Upload
samantha-rivera
View
221
Download
0
Tags:
Embed Size (px)
Citation preview
Neurological Complications Neurological Complications in HIV Infection/AIDSin HIV Infection/AIDS
Dr.K.Bujji Babu, MD., HIV PhysicianDr.K.Bujji Babu, MD., HIV PhysicianConsultant Consultant
Bujji Babu HIV ClinicBujji Babu HIV ClinicKanuruKanuru
VijayawadaVijayawada
IntroductionIntroduction
Deadly DUO in HIV infection Deadly DUO in HIV infection --Opportunistic infections --Opportunistic infections -- Neoplasms -- Neoplasms
Team effortTeam effort -- HIV physician-- HIV physician -- Neurologist -- Neurologist -- Radiologist, Microbiologist & -- Radiologist, Microbiologist & PathologistPathologist
Discuss patient profiles in AIDSDiscuss patient profiles in AIDS
Diagnostic dilemmasDiagnostic dilemmas
Treatment: Options, Complications, Treatment: Options, Complications, LimitationsLimitations
AIMSAIMS
EpidemiologyEpidemiology
Duration: 2 yearsDuration: 2 years
Total no HIV/AIDS cases: 490Total no HIV/AIDS cases: 490
No of patients with neurological No of patients with neurological complications:50 complications:50
Male:Female: 31:19Male:Female: 31:19
Age group : 25-55 yearsAge group : 25-55 years
Patient ProfilePatient Profile
Clinical examinationsClinical examinations
Laboratory InvestigationsLaboratory Investigations• Confirmation of serological status by ELISA/W.BConfirmation of serological status by ELISA/W.B• Hb%, TC, DC, ESR, VDRL, Hep A,B & C, Hb%, TC, DC, ESR, VDRL, Hep A,B & C,
S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG S.Bilirubin, S.Creatinine, S.Amylase, Serum IgG for Toxo, Montoux, CXR, USG abdomen, Urine for Toxo, Montoux, CXR, USG abdomen, Urine examinationexamination
• CD4 for Immunological status CD4 for Immunological status
CNS ExaminationCNS Examination
Clinical ExaminationClinical ExaminationExamination of fundusExamination of fundusLaboratory studyLaboratory study
CSF StudyCSF Study Chemical Analysis, AFB, Gramstain, Culture sensitivity, Chemical Analysis, AFB, Gramstain, Culture sensitivity,
KOH, VDRL, Indian Ink Preparation for Crypto, KOH, VDRL, Indian Ink Preparation for Crypto, Cryptococcal antigen, PCR.Cryptococcal antigen, PCR.
MRI studyMRI study
Tubercular meningitisTubercular meningitisNo. of Patients: 8 (M:F-5:3)No. of Patients: 8 (M:F-5:3)Clinical Features: Fever, Headache & Clinical Features: Fever, Headache & VomitingVomitingCSF AnalysisCSF Analysis
AFB Positive for 3 (1F, 2 M)AFB Positive for 3 (1F, 2 M) AFB Negative for 5 (1F, 4M)AFB Negative for 5 (1F, 4M)
CD4 countCD4 countMortality: One patient died in advanced Mortality: One patient died in advanced stage, even after shunting for TBM with stage, even after shunting for TBM with hydrocephaloushydrocephalous
TB SpineTB Spine
No. of Patients : 2 (M:F-1:1)No. of Patients : 2 (M:F-1:1)
Clinical Features: Fever, Backache, Loss Clinical Features: Fever, Backache, Loss of weightof weight
Diagnosis : MRI spine Diagnosis : MRI spine
Treatment : ATT followed by ARTTreatment : ATT followed by ART
Results:Therapeutic response very good Results:Therapeutic response very good both TBM & TB spine when the CD4 > 150both TBM & TB spine when the CD4 > 150
Cryptococcal MeningitisCryptococcal Meningitis
No. of patients: 8 [M:F- 5:3] No. of patients: 8 [M:F- 5:3] Clinical features: Throbbing Headache, Fever, Clinical features: Throbbing Headache, Fever, Occasional Convulsions.Occasional Convulsions.CD4 < 150CD4 < 150CSF: High Pressure, Clear FluidCSF: High Pressure, Clear FluidIndian ink for Cryptococcus +ve (5 cases)Indian ink for Cryptococcus +ve (5 cases)Cryptococcal antigen +ve (3 cases)Cryptococcal antigen +ve (3 cases)Treatment: Fluconazole 200mg IV BD, Treatment: Fluconazole 200mg IV BD, Amphotericin B 0.7mg/kg & followed by ARTAmphotericin B 0.7mg/kg & followed by ARTMortality: 2 [M:F-1:1]Mortality: 2 [M:F-1:1]
