Meningoencephalitis caused by Bovine alphaherpesvirus 5 in Pernambuco, Brazil / [Meningoencefalite causada pelo Bovine alphaherpesvirus 5 em Pernambuco, Brasil]

Objetivou-se descrever a ocorrência do Bovine alphaherpesvirus 5 (BoHV5) como causa de meningoencefalite não supurativa em bovinos do estado de Pernambuco, Brasil. Para tanto, 32 amostras de sistema nervoso embebidas em parafina foram obtidas de animais acometidos por doenças neurológicas atendidos na Clínica de Bovinos de Garanhuns da Universidade Federal Rural de Pernambuco (CBG-UFRPE), entre 2012 e 2016. As amostras foram analisadas quanto à presença do gene da glicoproteína C do BoHV5 por reação em cadeia da polimerase (PCR). Dois animais (6,25%) tiveram resultado positivo à PCR, e sua análise de sequenciamento indicou 100% de similaridade para o BoHV5. Os resultados histopatológicos desses dois animais revelaram lesões multifocais de meningoencefalite não supurativa associada à polioencefalomalácia, presença de corpúsculos de inclusão basofílicos, infiltração de células de Gitter e presença de manguitos perivasculares. A PCR se mostra uma importante ferramenta para diferenciação das infecções por BoHV5 de outras enfermidades neurológicas de bovinos, especialmente a raiva.(AU)

Dementia and cognitive impairment in adults as sequels of HSV-1-related encephalitis: a review / Demência e déficit cognitivo em adultos como sequelas de encefalite relacionada ao HSV-1: uma revisão

ABSTRACT. Considering the variety of mechanisms of Herpes simplex virus (HSV-1) contamination and its broad invasive potential of the nervous system, a life-long latent infection is established. Infected adult individuals may be susceptible to viral reactivation when under the influence of multiple stressors, especially regarding immunocompromised patients. This guides a series of neuroinflammatory events on the cerebral cortex, culminating, rarely, in encephalitis and cytotoxic / vasogenic brain edema. A sum of studies of such processes provides an explanation, even though not yet completely clarified, on how the clinical evolution to cognitive impairment and dementia might be enabled. In addition, it is of extreme importance to recognize the current dementia and cognitive deficit worldwide panorama. The aim of this literature review is to elucidate the available data upon the pathophysiology of HSV-1 infection as well as to describe the clinical panorama of the referred afflictions.

RESUMO. Considerando a variedade de mecanismos de contaminação pelo vírus Herpes simplex (HSV-1) e seu amplo potencial invasivo do sistema nervoso, uma infecção latente por toda a vida é estabelecida. Indivíduos adultos infectados podem ser suscetíveis à reativação viral quando estão sob a influência de múltiplos estressores, principalmente em pacientes imunocomprometidos. Esse fator orienta uma série de eventos neuroinflamatórios no córtex cerebral, culminando, raramente, em encefalite e edema cerebral citotóxico/vasogênico. Um somatório de estudos desses processos fornece uma explanação, embora ainda não totalmente esclarecida, de como a evolução clínica para déficit cognitivo e demência pode ser possibilitada. Além disso, é de extrema importância reconhecer o panorama mundial atual da demência e do déficit cognitivo. O objetivo da presente revisão de literatura é elucidar os dados disponíveis sobre a fisiopatologia da infecção pelo HSV-1, assim como descrever o panorama clínico das referidas afecções.

