Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome

Article Abstract:

Cryptococcus is a type of fungus, and meningitis (infection of the membranes surrounding the brain and spinal cord) caused by this organism was rare before the spread of AIDS. Most attention has focused on antifungal drugs as the primary treatment of this disease, while little focus has been placed on the cause and management of elevated cerebrospinal (CSF) pressures that occur in patients with the disease. Since CSF circulates throughout the brain and around the spinal cord, high fluid pressure means that high pressure is exerted on brain and nerve tissue. Of three patients with AIDS and cryptococcal meningitis, following major improvement, all had relapses accompanied by high CSF pressure. All had severe papilledema (fluid accumulation and inflammation of the optic nerve at its entry into the eyeball, a condition leading to blindness if not relieved), reduced vision, and impaired mental status or nerve abnormalities. Brain imaging studies of these patients were normal, suggesting that pressure was evenly distributed throughout the brain, without selective enlargement of ventricles (fluid-filled cavities through which CSF circulates). The authors believe that the early deaths that occur in cases of AIDS-related cryptococcal meningitis are due to high intracranial pressure (ICP), which damages cerebral circulation. The normal process of CSF formation, flow, and absorption is reviewed. Increased ICP is postulated to be caused by resistance to CSF outflow, but understanding of this process is poor and needs more study. Vasculitis (inflammation of blood vessels), caused by the fungus, may contribute to development of high ICP. Elevated CSF pressure in the three patients was treated by placement of a shunt to provide an alternative path for CSF flow, frequent lumbar (low back) punctures to drain off CSF, or a combination of steroid treatment with lumbar punctures. Blindness is attributed to pressure effects on the optic nerve, rather than effects on brain areas associated with vision. Pressure reduction resulted in improvements in two of three patients. Decreases in loss of vision, fewer early deaths, and earlier recovery may result from treatment of elevated ICP in AIDS patients with cryptococcal meningitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intracranial hypertension

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Clinical utility of liver biopsy in patients with serum antibodies to the human immunodeficiency virus

Article Abstract:

Patients with acquired immunodeficiency syndrome (AIDS) often have impaired liver function. Patients infected with human immunodeficiency virus (HIV) who do not have AIDS may benefit from biopsy or sampling of liver tissue. Liver biopsy was performed in 36 patients with HIV infection; 83 percent of the patients had unexplained fever and 89 percent had abnormalities in liver function. Twenty of the patients (56 percent) were diagnosed as having AIDS before the biopsy. Liver biopsy provided a diagnosis of liver infection by mycobacteria in 15 cases, cytomegalovirus in two, and schistosoma in one. The biopsies revealed granulomas or granular growths of unknown cause in four patients, cirrhosis or chronic liver disease in five patients, and chronic persistent hepatitis, or inflammation of the liver, in one patient. Patients with diagnostic liver biopsies, particularly those with mycobacterial liver infections, had an increased incidence of being diagnosed with AIDS prior to their liver biopsy. They also had a longer duration of AIDS, more infections, and higher levels of serum alkaline phosphatase, which indicates impaired liver function. Liver biopsy was more sensitive than bone marrow sampling for detecting mycobacterial infection. Diagnostic liver biopsies occurred in 70 percent of the patients with AIDS and only 25 percent of HIV-infected patients without AIDS. Patients with a diagnostic liver biopsy had a higher incidence of lung disease, mainly due to Pneumocystis carinii pneumonia. The findings demonstrate that liver biopsy is useful in detecting infections in HIV-infected patients without AIDS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Diseases, HIV (Viruses), HIV, Opportunistic infections, Biopsy

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AIDS and Chagas' disease with central nervous system tumor-like lesion

Article Abstract:

Chagas' disease is a parasitic infection caused by the protozoa Trypanosoma cruzi. It commonly occurs in Latin America, but rarely in the southern United States. Chagas' disease may be associated with inflammation of the heart, the brain and its membranes, and dilation of the heart, esophagus, and colon. Chagas' disease has not been previously reported in association with AIDS or AIDS-related complex (ARC). A case is described of a 19-year-old man with AIDS and unusual nerve symptoms of Chagas' disease. The patient was initially admitted with complaints of weight loss, sore throat, fever, headache, and photophobia or intolerance of light. A brain mass containing the protozoa T. cruzi was removed, although the patient later developed inflammation of the heart and esophagus. He died of respiratory failure due to pneumonia, caused by infection with Pneumocystis carinii. It is suggested that AIDS may cause the recurrence or reactivation of Trypanosomal infection with unusual features involving the brain. AIDS should be considered in the pathogenesis of Chagas's disease in endemic areas, or geographic regions where the disease is prevalent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Demographic aspects, Trypanosoma cruzi, Chagas' disease, Chagas disease, Nervous system tumors

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