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Aids-related progressive multifocal leukoencephalopathy: a retrospective study in a referral center in São Paulo,

José E Vidal1, Augusto C Penalva de Oliveira, Maria Cristina D S Fink

  • 1Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil. josevibe@gmail.com

Revista Do Instituto De Medicina Tropical De Sao Paulo
|September 25, 2008
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) is a significant neurological complication in Brazilian acquired immunodeficiency syndrome (AIDS) patients. This study highlights its frequency and clinical features in a São Paulo referral center.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Limited data exist on progressive multifocal leukoencephalopathy (PML) in Brazilian acquired immunodeficiency syndrome (AIDS) patients.
  • PML is a rare, demyelinating disease affecting the central nervous system (CNS).

Purpose of the Study:

  • To describe the clinical features of PML in AIDS patients.
  • To estimate the frequency of PML among CNS opportunistic diseases in AIDS patients in Brazil.

Main Methods:

  • Retrospective and descriptive study design.
  • Inclusion of patients with neurological diseases admitted to a specific institute in São Paulo from April 2003 to April 2004.
  • Analysis of clinical manifestations, CD4+ T-cell counts, and diagnostic confirmation.

Main Results:

  • Twelve cases (6%) of PML were identified among 219 patients with neurological diseases.
  • The median age of PML patients was 36 years, with 75% being male.
  • Common symptoms included focal weakness, speech and visual disturbances, and cognitive dysfunction; median CD4+ T-cell count was 45 cells/microL.
  • PML was the first AIDS-defining illness in 33% of cases.
  • PML incidence was lower than cerebral toxoplasmosis, cryptococcal meningoencephalitis, and CNS tuberculosis.

Conclusions:

  • Progressive multifocal leukoencephalopathy is a notable, though not the most frequent, opportunistic neurological condition in AIDS patients in Brazil.
  • The findings underscore the importance of considering PML in the differential diagnosis of neurological disorders in this population.
  • Further research is needed to understand PML's epidemiology and management in resource-limited settings.

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