Poliomielitis, una historia de inicio triste y final feliz / Poliomyelitis, a story with a sad beginning and a happy ending

Se desarrollan los principales elementos históricos en el estudio y la lucha contra la poliomielitis, su aislamiento por Karl Landsteiner en 1909, la primera vacuna con virus muerto (Jonas Salk, 1955), la segunda vacuna con virus vivo atenuado (Albert Sabin, 1961) y la reducción paulatina de la polio en todo el mundo, hasta llegar a menos de 200 casos al año (virus salvaje)(AU)

The main historical events in the study and fight against polio are shown, its isolation by Karl Landsteiner in 1909, the development of the first vaccine with dead virus (Jonas Salk, 1955), the second vaccine with live attenuated virus (Albert Sabin, 1961) and the gradual reduction of polio worldwide, reaching less than 200 cases a year (wild virus)(AU)

Revisión de la bibliografía. Coronavirus (COVID-19) y Sistema Nervioso Central. Un panorama para analizar en una situación de pandemia. Consideraciones sobre el neurotrofismo del Coronavirus / Literature review. Coronavirus (COVID-19) and Nervous System Central. A panorama to analyze in a pandemic situation. Considerations on coronavirus neurotrophy

En humanos, las infecciones virales del tracto respiratorio son una causa principal de morbilidad y mortalidad en todo el mundo. Varios agentes virales respiratorios reconocidos tienen una capacidad neuroinvasiva, ya que pueden propagarse desde el tracto respiratorio hasta el sistema nervioso central (SNC). Una vez allí, la infección de las células del SNC (neurotropismo) podría conducir a problemas de salud humana, como encefalitis y enfermedades neurológicas a largo plazo. Los coronavirus (HCoV) generalmente infectan el tracto respiratorio superior, donde se asocian principalmente con resfriados comunes. Sin embargo, en las poblaciones más vulnerables, como los recién nacidos, los bebés, los ancianos y las personas inmunocomprometidas, también pueden afectar el tracto respiratorio inferior y provocar neumonía, exacerbaciones del asma, síndrome de dificultad respiratoria o incluso síndrome respiratorio agudo severo (SRAS) . Se ha establecido claramente la afectación respiratoria del VHC desde la década de 1960. Además, durante casi tres décadas, la literatura científica también ha demostrado que los HCoV son neuroinvasivos y neurotrópicos y podrían inducir una activación excesiva del sistema inmune.

In humans, viral infections of the respiratory tract are a leading cause of morbidity and mortality worldwide. Several recognized respiratory viral agents have a neuroinvasive capacity since they can spread from the respiratory tract to the central nervous system (CNS). Once there, infection of CNS cells (neurotropism) could lead to human health problems, such as encephalitis and long-term neurological diseases. Coronaviruses (HCoV) usually infect the upper respiratory tract, where they are mainly associated with common colds. However, in more vulnerable populations, such as newborns, infants, the elderly and immune-compromised individuals, can also affect the lower respiratory tract, leading to pneumonia, exacerbations of asthma, respiratory distress syndrome, or even severe acute respiratory syndrome (SARS). It has been clearly established the respiratory involvement of HCoV since the 1960s. In addition, for almost three decades now, the scientific literature has also demonstrated that HCoV are neuroinvasive and neurotropic and could induce an over activation of the immune system

Encefalitis por enterovirus: análisis clínico y paraclínico en pacientes pediátricos de un hospital de tercer nivel en Quito-Ecuador, de enero a diciembre de 2016 / Enterovirus encephalitis: clinical and paraclinical analysis in pediatric patients in a tertiary hospital in Quito-Ecuador, from January to December 2016

La encefalitis es una entidad rara con manifestaciones clínicas variables. En los niños es usualmente leve y autolimitada. En 30 a 75% se desconoce la etiología y cuando el patógeno se identifica por PCR (reacción en cadena de la polimerasa), el 80% son enterovirus. En América Latina no están disponibles métodos específicos de diagnóstico. En nuestro país muy pocos centros realizan el examen y tampoco están disponibles estadísticas reales de su incidencia. Objetivo: correlacionar la etiología con los síntomas, resultados de laboratorio, imagen y electroencefalograma. Métodos: estudio transversal; de enero a diciembre de 2016 se revisaron las historias clínicas de 63 niños de 0 a 18 años hospitalizados con sospecha de encefalitis. Una vez identificado el enterovirus por PCR, se correlacionó con los hallazgos de los exámenes de laboratorio e imagen. Resultados: se confirmó encefalitis viral en 35 pacientes, enterovirus en 49%, predominio en la edad preescolar. Síntomas más comunes: fiebre, cefalea, signos meníngeos y síntomas digestivos, 24% alteraciones de la conciencia. Biometría hemática normal en 71%, proteina C reactiva alterada en 71%. De los pacientes con estudios de imagen, 6% tuvo resultado anormal y en aquellos con electroencefalograma 80% fue anormal. Se utilizó la U de Mann Whitney para el análisis estadístico, la relación entre enterovirus y alteración de estado de conciencia y síntomas digestivos fue significativa (p=0.029). Conclusión: en los pacientes con diagnóstico de encefalitis que presenten síntomas digestivos y alteración del estado de conciencia, se debe sospechar que el enterovirus es el agente etiológico.

