Unspecified encephalitis in HIV-infected patients: clinical and postmortem evaluation
- Authors: Voznesenskiy S.L.1, Shakhgildyan V.I.2, Petrova E.V.3, Kozhevnikova G.M.1, Ermak T.N.2, Tichkevich O.A.3, Samotolkina E.S.3, Soboleva Z.A.3, Emerole K.C1
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Affiliations:
- People’s Friendship University of Russia (RUDN University)
- Central Research Institute of Epidemiology
- Infectious Clinical Hospital №2
- Issue: Vol 93, No 11 (2021)
- Pages: 1278-1282
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/98449
- DOI: https://doi.org/10.26442/00403660.2021.11.201197
- ID: 98449
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Abstract
Background. The search for an aetiology of central nervous system (CNS) lesions In HIV patients can be extremely challenging.
Aim. To establish the nature and character of CNS lesion according to the data of pathological examination of deceased HIV-patients who had an antemortem clinical diagnosis of unspecified encephalitis.
Materials and methods. We analysed clinical and laboratory data of 225 HIV-patients admitted to the ICU at the Infectious Clinical Hospital №2 (Moscow, 2018). The principal diagnosis was unspecified encephalitis characterized by cerebral oedema. Had died 183 (67.9%) patients. We conducted pathological examination in 43 (23.5%).
Results. CNS lesions occurred in 331 patients (58.8% of 563 ICU). The antemortem diagnosis established were as follows: 12.1% – toxoplasmosis; 6.6% – HIV-encephalitis; 5.1% – CNS lymphoma; 3.6% – cryptococcal meningoencephalitis; 3.0% – cytomegaloviral diseases; 2.1% – progressive multifocal leukoencephalopathy. The cause of the pathology remained unidentified in 225 patients (68% with CNS lesions). Majority of patients were ART-naive. Post-mortem verification was conducted in 29 (67.4%) deceased patients, of which HIV-encephalitis – 34.5%, toxoplasmosis – 10.3%, progressive multifocal leukoencephalopathy – 3.4%. The nature of brain damage in the remaining 20.7% cases was not established even after post-mortem investigation. Productive lepto-meningitis – 8 (27.6%), indicating a prolonged duration of the inflammatory process. In the brain 48.1% patients with subacute and productive changes, had a pre-hospital time of more than 30 days, in contrast to 11.1% of patients who had acute pathological processes in the CNS (p<0.05). Autopsy didn’t reveal any inflammatory changes in the brain in 14 (32.6%) patients, though cerebral oedema – 93.3%, haemorrhagic syndrome – 60% cases.
Conclusion. Accurate retrospective identification of the aetiology of CNS lesions combined with assessing in vivo characterisation of the pathological process plays an essential role in subsequent formation of diagnostic approaches in pathologies of the CNS in HIV-patients.
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##article.viewOnOriginalSite##About the authors
Sergey L. Voznesenskiy
People’s Friendship University of Russia (RUDN University)
Author for correspondence.
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0001-5669-1910
канд. мед. наук, доц., доц. каф. инфекционных болезней с курсами эпидемиологии и фтизиатрии ФГАОУ ВО РУДН
Russian Federation, Moscow
Vasiliy I. Shakhgildyan
Central Research Institute of Epidemiology
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0002-8686-0487
канд. мед. наук, ст. науч. сотр. СНИО ЭП СПИД ФБУН «ЦНИИ эпидемиологии»
Russian Federation, Moscow
Elena V. Petrova
Infectious Clinical Hospital №2
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0002-6896-6851
зав. отд-нием интенсивной терапии для больных ВИЧ-инфекцией ГБУЗ ИКБ №2
Russian Federation, Moscow
Galina M. Kozhevnikova
People’s Friendship University of Russia (RUDN University)
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0003-2758-9313
д-р мед. наук, проф., зав. каф. инфекционных болезней с курсами эпидемиологии и фтизиатрии ФГАОУ ВО РУДН
Russian Federation, Moscow
Tatiana N. Ermak
Central Research Institute of Epidemiology
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0001-9490-7129
д-р мед. наук, вед. науч. сотр. СНИО ЭП СПИД ФБУН «ЦНИИ эпидемиологии»
Russian Federation, Moscow
Oleg A. Tichkevich
Infectious Clinical Hospital №2
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0002-0789-7709
врач-патологоанатом патологоанатомического отд-ния ГБУЗ ИКБ №2
Russian Federation, Moscow
Elena S. Samotolkina
Infectious Clinical Hospital №2
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0002-0533-9412
врач-инфекционист отд-ния интенсивной терапии для больных ВИЧ-инфекцией ГБУЗ ИКБ №2
Russian Federation, Moscow
Zinaida A. Soboleva
Infectious Clinical Hospital №2
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0003-3204-9143
врач-инфекционист отд-ния интенсивной терапии для больных ВИЧ-инфекцией ГБУЗ ИКБ №2
Russian Federation, Moscow
Karl C Emerole
People’s Friendship University of Russia (RUDN University)
Email: voznesenskiy_sl@pfur.ru
ORCID iD: 0000-0002-0636-2710
канд. мед. наук, ассистент каф. инфекционных болезней с курсами эпидемиологии и фтизиатрии ФГАОУ ВО РУДН
Russian Federation, Moscow
References
- Макаров А.Ю., Чикова Р.С., Улюкин И.М., Помников В.Г. Неврологические синдромы при ВИЧ-инфекции. Неврологический журнал. 2004;5:45-52 [Makarov AYu, Chikova RS, Ulyukin IM, Pomnikov VG. Neurological syndromes in HIV infection. Nevrologicheskii zhurnal. 2004;5:45-52 (in Russian)].
- Tauber SC, Staszewski O, Prinz M, et al. HIV encephalopathy: glial activation and hippocampal neuronal apoptosis, but limited neural repair. HIV Med. 2016;17(2):143-51. doi: 10.1111/hiv.12288
- Masliah E, DeTeresa RM, Mallory ME, et al . Changes in pathological findings at autopsy in AIDS cases for the last 15 years. AIDS. 2000;14:69-74. doi: 10.1097/00002030-200001070-00008
- ВИЧ-инфекция и СПИД. Национальное руководство. Под ред. В.В. Покровского. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2020 [VICh-infektsiia i SPID. Natsionalnoe rukovodstvo. 2-e izd., pererab. i dop. Ed. VV Pokrovsky. Moscow: GEOTAR-Media, 2020 (in Russian)].
- Перегудова А.Б., Ермак Т.Н., Шахгильдян В.И., и др. Церебральный токсоплазмоз в структуре поражения центральной нервной системы у больных ВИЧ-инфекцией. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2013;1:26-30 [Peregudova AB, Ermak TN, Shakhgildyan VI, et al. Cerebral toxoplasmosis in the pattern of central nervous system lesions in HIV-infected patients. Epidemiology and infectious diseases. 2013;1:26-30 (in Russian)]
- Шеломов А.С., Степанова Е.В., Леонова О.Н., Смирнова Н.Л. Оппортунистические заболевания как причины поражения центральной нервной системы у больных ВИЧ-инфекцией. Журнал инфектологии. 2016;8(3):107-15 [Shelomov AS, Stepanova EV, Leonova ON, Smirnova NL. Opportunistic diseases as the cause of damage to the central nervous system in patients with HIV-infection. Zhurnal infektologii. 2016;8(3):107-15 (in Russian)].
- Silva AC, Rodrigues BS, Micheletti AM, et al. Neuropathology of AIDS: An Autopsy Review of 284 Cases from Brazil Comparing the Findings Pre- and Post-HAART (Highly Active Antiretroviral Therapy) and Pre- and Postmortem Correlation. AIDS ResTreat. 2012;2012:186850. doi: 10.1155/2012/186850
- Кравченко А.В., Ладная Н.Н., Козырина Н.В., и др. Причины летальных исходов среди лиц, инфицированных ВИЧ, в Российской Федерации в 2008–2018 гг. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2020;10(3):63-9 [Kravchenko AV, Ladnaia NN, Kozyrina NV, et al. Causes of deaths among HIV-infected persons in the Russian Federationin 2008–2018. currentitems. Epidemiology and infectious diseases. 2020;10(3):63-9 (in Russian)]. doi: 10.18565/epdem.2020.10.3.63-9
- Цинзерлинг В.А. Инфекционные поражения нервной системы: вопросы этиологии, патогенеза и диагностики. Руководство для врачей многопрофильных стационаров. Под ред. В.А. Цинзерлинг, М.Л. Чухловина. СПб.: ЭЛБИ-СПб, 2005 [Tsinserling VA. Infektsionnye porazheniia nervnoi sistemy: voprosy etiologii, patogeneza i diagnostiki. Rukovodstvo dlia vrachei mnogoprofilnykh statsionarov. Ed. VA Tsinzerling, ML Chukhlovina. Saint Petersburg: ELBI-SPb, 2005 (in Russian)].
- Тимченко В.Н., Гузеева В.И., Архипова Ю.А. Поражение нервной системы при ВИЧ-инфекции. Детские инфекции. 2009;1:32-5 [Timchenko VN, Guzeeva VI, Arkhipova UA. Porazhenie nervnoi sistemy pri VICh-infektsii. Detskie infektsii. 2009;1:32-5 (in Russian)].
- Пархоменко Ю.Г., Зюзя Ю.Р., Мазус А.И. Морфологические аспекты ВИЧ-инфекции. М.: Литтера, 2016 [Parkhomenko IuG, Ziuzia IuR, Mazus AI. Morfologicheskie aspekty VICh-infektsii. Moscow: Littera, 2016 (in Russian)].
- Покровский В.В., Юрин О.Г., Кравченко А.В., и др. Рекомендации по лечению ВИЧ-инфекции и связанных с ней заболеваний, химиопрофилактике заражения ВИЧ. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2020;10(S4):1-87 [Pokrovsky VV, Yurin OG, Kravchenko AV, et al. Recommendations for the treatment of HIV infection and related diseases, chemoprophylaxis of HIV infection. current items. Epidemiology and infectious diseases. 2020;10(S4):1-87 (in Russian)].
- Badaut J, Plesnila N. Brain Edema: From Molecular Mechanisms to Clinical Practice. Academic Press is an imprint of Elsevier. 2017.
- Stokum JA, Gerzanich V, Simard JM. Molecular pathology of cerebral edema. J Cereb Blood Flow Metab. 2016;36(N3):513-38.
- Гоженко А.И., Гуменюк Н.А., Бурлаченко В.П., и др. Особенности изменения гематоэнцефалического барьера ВИЧ-инфицированных больных с разными этиологическими возбудителями менингоэнцефалита. Международный неврологический журнал. 2012;4(50):29-32 [Gozhenko AI, Gumenyuk NA, Burlachenko VP, et al. Features of blood-brain barrier changes in HIV-infected patients with various etiological agents of meningoencephalitis. Mezhdunarodnyi nevrologicheskii zhurnal. 2012;4(50):29-32 (in Russian)].
- Langford TD, Letendre SL, Larrea GJ, Masliah E. Changing patterns in the neuropathogenesis of HIV during the HAART era. BrainPathology. 2003;13(2):195-210. doi: 10.1111/j.1750-3639.2003.tb00019
- Jellinger K, Setinek U, Drlicek M, et al. Neuropathology and general autopsy findings in AIDS during the last 15 years. Acta Neuropathol. 2000;100:213-20. doi: 10.1007/s004010000245
- Kumar AM, Borodowsky I, Fernandez B, et al. Human immunodeficiency virus type 1 RNA Levels in different regions of human brain: quantification using real-time reverse transcriptase-polymerase chain reaction. J Neurovirol. 2007;13:210-24.
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