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Cytomegalovirus infection of the brain in AIDS: a clinicopathological study
U Setinek1, E Wondrusch, K Jellinger
1Institute of Pathology and Bacteriology, Vienna, Austria.
Abstract:
Based on neuropathological findings, a retrospective case control study of 39 patients with acquired immune deficiency syndrome (AIDS) and confirmed cytomegalovirus (CMV) infection of the brain is presented. Since 1989, the incidence has increased progressively and, in 1994, CMV was the most frequent opportunistic central nervous system (CNS) infection. Of the patients with CMV infections of the brain 16 had one or more coexisting secondary opportunistic and/or tumorous lesions in the CNS. Cerebral involvement by CMV was more frequent in patients with multiple extracerebral organ infections, while 7 among the 39 reported cases showed isolated CMV infection of the brain. The evaluation of the clinical records of 21 patients revealed neuropsychiatric signs and symptoms in 10, while these were absent in 11. All of these patients revealed various types of cerebral lesions related to CMV infection: ventriculitis, focal lesions, and microglial nodule encephalitis. The extent and distribution of cerebral lesions showed no significant correlations with clinical, radiological, or laboratory findings. Further clinicopathological studies are warranted to recognize CMV infections of the CNS and to allow earlier and more efficient treatment of this rather frequent complication of AIDS.
Insights
Cytomegalovirus (CMV) brain infections are a frequent complication in acquired immune deficiency syndrome (AIDS). Neuropathological findings show varied cerebral lesions, often without clear clinical or radiological correlation, necessitating further study.
Area of Science:
- Neuropathology
- Infectious Diseases
- Neuroscience
Background:
- Cytomegalovirus (CMV) is a significant opportunistic pathogen in individuals with acquired immune deficiency syndrome (AIDS).
- CMV infection of the central nervous system (CNS) has emerged as a frequent complication, particularly affecting the brain.
- The incidence of CMV brain infections in AIDS patients has shown a progressive increase since 1989.
Purpose of the Study:
- To present neuropathological findings in a cohort of AIDS patients with confirmed CMV brain infection.
- To analyze the frequency, patterns, and clinical correlations of CMV CNS involvement in AIDS.
- To highlight the need for improved recognition and treatment strategies for CMV CNS infections.
Main Methods:
- Retrospective case-control study.
- Analysis of neuropathological findings in 39 AIDS patients with confirmed CMV brain infection.
- Review of clinical records for 21 patients to assess neuropsychiatric signs and symptoms.
Main Results:
- CMV was the most frequent opportunistic CNS infection in 1994.
- 16 out of 39 patients had coexisting secondary opportunistic lesions or tumors in the CNS.
- Cerebral CMV involvement was more common in patients with multiple extracerebral organ infections.
- 7 cases presented with isolated CMV infection of the brain.
- Neuropsychiatric signs were present in 10 of 21 evaluated patients.
- Observed cerebral lesions included ventriculitis, focal lesions, and microglial nodule encephalitis.
- No significant correlation was found between lesion extent/distribution and clinical, radiological, or laboratory findings.
Conclusions:
- CMV is a prevalent cause of CNS opportunistic infections in AIDS patients.
- The neuropathological presentation of CMV brain lesions is diverse.
- Clinical manifestations may not correlate with the extent or distribution of cerebral lesions.
- Further clinicopathological studies are crucial for earlier diagnosis and effective management of CMV CNS infections in AIDS.