==================================BSR27================================== 27. AIDS (acquired immune deficiency syndrome) and central nervous system- especially subacute encephalitis, AIDS encephalopathy, AIDS dementia. And peripheral nervous system. 1 UI - 87123733 AU - Piazza E ; Condorelli A ; Arcidiacono R ; Tropea R ; Chiaramonte I ; Mancuso P TI - Intracerebral mass lesions in patients affected by AIDS. AB - "Toxoplasma gondii: cerebral abscess is a common opportunistic infection in patients affected by AIDS. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in AIDS patients because of the lack of specificity of serological data and neuroradiological findings. Brain biopsy is the only procedure which enables a reliable diagnosis to be made a trial of specific medical therapy for toxoplasmosis in patients affected by AIDS and intracranial mass lesion can be advisable before performing brain biopsy. The authors report the cases of three patients affected by AIDS and cerebral toxoplasmosis. Tissue diagnosis was made in the first patient from autopsy material while a presumptive diagnosis was made in the other two cases since specific medical therapy resulted in a dramatic improvement of the neurological status. Despite the good possibilities in the treatment of this complication AIDS, however, carries a poor prognosis. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Brain Abscess/ *ETIOLOGY/RADIOGRAPHY ; Case Report ; Human ; Male ; Opportunistic Infections/*ETIOLOGY/RADIOGRAPHY ; Tomography, X-Ray Computed ; Toxoplasmosis/*ETIOLOGY/RADIOGRAPHY SO - Acta Neurochir (Wien) 1986;83(3-4):116-20 2 UI - 87120106 AU - Hagberg L ; Malmvall BE ; Svennerholm L ; Alestig K ; Norkrans G TI - Guillain-Barr:e syndrome as an early manifestation of HIV central nervous system infection. AB - Two cases of HIV infection associated with Guillain-Barr:e syndrome are described. The neurologic symptoms started 1 week and 20 weeks, respectively, after the primary HIV infection. Seroconversion for anti-HIV occurred during the disease. A rapid spread of virus to the central nervous system was shown. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Aged ; Antibodies, Viral/ANALYSIS ; Case Report ; Human ; HTLV-III/IMMUNOLOGY ; Male ; Middle Age ; Polyradiculoneuritis/*COMPLICATIONS SO - Scand J Infect Dis 1986;18(6):591-2 3 UI - 87093715 AU - Mills J TI - Pneumocystis carinii and Toxoplasma gondii infections in patients with AIDS. AB - Pneumocystis carinii and Toxoplasma gondii are the commonest protozoans causing infections in patients with acquired immunodeficiency syndrome (AIDS). P. carinii is almost exclusively a pulmonary pathogen and caused the commonest serious infection experienced by AIDS patients. The clinical findings are those of progressive pneumonia. Diagnosis requires microscopic examination of lower respiratory secretions or lung tissue. Pentamidine or combinations of trimethoprim and sulfamethoxazole are equally effective (85% recovery), but about one-half of patients thus treated experience severe toxicity. T. gondii infections occur primarily in the brain; patients present with focal seizures or neurologic deficit and have focal abnormalities as assessed by computed tomography. Serologic tests for toxoplasmosis are rarely diagnostic in AIDS patients, and most patients are treated empirically with a combination of pyrimethamine and sulfonamide. Less invasive diagnostic tests and better chemotherapeutic agents are required for both pneumocystosis and toxoplasmosis. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Brain Diseases/ DIAGNOSIS/*ETIOLOGY ; Human ; Opportunistic Infections/*ETIOLOGY ; Pneumonia, Pneumocystis Carinii/DRUG THERAPY/*ETIOLOGY ; Review ; Support, Non-U.S. Gov't ; Toxoplasmosis/DIAGNOSIS/*ETIOLOGY SO - Rev Infect Dis 1986 Nov-Dec;8(6):1001-11 4 UI - 87086188 AU - Milam SB ; Rees TD ; Leiman HI TI - An unusual cause of bilateral mental neuropathy in an AIDS patient. Report of a case. AB - A case is reported of a patient with sudden onset, generalized toothache accompanied with a numb chin and lower lip. A thorough oral examination was negative. A complete medical evaluation revealed a positive HTLV-III antibody titer and acute lymphoblastic leukemia (Burkitt's-type). An unexplained trigeminal neuropathy should prompt the dentist to refer the patient for complete medical evaluation. A high index of suspicion of a malignant process should be maintained in all cases of unexplained numb lower lip and/or chin. MH - *Acquired Immunodeficiency Syndrome/COMPLICATIONS ; Acute Disease ; Adult ; Case Report ; Human ; Leukemia, Lymphoblastic/COMPLICATIONS ; Male ; Paresthesia/*ETIOLOGY ; Peripheral Nerve Diseases/ETIOLOGY ; Sensation ; Toothache/*ETIOLOGY ; *Trigeminal Nerve SO - J Periodontol 1986 Dec;57(12):753-5 5 UI - 87085675 AU - Rosemberg S ; Lopes MB ; Tsanaclis AM TI - Neuropathology of acquired immunodeficiency syndrome (AIDS). Analysis of 22 Brazilian cases. AB - The neuropathologic study of 22 Brazilian cases of acquired immuno-deficiency syndrome (AIDS) was performed. Thirteen cases (59%) showed neuropathologic lesions. These included infection by Toxoplasma (n = 4), Cryptococcus neoformans (n = 3), viral encephalitis (n = 4), primary lymphomas (n = 2), isolated cerebral infarct (n = 1), and reactive gliosis (n = 1). In 2 cases, primary lymphoma and viral encephalitis were associated. Axonal spheroids in the gracilis and cuneatus nuclei were present in a case of toxoplasmosis. Mammillary bodies lesions consistent with Wernicke's encephalopathy were found in a case of viral encephalitis. In addition, circulatory changes (focal cortical infarcts) were associated lesions in 3 cases. These findings were compared with the main series reported in American and European literature. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/OCCURRENCE ; Adolescence ; Adult ; Brain Abscess/ETIOLOGY/PATHOLOGY ; Brain Diseases/ ETIOLOGY/*PATHOLOGY ; Brain Neoplasms/ETIOLOGY/PATHOLOGY ; Brain/ *PATHOLOGY ; Brazil ; Cryptococcosis/PATHOLOGY ; Human ; Lymphoma/ ETIOLOGY/PATHOLOGY ; Male ; Middle Age ; Toxoplasmosis/PATHOLOGY SO - J Neurol Sci 1986 Dec;76(2-3):187-98 6 UI - 87082578 AU - Faulstich ME TI - Acquired immune deficiency syndrome: an overview of central nervous system complications and neuropsychological sequelae. AB - The Acquired Immune Deficiency Syndrome (AIDS) has been associated with a series of central nervous system (CNS) complications, including focal and nonfocal neurological indications. Overall, the most common form of CNS dysfunction is diffuse cerebral atrophy pathologically characterized by neuronal loss, glial nodules, and microfocal demyelination. Consequent neuropsychological deficits present an insidious course initially typified by poor memory and concentration, along with psychomotor retardation and blunted affect which resembles psychological depression. Gradually over several weeks to months, patients exhibit marked global cognitive impairment and can become severely disoriented and delusional. Clinical research relevant to these CNS complications and neuropsychological sequelae are reviewed. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Central Nervous System Diseases/*COMPLICATIONS ; Human ; Organic Mental Disorders/ *ETIOLOGY ; Review SO - Int J Neurosci 1986 Nov;30(4):249-54 7 UI - 87079218 AU - Schlitt MJ ; Morawetz RB ; Bonnin JM ; Zeiger HE ; Whitley RJ TI - Brain biopsy for encephalitis. AB - Brain biopsy is justified in patients suspected of having encephalitis or viral encephalopathy because those patients are most likely to be helped if a diagnosis is made rapidly and with the greatest certainty possible. Neurosurgeons are occasionally reluctant to undertake brain biopsy because the procedure is diagnostic rather than therapeutic in intent. However, using currently available techniques a 1 cm3 sample of brain tissue can be taken with very low risk of morbidity or mortality. We recommend that the sample be taken from the anterior portion of the inferior temporal gyrus on the more affected side in patients with herpes simplex encephalitis, and from an area of maximum demonstrated involvement in other situations, using stereotactic techniques and intraoperative ultrasound as necessary. The risk to the operating surgeon and to the other members of the operating team appears very low in all of the situations discussed in this chapter. However, the authors feel that every patient should be approached as if he carries the hepatitis B virus. As indicated, the incidence of contracting hepatitis B after sustaining needle stick exposure to blood from persons positive for hepatitis B surface antigen is 10-15%. Conjunctival contamination by splash from the wound is a known method of inoculation of surgeons with hepatitis B virus and is a possible means for transmission of other viral diseases. We recommend that every patient be approached as if he has hepatitis B, not because the agent diseases discussed are known to be as infectious as hepatitis B, but because constant vigilance and careful technique offer the best protection to the surgeon and the members of the operating team in most situations, and because one can never be certain what agent diseases a given patient may harbor. With the exception of the Creutzfeldt-Jakob virus, the agents responsible for all of the viral diseases discussed are inactivated by standard procedures for sterilization of operating room instruments. Procedures necessary to inactivate the Creutzfeldt-Jakob disease virus have been presented. In the report documenting transmission of Creutzfeldt-Jakob disease through human growth hormone preparations the authors state, "We are once again dramatically reminded that human tissues are a source of infectious disease, and that any therapeutic transfer of tissue from one person to another carries an unavoidable risk of transferring the infection.(ABSTRACT TRUNCATED AT 400 WORDS) MH - Acquired Immunodeficiency Syndrome/PATHOLOGY ; Biopsy ; Brain/*PATHOLOGY ; Diagnosis, Differential ; Encephalitis/*PATHOLOGY ; Herpes Simplex/ PATHOLOGY ; Human ; Immunologic Deficiency Syndromes/PATHOLOGY ; Jakob-Creutzfeldt Syndrome/PATHOLOGY ; Leukoencephalopathy, Progressive Multifocal/PATHOLOGY ; Opportunistic Infections/PATHOLOGY SO - Clin Neurosurg 1986;33:591-602 8 UI - 87074738 AU - So YT ; Beckstead JH ; Davis RL TI - Primary central nervous system lymphoma in acquired immune deficiency syndrome: a clinical and pathological study. AB - Twenty cases of primary lymphoma of the central nervous system associated with acquired immune deficiency syndrome were seen over a period of four years and were studied clinically and pathologically. Biopsy established the diagnosis in 11 cases, and autopsy confirmed it in 9. Multicentricity was demonstrated in all cases for which there was adequate autopsy material. Both large-cell immunoblastic and small noncleaved lymphomas were seen, and marker studies in 5 patients established that the lymphomas were of B-cell origin. Neurological symptoms and signs, cerebrospinal fluid characteristics, and radiographic appearance were reviewed. The clinical and radiographic picture is nonspecific and histological confirmation is essential for diagnosis. Although the tumor appears to be radiosensitive, prognosis is extremely poor, with an average survival of less than two months. MH - Acquired Immunodeficiency Syndrome/CEREBROSPINAL FLUID/*COMPLICATIONS ; Adult ; Brain Neoplasms/ETIOLOGY/*PATHOLOGY ; Brain/PATHOLOGY/RADIOGRAPHY ; Human ; Lymphoma/*ETIOLOGY/PATHOLOGY ; Male ; Middle Age ; Nuclear Magnetic Resonance/DIAGNOSTIC USE ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Tomography, X-Ray Computed SO - Ann Neurol 1986 Nov;20(5):566-72 9 UI - 87063797 AU - Epstein LG ; Sharer LR ; Gajdusek DC TI - Hypothesis: AIDS encephalopathy is due to primary and persistent infection of the brain with a human retrovirus of the lentivirus subfamily. AB - Recent evidence has demonstrated that human T-lymphotropic retroviruses are present in the brain of patients with acquired immunodeficiency syndrome (AIDS). Studies by neuropathological, ultrastructural and nucleic acid hybridization techniques indicate that these human retroviruses are neurotropic as well as lymphotropic. Striking similarities to the animal retroviruses of the lentivirus subfamily provide a rationale to implicate these human retroviruses (lentiviruses) in the pathogenesis of AIDS encephalopathy. MH - Acquired Immunodeficiency Syndrome/*ETIOLOGY/MICROBIOLOGY/PATHOLOGY ; Adult ; Animal ; Child ; Disease Models, Animal ; Encephalitis/*ETIOLOGY/ MICROBIOLOGY/PATHOLOGY ; Human ; HTLV-III/ISOLATION & PURIFICATION ; *Models, Biological ; Review SO - Med Hypotheses 1986 Sep;21(1):87-96 10 UI - 87045329 AU - Brun B ; Boesen F ; Gerstoft J ; Nielsen JO ; Praestholm J TI - Cerebral computed tomography in men with acquired immunodeficiency syndrome. AB - Cerebral CT scannings were performed in 19 homosexual men with the acquired immunodeficiency syndrome (AIDS). Nearly half of them (9 patients) had cortical atrophy. Three patients with toxoplasmosis had cerebral pathology, in two of them with ring enhancement while the third had an ill-defined nonspecific lesion with slight heterogeneous enhancement without ring formation. Two patients with multifocal leucoencephalopathy and non-Hodgkin's lymphoma, respectively, presented non-enhancing, low attenuating lesions at CT. MH - Acquired Immunodeficiency Syndrome/*RADIOGRAPHY ; Adult ; Brain Diseases/ *RADIOGRAPHY ; Human ; Male ; Middle Age ; *Tomography, X-Ray Computed ; Toxoplasmosis/RADIOGRAPHY SO - Acta Radiol [Diagn] (Stockh) 1986 Jul-Aug;27(4):385-7 11 UI - 87037100 AU - Gartner S ; Markovits P ; Markovitz DM ; Betts RF ; Popovic M TI - Virus isolation from and identification of HTLV-III/LAV-producing cells in brain tissue from a patient with AIDS. AB - Primary cultures from a brain biopsy specimen of a human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) seropositive patient with progressive dementia contained small numbers of monocytoid cells and showed reverse transcriptase activity that persisted for as long as 100 days. Electron microscopy of these cells revealed the presence of HTLV-III/LAV virions. Subcultured cells removed from primary cultures by trypsinization were nonspecific esterase negative and did not express virus or show evidence of HTLV-III/LAV proviral sequences, while those remaining in the original flasks were nonspecific esterase positive and continued to produce virus. Virus from primary cultures was transmitted to peripheral blood-derived monocyte-macrophages and T cells. Virus production in T-cell cultures was transient while the monocyte-macrophages, like the primary cultures, produced virus for at least 120 days. Infection of several brain-derived cells with this and another HTLV-III/LAV isolate failed to demonstrate virus replication. These results indicate that the HTLV-III/LAV-infected cells recovered from the brain of this patient are cells of the mononuclear phagocyte series. MH - Acquired Immunodeficiency Syndrome/*MICROBIOLOGY/PATHOLOGY ; Brain/ *MICROBIOLOGY/PATHOLOGY ; Case Report ; Dementia/MICROBIOLOGY ; Encephalitis/*MICROBIOLOGY/PATHOLOGY ; Human ; HTLV-III/*ISOLATION & PURIFICATION/PHYSIOLOGY ; Macrophages/MICROBIOLOGY ; Male ; Middle Age ; Monocytes/MICROBIOLOGY ; Nucleic Acid Hybridization ; T Lymphocytes/ MICROBIOLOGY ; Virus Cultivation ; Virus Replication SO - JAMA 1986 Nov 7;256(17):2365-71 12 UI - 87037099 AU - Stoler MH ; Eskin TA ; Benn S ; Angerer RC ; Angerer LM TI - Human T-cell lymphotropic virus type III infection of the central nervous system. A preliminary in situ analysis. AB - Patients with the acquired immunodeficiency syndrome (AIDS) are subject to a spectrum of central nervous system (CNS) disorders. Recent evidence implicates the human T-cell lymphotropic virus type III (HTLV-III) in the pathogenesis of some of these illnesses, although, the cells infected by the virus have yet to be identified. Using