As many as 20% of HIV-infected patients develop neurological complications. Some of these result from a direct encephalitic effect of HIV, and others are due to neoplastic lesions, notably lymphomas. Toxoplasma encephalitis accounts for most focal lesions while cytomegalovirus and herpes simplex viruses are more rarely implicated. Life-threatening meningitis is often due to Cryptococcus neoformans and occasionally due to coccidioidomycosis or tuberculoma.
Summary of CNS infections
| |
Symptoms |
Laboratory investigations/imaging |
1st line treatment |
Outcome |
Toxoplasmosis |
focal neurology fever evolution over days |
space occupying lesion on CT, possible ring enhancement (if available) |
sulfadiazine and pyrimethamine and calcium folinate |
75% response to treatment prophylaxis needed after treatment |
Cryptococcal meningitis |
fever headache menigeal symptoms often absent evolution over weeks |
advanced immuno-suppression India ink or specific stain of CSF (lumbar puncture) antigen detection test (from serum or CSF) |
amphotericin B (IV) and flucytosine (2 weeks) followed by fluconazole |
65% response to treatment fluconazole prophylaxis needed after treatment |
CMV encephalitis |
confusion lethargy cranial nerve palsies nystagmus |
advanced immuno-suppression |
symptomatic or foscarnet or ganciclovir if available |
very poor prognosis |
HIV encepalopathy |
cognitive and motor impairment |
|
symptomatic or antiretrovirals with CNS penetration, if available |
deterioration over months |
Protozoal infection: Toxoplasma gondii
Mycobacterial infection: Mycobacterium tuberculosis
Fungal infection: Cryptococcus neoformans, Candida species.
Viral infection: Cytomegalovirus, herpes simplex virus, varicella zoster virus, JC virus (progressive multifocal leukoencephalopathy)
Non infectious disorders: Primary CNS lymphoma, Kaposi’s sarcoma, direct HIV disease |
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