Encephalitis is a rare entity with variable clinical manifestations. In children it is usually mild and self-limited. In 30-75% of cases, the etiology is unknown and when the pathogen is identified by PCR (polymerase chain reaction), 80% are enteroviruses. In Latin America specific diagnostic methods are not available. In our country very few centers carry out the specific test, real statistics of their incidence are not available Objective: To correlate etiology with symptoms, laboratory results, imaging and electroencephalogram. Methods: Cross-sectional study, clinical records of 63 children between 0 and 18 years hospitalized with suspected encephalitis from January to December 2016 were reviewed. Once Enterovirus was identified by PCR, it was correlated with the findings of laboratory and imaging tests. Results: Viral encephalitis was confirmed in 35 patients, Enterovirus in 49%, predominance in pre-school age. Most common symptoms: fever, headache, meningeal signs and digestive symptoms, 24% alterations of consciousness. Normal blood count in 71%, Protein C Reactive altered in 71%. In patients with imaging studies, 6% had an abnormal result and in those who underwent electroencephalography, 80% were abnormal. The Mann Whitney U was used for the statistical analysis, the relationship between enterovirus and alteration of consciousness and digestive symptoms was significant (p: 0.029) Conclution: In patients with a diagnosis of encephalitis presenting digestive symptoms and altered state of consciousness, Enterovirus should be suspected as an etiologic agent.

Chikungunya virus infection with severe neurologic manifestations: report of four fatal cases

Abstract Here, we present four patients with confirmed Chikungunya virus infection showing atypical neurologic manifestations and death. This case series includes patients ranging in age from five to 92 years, with or without comorbidities. This report is important, as very few cases in the literature reporting death due to atypical Chikungunya virus infection are available.

Potenciales consecuencias neurocognitivas de infección por virus respiratorio sincicial humano / Potential neurocognitive consequences of infection by human respiratory syncytial virus

Human respiratory syncytial virus (RSV) infection remains as a major cause of morbidity and mortality among pediatric population. Immune response is poor and unable to establish a long term effective protection against this virus. Of particular interest has been the description of extrapulmonary manifestations of RSV infection in liver, kidney, endocrine system, heart and brain, associated to infection of peripheral blood. In the central nervous system (CNS), recent studies in animals have suggested long term neurocognitive impairment due to a direct damage from the virus. This was prevented in rats by a recombinant BCG vaccine expressing a nucleoprotein N of RSV that produces an effective immune response against the virus, not allowing its dissemination to the CNS. These findings in animal models highlight the importance of conducting more specific studies in children affected with severe infection by RSV. Therefore, our group is currently conducting an assessment of the possible long-term cognitive impairment in children under 2 years. The results of this study could be a strong argument to continue looking for an effective method for protecting against RSV infection.

La infección por virus respiratorio sincicial humano (VRS) es una de las principales causas de morbimortalidad en población pediátrica. La respuesta inmune generada contra VRS es poco eficiente para su eliminación y logra establecer sólo protección parcial contra infecciones posteriores. De especial interés en los últimos años ha sido la descripción de manifestaciones extra-pulmonares de la infección por VRS en hígado, riñón, sistema endocrino, corazón y cerebro. A nivel de sistema nervioso central (SNC), estudios recientes en modelos animales han sugerido problemas neurocognitivos a largo plazo derivados de un daño directo del virus en el cerebro. Este daño logró ser prevenido con vacuna experimental BCG recombinante, que expresa la nucleoproteína N de VRS e induce inmunidad efectiva, impidiendo la diseminación del virus hacia el SNC. Estos hallazgos en modelo animal han dado cuenta de la importancia de efectuar estudios más detallados en niños afectados por VRS grave. Por tal motivo, actualmente se está realizando una evaluación de la posible alteración cognitiva a largo plazo en niños bajo dos años de edad por parte de nuestro grupo. Los resultados de este estudio podrían significar un argumento muy importante para continuar en la búsqueda de un método efectivo de protección contra esta infección.

Situación epidemiológica de las meningoencefalitis / Epidemiological situation of meningoencephalitis

La meningoencefalitis son enfermedades endemoepidémicas de distribución universal, generalmente graves, que requieren un rápido tratamiento por la velocidad de su evolución y la posibilidad de secuelas o muerte. La meningitis de etiología infecciosa es una patología de notificación obligatoria, inmediata y universal, lo que permite conocer su incidencia, distribución etaria, ubicación geográfica, estacionalidad, características de su evolución, entre otras variables, para orientar las estrategias de prevención y control. Se analizan los casos de meningitis desde la SE 1 a la 37 del 2016, (17 de Septiembre) provenientes de la notificación a través del Sistema Nacional de Vigilancia Sanitaria, y la situación epidemiológica en la Ciudad de Buenos Aires

Infection of the central nervous system with dengue virus 3 genotype I causing neurological manifestations in Brazil

Abstract: A case of dengue virus 3 (DENV-3) genotype I infection with neurological manifestations occurred in Belo Horizonte, Minas Gerais in October 2012. The serotype was detected by PCR, and the genotype was assessed by sequencing and phylogenetic analysis of the C-prM region. The virus causing neurological manifestations clustered with other sequences of DENV-3 genotype I. Because neurological manifestations of DENV are possibly misdiagnosed in Brazil, this study serves as an alert of the importance of DENV diagnoses in CNS infections.

Changes of hearing threshold and calcium/calmodulin in the cochlear nucleus cells of mice with cytomegalovirus intracranial infection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the changes in the threshold of auditory brainstem response (ABR) and [Ca(2+)]I and calmodulin (CaM) in cochlear nucleus of newborn mice infected by murine cytomegalovirus (MCMV) in the brain.</p><p><b>METHODS</b>Sixty-nine newborn mice were randomized into model group and control group. The model group (54 mice) was established by intracranial injection with MCMV viral suspension 20 l and the same volume of 0.9% sodium chloride was injected in the control group (15 mice). After 1 month, the ABR was tested in a sound-electric screen environment and the threshold was recorded. Then intracellular free calcium [Ca(2+)]i and the mRNA level of CaM in the cochlear nucleus were assayed by flow cytometry and RT-PCR.</p><p><b>RESULTS</b>Compare to the control group [(64.0 ± 1.3) dBSPL], the threshold of ABR in the model group [(84.5 ± 2.7) dBSPL] was increased (F = 2.789,P = 0.000). Moreover, in the model group the intracellular free calcium [Ca(2+)]i and the mRNA level of CaM in the cochlear nucleus were increased (F = 1.290, P = 0.000; F = 4.252, P = 0.023), and the differences were statistically significant.</p><p><b>CONCLUSIONS</b>The intracranial injection of MCMV can lead to abnormal changes in the threshold of ABR in mice, and the change of [Ca(2+) ]I/CaM in cochlear nucleus may be the important pathological basis of sensorineural hearing loss induced by MCMV infection.</p>

Prevalencia de infección por citomegalovirus en pacientes pediátricos con afecciones neurológicas en el estado Zulia, Venezuela (2007-2008) / Prevalence of cytomegalovirus infection in pediatric patients with neurological disorders in Zulia state, Venezuela (2007-2008)

