Molecular Diagnosis of Central Nervous System Opportunistic Infections in HIV-Infected Zambian Adults
| Autor: | Xin Dang, Michael N. Khoury, Patrick Kaonga, Masharip Atadzhanov, Omar K. Siddiqi, Igor J. Koralnik, Musie Ghebremichael |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
DNA Bacterial Male Microbiology (medical) Tuberculosis AIDS-Related Opportunistic Infections JC virus Zambia Neisseria meningitidis medicine.disease_cause Virus Herpesviridae Central Nervous System Infections Seizures parasitic diseases Humans Medicine DNA Fungal business.industry Varicella zoster virus virus diseases Bacterial Infections Cryptococcosis DNA Mycobacterium tuberculosis DNA Protozoan medicine.disease JC Virus Virology Toxoplasmosis CD4 Lymphocyte Count Cryptococcus Cross-Sectional Studies Streptococcus pneumoniae Infectious Diseases Molecular Diagnostic Techniques Virus Diseases DNA Viral Immunology Coinfection HIV/AIDS Female business Toxoplasma |
| Zdroj: | Clinical Infectious Diseases. 58:1771-1777 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciu191 |
| Popis: | Background. Knowledge of central nervous system (CNS) opportunistic infections (OIs) among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa is limited. Methods. We analyzed 1 cerebrospinal fluid (CSF) sample from each of 331 HIV-infected adults with symptoms suggestive of CNS OI at a tertiary care center in Zambia. We used pathogen-specific primers to detect DNA from JC virus (JCV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) types 1 and 2, Mycobacterium tuberculosis, and Toxoplasma gondii via real-time polymerase chain reaction (PCR). Results. The patients’ median CD4 + T-cell count was 89 cells/µL (interquartile range, 38–191 cells/µL). Of 331 CSF samples, 189 (57.1%) had at least 1 pathogen. PCR detected DNA from EBV in 91 (27.5%) patients, M. tuberculosis in 48 (14.5%), JCV in 20 (6.0%), CMV in 20 (6.0%), VZV in 13 (3.9%), HSV-1 in 5 (1.5%), and HSV-2 and T. gondii in none. Fungal and bacteriological studies showed Cryptococcus in 64 (19.5%) patients, pneumococcus in 8 (2.4%), and meningococcus in 2 (0.6%). Multiple pathogens were found in 68 of 189 (36.0%) samples. One hundred seventeen of 331 (35.3%) inpatients died during their hospitalization. Men were older than women (median, 37 vs 34 years; P = .01), more recently diagnosed with HIV (median, 30 vs 63 days; P = .03), and tended to have a higher mortality rate (40.2% vs 30.2%; P= .07). Conclusions. CNS OIs are frequent, potentially treatable complications of AIDS in Zambia. Multiple pathogens often coexist in CSF. EBV is the most prevalent CNS organism in isolation and in coinfection. Whether it is associated with CNS disease or a marker of inflammation requires further investigation. More comprehensive testing for CNS pathogens could improve treatment and patient outcomes in Zambia. |
| Databáze: | OpenAIRE |
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