ToxoplasmosisToxoplasmosis
No. of Patients: 6 ( M:F- 5:1) No. of Patients: 6 ( M:F- 5:1) Clinical Features: Fever & SeizuresClinical Features: Fever & SeizuresDiagnosis: Serum IgG Toxo, MRIDiagnosis: Serum IgG Toxo, MRICD4 < 200CD4 < 200Treatment: Anti TOXO Treatment: Anti TOXO Alternative: Clindamycin & DapsoneAlternative: Clindamycin & Dapsone
Followed by ARTFollowed by ARTMortality: 1 Mortality: 1
PMLPML
No. of Patients: 6 (M:F- 4:2) No. of Patients: 6 (M:F- 4:2)
Clinical features: Loss of memory, Clinical features: Loss of memory, irrelevant speech, insomniairrelevant speech, insomnia
Diagnosis : MRIDiagnosis : MRI
CD4 <150CD4 <150
Treatment: Symptomatic & ART Treatment: Symptomatic & ART
Mortality: 1Mortality: 1
Cerebral AtrophyCerebral Atrophy
No. of Patients: 3 (M:F-2:1)No. of Patients: 3 (M:F-2:1)
Clinical Features: Clinical Features:
Loss of memory,irrelevant speech,insomnia Loss of memory,irrelevant speech,insomnia
insomniainsomnia
Diagnosis – MRIDiagnosis – MRI
CD4 < 150CD4 < 150
Treatment: Symptomatic & ARTTreatment: Symptomatic & ART
Pneumococcal MeningitisPneumococcal Meningitis
No. of patients – 2 (M)No. of patients – 2 (M)
Clinical Features: Fever, Headache and Clinical Features: Fever, Headache and vomitingvomiting
Diagnosis: CSF analysis, Gram stain / Diagnosis: CSF analysis, Gram stain / CultureRx CultureRx
Treatment : standard+ ARTTreatment : standard+ ART
Results: 1 patient died, CD4 = 27, one Results: 1 patient died, CD4 = 27, one patient survive CD4 = 150patient survive CD4 = 150
HIV Myelopathy with MyopathyHIV Myelopathy with Myopathy
1 (F) patient1 (F) patient
Clinical Features: Tingling sensation & Clinical Features: Tingling sensation & weakness in lower limbsweakness in lower limbs
CD4:110CD4:110
Treatment : ART Treatment : ART
Facial Palsy due to Herpes-Facial Palsy due to Herpes-ZosterZoster
No. of cases: 6 (M:F-4:2)No. of cases: 6 (M:F-4:2)
Diagnosis – ClinicalDiagnosis – Clinical
CD4 < 200CD4 < 200
Treatment: Acyclovir , Famcyclovir , Treatment: Acyclovir , Famcyclovir , Valcyclovir Valcyclovir
PhysiotherapyPhysiotherapy
Peripheral NeuropathyPeripheral Neuropathy
No. of Patients: 5 (M:F- 3: 2)No. of Patients: 5 (M:F- 3: 2)
Cause : Mainly drug inducedCause : Mainly drug induced
Clinical Features: Numbness, tingling Clinical Features: Numbness, tingling sensations & weakness in lower limbs sensations & weakness in lower limbs
CD4 : 50 – 150CD4 : 50 – 150
Diagnosis : Clinical and NCSDiagnosis : Clinical and NCS
Treatment : Vitamin supplements Treatment : Vitamin supplements
Spinal Masses Other than Spinal Masses Other than KOCH’sKOCH’s
No. of Patients: 3 (M:F- 2:1)No. of Patients: 3 (M:F- 2:1)Clinical Features: Fever, Paraplegia,Urinary Clinical Features: Fever, Paraplegia,Urinary retention, Bowel incontinenceretention, Bowel incontinenceCD4; < 100CD4; < 100Diagnosis: MRI & BiopsyDiagnosis: MRI & BiopsyResults : 1(M) Secondary from renal cell Ca. - Results : 1(M) Secondary from renal cell Ca. - dieddied
1(M) NHL operated - doing well1(M) NHL operated - doing well 1(F) Spinal inflammatory/Neoplastic lesions 1(F) Spinal inflammatory/Neoplastic lesions
nature not known (died because neutropenia) nature not known (died because neutropenia)
ConclusionConclusion
TBM , Crypto, Toxo TBM , Crypto, Toxo CD4 < 200 CD4 < 200
Cerebral atrophy & Cerebral atrophy & PML PML
Neoplasms common Neoplasms common CD4 <100 CD4 <100
Neuro AIDSNeuro AIDS
-- More common-- More common
-- high morbidity-- high morbidity
-- Very high mortality-- Very high mortality
-- ART -- ART