier de Cayenne, 97300 Cayenne, France
| | - Lucie Hopes
- Service de neurologie, Hôpital Central, CHRU Nancy, 54035 Nancy, France
| | - Anne-Laure Kaminsky
- Service de neurologie, CHU de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Marion Philbert
- Service de neuropédiatrie, Site Mère Enfant, CHU Martinique, 97200 Fort-de-France, France
| | - Eve Chanson
- Service de neurologie, CHU Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - Amelie Leblanc
- Service de neurologie, Hôpital d'Instruction des Armées Clermont-Tonnerre, 29240 Brest, France
| | - Erwan Morvan
- Service de neurologie, Hôpital Fondation Adolphe de Rothschild, 75019 Paris, France
| | - Daniela Andriuta
- Service de Neurologie et Laboratoire de Neurosciences Fonctionnelles et Pathologies, Centre Hospitalier universitaire d'Amiens et Université de Picardie Jules Verne, Amiens, France
| | - Philippe Diraison
- Service de neurologie, Hôpital Laënnec, Centre Hospitalier de Cornouaille, 29107 Quimper, France
| | - Gabriel Mirebeau
- Service de neurologie, Centre Hospitalier Universitaire de La Réunion, 97410 Saint Pierre, France
| | - Celine Derollez
- Service de neurologie, Hôpital Roger Salengro, Centre Hospitalier Universitaire de Lille, 59037 Lille, France
| | - Veronique Bourg
- Service de neurologie, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, 06000 Nice, France
| | - Quentin Bodard
- Service de médecine interne et maladies infectieuses, Centre Hospitalier d'Angoulême, 16959 Angoulême, France
| | - Clementine Fort
- Service de neurologie pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69677 Lyon/Bron, France
| | | | - Guillaume Rieul
- Service de réanimation, Centre Hospitalier de Saint-Brieuc, 22027 Saint-Brieuc, France
| | - Daniela Molinier-Tiganas
- Service de médecine polyvalente et de médecine interne, Centre Hospitalier Le Mans, 72037 Le Mans, France
| | - Mickaël Bonnan
- Service de neurologie, Centre Hospitalier de Pau, 64046 Pau, France
| | - Thierry Tchoumi
- Service de neurologie/UNV, Centre Hospitalier de Saintonge, 17100 Saintes, France
| | - Jérôme Honnorat
- Centre de référence des syndromes neurologiques paranéoplasiques et encéphalites auto-immunes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France ; Institut NeuroMyoGène, INSERM 1217 et CNRS UMR5310, 69008 Lyon, France ; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69008 Lyon, France
| | - Romain Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677 Lyon/Bron, France.,Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, 69003 Lyon, France
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Gynthersen RMM, Mens H, Wegener M, Wareham NE. Intracranial hypertension and papilloedema as a complication to low antiretroviral therapy adherence in a man living with chronic HIV. BMJ Case Rep 2021; 14:14/3/e237504. [PMID: 33727285 PMCID: PMC7970204 DOI: 10.1136/bcr-2020-237504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a 61-year-old man living with HIV on antiretroviral therapy (ART), who presented with headache, dizziness and blurred vision. Latest CD4+ cell count 3 months prior to admission was 570×106 cells/mL and HIV viral load <20 copies/mL. The patient was diagnosed with cerebrospinal fluid (CSF) lymphocytic pleocytosis, raised intracranial pressure and papilloedema. Neuroimaging showed normal ventricular volume and no mass lesions, suggesting (1) neuroinfection (2) idiopathic intracranial hypertension or (3) retroviral rebound syndrome (RRS) as possible causes. Neuroinfection was ruled out and idiopathic intracranial hypertension seemed unlikely. Elevated plasma HIV RNA level was detected consistent with reduced ART adherence prior to admission. RRS is a virological rebound after ART interruption, which can mimic the acute retroviral syndrome of acute primary infection. To the best of our knowledge, we describe the second case of RRS presenting as CSF lymphocytic pleocytosis and elevated intracranial pressure after low ART adherence.
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Affiliation(s)
| | - Helene Mens
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Wegener
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Neval Ete Wareham
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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3
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Magid-Bernstein J, Guo CY, Chow FC, Thakur KT. A rare case of HIV CNS escape in a patient previously considered a viral controller. Int J STD AIDS 2020; 31:694-698. [PMID: 32538333 DOI: 10.1177/0956462420922452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human immunodeficiency virus (HIV) ribonucleic acid (RNA) levels generally remain undetectable in the cerebrospinal fluid of people living with HIV with peripheral viral suppression. Secondary HIV central nervous system (CNS) escape refers to the rare independent replication of HIV RNA in the central nervous system despite peripheral viral suppression that occurs in the setting of a concomitant non-HIV infection. We describe here a young man with perinatal HIV infection considered a viral controller who developed secondary HIV CNS escape in the setting of a presumed fungal CNS infection.
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Affiliation(s)
| | - Chu-Yueh Guo
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Felicia C Chow
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA.,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
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Malano D, Tiraboschi J, Saumoy M, Podzamczer D. Acute inflammatory demyelinating polyneuropathy following interruption of antiretroviral treatment and HIV rebound. J Antimicrob Chemother 2020; 75:1356-1357. [PMID: 31998944 DOI: 10.1093/jac/dkz573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Daniela Malano
- HIV and STI Unit, Infectious Disease Service, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Tiraboschi
- HIV and STI Unit, Infectious Disease Service, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Saumoy
- HIV and STI Unit, Infectious Disease Service, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STI Unit, Infectious Disease Service, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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5
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Abstract
Encephalitis, inflammation of the brain, is most commonly caused by a viral infection (especially herpes simplex virus [HSV] type 1 in the UK) although autoimmune causes, such as N-methyl D-aspartate receptor (NMDAR) antibody encephalitis, are increasingly recognised. Most patients present with a change in consciousness level and may have fever, seizures, movement disorder or focal neurological deficits. Diagnosis hinges crucially on lumbar puncture and cerebrospinal fluid (CSF) examination, but imaging and electroencephalography (EEG) may also be helpful. Treatment of HSV encephalitis with aciclovir dramatically improves outcome, but the optimal management of autoimmune encephalitis is still uncertain. Many patients with encephalitis are left with residual physical or neuropsychological deficits which require long-term multidisciplinary management. Here we review assessment of patients with suspected encephalitis, general aspects of management and areas of ongoing research.
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Affiliation(s)
- Mark Ellul
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Tom Solomon
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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Abstract
Primary human immunodeficiency virus type 1 (HIV-1) infection is defined as the period from initial infection with HIV to complete seroconversion. Neurologic sequelae of primary HIV-1 infection are not uncommon, potentially affecting all parts of the nervous system. It is important for the neurologist to be aware of symptomatic primary HIV infection, as it may afford an early and accurate diagnosis of HIV infection and the opportunity for consideration of early antiretroviral therapy. This chapter introduces the clinical manifestations of primary HIV infection, including the laboratory and diagnostic approach, before detailing the various neurologic sequelae. Finally the treatment of primary HIV infection and neurologic sequelae are discussed, in the context of recent advances in the field of HIV reservoirs and longer-term neurologic complications.
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Affiliation(s)
- Bruce James Brew
- Departments of Neurology and HIV Medicine, St. Vincent's Hospital and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, St. Vincent's Hospital, Sydney, NSW, Australia.
| | - Justin Y Garber
- Department of Neurology, St. Vincent's Hospital, Sydney, NSW, Australia
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7
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Ambrosioni J, Artigues F, Nicolás D, Peñafiel J, Agüero F, Manzardo C, Mar Mosquera M, Sánchez-Palomino S, De Lazzari E, Marcos MA, Plana M, Miró JM. Neurological involvement in patients with acute/recent HIV-1 infection. A case-control study. J Neurovirol 2017; 23:679-685. [PMID: 28718069 DOI: 10.1007/s13365-017-0548-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/13/2017] [Indexed: 01/30/2023]
Abstract
Primary HIV-1 infection is a relevant period for its virological and epidemiological consequences. Most patients present a symptomatic disease that can be potentially serious, but neurological involvement during primary HIV-1 infection has been poorly studied. The aim of this study was to describe the characteristics and outcomes of primary HIV-1 infection patients presenting neurological symptoms and to compare them with primary HIV-1 infection patients without neurological involvement. Retrospective case-control study (1:3) comparing primary HIV-1 infection patients with and without neurological involvement enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016. Matching criteria included age (±10 years), gender, year of diagnosis (±4 years), and Fiebig stage. The conditional logit model was used for comparisons. Fourteen out of 463 patients (3.02%) enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016 presented neurological symptoms. 28.5% of cases presented as meningitis and 71.5% as meningoencephalitis. Cerebrospinal fluid showed non-specific findings, including pleocytosis with lymphocyte predominance and increased protein levels. All cases required hospitalisation, whereas only 19% of the controls did. No other pathogen was identified in any case, but five patients initiated empirically antimicrobial treatment for other aetiologies until diagnosis was confirmed. CD4/CD8 ratio was significantly lower (p = 0.039) and plasmatic viral load significantly higher in the case group, compared to controls (p = 0.028). Risk factors, HIV-1 tropism, subtype distribution, and prescribed ART regimens were comparable between cases and controls. After 6 months on ART, 92% of cases had undetectable viral load, similar to controls, and CD4/CD8 ratio became also comparable between groups. All cases recovered rapidly with ART and were discharged without sequels. Neurological involvement during primary HIV-1 infection is unusual but serious, always requiring hospitalisation. Diagnosis is difficult because of the wide range of symptoms and similarities with other viral aetiologies. Neurological manifestations during primary HIV-1 infection are associated with a lower CD4/CD8 ratio and with a higher viral load than controls. Immediate ART initiation and rapid viral load decrease are required, allowing complete clinical recovery.
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | | | - David Nicolás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Judit Peñafiel
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Fernando Agüero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María Mar Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Sonsoles Sánchez-Palomino
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María A Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain.
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9
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Abstract
CNS infection is a nearly constant facet of systemic CNS infection and is generally well controlled by suppressive systemic antiretroviral therapy (ART). However, there are instances when HIV can be detected in the cerebrospinal fluid (CSF) despite suppression of plasma viruses below the clinical limits of measurement. We review three types of CSF viral escape: asymptomatic, neuro-symptomatic, and secondary. The first, asymptomatic CSF escape, is seemingly benign and characterized by lack of discernable neurological deterioration or subsequent CNS disease progression. Neuro-symptomatic CSF escape is an uncommon, but important, entity characterized by new or progressive CNS disease that is critical to recognize clinically because of its management implications. Finally, secondary CSF escape, which may be even more uncommon, is defined by an increase of CSF HIV replication in association with a concomitant non-HIV infection, as a consequence of the local inflammatory response. Understanding these CSF escape settings not only is important for clinical diagnosis and management but also may provide insight into the CNS HIV reservoir.
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The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016; 72:405-38. [PMID: 26845731 DOI: 10.1016/j.jinf.2016.01.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/14/2016] [Accepted: 01/23/2016] [Indexed: 02/06/2023]
Abstract
Bacterial meningitis and meningococcal sepsis are rare conditions with high case fatality rates. Early recognition and prompt treatment saves lives. In 1999 the British Infection Society produced a consensus statement for the management of immunocompetent adults with meningitis and meningococcal sepsis. Since 1999 there have been many changes. We therefore set out to produce revised guidelines which provide a standardised evidence-based approach to the management of acute community acquired meningitis and meningococcal sepsis in adults. A working party consisting of infectious diseases physicians, neurologists, acute physicians, intensivists, microbiologists, public health experts and patient group representatives was formed. Key questions were identified and the literature reviewed. All recommendations were graded and agreed upon by the working party. The guidelines, which for the first time include viral meningitis, are written in accordance with the AGREE 2 tool and recommendations graded according to the GRADE system. Main changes from the original statement include the indications for pre-hospital antibiotics, timing of the lumbar puncture and the indications for neuroimaging. The list of investigations has been updated and more emphasis is placed on molecular diagnosis. Approaches to both antibiotic and steroid therapy have been revised. Several recommendations have been given regarding the follow-up of patients.
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Hernández Febles M, Gilarranz Luengo R, Chamizo López FJ, Pena Lopez MJ. Meningoencefalitis viral en pacientes inmunocompetentes: papel del VIH. Enferm Infecc Microbiol Clin 2015; 33:574-5. [DOI: 10.1016/j.eimc.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 01/15/2015] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
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Helleberg M, Kirk O. Encephalitis in primary HIV infection: challenges in diagnosis and treatment. Int J STD AIDS 2013; 24:489-93. [PMID: 23970754 DOI: 10.1177/0956462412472806] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of primary HIV encephalitis, which initially presented as acute psychosis. Magnetic resonance imaging of the brain was suggestive of vasculitis and multiple infarctions, whereas a brain biopsy after six weeks of symptoms showed HIV encephalitis with microglial nodules, but no signs of vasculitis. We review previous reported cases and radiological findings in HIV encephalitis and discuss the role of antiretroviral therapy and steroids in its management.