El objetivo de este estudio fue determinar la prevalencia de citomegalovirus en pacientes pediátricos con afecciones neurológicas, provenientes del Estado Zulia, Venezuela durante el período 2007-2008. Se recolectaron 186 muestras pareadas de líquido cefalorraquídeo (LCR) y suero, de pacientes entre 1 mes y 14 años de edad, que presentaron sintomatología clínica sugestiva de afectación del SNC y cuyo estudio bacteriológico convencional de LCR resultó negativo. Se determinó la relación albúmina LCR/suero a fin de descartar contaminación y a los pares óptimos se les determinó por la técnica de ELISA anticuerpos IgM e IgG en suero e IgG en LCR anti-CMV. Del total de muestras recolectadas 40,86% (76/186) resultaron óptimas para el análisis. De los 76 casos analizados, el 2,6% (2/76) de las muestras de suero resultaron positivas para IgM; 93,4% (71/76) fueron seropositivas a IgG mientras que el 31,6% (24/76) de las muestras de LCR presentaron anticuerpos IgG. En cuanto a los parámetros citoquímicos del LCR, se observaron valores de glucosa aumentados en el 58,3% (p<0,05) de los pacientes con CMV que presentaron meningoencefalitis. En los pacientes con meningitis que presentaron positividad de anticuerpos IgG anti-CMV en el LCR se observó un aumento significativo (p<0,01) en las proteínas del LCR. Se evidencia que una proporción de los pacientes pediátricos con afecciones neurológicas presentaron infección aguda por CMV, lo que demuestra una participación importante de este agente en pacientes del estado Zulia, Venezuela para el período en estudio.

The aim of this study was to determine the prevalence of cytomegalovirus (CMV) in pediatric patients with neurological disorders from Zulia State, Venezuela, during the period 2007-2008. Samples of cerebrospinal fluid (CSF) and serum were obtained from 186 patients with neurological symptoms and bacteriological negative CSF. The albumin CSF/serum content was determined to rule out contamination of CSF and optimal pairs were determined by ELISA of IgM and IgG anti-CMV antibodies in serum and IgG in CSF. Only 40.86% (76/186) of patients were optimal for this study. Serum samples positive for IgM antibodies (2/76; 2.6%) and IgG antibodies (71/76; 93.4%) were obtained. CSF IgG antibodies were observed in 24/76 patients (31.6%). Increased values of glucose in CSF (p<0.05) were observed in 58.3% of CMV patients with meningoencephalitis. In addition, increased CSF protein concentration (p<0.01) was observed in CSF anti-CMV antibodies positive patients with meningitis. This study shows high prevalence of acute CMV infection in pediatric patients with neurological affections suggesting an important role of this virus in this pathology during the studied period.

Analysis of correlation between cerebrospinal fluid and plasma HIV-1 RNA levels in patients with neurological opportunistic diseases / Análise da correlação entre os níveis de RNA do HIV-1 no líquido cefalorraquidiano e plasma em pacientes com doença neurológica oportunista

The question of whether HIV-1 RNA in cerebrospinal fluid (CSF) is derived from viral replication in the central nervous system or simply reflects the transit of infected lymphocytes from the blood compartment has long been a matter of debate. Some studies found no correlation between CSF and plasma viral load, whereas others did. The lack of a correlation between the two compartments suggests that the presence of HIV-1 RNA is not simply due to the passive passage of the virus from blood to CSF but rather due to intrathecal replication. To evaluate the correlation between plasma and CSF HIV-1 RNA levels and to identify situations in which there is no correlation between the two compartments, seventy patients were prospectively studied. The association between CSF and plasma viral load was evaluated in the total population and in subgroups of patients with similar characteristics. A correlation between the CSF and plasma compartments was observed for patients undergoing highly active antiretroviral therapy (HAART), those with a CD4 T lymphocyte count lower than 200 cells/mm³, and those with increased CSF protein content. On the other hand, no correlation was observed for patients without adequate virological control, who had a CD4 count higher than 200 cells/mm³ and who did not use HAART. The correlation between the two compartments observed in some patients suggests that CSF HIV-1 RNA levels may reflect plasma levels in these subjects. In contrast, the lack of a correlation between the two compartments in patients who were not on HAART and who had normal CSF proteins and a poor virological control possibly indicates compartmentalization of the virus in CSF and, consequently, plasma-independent intrathecal viral replication.

