PML-not a surprise in four young HIV infected patients
BMC Infectious Diseases ,
May 2014
Andreea Cioară , Cristian Marcu , Roxana Iubu , Daniela Marcu , Ariana Almaşu , Mirela Flonta , Mihaela Lupşe , Corina Itu
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PML-not a surprise in four young HIV infected patients
Andreea Cioar
1
Cristian Marcu
0
Roxana Iubu
0
Daniela Marcu
0
Ariana Almau
0
Mirela Flonta
0
Mihaela Lupe
1
Corina Itu
0
0
Infectious Diseased Clinic
,
Cluj-Napoca
,
Romania
1
Infectious Disease Department, Iuliu Hatieganu University of Medicine and Pharmacy
,
Cluj-Napoca
,
Romania
-
From The 7th Romanian National HIV/AIDS Congress and The 2nd Central European HIV Forum
Sibiu, Romania. 29-31 May 2014
An important cause of mortality in patients from
Romanian cohort remains progressive multifocal
leukoencephalopathy (PML) caused by the polyomavirus, JC virus (JCV).
PML is an opportunistic infection and one of the
AIDS-defining conditions in HIV-infected patients and
is associated with both HIV-1 and HIV-2.
We perform a retrospective study in which we
included 4 patients from Cluj-Napoca HIV Center.
These patients belong to Romanian cohort and were
with poor adherence to treatment.
We collected information on clinical and
immunological status, microbiologic and virological analysis,
neuroimaging, treatment and outcome.
From 4 patients with a median age of 20.75 years at
the moment of PML diagnosis, 3 were male and 1 was a
female, 3 died and 1 is alive.
All patients were already in stage AIDS C3 at the
moment of PML diagnosis and with a CD4 lymphocytes
level below 20 cells/cmm.
The onset was insidious in all cases with focal
neurological signs (hemiparesis, facial palsy, dysarthria and
mental alteration) without fever.
In two cases we performed lumbar puncture that
revealed clear CSF, with normal level of glucose and
proteins, negative Gram stain and negative culture but with
JC virus load positive (RT-PCR JCV from CSF).
The imagistic methods (cerebral MRI) showed in all
cases lesions localized in white matter, without mass effect
from these lesions. For two cases we completed
examination with cerebral MR spectroscopy which revealed
spectroscopic disorders specific for PML.
In all cases we excluded other etiologies by serological,
bacteriological and imagistic tests.
All patients received cART with good penetration in
CSF and corticotherapy, but in 3 cases neurologic
disorders evolved to tetraparesis, aphasia and profound altered
mental status and finally death.
1 patient had a good neurologic recovery and remains
with easy ataxia and dysarthria.
In these cases PML is a result of low adherence to
treatment of patients from Romanian cohort and opportunistic
infection was not a surprise. The most important
differential diagnosis was HIV encephalopathy.
We can conclude that our patients with PML had a poor
prognosis despite intensive cART with good penetration
in CSF.
(...truncated)
This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/1471-2334-14-S4-P34.pdf
Andreea Cioară, Cristian Marcu, Roxana Iubu, Daniela Marcu, Ariana Almaşu, Mirela Flonta, Mihaela Lupşe, Corina Itu.
PML-not a surprise in four young HIV infected patients ,
BMC Infectious Diseases,
2014, pp. P34, 14,