Neurological manifestations of cytomegalovirus infection in the acquired immunodeficiency syndrome

Cytomegalovirus (CMV) infection is one of the most important opportunistic infections in AIDS. The most common manifestation of neurological CMV disease in HIV infection is retinitis followed by encephalitis, polyradiculopathy, and multifocal neuropathy. Untreated necrotizing retinitis proceeds to blindness but can readily be diagnosed by ophthalmological examination. CMV polyradiculopathy presents as subacute leg weakness, paraesthesia, and urinary retention. Untreated patients develop ascending paralysis and die within weeks. Multifocal neuropathy commonly affects the radial, ulnar, and peroneal nerves but cranial nerves may also be involved. Confusion, cranial nerve palsies, and hyperreflexia are signs of ventriculoencephalitis, whereas the presentation of diffuse micronodular encephalitis is often asymptomatic. The diagnostic approach relies on the detection of CMV DNA in the cerebrospinal fluid for polyradiculopathy, encephalitis, and neuropathy. Neuroimaging can exclude other causes of encephalitis and polyradiculopathy. Ganciclovir, foscarnet, and cidofovir monotherapy are current medical treatment options. Intraocular administration can be used for refractory retinitis, but additional systemic prophylaxis is required to suppress extraocular disease. Ganciclovir and foscarnet have improved the prognosis of multifocal neuropathy and polyradiculopathy, but response rates for encephalitis are low. However, despite therapy survival of central nervous CMV disease is still limited to months. Recently highly active antiretroviral therapy (HAART) has decreased the overall incidence of CMV disease in AIDS. Furthermore (HAART) has become a mainstay for CMV therapy by improving the patient's immunocompetence against CMV.

[1]  P. Kissinger,et al.  Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. , 1998, The New England journal of medicine.

[2]  F. Goebel,et al.  Cytomegalovirus polyradiculopathy in patients with AIDS. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  M. Polis,et al.  Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. , 1998, Archives of internal medicine.

[4]  P. Jain,et al.  Profile of central nervous system pathology in patients with AIDS: an autopsy study from India , 1998, AIDS.

[5]  F. Goebel,et al.  Ganciclovir and foscarnet efficacy in AIDS-related CMV polyradiculopathy. , 1998, The Journal of infection.

[6]  G. Gerna,et al.  Diagnosis and Clinical Management of Neurological Disorders Caused by Cytomegalovirus in Aids Patients for the European Union Concerted Action on Virus Meningitis and Encephalitis* , 1997 .

[7]  J. Gatell,et al.  Cytomegalovirus disease in HIV-1-infected patients treated with protease inhibitors. , 1997, AIDS.

[8]  D. Stein Cytomegalovirus retinitis after initiation of highly active antiretroviral therapy , 1997, The Lancet.

[9]  H. Budka,et al.  Neuropathology of myelitis, myelopathy, and spinal infections in AIDS. , 1997, Neuroimaging clinics of North America.

[10]  B. Gazzard,et al.  Successful treatment of cytomegalovirus encephalitis in an AIDS patient using cidofovir. , 1997, AIDS.

[11]  M. Jacobson,et al.  Treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome. , 1997, The New England journal of medicine.

[12]  M. Davis,et al.  Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant , 1997 .

[13]  M. Polis,et al.  Therapeutic effect of combination antiretroviral therapy on cytomegalovirus retinitis. , 1997, JAMA.

[14]  G. Blick,et al.  Successful use of cidofovir in treating AIDS-related cytomegalovirus retinitis, encephalitis, and esophagitis. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[15]  D. Zagzag,et al.  Cytomegalovirus disease presenting as a focal brain mass: report of two cases. , 1997, Neurosurgery.

[16]  F. Scaravilli,et al.  Comparison of magnetic resonance imaging with neuropathological findings in the diagnosis of HIV and CMV associated CNS disease in AIDS. , 1997, Journal of neurology, neurosurgery, and psychiatry.

[17]  M. Nelson,et al.  Peripheral neuropathy in HIV , 1997, International journal of STD & AIDS.

[18]  B. Kuppermann Therapeutic options for resistant cytomegalovirus retinitis. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[19]  I. Schwab,et al.  Regression of cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS. , 1997, American journal of ophthalmology.