Tem sido objeto de debate a questão se o RNA do HIV-1 no líquido cefalorraquidiano (LCR) é derivado da replicação viral no sistema nervoso central ou simplesmente reflete o tráfego de linfócitos infectados do compartimento sanguíneo. Alguns estudos não mostraram correlação entre a carga viral do plasma e LCR, mas outros sim. A falta de correlação entre os dois compartimentos sugere que a presença de RNA do HIV-1 não é simplesmente devido à passagem do vírus do plasma para o LCR, mas sim a uma replicação intratecal. Para avaliar a correlação entre os níveis de RNA do HIV-1 no plasma e no LCR e tentar identificar situações, na qual, não existe a correlação entre os dois compartimentos avaliaram-se setenta pacientes prospectivamente. A associação entre a carga viral do LCR e plasma foi avaliada na população total e em subgrupos de pacientes com características similares. A correlação entre os dois compartimentos foi observada em pacientes que estavam em uso da terapia antiretroviral (HAART), naqueles que tinham contagem de linfócitos CD4 menor que 200 céls/mm³ e naqueles com aumento da concentração de proteínas no LCR. Por outro lado, não houve correlação para os pacientes que não tinham um controle virológico adequado, os que tinham contagem de CD4 maior que 200 céls/mm³ e aqueles que não estavam usando HAART. A correlação entre os dois compartimentos observada em alguns pacientes sugere que os níveis de RNA do HIV-1 no LCR podem refletir os níveis plasmáticos nestes pacientes. E a falta de correlação ente os dois compartimentos em pacientes que não usavam HAART, nos que tinham uma concentração de proteínas no LCR normal, e nos que não apresentavam bom controle virológico, indica provavelmente a compartimentalização do vírus no LCR e consequentemente replicação viral intratecal independente da do plasma.

Encefalopatía aguda y muerte encefálica en un niño con influenza A (H1N1) 2009 durante la primera ola pandémica / Acute encephalopathy and brain death in a child with influenza A (H1N1) during the 2009 pandemic

Desde que la Organización Mundial de la Salud declarara la pandemia por el nuevo virus influenza A (H1N1), gran parte de la atención se ha puesto en sus manifestaciones respiratorias, existiendo escasa información referida a las complicaciones neurológicas de esta condición en niños. Reportamos el curso clínico de un niño con infección confirmada por influenza A (H1N1) pandémico que evolucionó con una encefalopatía aguda y rápida progresión a muerte encefálica.

Since the World Health Organization declared a pandemic of a novel influenza A (H1N1) virus, much attention has been focused on its respiratory manifestations, but limited information regarding neurologic complications has been reported in children. We describe a case of acute encephalopathy progressing to brain death in a pediatric patient with confirmed infection with novel influenza A (H1N1).

Principal causes of coma in medical units of a tertiary care hospitals of Peshawar

To determine the principal causes of coma in patients admitted to the medical units of a tertiary care hospital of Peshawar. This cross sectional study was conducted at department of medicine, Khyber teaching hospital Peshawar, from July 2006 to August 2007. All patients were randomly selected. Relevant information's were recorded on a questionnaire prepared in accordance with the objectives of the study. A total of 124 patients with coma, 96[77.41%] males and 28[22.58%] females were included in the study. The age range of patients was from 12 years to 72 year with mean age of 50.5 years. The principal causes of coma were: cerebrovascular accident [CVA] 73.38% [n=91], epilepsy in 10.48% [n=13], injury head 5.64% [n=11], hepatic coma 2.41% [n=3], central nervous system [CNS] infections 2.41% [n=3], metabolic acidosis, drug abuse [1.61%] [n=2] each and cerebral malaria, hypoglycemia and uremia 0.8% [n=1] each. Risk factors for stroke recorded were hypertension in 46.2% [n=42/91], diabetes in 15.4% [n=14/91], ischemic heart disease 12.1% [n=11/91], smoking 5.5% [n=5/91], hyperlipedemia 3.3% [n=3/91] and atrial fibrillation 1.1% [n=1/91]. Scoring on Glasgow coma scale showed that 74.2% [n=92] patients scored 3-8, 25.8% [n=32] scored 9-12 and none of the patients scored 13-15. In our setup CVA is the most common cause of coma followed by epilepsy, and trauma head. Other minor causes recorded were metabolic acidosis, drug abuse, central nervous system infections, cerebral malaria, hypoglycemia and uremia

Bibliomed sobre infecciones del sistema nervioso / Bibliomed on central nervous system infections

Se proponen varios articulos sobre las infecciones del sistema nervioso central

Análise molecular de patógenos pela reação em cadeia da polimerase no líquido cefalorraquiano de pacientes infectados com HIV / Molecular analysis of pathogens in cerebrospinal fluid by the polymerase chain reaction in HIV-infected patients

Introdução: A reação em cadeia da polimerase (PCR) foi teste de grande impacto no diagnóstico das meningites e encefalites linfocíticas durante a última década. Esse método foi extensivamente usado no diagnóstico das infecções do sistema nervoso central (SNC), devido a sua habilidade em detectar amostras mínimas de DNA-alvo no líquido cefalorraquiano. Objetivo: O objetivo deste estudo foi identificar a prevalência dos patógenos oportunistas responsáveis por causar problemas neurológicos em pacientes infectados com o vírus da imunodeficiência humana (HIV) e avaliar sua associação com os achados clínicos, laboratoriais e da tomografia computadorizada cerebral (TCC). Pacientes e métodos: Um estudo transversal foi realizado em 203 amostras de líquido cefalorraquiano (LCR) de pacientes do sul do Brasil infectados com HIV e com aparente encefalite e meningite linfocíticas. As amostras foram analisadas para os seguintes agentes pelo método da reação em cadeia da polimerase "nested" ou dupla (N-PCR): citomegalovírus, vírus do Epstein-Barr, vírus do herpes simplex tipos 1 e 2, vírus da varicella zoster, vírus do herpes humano tipo 6, vírus JC, Toxoplasma gondii e micobactérias. Resultado: Pelo menos um patógeno foi encontrado em 77 (38%) dos indivíduos. O Epstein-Barr foi o mais prevalente, com 40 casos (19,7%), seguido pelo citomegalovívus, com 12 casos (15%) e pelo vírus JC, em 9 casos (4,4%). Um N-PCR positivo mostrou associação com aumento de proteínas e de celularidade (P=0,001), meningismo (P=0,017) e tomografia computadorizada anormal (P=0,006). Conclusão: O painel de PCR empregado foi efetivo na identificação de infecções neurológicas severas em pacientes HIV positivos (AU)

Introduction: Polymerase chain reaction (PCR) has had great impact on the diagnosis of lymphocytic meningitis and encephalitis over the last decade. It has been extensively used in the diagnosis of central nervous system (CNS) infections for its ability to detect small amounts of target DNA in the cerebrospinal fluid (CSF). Objective: The aim of this study was to identify the prevalence of opportunistic pathogens responsible for neurological disorders in patients infected with human immunodeficiency virus (HIV) and to evaluate its association with clinical, laboratory and cerebral computed tomography (CCT) findings. Patients and methods: A cross-sectional study was performed on 203 cerebrospinal fluids (CSF) from HIV-infected patients from Southern Brazil, with apparent lymphocytic meningitis and encephalitis. CSF samples were analyzed with probes for cytomegalovirus, Epstein-Barr virus, herpes simplex virus types 1 and 2, varicella zoster virus, human herpes virus type 6, JC virus, Toxoplasma gondii and mycobacterium in nested polymerase chain reaction (N-PCR). Results: At least one pathogen was found in 77 (38.0%) individuals. Epstein-Barr virus was the most prevalent with 40 cases (19.7%), followed by cytomegalovirus with 12 cases (5.9%) and JC virus with 9 cases (4.4%). Positive NPCR showed association with high spinal fluid protein and cell count (P=0.001), meningism (P=0.017) and abnormal CCT (P=0.006). Conclusion: The PCR panel used was effective in screening several neurological infections in HIV positive patients (AU)

La biopsia estereotáctica en el diagnóstico de las lesiones cerebrales focales en sida / Stereotactic brain biopsy in the diagnosis of focal brain lesions in AIDS

Las lesiones cerebrales focales constituyen una complicación frecuente en los pacientes con infección por el virus de la inmunodeficiencia humana (HIV) y síndrome de inmunodeficiencia adquirida (sida). Durante el período comprendido entre enero de 1999 y mayo de 2007 se realizaron un total de 83 biopsias en pacientes con sida y lesiones cerebrales. Se incluyeron aquellos pacientes que no hubiesen respondido al algoritmo habitual de enfoque diagnóstico-terapéutico de estas lesiones. Todas las muestras obtenidas fueron sometidas a evaluación intraoperatoria para asegurar la obtención de material patológico y posterior análisis histopatológico y exámenes microbiológicos. De los 41 pacientes con lesiones cerebrales múltiples, 62 tenían localización supratentorial, en 4 eran infratentoriales y 17 mostraron ambas localizaciones. Cincuenta y un lesiones seleccionadas como blanco estereotáctico tuvieron refuerzo periférico del contraste. Se obtuvo material histopatológico en el 100% de los procedimientos. El diagnóstico más frecuente fue el de leucoencefalopatía multifocal progresiva (LEMP) con 24 casos (29%), seguido del linfoma primario del sistema nervioso central (LPSNC) con 19 diagnósticos (23%) y de toxoplasmosis en 13 pacientes (15.7%). Se comprobó una relación significativa entre los diagnósticos histopatológicos y la localización de las lesiones y entre los diagnósticos histopatológicos y el comportamiento de las imágenes luego de la administración de la sustancia de contraste. El rédito diagnóstico alcanzó el 90.3% (75 biopsias). La morbiletalidad en esta serie fue de 2.4%. La biopsia cerebral estereotáctica permitió alcanzar el diagnóstico etiológico y adecuar el enfoque terapéutico en la mayoría de los pacientes de esta serie.

Focal brain lesions are frequent complications among HIV/AIDS patients. Between January 1999 and May 2007, 83 procedures of stereotactic brain biopsies in HIV/AIDS patients with focal cerebral lesions were carried out. The inclusion criteria were lack of response to current diagnostic and therapeutic guidelines for brain lesions. All the samples underwent microscopic evaluation during surgery to assert valid material and delayed histopathological and microbiological examination. Forty one patient images demonstrated multiple brain lesions. Sixty two cases had supratentorial localization, 4 lesions were located beneath the tentorium and 17 showed both settings. Fifty one lesions presented peripheral enhancement after contrast computed tomography (CT) or magnetic resonance imaging (MRI). A 100% of useful samples recovery was achieved. Progressive multifocal leucoencephalopathy (PML) was the most frequent diagnosis (29%), followed by primary central nervous system lymphoma (PCNSL) (23%), and toxoplasmosis (15.7%). Statistically significant association was observed between histopathological diagnosis and lesion location and between those and peripheral ring enhancement images. The positive diagnostic rate of the invasive procedure was 90.3%. The morbidity/mortality rate was 2.4% in this series. In conclusion, the stereotactic brain biopsy ordered early during the patient’s evolution showed a good performance in order to achieve a prompt and accurate diagnosis and to guide the therapeutic scheme in these AIDS patients with focal brain lesions.