Neurological manifestations of cytomegalovirus infection in the acquired immunodeficiency syndrome

被引:21
作者
Anders, HJ [1 ]
Goebel, FD [1 ]
机构
[1] Univ Munich, Med Poliklin, D-80336 Munich, Germany
关键词
human immunodeficiency virus; acquired immunodeficiency syndrome; AIDS; cytomegalovirus; central nervous system;
D O I
10.1258/0956462991913817
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Cytomegalovirus (CMV) infection is one of the most important opportunistic infections in AIDS. The most common manifestation of neurological CMV disease in HIV infection is retinitis followed by encephalitis, polyradiculopathy, and multifocal neuropathy. Untreated necrotizing retinitis proceeds to blindness but can readily be diagnosed by ophthalmological examination. CMV polyradiculopathy presents as subacute Beg weakness, paraesthesia, and urinary retention. Untreated patients develop ascending paralysis and die within weeks. Multifocal neuropathy commonly affects the radial, ulnar, and peroneal nerves but cranial nerves may also be involved. Confusion, cranial nerve palsies, and hyperreflexia are signs of ventriculoencephalitis, whereas the presentation of diffuse micronodular encephalitis is often asymptomatic. The diagnostic approach relies on the detection of CMV DNA in the cerebrospinal fluid for polyradiculopathy, encephalitis, and neuropathy. Neuroimaging can exclude other causes of encephalitis and polyradiculopathy. Ganciclovir, foscarnet, and cidofovir monotherapy are current medical treatment options. Intraocular administration can be used for refractory retinitis, but additional systemic prophylaxis is required to suppress extraocular disease. Ganciclovir and foscarnet have improved the prognosis of multifocal neuropathy and polyradiculopathy, but response rates for encephalitis are low. However, despite therapy survival of central nervous CMV disease is still limited to months. Recently highly active antiretroviral therapy (HAART) has decreased the overall incidence of CMV disease in AIDS. Furthermore (HAART) has become a mainstay for CMV therapy by improving the patient's immunocompetence against CMV.
引用
收藏
页码:151 / 161
页数:11
相关论文
共 89 条
  • [1] Ganciclovir and foscarnet efficacy in AIDS-related CMV polyradiculopathy
    Anders, HJ
    Weiss, N
    Bogner, JR
    Goebel, FD
    [J]. JOURNAL OF INFECTION, 1998, 36 (01) : 29 - 33
  • [2] Cytomegalovirus polyradiculopathy in patients with AIDS
    Anders, HJ
    Goebel, FD
    [J]. CLINICAL INFECTIOUS DISEASES, 1998, 27 (02) : 345 - 352
  • [3] [Anonymous], 1992, Control Clin Trials, V13, P22
  • [4] INTRAVITREOUS AND PLASMA-CONCENTRATIONS OF GANCICLOVIR AND FOSCARNET AFTER INTRAVENOUS THERAPY IN PATIENTS WITH AIDS AND CYTOMEGALOVIRUS RETINITIS
    AREVALO, JF
    GONZALEZ, C
    CAPPARELLI, EV
    KIRSCH, LS
    GARCIA, RP
    QUICENO, JI
    CONNOR, JD
    GAMBERTOGLIO, J
    BERGERONLYNN, G
    FREEMAN, WR
    [J]. JOURNAL OF INFECTIOUS DISEASES, 1995, 172 (04) : 951 - 956
  • [5] Cytomegalovirus encephalitis
    Arribas, JR
    Storch, GA
    Clifford, DB
    Tselis, AC
    [J]. ANNALS OF INTERNAL MEDICINE, 1996, 125 (07) : 577 - 587
  • [6] THE DEVELOPMENT OF CYTOMEGALOVIRUS ENCEPHALITIS IN AIDS PATIENTS RECEIVING GANCICLOVIR
    BERMAN, SM
    KIM, RC
    [J]. AMERICAN JOURNAL OF MEDICINE, 1994, 96 (05) : 415 - 419
  • [7] Selective elevation of monocyte chemotactic protein-1 in the cerebrospinal fluid of AIDS patients with cytomegalovirus encephalitis
    Bernasconi, S
    Cinque, P
    Peri, G
    Sozzani, S
    Crociati, A
    Torri, W
    Vicenzi, E
    Vago, L
    Lazzarin, A
    Poli, G
    Mantovani, A
    [J]. JOURNAL OF INFECTIOUS DISEASES, 1996, 174 (05) : 1098 - 1101
  • [8] Blick G, 1997, J ACQ IMMUN DEF SYND, V15, P84
  • [9] Natural history of untreated cytomegalovirus retinitis
    Bowen, EF
    Wilson, P
    Atkins, M
    Madge, S
    Griffiths, PD
    Johnson, MA
    Emery, VC
    [J]. LANCET, 1995, 346 (8991-2) : 1671 - 1673
  • [10] Budka H, 1997, NEUROIMAG CLIN N AM, V7, P639