1/9. coccidioidomycosis meningitis with massive dural and cerebral venous thrombosis and tissue arthroconidia.To our knowledge we report the first case of meningitis from coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
2/9. Unusual patterns of histoplasma capsulatum meningitis and progressive multifocal leukoencephalopathy in a patient with the acquired immunodeficiency virus.Disseminated histoplasmosis (DH) and progressive multifocal leukoencephalopathy occur in acquired immunodeficiency syndrome (AIDS). At autopsy, DH patients with central nervous system involvement almost always show extensive involvement of the lungs and reticuloendothelial system in addition to the brain, and progressive multifocal leukoencephalopathy is manifest as multiple demyelinating lesions in several locations in the brain. We describe an AIDS patient with a long history of aggressively treated DH who died with DH in the brain only; fungus was not found elsewhere at autopsy. In addition, there was a papovavirus infection restricted to the cerebellum with predominant involvement of the internal granular cell layer; again, demyelinating lesions were not found elsewhere in the brain. Each of these patterns of brain involvement is rare. As the incidence of AIDS increases and patients are treated aggressively, the frequency of unusual neuropathologic patterns of opportunistic infections may be expected to increase.- - - - - - - - - - ranking = 1.6187770535459keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
3/9. diagnosis and management of central nervous system histoplasmosis.Two cases of histoplasma meningitis are presented, illustrating the difficulty in diagnosis and treatment. The first case occurred in a patient with acquired immunodeficiency syndrome as a relapse of disseminated histoplasmosis and resolved after prolonged treatment and ongoing antiretroviral therapy. The second case occurred in a cardiac allograft recipient as meningitis and focal brain lesions that responded to liposomal amphotericin b, but the patient died shortly after therapy was completed. Unfortunately, there are no prospective studies addressing the diagnosis and management of patients with histoplasmosis of the central nervous system from which to provide evidence-based guidelines for care. In the absence of such data, an approach will be presented on the basis of our experience and opinions.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
4/9. meningitis due to histoplasma capsulatum and mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome.histoplasmosis has rarely been reported in taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (hiv) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin b and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast asia who are in the advanced stage of hiv infection.- - - - - - - - - - ranking = 5.1546942633865keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
5/9. Isolated central nervous system aspergillosis in the acquired immunodeficiency syndrome.aspergillus infection involving the central nervous system are unusual, but should be included in the differential diagnosis in patients with the acquired immunodeficiency syndrome and neurologic signs and symptoms. Of the few reported AIDS cases with central nervous system aspergillosis, the majority have had focal brain abscesses. We report an atypical case that presented as a basal meningitis with pontine infarction secondary to invasive aspergillus sinusitis.- - - - - - - - - - ranking = 5keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
6/9. Candidal meningitis in hiv-infected patients: analysis of 14 cases.Five cases of candidal meningitis in human immunodeficiency virus (hiv)-infected patients have been diagnosed in our hospital. This article describes these cases and reviews another nine previously reported in the literature. Most patients (71%) had at least one well-known predisposing factor for candidiasis. Median CD4 cell count was 135/mm3. headache and fever, in the absence of focal neurologic signs, were the predominant clinical features. The CSF analysis revealed mild pleocytosis and hypoglycorrachia, indistinguishable from those seen in tuberculous or cryptococcal meningitis. Twelve patients (92%) received amphotericin b for a median of 51 days, in combination with flucytosine in five cases. The overall mortality among treated patients was 31%. Although the risk of relapse of candidal meningitis is unknown, maintenance antifungal therapy was given to seven patients (63%), usually with fluconazole. candida species must be kept in mind as a cause of chronic meningitis in hiv-infected patients who have a known predisposing factor.- - - - - - - - - - ranking = 0.15469426338648keywords = immunodeficiency (Clic here for more details about this article) |
7/9. pneumocystis carinii meningoradiculitis in a patient with AIDS.pneumocystis carinii is a common opportunistic pathogen in patients infected with the human immunodeficiency virus (hiv). pneumocystis carinii pneumonia is common, while extrapulmonary infections with pneumocystis carinii have been reported sparingly. The clinical features are frequently nonspecific. The detection of pneumocystis carinii in cerebrospinal fluid (CSF) has not been reported thus far. In this report, an unusual case of pneumocystis carinii meningoradiculitis in an hiv-infected patient who had previously received primary prophylaxis with trimethoprim-sulfamethoxazole is presented.- - - - - - - - - - ranking = 0.15469426338648keywords = immunodeficiency (Clic here for more details about this article) |
8/9. Recurrent central diabetes insipidus secondary to cryptococcal meningitis.meningitis is often associated with hyponatremia due to inappropriate secretion of antidiuretic hormone, and diabetes insipidus is associated with bacterial meningitis. This article describes a patient with acquired immunodeficiency syndrome who experienced recurrent episodes of central diabetes insipidus in association with recurrent fungal meningitis. Desmopressin was effective in controlling the polyuria until the episodes of meningitis resolved.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/9. arteritis and fatal subarachnoid hemorrhage complicating occult candida meningitis: unusual presentation in pediatric acquired immunodeficiency syndrome.We report the case of an 11-month-old child with acquired immunodeficiency syndrome, who despite treatment for systemic candidiasis developed undetected candida meningitis. This uncommon manifestation of candidiasis was accompanied by basilar granulomatous inflammation and fibrosis of meninges with arteritis, vascular invasion by fungi, and terminal subarachold hemorrhage. To our knowledge, this constellation of findings has not been reported previously in pediatric acquired immunodeficiency syndrome.- - - - - - - - - - ranking = 6keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |