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He YS, Qin XH, Feng M, Huang QJ, Zhang MJ, Guo LL, Bao MB, Tao Y, Dai HY, Wu B. Human immunodeficiency virus-associated dementia complex with positive 14-3-3 protein in cerebrospinal fluid: A case report. World J Clin Cases 2024; 12:2065-2073. [PMID: 38680258 PMCID: PMC11045508 DOI: 10.12998/wjcc.v12.i12.2065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/22/2023] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated dementia (HAD) is a subcortical form of dementia characterized by memory deficits and psychomotor slowing. However, HAD often presents with symptoms similar to those of Creutzfeldt-Jakob disease (CJD), particularly in patients with acquired immune deficiency syndrome (AIDS). CASE SUMMARY We report the case of a 54-year-old male who exhibited cognitive dysfunction and secondary behavioral changes following HIV infection and suspected prion exposure. The patient was diagnosed with HIV during hospitalization and his cerebrospinal fluid tested positive for 14-3-3 proteins. His electroencephalogram showed a borderline-abnormal periodic triphasic wave pattern. Contrast-enhanced magnetic resonance imaging revealed moderate encephalatrophy and demyelination. Initially, symptomatic treatment and administration of amantadine were pursued for presumed CJD, but the patient's condition continued to deteriorate. By contrast, the patient's condition improved following anti-HIV therapy. This individual is also the only patient with this prognosis to have survived over 4 years. Thus, the diagnosis was revised to HAD. CONCLUSION In the diagnostic process of rapidly progressive dementia, it is crucial to rule out as many potential causes as possible and to consider an autopsy to diminish diagnostic uncertainty. The 14-3-3 protein should not be regarded as the definitive marker for CJD. Comprehensive laboratory screening for infectious diseases is essential to enhance diagnostic precision, especially in AIDS patients with potential CJD. Ultimately, a trial of diagnostic treatment may be considered when additional testing is not feasible.
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Affiliation(s)
- Yun-Sen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu 610036, Sichuan Province, China
| | - Xiao-Hong Qin
- Department of Psychiatry, Sichuan Provincial Center for Mental Health, Chengdu 610072, Sichuan Province, China
| | - Min Feng
- Department of Geriatrics, Municipal People’s Hospital in Luzhou, Luzhou 646000, Sichuan Province, China
| | - Qin-Jiang Huang
- Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu 611100, Sichuan Province, China
| | - Meng-Jun Zhang
- Department of Psychiatry, Sichuan Provincial Center for Mental Health, Chengdu 610072, Sichuan Province, China
| | - Li-Li Guo
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Chengdu 610072, Sichuan Province, China
| | - Ming-Bin Bao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Chengdu 610072, Sichuan Province, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Chengdu 610072, Sichuan Province, China
| | - Hong-Yuan Dai
- Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Chengdu 610072, Sichuan Province, China
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Dahy FE, Novaes CTG, Bandeira GA, Ramin LF, de Oliveira ACP, Smid J. Sporadic Creutzfeldt-Jakob disease in two clinically and virologically controlled Brazilian HIV patients who progressed rapidly to dementia: case reports and literature review. Rev Inst Med Trop Sao Paulo 2021; 63:e23. [PMID: 33787743 PMCID: PMC7997664 DOI: 10.1590/s1678-9946202163023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorders are the main cause of cognitive decline and dementia in people living with HIV (PLHIV). However, extensive workup should be done in patients with rapidly progressive dementia (RPD) and HIV, especially when secondary infection in the central nervous system (CNS) is ruled out. Sporadic Creutzfeldt-Jakob disease (sCJD) is the main cause of RPD in non-HIV patients. It is a fatal neurodegenerative condition caused by prions that mainly affects elderly patients. Our objective is to describe two cases of PLHIV presenting with controlled infections and sCJD, and to review the literature. Our patients were younger than expected for sCJD and one of them had a longer disease course. As aging is expected to occur earlier in PLHIV, sCJD must be excluded in younger PLHIV presenting with RPD and without CNS infection.
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Affiliation(s)
- Flávia Esper Dahy
- Instituto de Infectologia Emílio Ribas, São Paulo, São Paulo,
Brazil
| | - Christina T. G. Novaes
- Universidade de São Paulo, Hospital das Clínicas, Departamento
de Doenças Infecciosas, São Paulo, São Paulo, Brazil
| | - Gabriela A. Bandeira
- Universidade de São Paulo, Hospital das Clínicas, Departamento
de Radiologia, São Paulo, São Paulo, Brazil
| | - Laís F. Ramin
- Universidade de São Paulo, Hospital das Clínicas, Departamento
de Radiologia, São Paulo, São Paulo, Brazil
| | | | - Jerusa Smid
- Instituto de Infectologia Emílio Ribas, São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento
de Neurologia, São Paulo, São Paulo, Brazil
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Rizzi L, Aventurato ÍK, Balthazar MLF. Neuroimaging Research on Dementia in Brazil in the Last Decade: Scientometric Analysis, Challenges, and Peculiarities. Front Neurol 2021; 12:640525. [PMID: 33790850 PMCID: PMC8005640 DOI: 10.3389/fneur.2021.640525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
The last years have evinced a remarkable growth in neuroimaging studies around the world. All these studies have contributed to a better understanding of the cerebral outcomes of dementia, even in the earliest phases. In low- and middle-income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of diagnosing mild cognitive impairment and dementia, the purpose of this paper is to offer an overview of neuroimaging dementia research in Brazil. The review includes a brief scientometric analysis of quantitative information about the development of this field over the past 10 years. Besides, discusses some peculiarities and challenges that have limited neuroimaging dementia research in this big and heterogeneous country of Latin America. We systematically reviewed existing neuroimaging literature with Brazilian authors that presented outcomes related to a dementia syndrome, published from 2010 to 2020. Briefly, the main neuroimaging methods used were morphometrics, followed by fMRI, and DTI. The major diseases analyzed were Alzheimer's disease, mild cognitive impairment, and vascular dementia, respectively. Moreover, research activity in Brazil has been restricted almost entirely to a few centers in the Southeast region, and funding could be the main driver for publications. There was relative stability concerning the number of publications per year, the citation impact has historically been below the world average, and the author's gender inequalities are not relevant in this specific field. Neuroimaging research in Brazil is far from being developed and widespread across the country. Fortunately, increasingly collaborations with foreign partnerships contribute to the impact of Brazil's domestic research. Although the challenges, neuroimaging researches performed in the native population regarding regional peculiarities and adversities are of pivotal importance.
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Affiliation(s)
- Liara Rizzi
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
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