[20]  W. Hardy Management strategies for patients with cytomegalovirus retinitis. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[21]  A. Lazzarin,et al.  Selective elevation of monocyte chemotactic protein-1 in the cerebrospinal fluid of AIDS patients with cytomegalovirus encephalitis. , 1996, The Journal of infectious diseases.

[22]  B. Gazzard,et al.  Acute lumbosacral polyradiculopathy due to cytomegalovirus in advanced HIV disease: CSF findings in 17 patients. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[23]  W. Freeman,et al.  Polyradiculopathy associated with ganciclovir-resistant cytomegalovirus in an AIDS patient: phenotypic and genotypic characterization of sequential virus isolates. , 1996, The Journal of infectious diseases.

[24]  J. VerdejoOrtés Cytomegalovirus retinitis in patients with AIDS , 1996 .

[25]  A. Moulignier,et al.  AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  M. Dalakas,et al.  Neuropathies in HIV infection. , 1996, Bailliere's clinical neurology.

[27]  W. Freeman,et al.  Intravitreous and plasma concentrations of ganciclovir and foscarnet after intravenous therapy in patients with AIDS and cytomegalovirus retinitis , 1996 .

[28]  B. Cohen Prognosis and response to therapy of cytomegalovirus encephalitis and meningomyelitis in AIDS. , 1996, Neurology.

[29]  D. Salmon,et al.  [Left vocal cord paralysis in cytomegalovirus multifocal neuropathy in a patient with HIV infection]. , 1996, Presse medicale.

[30]  J. Phair,et al.  Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS: The cytomegalovirus retreatment trial , 1996 .

[31]  D. Clifford,et al.  Magnetic resonance brain imaging lacks sensitivity for AIDS associated cytomegalovirus encephalitis. , 1996, Journal of neurovirology.

[32]  D. Clifford,et al.  Cytomegalovirus Encephalitis , 1996, Annals of Internal Medicine.

[33]  P. Griffiths,et al.  Natural history of untreated cytomegalovirus retinitis , 1995, The Lancet.

[34]  C. Crumpacker,et al.  Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. Syntex Cooperative Oral Ganciclovir Study Group. , 1995, The New England journal of medicine.

[35]  F. Baldanti,et al.  Ganciclovir therapy for cytomegalovirus (CMV) infection of the central nervous system in AIDS patients: monitoring by CMV DNA detection in cerebrospinal fluid. , 1995, The Journal of infectious diseases.

[36]  J. McCutchan Cytomegalovirus infections of the nervous system in patients with AIDS. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[37]  S. Mallal,et al.  Cerebral mass lesions due to cytomegalovirus in patients with AIDS: report of two cases. , 1995, The Journal of infection.

[38]  V. Vullo,et al.  Cytomegalovirus encephalitis in two patients with AIDS receiving ganciclovir for cytomegalovirus retinitis. , 1994, The Journal of infection.

[39]  W. Rozenbaum,et al.  Cytomegalovirus multifocal neuropathy in AIDS , 1994, Neurology.

[40]  S. Berman,et al.  The development of cytomegalovirus encephalitis in AIDS patients receiving ganciclovir. , 1994, The American journal of medicine.

[41]  V. Mathews,et al.  Cytomegalovirus encephalitis in acquired immunodeficiency syndrome (AIDS) , 1994, Neurology.

[42]  J. Phair,et al.  Clinical manifestations of AIDS in the era of pneumocystis prophylaxis. Multicenter AIDS Cohort Study. , 1993, The New England journal of medicine.

[43]  W. Freeman,et al.  Combination ganciclovir and foscarnet in the treatment of clinically resistant cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. , 1993, Archives of ophthalmology.

[44]  M. Alonso,et al.  Pseudotumoral appearance of cytomegalovirus esophagitis and gastritis in AIDS patients. , 1993, The American journal of gastroenterology.

[45]  C. Katlama,et al.  Human CMV infection of the CNS: concordance between PCR detection in CSF and pathological examination. , 1993, AIDS.

[46]  U. Hengge,et al.  Foscarnet penetrates the blood-brain barrier: rationale for therapy of cytomegalovirus encephalitis , 1993, Antimicrobial Agents and Chemotherapy.

[47]  R. Guiloff,et al.  Nature and incidence of peripheral nerve syndromes in HIV infection. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[48]  R. Bonomo,et al.  Cytomegalovirus Ventriculoencephalitis in AIDS: A Syndrome with Distinct Clinical and Pathologic Features , 1993, Medicine.

[49]  J. Glass,et al.  Neurologic prognosis of cytomegalovirus polyradiculomyelopathy in AIDS , 1993, Neurology.

[50]  R. Chaisson,et al.  Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. , 1992, The Journal of infectious diseases.

[51]  S. Kazanjian,et al.  Discrete gastrointestinal mass lesions caused by cytomegalovirus in patients with AIDS: report of three cases and review. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[52]  D. Pillay,et al.  Diagnosis of cytomegalovirus infection: a review. , 1992, Genitourinary medicine.

[53]  J. Bartlett,et al.  Studies of ocular complications of AIDS Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial: 1. Rationale, design, and methods. AIDS Clinical Trials Group (ACTG). , 1992, Controlled clinical trials.

[54]  M. Heinemann Characteristics of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome. , 1992, The American journal of medicine.

[55]  G. Fuller Cytomegalovirus and the peripheral nervous system in AIDS. , 1992, Journal of acquired immune deficiency syndromes.

[56]  W. Owen,et al.  Prevalence of resistance in patients receiving ganciclovir for serious cytomegalovirus infection. , 1991, The Journal of infectious diseases.

[57]  C. Lacroix,et al.  Cytomegalovirus neuropathy in acquired immunodeficiency syndrome: A clinical and pathological study , 1991, Annals of neurology.

[58]  D. Troost,et al.  Predominance of polymorphonuclear leukocytes in cerebrospinal fluid of AIDS patients with cytomegalovirus polyradiculomyelitis. , 1990, Journal of acquired immune deficiency syndromes.

[59]  P. Gaulard,et al.  Necrotizing vasculitis and HIV replication in peripheral nerves. , 1989, The New England journal of medicine.

[60]  C. Wiley,et al.  Spinal cord and peripheral nerve pathology in AIDS: The roles of cytomegalovirus and human immunodeficiency virus , 1989, Annals of neurology.

[61]  H. Balfour,et al.  Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients. , 1989, The New England journal of medicine.

[62]  H. Vinters,et al.  Cytomegalovirus in the nervous system of patients with the acquired immune deficiency syndrome. , 1989, Brain : a journal of neurology.

[63]  J. Bartlett,et al.  Cytomegalovirus retinitis and acquired immunodeficiency syndrome. , 1989, Archives of ophthalmology.

[64]  P. Small,et al.  Cytomegalovirus infection of the laryngeal nerve presenting as hoarseness in patients with acquired immunodeficiency syndrome. , 1989, The American journal of medicine.

[65]  R. L. Davis,et al.  NEUROPATHOLOGY OF ACQUIRED IMMUNODEFICIENCY SYNDROME , 1988, Neuropathology and applied neurobiology.

[66]  R. Gherardi,et al.  PATHOLOGY OF THE CENTRAL NERVOUS SYSTEM IN 40 CASES OF ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) , 1988, Neuropathology and applied neurobiology.

[67]  D. Richman,et al.  Acquired Immunodeficiency Syndrome: Mangnetic Resonance Patterns of Brain Involvement With Pathologic Correlation , 1988 .

[68]  W. Freeman,et al.  A typical Retinitis in Patients With the Acquired Immunodeficiency Syndrome , 1988 .

[69]  W. Freeman,et al.  Prevalence, pathophysiology, and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. , 1987, American journal of ophthalmology.

[70]  H. Handsfield,et al.  Cytomegalovirus infection in homosexual men. Relationship to sexual practices, antibody to human immunodeficiency virus, and cell-mediated immunity. , 1987, The American journal of medicine.

[71]  O. Devinsky,et al.  Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature. , 1987, Human pathology.

[72]  G. Wormser,et al.  Spinal cord syndromes in the acquired immune deficiency syndrome , 1986, Acta neurologica Scandinavica.

[73]  C. Wiley,et al.  Localization of Cytomegalovirus Proteins and Genome During Fulminant Central Nervous System Infection in an AIDS Patient , 1986, Journal of neuropathology and experimental neurology.

[74]  B. Polk,et al.  Microvascular aspects of acquired immune deficiency syndrome retinopathy. , 1984, American journal of ophthalmology.

[75]  W. Freeman,et al.  A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome. , 1984, American journal of ophthalmology.

[76]  D. Hawley,et al.  Cytomegalovirus encephalitis in acquired immunodeficiency syndrome. , 1983, American journal of clinical pathology.