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Affiliation(s)
- M Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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13
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Meningiti acute. Neurologia 2013. [DOI: 10.1016/s1634-7072(13)64518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Intracranial hypertension following highly active antiretroviral therapy interruption in an HIV-infected woman: case report and review of the literature. AIDS 2013; 27:668-70. [PMID: 23364446 DOI: 10.1097/qad.0b013e32835db0af] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Ory F, Avellón A, Echevarría JE, Sánchez-Seco MP, Trallero G, Cabrerizo M, Casas I, Pozo F, Fedele G, Vicente D, Pena MJ, Moreno A, Niubo J, Rabella N, Rubio G, Pérez-Ruiz M, Rodríguez-Iglesias M, Gimeno C, Eiros JM, Melón S, Blasco M, López-Miragaya I, Varela E, Martinez-Sapiña A, Rodríguez G, Marcos MÁ, Gegúndez MI, Cilla G, Gabilondo I, Navarro JM, Torres J, Aznar C, Castellanos A, Guisasola ME, Negredo AI, Tenorio A, Vázquez-Morón S. Viral infections of the central nervous system in Spain: a prospective study. J Med Virol 2012; 85:554-62. [PMID: 23239485 DOI: 10.1002/jmv.23470] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/10/2022]
Abstract
The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis.
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Affiliation(s)
- F de Ory
- National Centre for Microbiology, Majadahonda, Spain.
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16
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Abstract
The human immunodeficiency virus displays a narrow tropism for CD4+ mononuclear cells, and activated CD4+ T lymphocytes are the main target. When these cells are depleted by viral replication, bystander apoptosis and increased cell turnover mediated by immune activation, there is a progressive immunodeficiency (i.e., AIDS). Despite this specific cell tropism, HIV-infected persons demonstrate pathology in nearly every organ system. This article reviews current understanding of tissue-specific HIV-1 infection in the CNS, the genital tract, and gastrointestinal-associated lymphoid tissue.
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Affiliation(s)
- Maile Ay Karris
- University of California, San Diego, Division of Infectious Diseases, Stein Clinical Research Bldg MC 0679, 9500 Gilman Drive, La Jolla, CA 92037, USA
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17
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Abstract
Neuronal damage induced by ongoing human immunodeficiency virus type 1 (HIV-1) infection was investigated in humanized NOD/scid-IL-2Rγ(c)(null) mice transplanted at birth with human CD34-positive hematopoietic stem cells. Mice infected at 5 months of age and followed for up to 15 weeks maintained significant plasma viral loads and showed reduced numbers of CD4(+) T-cells. Prospective serial proton magnetic resonance spectroscopy tests showed selective reductions in cortical N-acetyl aspartate in infected animals. Diffusion tensor imaging revealed structural changes in cortical gray matter. Postmortem immunofluorescence brain tissue examinations for neuronal and glial markers, captured by multispectral imaging microscopy and quantified by morphometric and fluorescence emission, showed regional reduction of neuronal soma and synaptic architectures. This was evidenced by loss of microtubule-associated protein 2, synaptophysin, and neurofilament antigens. This study is the first, to our knowledge, demonstrating lost neuronal integrity after HIV-1 infection in humanized mice. As such, the model permits studies of the relationships between ongoing viral replication and virus-associated neurodegeneration.
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Scriven J, Davies S, Banerjee AK, Jenkins N, Watson J. Limbic encephalitis secondary to HIV seroconversion. Int J STD AIDS 2011; 22:236-7. [DOI: 10.1258/ijsa.2011.010331] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a case of acute limbic encephalitis secondary to HIV seroconversion. The patient made a gradual neurological recovery following treatment with antiretroviral therapy, steroids and intravenous immunoglobulin.
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Affiliation(s)
- J Scriven
- Department of Infection and Tropical Medicine
| | - S Davies
- Department of Sexual Health and HIV Medicine
| | - A K Banerjee
- Department of Radiology, Birmingham Heartlands Hospital, Birmingham, UK
| | - N Jenkins
- Department of Infection and Tropical Medicine
| | - J Watson
- Department of Sexual Health and HIV Medicine
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