in situ hybridization, we examined brain tissue from two patients with AIDS encephalopathy for the presence of HTLV-III RNA. In both cases, viral RNA was detected and concentrated in, though not limited to, the white matter. The CNS cells most frequently infected included macrophages, pleomorphic microglia, and multinucleated giant cells. Less frequently, cells morphologically consistent with astrocytes, oligodendroglia, and rarely neurons were also infected. The findings strengthen the association of HTLV-III with the pathogenesis of AIDS encephalopathy. In situ hybridization can be applied to routinely prepared biopsy tissue in the diagnosis of HTLV-III infection of the CNS. MH - Acquired Immunodeficiency Syndrome/*MICROBIOLOGY/PATHOLOGY ; Adult ; Brain/MICROBIOLOGY/PATHOLOGY ; Case Report ; Encephalitis/*MICROBIOLOGY/ PATHOLOGY ; Human ; HTLV-III/*ISOLATION & PURIFICATION ; Male ; Middle Age ; Nucleic Acid Hybridization ; RNA, Viral/ANALYSIS ; Support, U.S. Gov't, P.H.S. SO - JAMA 1986 Nov 7;256(17):2360-4 13 UI - 87035695 AU - Petito CK ; Cho ES ; Lemann W ; Navia BA ; Price RW TI - Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review. AB - In the brains and spinal cords of 153 adult patients dying with acquired immunodeficiency syndrome (AIDS) at New York and Memorial Hospitals a subacute encephalitis with multinucleated cells was present in 28% of all patients. This encephalitis was characterized by multinucleated cells primarily located in the white matter and associated with myelin pallor and sparse infiltrates of rod cells, macrophages, gemistocytic astrocytes and lymphocytes. The incidence per 12 month period ranged from 0 to 43% and significantly increased between 1983-84 (14%) and 1984-85 (43%). Recent virologic and pathologic studies suggest that this encephalitis may be caused by direct LAV/HTLV-III infection of the central nervous system (CNS). Cytomegalovirus encephalomyelitis and toxoplasmosis were the most common opportunistic infections (26% and 10%, respectively). Progressive multifocal leukoencephalopathy, herpes simplex ventriculitis, varicella-zoster leukoencephalitis and fungal infections were infrequent (less than 3% each). A nonspecific encephalitis with microglial nodules and with mild white matter changes occurred in 17%, vacuolar myelopathy in 29% and CNS lymphoma in 6%. Less than 20% of patients had either normal brains or terminal metabolic encephalopathies. This survey shows that neuropathologic complications of AIDS are frequent. Infections are the most common complication and are caused by probable LAV/HTLV-III infection, or by opportunistic organisms. MH - Acquired Immunodeficiency Syndrome/*PATHOLOGY ; Central Nervous System Diseases/PATHOLOGY ; Central Nervous System/*PATHOLOGY ; Encephalitis/ PATHOLOGY ; Herpesvirus Infections/PATHOLOGY ; Human ; Spinal Cord Diseases/PATHOLOGY ; Toxoplasmosis/PATHOLOGY SO - J Neuropathol Exp Neurol 1986 Nov;45(6):635-46 14 UI - 87035180 AU - McArthur JH ; McArthur JC TI - Neurological manifestations of acquired immunodeficiency syndrome. AB - This article provides an overview of the range of neurological manifestations that have been described in association with human immunodeficiency virus (HIV) infection. The transmission of acquired immunodeficiency syndrome (AIDS) and the precautions personnel must take when having contact with patients with AIDS are briefly reviewed. The nursing approach to the neurologically impaired victim of HIV infection is discussed. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Central Nervous System Diseases/*ETIOLOGY/NURSING ; Cryptococcosis/ETIOLOGY ; Dementia/ ETIOLOGY ; Female ; Herpesvirus Infections/ETIOLOGY ; Human ; Hyperesthesia/ETIOLOGY ; HTLV Infections/COMPLICATIONS ; Leukoencephalopathy, Progressive Multifocal/ETIOLOGY ; Male ; Meningitis, Viral/ETIOLOGY ; Nervous System Neoplasms/ETIOLOGY ; Spinal Cord Diseases/ ETIOLOGY ; Toxoplasmosis/ETIOLOGY SO - J Neurosci Nurs 1986 Oct;18(5):242-9 15 UI - 87032187 AU - Sethi KK ; N:aher H TI - Elevated titers of cell-free interleukin-2 receptor in serum and cerebrospinal fluid specimens of patients with acquired immunodeficiency syndrome. AB - A sensitive monoclonal antibody based ELISA was used to detect cell-free interleukin-2 receptor (IL-2R) in the body fluids of patients with acquired immune deficiency syndrome (AIDS), a variety of other disease conditions and a control group of apparently healthy (heterosexual and homosexual) males. Two of the 25 control donors showed low titers (1:8) of IL-2 receptor in the serum samples; the cerebrospinal fluid (CSF) specimens from these individuals proved negative. However, serum and CSF specimens from all the 9 patients with AIDS showed significantly elevated titers (range 1:128 to 1:4096) of IL-2 receptor. The presence of moderate titers (range 1:128 to 1:512) of circulating IL-2 receptor could also be detected in all of the 4 patients with acute lymphocytic leukemia. IL-2 receptor was detectable in the CSF and/or serum specimens from 3 of 3 patients with lung cancer, 3 of 4 patients with acute hepatitis B infection, and 2 of 3 patients with multiple sclerosis. IL-2 receptor could not be detected in the serum or CSF specimens originating from patients with legionellosis (3/3), asthma (3/3), or those with non-pulmonary febrile bacterial infections (4/4). It is concluded that soluble IL-2 receptor may be found in serum or CSF specimens from patients with certain (but not all) disease conditions including AIDS. The conspicuously elevated titers of cell-free IL-2R in the body fluids of patients with AIDS may contribute to the drastic impairment of the immune system regulation observed in such patients. MH - Acquired Immunodeficiency Syndrome/BLOOD/CEREBROSPINAL FLUID/*IMMUNOLOGY ; Antibodies, Viral/ANALYSIS ; Comparative Study ; Enzyme-Linked Immunosorbent Assay ; Human ; HTLV-III/IMMUNOLOGY ; Interleukin 2/ IMMUNOLOGY ; Leukemia, Lymphoblastic/BLOOD/CEREBROSPINAL FLUID/IMMUNOLOGY ; Multiple Sclerosis/BLOOD/CEREBROSPINAL FLUID/IMMUNOLOGY ; Receptors, Immunologic/*BIOSYNTHESIS SO - Immunol Lett 1986 Oct;13(4):179-84 16 UI - 87025054 AU - Dickson DW TI - Multinucleated giant cells in acquired immunodeficiency syndrome encephalopathy. Origin from endogenous microglia? AB - Multinucleated giant cells that are characteristic of the encephalomyelopathy of acquired immunodeficiency syndrome are stained by a lectin histochemical method. The particular lectin used, Ricinus communis agglutinin I, has been shown to bind to endogenous microglial cells in human brain, as well as to endothelial cells of blood vessels. These results suggest that multinucleated giant cells in the brain of patients with acquired immunodeficiency syndrome may be derived from endogenous microglia. MH - Acquired Immunodeficiency Syndrome/*PATHOLOGY ; Adult ; Astrocytes/ PATHOLOGY ; Brain Diseases/*PATHOLOGY ; Cell Membrane/PATHOLOGY ; Cell Nucleus/PATHOLOGY ; Child ; Cytoplasm/PATHOLOGY ; Endothelium/PATHOLOGY ; Histocytochemistry ; Human ; Immunoenzyme Technics ; Lectins SO - Arch Pathol Lab Med 1986 Oct;110(10):967-8 17 UI - 87024226 AU - Zaidman GW TI - Neurosyphilis and retrobulbar neuritis in a patient with AIDS. AB - A 33-year-old homosexual patient with acquired immune deficiency syndrome (AIDS) developed sudden unilateral loss of vision. Slit-lamp and funduscopic examination of the affected eye was completely within normal limits. The patient, however, had a Marcus Gunn pupil, decreased color vision, and a large central scotoma on visual field examination. This was consistent with retrobulbar optic neuritis. Laboratory investigation revealed a highly positive serum and cerebrospinal fluid venereal disease reaction level (VDRL). A diagnosis of neurosyphilis was made, and the patient was treated with ten days of intravenous penicillin therapy. Ophthalmologists should be aware that many patients with AIDS have also been exposed to syphilis. Regardless of their clinical presentation, all AIDS patients should be examined and tested for syphilis and treated as is necessary. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Case Report ; Fluorescein Angiography ; Human ; Male ; Neurosyphilis/*COMPLICATIONS ; Optic Neuritis/*COMPLICATIONS/PATHOLOGY/PHYSIOPATHOLOGY ; Visual Fields SO - Ann Ophthalmol 1986 Sep;18(9):260-1 18 UI - 87022686 AU - Levy RM ; Rosenbloom S ; Perrett LV TI - Neuroradiologic findings in AIDS: a review of 200 cases. AB - The radiologic studies of 200 consecutive AIDS patients with neurologic symptoms were evaluated to determine their diagnostic specificity and prognostic value. Of 81 patients with initially normal CT scans, four (5%) later developed progressive neurologic illness. Of 75 patients with CT evidence of diffuse cerebral atrophy, 12 (16%) later developed CT abnormalities or had postmortem CNS disease. CT scans showed mass lesions initially in 44 patients and later in an additional seven patients. Although toxoplasma gondii infection was the most frequent cause of these lesions, the CT characteristics of cerebral toxoplasmosis are too nonspecific to warrant diagnosis without biopsy. Preliminary evidence suggests that MRI may be more sensitive than CT in detecting intracranial disease in patients with AIDS. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/*RADIOGRAPHY ; Adult ; Brain Abscess/ETIOLOGY/*RADIOGRAPHY ; Brain Neoplasms/ETIOLOGY/ *RADIOGRAPHY ; Central Nervous System Diseases/RADIOGRAPHY ; Human ; Lymphoma/ETIOLOGY/*RADIOGRAPHY ; Male ; Middle Age ; Support, Non-U.S. Gov't ; Toxoplasmosis/ETIOLOGY/*RADIOGRAPHY SO - AJR 1986 Nov;147(5):977-83 19 UI - 87016079 AU - Epstein LG ; Sharer LR ; Oleske JM ; Connor EM ; Goudsmit J ; Bagdon L ; Robert-Guroff M ; Koenigsberger MR TI - Neurologic manifestations of human immunodeficiency virus infection in children. AB - This report describes the neurologic manifestations of 36 children with human immunodeficiency virus (HIV) infection. In this cohort, in 16 of 21 children with acquired immunodeficiency syndrome (AIDS), three of 12 children with AIDS-related complex, and one of three asymptomatic seropositive children, a progressive encephalopathy developed. Neurologic signs were often detected early but tended to worsen coincident with progression of the immunodeficiency. The presence of progressive encephalopathy correlated with the absence of serum neutralizing antibodies to HIV and with a poor, usually fatal, outcome. The incubation period from initial HIV infection in the perinatal period to the onset of progressive encephalopathy varied from 2 months to 5 years. Intrablood-brain barrier synthesis of HIV-specific antibodies was demonstrated in eight of 14 children with AIDS and AIDS-related complex, indicating active brain infection with HIV. In three cases this was unassociated with progressive neurologic signs. Unique neuropathologic findings in children who died with HIV infection further suggest that the progressive encephalopathy is the result of primary and persistent infection of the brain with this retrovirus. These findings broaden the spectrum of HIV infection in children and have important implications for the development of antiviral therapy. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY ; Antibodies, Viral/ANALYSIS ; Brain Diseases/*ETIOLOGY/PATHOLOGY/ RADIOGRAPHY ; Cerebrospinal Fluid/ANALYSIS ; Child Development Disorders/ ETIOLOGY ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Infant ; Male ; Prognosis ; Support, U.S. Gov't, P.H.S. ; Tomography, X-Ray Computed SO - Pediatrics 1986 Oct;78(4):678-87 20 UI - 87000017 AU - Gould IA ; Belok LC ; Handwerger S TI - Listeria monocytogenes: a rare cause of opportunistic infection in the acquired immunodeficiency syndrome (AIDS) and a new cause of meningitis in AIDS. A case report. AB - A forty-two year-old male homosexual with the acquired immunodeficiency syndrome (AIDS) developed Listeria monocytogenes septicemia and meningitis. The gastrointestinal tract was the likely portal of entry. The patient was treated with intravenous ampicillin with complete and permanent resolution of his listerial infection. Although L. monocytogenes infection has been reported as an uncommon complications of AIDS, we are unaware of Listeria meningitis being previously reported in an AIDS patient. It is hoped that this case report will alert health care workers to the possibility of Listeria infection in AIDS patients, particularly since this infection responds well to readily-available antibiotic therapy. The microbiology, epidemiology, clinical, and neurologic aspects of listerial infection and general aspects of the acquired immunodeficiency syndrome are discussed. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Case Report ; Homosexuality ; Human ; Male ; Meningitis, Listeria/*COMPLICATIONS ; Middle Age ; Septicemia/COMPLICATIONS SO - AIDS Res 1986 Summer;2(3):231-4 21 UI - 86294297 AU - Rosenberg NL ; Hochberg FH ; Miller G ; Kleinschmidt-DeMasters BK TI - Primary central nervous system lymphoma related to Epstein-Barr virus in a patient with acquired immune deficiency syndrome. AB - The study of a patient suggested a relationship between Epstein-Barr virus infection and primary lymphoma of the central nervous system in the acquired immune deficiency syndrome. Deoxyribonucleic acid preparations from tumor tissue contained 30 to 100 copies of Epstein-Barr virus genome per cell when hybridized with a probe consisting of the Bam-HI K fragment of Epstein-Barr virus strain FF41. This hybridization study suggests that induction of this patient's central nervous system lymphoma was related to Epstein-Barr virus infection. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Brain Neoplasms/ ANALYSIS/*COMPLICATIONS ; Case Report ; DNA, Viral/ANALYSIS ; Epstein-Barr Virus ; Human ; Lymphoma, Non-Hodgkin's/ANALYSIS/ *COMPLICATIONS ; Male ; Middle Age ; *Occipital Lobe ; Tumor Virus Infections/*COMPLICATIONS SO - Ann Neurol 1986 Jul;20(1):98-102 22 UI - 86319782 AU - Lee YY ; Bruner JM ; Van Tassel P ; Libshitz HI TI - Primary central nervous system lymphoma: CT and pathologic correlation. AB - CT findings of 15 patients with histologically proven primary central nervous system (CNS) lymphoma were reviewed with pathologic correlation in order to evaluate variable CT patterns. There were a total of 32 lesions. Of the 15 patients studied, seven had acquired immunodeficiency syndrome (AIDS), all diagnosed within the past 3 years. The CT observations of eight non-AIDS patients were consistent with findings reported previously. Most of the lymphomatous lesions were either hyper- or isodense, round or oval masses with homogeneous contrast enhancement and variable surrounding edema. Pathologic examination showed tightly packed preserved lymphoma cells without necrosis. In AIDS patients, rim or ring enhancement of lymphoma, indistinguishable from brain abscess, was frequently seen. Histologic examination consistently showed extensive tumor necrosis with preservation of viable tumor cells at the periphery. A third and infrequent CT pattern was multiple infiltrative nonnodular solid enhancement with extensive edema. Pathologic correlation showed infiltrating viable tumor cells without necrosis. The rim- or ring-enhancing brain lesion seen in AIDS patients can either be an abscess or a primary lymphoma; proper tissue collection is essential for correct diagnosis and appropriate treatment. MH - Acquired Immunodeficiency Syndrome/PATHOLOGY/RADIOGRAPHY ; Adolescence ; Adult ; Aged ; Brain Neoplasms/PATHOLOGY/*RADIOGRAPHY ; Child ; Female ; Human ; Lymphoma/PATHOLOGY/*RADIOGRAPHY ; Male ; Middle Age ; Tomography, X-Ray Computed SO - AJR 1986 Oct;147(4):747-52 23 UI - 86319066 AU - Bernstein WB ; Scherokman B TI - Neuroleptic malignant syndrome in a patient with acquired immunodeficiency syndrome. AB - A patient with acquired immunodeficiency syndrome treated with prochlorperazine and droperidol developed neuroleptic malignant syndrome, characterized by akinetic mutism, resting tremor, cogwheel rigidity, and elevated serum creatine phosphokinase. An identical syndrome reappeared with subsequent administration of haloperidol. Neuroleptic malignant syndrome has not been previously reported in acquired immunodeficiency syndrome. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PSYCHOLOGY ; Adult ; Case Report ; Female ; Human ; Neuroleptic Malignant Syndrome/*ETIOLOGY/ PSYCHOLOGY SO - Acta Neurol Scand 1986 Jun;73(6):636-7 24 UI - 86319059 AU - Singh BM ; Levine S ; Yarrish RL ; Hyland MJ ; Jeanty D ; Wormser GP TI - Spinal cord syndromes in the acquired immune deficiency syndrome. AB - Two patients with AIDS developed paraparesis. Neuropathological post mortem examination in one revealed cytomegalovirus polyradiculopathy, and in the second, vacuolar myelopathy which occurred in association with brain lesions resembling Marchiafava-Bignami Syndrome. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY ; Adult ; Case Report ; Cytomegalic Inclusion Disease/ETIOLOGY/PATHOLOGY ; Hemoglobinuria, Paroxysmal/ETIOLOGY/PATHOLOGY ; Human ; Male ; Myelin Sheath/PATHOLOGY ; Spinal Cord Diseases/*ETIOLOGY/PATHOLOGY SO - Acta Neurol Scand 1986 Jun;73(6):590-8 25 UI - 86306818 AU - Farkash AE ; Maccabee PJ ; Sher JH ; Landesman SH ; Hotson G TI - CNS toxoplasmosis in acquired immune deficiency syndrome: a clinical-pathological-radiological review of 12 cases. AB - From January 1981 to January 1983 acquired immune deficiency syndrome (AIDS) was diagnosed in 90 patients admitted to Kings County Hospital-Downstate Medical Center. CNS involvement occurred in 18 patients of whom 12 had toxoplasmosis confirmed by biopsy or necropsy. Pathological specimens from these 12 patients were notable for a marked diminution or absence of cellular inflammation. Each patient had elevated serological studies for toxoplasma. AIDS presented with symptoms referable to CNS toxoplasma in eight patients. In the remaining four patients, toxoplasma was found late in the course of the illness. CT showed either ring enhancing lesions or solid nodules. The course was uniformly fatal, though patients treated continuously with pyrimethamine and sulfadiazine survived longer. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Brain/ ULTRASTRUCTURE ; Central Nervous System Diseases/*COMPLICATIONS/DIAGNOSIS/ PATHOLOGY ; Human ; Male ; Microscopy, Electron ; Middle Age ; Toxoplasmosis/*COMPLICATIONS/DIAGNOSIS/PATHOLOGY SO - J Neurol Neurosurg Psychiatry 1986 Jul;49(7):744-8 26 UI - 86293841 AU - Wolcott DL TI - Psychosocial aspects of acquired immune deficiency syndrome and the primary care physician. AB - Acquired immune deficiency syndrome is now an epidemic in the United States. Multiple factors contribute to the high degree of psychosocial stress experienced by those with HTLV-III infection, regardless of their current clinical status. Family members, friends, and health care professionals all often experience significant stresses associated with HTLV-III infection or AIDS-spectrum illness in the patient. Knowledge about the psychosocial consequences of cancer, of the unique psychosocial stresses experienced by individuals with AIDS-spectrum illness, and of the functional psychiatric syndromes and organic mental disorders common to AIDS can assist the primary care physician as he cares for individuals with HTLV-III infection and AIDS-spectrum illness. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/PSYCHOLOGY/*THERAPY ; Attitude to Death ; Central Nervous System Diseases/ETIOLOGY ; Communicable Disease Control ; Human ; Meningitis, Aseptic/ETIOLOGY ; Patient Education ; *Physicians, Family ; *Social Environment ; Social Isolation ; Social Problems ; *Social Support ; Stress, Psychological SO - Ann Allergy 1986 Aug;57(2):95-102 27 UI - 86289457 AU - Koenig S ; Gendelman HE ; Orenstein JM ; Dal Canto MC ; Pezeshkpour GH ; Yungbluth M ; Janotta F ; Aksamit A ; Martin MA ; Fauci AS TI - Detection of AIDS virus in macrophages in brain tissue from AIDS patients with encephalopathy. AB - One of the common neurological complications in patients with the acquired immune deficiency syndrome (AIDS) is a subacute encephalopathy with progressive dementia. By using the techniques of cocultivation for virus isolation, in situ hybridization, immunocytochemistry, and transmission electron microscopy, the identity of an important cell type that supports replication of the AIDS retrovirus in brain tissue was determined in two affected individuals. These cells were mononucleated and multinucleated macrophages that actively synthesized viral RNA and produced progeny virions in the brains of the patients. Infected brain macrophages may serve as a reservoir for virus and as a vehicle for viral dissemination in the infected host. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/*MICROBIOLOGY/PATHOLOGY ; Brain/MICROBIOLOGY/PATHOLOGY ; Brain Diseases/ETIOLOGY/*MICROBIOLOGY/ PATHOLOGY ; Dementia/ETIOLOGY/MICROBIOLOGY ; Demyelinating Diseases/ MICROBIOLOGY/PATHOLOGY ; Encephalitis/MICROBIOLOGY ; Human ; Human T-Cell Leukemia Virus/ANALYSIS/*ISOLATION & PURIFICATION ; Macrophages/ *MICROBIOLOGY ; Microscopy, Electron ; Nucleic Acid Hybridization ; Papovaviridae/ISOLATION & PURIFICATION ; RNA, Viral/ANALYSIS SO - Science 1986 Sep 5;233(4768):1089-93 28 UI - 86266880 AU - Bishburg E ; Sunderam G ; Reichman LB ; Kapila R TI - Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. AB - Central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with AIDS-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All Mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the AIDS-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or AIDS-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in drug abusers without disease. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Brain Abscess/ ETIOLOGY/RADIOGRAPHY ; Case Report ; Central Nervous System Diseases/ *ETIOLOGY ; Female ; Human ; Male ; Tomography, X-Ray Computed ; Tuberculoma/ETIOLOGY/RADIOGRAPHY ; Tuberculosis/*ETIOLOGY/RADIOGRAPHY ; Tuberculosis, Meningeal/ETIOLOGY SO - Ann Intern Med 1986 Aug;105(2):210-3 29 UI - 86257042 AU - Sarwar M ; Falkoff G ; Naseem M TI - Radiologic techniques in the diagnosis of CNS infections. AB - The radiologic diagnosis of CNS infections remains a challenge. CT scan findings, though admittedly nonspecific to a large extent, assume great diagnostic significance when considered in conjunction with clinical and laboratory findings. MRI is expected to show abnormalities in the earlier stages of these infections. MH - Acquired Immunodeficiency Syndrome/RADIOGRAPHY ; Arteritis/RADIOGRAPHY ; Brain Abscess/RADIOGRAPHY ; Central Nervous System Diseases/DIAGNOSIS/ *RADIOGRAPHY ; Cerebral Angiography ; Cerebral Ventricles ; Cerebrovascular Disorders/RADIOGRAPHY ; Cysticercosis/RADIOGRAPHY ; Encephalitis/ETIOLOGY/RADIOGRAPHY ; Herpes Simplex ; Human ; Infection/ DIAGNOSIS/*RADIOGRAPHY ; Jakob-Creutzfeldt Syndrome/RADIOGRAPHY ; Leukoencephalopathy, Progressive Multifocal/RADIOGRAPHY ; Lymphoma/ RADIOGRAPHY ; Meningitis/RADIOGRAPHY ; Mycoses/RADIOGRAPHY ; Nuclear Magnetic Resonance ; Subacute Sclerosing Panencephalitis/RADIOGRAPHY ; Subdural Effusion/RADIOGRAPHY ; Subdural Empyema/RADIOGRAPHY ; *Tomography, X-Ray Computed ; Toxoplasmosis/RADIOGRAPHY ; Tuberculosis, Meningeal/RADIOGRAPHY ; Ultrasonic Diagnosis SO - Neurol Clin 1986 Feb;4(1):41-68 30 UI - 86257039 AU - Price RW ; Navia BA ; Cho ES TI - AIDS encephalopathy. AB - It is now recognized that AIDS is frequently complicated by a progressive encephalopathy characterized by dementia and motor dysfunction. This article reviews the early and late clinical features of this disorder and examines current evidence that it is due to direct brain infection by the retrovirus that causes AIDS. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/ETIOLOGY/OCCURRENCE ; America ; Brain Diseases/*COMPLICATIONS/PATHOLOGY ; Child ; Child, Preschool ; Dementia/COMPLICATIONS/DIAGNOSIS/OCCURRENCE/PSYCHOLOGY ; Europe ; Human ; Male ; Support, Non-U.S. Gov't SO - Neurol Clin 1986 Feb;4(1):285-301 31 UI - 86257034 AU - Bia FJ ; Barry M TI - Parasitic infections of the central nervous system. AB - The authors give a comprehensive review of the epidemiology, clinical presentations, diagnosis and current therapy of parasitic infections with CNS manifestations in both the normal and immunocompromised host. These include toxoplasmosis, malaria, amebiasis, neurocystcersosis, hydatid disease, and trichinosis. Additional sections cover disseminated strongyloidiasis, eosinophilic meningitis, visceral and ocular larva migrans, schistosomiasis, and cerebral paragonimiasis. Emphasis is on the neurologic complications of these diseases and their presentations in populations at increased risk for acquiring or reactivating these infections. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS ; Adult ; Amebiasis ; Amebicides/THERAPEUTIC USE ; Antimalarials/THERAPEUTIC USE ; Brain Abscess/DIAGNOSIS/DRUG THERAPY/ETIOLOGY ; Central Nervous System Diseases/ COMPLICATIONS/*DIAGNOSIS/DRUG THERAPY/PARASITOLOGY ; Cysticercosis/ DIAGNOSIS/DRUG THERAPY/PATHOLOGY/PARASITOLOGY ; Echinococcosis/DIAGNOSIS/ DRUG THERAPY/PARASITOLOGY ; Entamoebiasis/COMPLICATIONS ; Eosinophilia/ COMPLICATIONS/DIAGNOSIS/DRUG THERAPY/PARASITOLOGY ; Human ; Malaria/ COMPLICATIONS/DIAGNOSIS/DRUG THERAPY/ETIOLOGY ; Male ; Meningitis/ COMPLICATIONS/DIAGNOSIS/DRUG THERAPY/PARASITOLOGY ; Meningoencephalitis/ DIAGNOSIS/DRUG THERAPY/ETIOLOGY ; Neoplasms/COMPLICATIONS ; Paragonimiasis/DIAGNOSIS/DRUG THERAPY/ETIOLOGY ; Parasitic Diseases/ COMPLICATIONS/*DIAGNOSIS/DRUG THERAPY/PARASITOLOGY ; Review ; Schistosomiasis/CLASSIFICATION/DIAGNOSIS/DRUG THERAPY/PARASITOLOGY ; Strongyloidiasis/COMPLICATIONS/DIAGNOSIS/PARASITOLOGY ; Support, U.S. Gov't, Non-P.H.S. ; Toxoplasmosis/COMPLICATIONS/PARASITOLOGY ; Trichinosis/DIAGNOSIS/DRUG THERAPY/MORTALITY/PREVENTION & CONTROL SO - Neurol Clin 1986 Feb;4(1):171-206 32 UI - 86257033 AU - Lyons RW ; Andriole VT TI - Fungal infections of the CNS. AB - Most CNS fungal infections can be divided into those that occur in normal hosts and those that occur in the immunosuppressed host. Cryptococcal infection, however, is common in both groups. The usual clinical presentation of a CNS fungal infection is chronic headache and mental status change. The CSF shows a lymphocytic meningitis with low sugar and high protein. Amphotericin B remains the drug of choice for most CNS fungal infections. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS ; Antifungal Agents/ THERAPEUTIC USE ; Blastomycosis/COMPLICATIONS/DIAGNOSIS ; Central Nervous System Diseases/COMPLICATIONS/*MICROBIOLOGY/PATHOLOGY/THERAPY ; Cerebrospinal Fluid/ANALYSIS/CYTOLOGY ; Coccidioidomycosis/COMPLICATIONS/ DIAGNOSIS ; Cryptococcosis/COMPLICATIONS/MICROBIOLOGY ; Diabetes Mellitus/ COMPLICATIONS ; Histoplasmosis/COMPLICATIONS/DIAGNOSIS ; Human ; Immune Tolerance ; Maduromycosis/COMPLICATIONS ; Mucormycosis/COMPLICATIONS/ DIAGNOSIS/PATHOLOGY/TRANSMISSION ; Mycoses/COMPLICATIONS/*MICROBIOLOGY/ PATHOLOGY/THERAPY ; Review SO - Neurol Clin 1986 Feb;4(1):159-70 33 UI - 86256022 AU - Goudsmit J ; de Wolf F ; Paul DA ; Epstein LG ; Lange JM ; Krone WJ ; Speelman H ; Wolters EC ; Van der Noordaa J ; Oleske JM ; et al TI - Expression of human immunodeficiency virus antigen (HIV-Ag) in serum and cerebrospinal fluid during acute and chronic infection. AB - Human immunodeficiency virus antigen (HIV-Ag) was detected in the serum of most adult (13/16) and paediatric (6/6) AIDS patients and rarely in the serum of symptomless seropositive controls (1/13). It was present in the cerebrospinal fluid (CSF) of all 5 children and most (5/9) adults with AIDS-related encephalopathy, but not in the CSF of 13 symptomless seropositive controls, of whom 8 had antibody in the CSF. A longitudinal study of 1 of the controls with antibody in the CSF showed that HIV-Ag in CSF was present transiently before the occurrence of antibody in the CSF. In serial samples of serum from 35 men who seroconverted HIV-Ag was detected in 11 persons--in 5 before seroconversion and in 6 after. 3 of the 6 who became antigenaemic after seroconversion remained so for the rest of the follow-up. AIDS was diagnosed in 1 patient, 3 months after HIV-Ag was first detected in serum and 6 months after seroconversion. The findings suggest that HIV-Ag appears early and transiently in primary HIV infection. Antibody production follows, after which HIV-Ag may disappear. Its persistence or reappearance seems to correlate with clinical, immunological, and neurological deterioration. MH - Acquired Immunodeficiency Syndrome/DIAGNOSIS/*IMMUNOLOGY ; Acute Disease ; Adult ; Antibodies, Viral/ANALYSIS ; Antigens, Viral/*ANALYSIS/ CEREBROSPINAL FLUID ; Brain Diseases/IMMUNOLOGY ; Child ; Child, Preschool ; Chronic Disease ; Female ; Homosexuality ; Human ; Human T-Cell Leukemia Virus/*IMMUNOLOGY ; Immunoassay ; Infant ; Male ; Middle Age ; Prospective Studies ; Risk ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Time Factors SO - Lancet 1986 Jul 26;2(8500):177-80 34 UI - 86254284 AU - Raedler A ; Bredow G ; Kirch W ; Thiele HG ; Greten H TI - In vivo activated peripheral T cells in autoimmune disease. AB - Starting from the observation, if that in patients suffering from inflammatory bowel diseases elevated numbers of activated peripheral immunocytes can be detected in correlation to the activity of the disease, subpopulations of lymphocytes in immune-mediated disorders were analyzed for the expression of activation associated antigens. It was found that in patients with immunovasculitis, sarcoidosis, M. Beh:cet, multiple sclerosis, antibody-mediated hemophilia, SLE,--but not in those with scleroderma--, increased numbers of activated immunocytes could be detected during acute exacerbation, whereas, in remission, the population of activated immunocytes was in the upper normal range. Analyses of phenotypes revealed that the majority of activated immunocytes are T cells. However, a variable minority of cells bear B cell associated determinants. As is the case in total peripheral T cells, the T4 to T8 ratio was in a normal range. Only in Beh:cet disease and immunovasculitis was the ratio of activated T4 positive to activated T8 positive lymphocytes found to be decreased. In contrast to T cells in patients with inflammatory bowel disease, the majority of activated T cells in the autoimmune disorders under study does not express Fc alpha-receptors. In Beh:cet disease and immunovasculitis moreover, the incidence of activated Leu 7 positive (= natural killer) cells is low compared to T cells from patients with Crohn's disease or ulcerative colitis. These experiments lead to the conclusion that the assessment of activated immunocytes may serve as a parameter in the evaluation of the clinical activity of autoimmune diseases.(ABSTRACT TRUNCATED AT 250 WORDS) MH - Acquired Immunodeficiency Syndrome/BLOOD ; Adult ; Aged ; Autoimmune Diseases/*BLOOD/FAMILIAL & GENETIC ; Behcet's Syndrome/BLOOD ; Comparative Study ; Helper Cells/IMMUNOLOGY ; Human ; Killer Cells, Natural/IMMUNOLOGY ; Lupus Erythematosus, Systemic/BLOOD ; Lymphocyte Transformation ; Middle Age ; Multiple Sclerosis/BLOOD ; Phenotype ; Receptors, Fc/PHYSIOLOGY ; Sarcoidosis/BLOOD ; Support, Non-U.S. Gov't ; T Lymphocytes/*IMMUNOLOGY ; T Lymphocytes, Cytotoxic/IMMUNOLOGY ; Vasculitis/BLOOD/IMMUNOLOGY SO - J Clin Lab Immunol 1986 Apr;19(4):181-6 35 UI - 86249793 AU - Detmer WM ; Lu FG TI - Neuropsychiatric complications of AIDS: a literature review. AB - Acquired immune deficiency syndrome (AIDS) has become a major public health problem with over 12,000 cases and 6,000 deaths reported to date. Although there has been an explosion of knowledge in the virology, immunology and pathology of AIDS, relatively little has been written on the neuropsychiatric aspects. This report reviews the existing literature on the neuropsychiatric complications of AIDS. As many as 40 percent of patients with AIDS have neurologic complications at some point in their illness. These complications include either focal deficits attributable to opportunistic organisms infecting the CNS or diffuse encephalopathy caused by viral infection or lymphoma infiltration. Psychiatric complications include major depression, adjustment disorder with depressed mood, and organic brain syndrome with affective, delusional or demented features. Inpatient and consulting psychiatrists must be alert to these complications of AIDS so as to make accurate diagnoses and deliver appropriate therapy. Further studies, integrating both psychiatric and neurologic perspectives, are needed to better elucidate the neuropsychiatric complications of AIDS and help plan appropriate therapeutic interventions. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adjustment Disorders/ ETIOLOGY ; Brain Diseases/*ETIOLOGY ; Brain Neoplasms/ETIOLOGY ; Cerebrovascular Disorders/ETIOLOGY ; Cryptococcosis/ETIOLOGY ; Depressive Disorder/ETIOLOGY ; Encephalitis/ETIOLOGY ; Human ; Lymphoma/ETIOLOGY ; Mental Disorders/*ETIOLOGY ; Organic Mental Disorders/ETIOLOGY ; Review ; Toxoplasmosis/ETIOLOGY SO - Int J Psychiatry Med 1986-87;16(1):21-9 36 UI - 86238345 AU - Lindboe CF ; Fr:land SS ; Wefring KW ; Linnestad PJ ; B:hmer T ; Foerster A ; L:ken AC TI - Autopsy findings in three family members with a presumably acquired immunodeficiency syndrome of unknown etiology. AB - This paper presents clinical, immunological and post-mortem findings in three family members (husband, wife and daughter) who all died in 1976 after having had chronic and recurrent opportunistic infections for many years. In all of them a progressive, presumably acquired T-lymphocyte defect associated with B-lymphocyte dysfunction had been diagnosed several years before death. The clinical and immunological findings are compatible with those seen in acquired immunodeficiency syndrome (AIDS) caused by HTLV-III/LAV infection, but examinations of stored blood samples from the three patients were negative with regard to the presence of HTLV-III/LAV antibodies. This immunodeficiency may therefore have been caused by an infectious agent of unknown nature. The most remarkable finding on post-mortem examination was the presence of a granulomatous encephalomyelitis with multinucleated giant cells in the husband and his wife. In addition, the wife's CNS revealed scattered microglial nodules. No infectious agents could be demonstrated, and the etiology of this peculiar CNS affection therefore remains obscure. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/FAMILIAL & GENETIC/ *PATHOLOGY ; Autopsy ; B Lymphocytes/IMMUNOLOGY ; Candidiasis/ COMPLICATIONS ; Cerebral Cortex/PATHOLOGY ; Encephalomyelitis/PATHOLOGY ; Human ; Pulmonary Alveoli/PATHOLOGY ; Spinal Cord/PATHOLOGY ; T Lymphocytes/IMMUNOLOGY SO - Acta Pathol Microbiol Immunol Scand [A] 1986 Mar;94(2):117-23 37 UI - 86231462 AU - Eidelberg D ; Sotrel A ; Vogel H ; Walker P ; Kleefield J ; Crumpacker CS 3d TI - Progressive polyradiculopathy in acquired immune deficiency syndrome. AB - We studied three patients with acquired immune deficiency syndrome (AIDS) and progressive polyradiculopathy. Postmortem examination of one patient disclosed extensive necrosis, inflammatory infiltrates, and focal vasculitis of spinal roots. Typical cytomegaloviral (CMV), intranuclear, and intracytoplasmic inclusions were noted within enlarged endoneurial and endothelial cells. Progressive polyradiculopathy is an unusual complication of AIDS; CMV may be the causative agent in certain cases. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Case Report ; Cauda Equina ; Cytomegalic Inclusion Disease/COMPLICATIONS ; Human ; Lumbar Vertebrae ; Male ; Polyradiculitis/*ETIOLOGY/PATHOLOGY/RADIOGRAPHY ; Sacrum ; Spinal Nerve Roots/PATHOLOGY/RADIOGRAPHY ; Tomography, X-Ray Computed SO - Neurology 1986 Jul;36(7):912-6 38 UI - 86226623 AU - Shih WJ ; Domstad PA ; DeLand FH TI - Opportunistic intracranial infection in AIDS detection by technetium-99m DTPA brain scintigraphy. AB - Radionuclide brain scintigraphy and computed tomography (CT) demonstrated cerebral lesions in two patients with acquired immunodeficiency disease syndrome (AIDS) complicated by opportunistic infection of the brain. In the detection of these cerebral lesions, [99mTc]DTPA radionuclide scintigraphy was as reliable as CT. Since malignant lymphoma involving the brain has been seen with increasing frequency in patients with AIDS, the positive brain scan alone is nonspecific and should be correlated appropriately with the clinical setting. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/RADIOGRAPHY/ *RADIONUCLIDE IMAGING ; Adult ; Bacterial Infections/RADIONUCLIDE IMAGING ; Brain/RADIOGRAPHY/*RADIONUCLIDE IMAGING ; Case Report ; Encephalitis/ *RADIONUCLIDE IMAGING ; Human ; Male ; Meningitis/*RADIONUCLIDE IMAGING ; Middle Age ; Tomography, X-Ray Computed ; Virus Diseases/RADIONUCLIDE IMAGING SO - J Nucl Med 1986 Apr;27(4):498-501 39 UI - 86224951 AU - Smith JP TI - Nursing and health care in the twentieth century: myth, reality and dichotomy. AB - In this Fourth Ruth Langton Memorial Lecture, the author highlights some of the major health problems in children, mentally and physically handicapped people, and in the growing numbers of elderly people in society. Nurses' roles are discussed. He identifies many major areas of concern and points out that many of the afflictions affecting people throughout the world, such as infectious diseases, blindness and malnutrition, could so easily be prevented. The author also focuses on the diseases caused by unhealthy lifestyles, in particular heart disease, cancers, drug addiction and obesity. He argues that a redirection of resources spent on arms and defense could do much to alleviate disease and suffering throughout the world. He also questions the present effectiveness of nursing education programmes and community care programmes. The paper concludes with a challenge to all nurses to explode the myth that society is becoming healthier, to face the reality of the urgent need for more primary health care and health education programmes, and to heal the dichotomy between present nursing and health care provision and the actual health needs of society. MH - Acquired Immunodeficiency Syndrome/NURSING ; Adult ; Aged ; Alzheimer's Disease/NURSING ; Child ; Great Britain ; Handicapped ; *Health ; Health Resources ; *Health Status ; Human ; Life Style ; Mental Disorders/ NURSING ; Mental Retardation/NURSING ; Middle Age ; Nursing/*TRENDS ; Role ; Technology SO - J Adv Nurs 1986 Mar;11(2):127-32 40 UI - 86214444 AU - Gal AA ; Koss MN ; Hawkins J ; Evans S ; Einstein H TI - The pathology of pulmonary cryptococcal infections in the acquired immunodeficiency syndrome. AB - Specimens from premortem pulmonary cytology, transbronchial biopsy, and autopsy were studied in 11 patients with acquired immunodeficiency syndrome who developed pulmonary cryptococcal disease. Nine of 11 patients had culture-proved cryptococcal meningitis. Extremely low T-cell helper/suppressor ratios (mean, 0.12) were observed in seven of 11 patients. In six of eight patients, transbronchial biopsy specimens showed a characteristic interstitial pattern with yeasts in the alveolar septae, minimal cellular inflammation, and no well-formed granulomas. On cytologic examination, organisms were present in seven (100%) of seven cell blocks and five (83%) of six smears prepared from the bronchoalveolar lavage, and in five (63%) of eight bronchial brushings. Small, poorly encapsulated yeast forms were sometimes present, requiring mucicarmine and acid mucopolysaccharide stains for confirmation of the diagnosis of pulmonary cryptococcosis. Overall, bronchoscopy yielded a diagnosis in seven of eight patients. At autopsy, two of five patients demonstrated an interstitial pattern of infection in all lobes of the lung with marked pleural thickening and giant-cell formation; two other patients showed mixed interstitial and intra-alveolar cryptococcal infiltrates. Nodal and disseminated infection were present in four patients. In patients with acquired immunodeficiency syndrome who have cryptococcal meningitis, pulmonary cryptococcal disease is common and must be distinguished from other opportunistic infections. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Cryptococcosis/ETIOLOGY/*PATHOLOGY ; Human ; Irrigation ; Kidney/ MICROBIOLOGY/PATHOLOGY ; Lung/MICROBIOLOGY/PATHOLOGY ; Lung Diseases, Fungal/ETIOLOGY/*PATHOLOGY ; Meningitis/ETIOLOGY/PATHOLOGY ; Pulmonary Alveoli/MICROBIOLOGY/PATHOLOGY SO - Arch Pathol Lab Med 1986 Jun;110(6):502-7 41 UI - 86141973 AU - Haase AT TI - The pathogenesis of slow virus infections: molecular analyses. AB - Slow infections raise some novel issues in understanding the pathogenesis of viral diseases that have been increasingly addressed at the molecular level with in situ hybridization. These developments are reviewed as the framework for discussion of the realized and potential impact of these investigations for major neurological afflictions of humans and for AIDS. MH - Acquired Immunodeficiency Syndrome/MICROBIOLOGY ; Adult ; Aged ; Alzheimer's Disease/MICROBIOLOGY ; Animal ; DNA/ANALYSIS ; DNA, Viral/ METABOLISM ; Gene Expression Regulation ; Human ; Lysogeny ; Measles Virus/*GENETICS ; Nucleic Acid Hybridization ; Reverse Transcriptase/ METABOLISM ; RNA, Viral/ANALYSIS ; Scrapie/FAMILIAL & GENETIC/ *MICROBIOLOGY ; Slow Virus Diseases/*ETIOLOGY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. ; Visna-Maedi Viruses/PATHOGENICITY SO - J Infect Dis 1986 Mar;153(3):441-7 42 UI - 86211753 AU - Post MJ ; Hensley GT ; Moskowitz LB ; Fischl M TI - Cytomegalic inclusion virus encephalitis in patients with AIDS: CT, clinical, and pathologic correlation. AB - The computed tomographic (CT) scans of 10 patients with acquired immunodeficiency syndrome who had central nervous system (CNS) involvement by cytomegalovirus (CMV) were retrospectively reviewed and correlated with clinical data and pathologic findings. Diagnosis was established in all 10 patients by autopsy, which showed the pathognomonic "owl's eye: intracellular inclusions of CMV. In six patients CMV caused an initial CNS infection that was directly responsible for the patient's progressive encephalopathy and death. In four patients CMV caused a superimposed nondominant CNS infection that had no clinical expression in two. Cortical atrophy and mild hydrocephalus ex vacuo were seen on CT in all 10 patients. Positive findings on CT that could be attributed to infection with CMV were present in only three of the 10 patients, and in these three symptomatic cases autopsy correlation revealed that CT underestimated the degree of CNS involvement. In the other three symptomatic patients, CT showed nonormalities, while autopsy demonstrated diffuse cerebral involvement. In the four patients whose CNS was secondarily involved by CMV, CT showed changes proven at autopsy to be related only to the dominant infection with Toxoplasma gondii and to postoperative hematomas. CT did not demonstrate any abnormalities at the sites of CMV involvement, which were found at autopsy in this latter group. It was concluded that CT is not very sensitive for the detection of CMV encephalitis. MH - Acquired Immunodeficiency Syndrome/COMPLICATIONS/PATHOLOGY/*RADIOGRAPHY ; Adult ; Brain/PATHOLOGY/*RADIOGRAPHY ; Cytomegalic Inclusion Disease/ COMPLICATIONS/PATHOLOGY/*RADIOGRAPHY ; Cytomegaloviruses ; Encephalitis/ MICROBIOLOGY/PATHOLOGY/*RADIOGRAPHY ; Female ; Florida ; Haiti/ETHNOLOGY ; Homosexuality ; Human ; Male ; Middle Age ; Nuclear Magnetic Resonance/ DIAGNOSTIC USE ; Papovaviridae ; Retrospective Studies ; *Tomography, X-Ray Computed ; Toxoplasma ; Tumor Virus Infections/RADIOGRAPHY SO - AJR 1986 Jun;146(6):1229-34 43 UI - 86205560 AU - Delisle MB ; Bouissou H ; Saidi A TI - What's new in cerebral pathology in acquired immune deficiencies? AB - Over the last few decades, a new pathology has appeared, directly related to the modified immune status of the hosts. It presents several distinctive points. The central nervous system is particularly affected. The opportunistic pathogenic agents do not usually injure the brain parenchyma and are not known for their aggressiveness in normal adults (papovavirus). Diagnosis of these different diseases is often difficult, some biological tests being irrelevant because of alterations of the immune system (toxoplasmosis). The lesions may be exclusively located in the brain (tuberculosis, lymphomas) which is not usually affected by these agents. Response to therapy is frequently poor, the clinical course being rapid and fatal. However, therapy may be successful in some cases, justifying the use of somewhat aggressive procedures (biopsy) in order to obtain an accurate diagnosis. It is important to be aware of these data, and an understanding of them may help in managing these already difficult patients. They also make possible some interesting pathogenic hypotheses. MH - Acquired Immunodeficiency Syndrome/PATHOLOGY ; Adult ; Bacterial Infections/DIAGNOSIS ; Brain/*PATHOLOGY ; Brain Neoplasms/ETIOLOGY/ PATHOLOGY ; Cytomegalic Inclusion Disease/ETIOLOGY/PATHOLOGY ; Encephalitis/ETIOLOGY/PATHOLOGY ; Female ; Human ; Immunologic Deficiency Syndromes/COMPLICATIONS/*PATHOLOGY ; Leukoencephalopathy, Progressive Multifocal/ETIOLOGY/PATHOLOGY ; Lymphoma/ETIOLOGY/PATHOLOGY ; Male ; Middle Age ; Mycoses/DIAGNOSIS ; Review ; Toxoplasmosis/ETIOLOGY/ PATHOLOGY ; Transplantation/ADVERSE EFFECTS ; Virus Diseases/DIAGNOSIS SO - Pathol Res Pract 1986 Mar;181(1):85-92 44 UI - 86196983 AU - Post MJ ; Curless RG ; Gregorios JB ; Scott GB ; Sheldon JJ TI - Reactivation of congenital cytomegalic inclusion disease in an infant with HTLV-III associated immunodeficiency: a CT-pathologic correlation. AB - Serial CT findings in an infant with HTLV-III infection and cytomegalic inclusion virus encephalitis are presented. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Case Report ; Comparative Study ; Cytomegalic Inclusion Disease/*CONGENITAL ; Encephalitis/*ETIOLOGY/PATHOLOGY/RADIOGRAPHY ; Female ; Human ; Infant ; Retrovirus Infections/*COMPLICATIONS ; Tomography, X-Ray Computed SO - J Comput Assist Tomogr 1986 May-Jun;10(3):533-6 45 UI - 86185611 AU - Pippard MJ ; Dalgleish A ; Gibson P ; Malkovsky M ; Webster AD TI - Acquired immunodeficiency with disseminated cryptococcosis. AB - A 9 year old Portuguese boy presented with severe wasting and a disseminated cryptococcal infection that resolved after massive doses of intrathecal and parenteral antifungal agents. Clinical and laboratory findings were consistent with AIDS. Apart from neonatal blood transfusions, there were no identified risk factors for HTLV III infection. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY ; Brain Diseases/CEREBROSPINAL FLUID/ETIOLOGY ; Case Report ; Cerebral Cortex/ PATHOLOGY ; Child ; Cryptococcosis/CEREBROSPINAL FLUID/DRUG THERAPY/ *ETIOLOGY ; Human ; Male SO - Arch Dis Child 1986 Mar;61(3):289-91 46 UI - 86185367 AU - Navia BA ; Petito CK ; Gold JW ; Cho ES ; Jordan BD ; Price RW TI - Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. AB - We reviewed the clinical, neuroradiological, and serological findings in 27 patients with cerebral toxoplasmosis complicating the acquired immune deficiency syndrome, 19 of whom were also analyzed neuropathologically. The clinical manifestations of this disorder varied, ranging from headache and fever to coma. However, the characteristic presentation included focal neurological symptoms and signs, usually of subacute onset. In addition, two-thirds of the patients exhibited more generalized cerebral dysfunction with confusion and lethargy. The computed tomographic (CT) scan most commonly revealed ring contrast enhancement, which appeared to correlate best with the histological presence of vascular proliferation and inflammation surrounding the abscesses. However, in 5 patients the CT scan revealed either homogeneous enhancement or no enhancement, and in 3 patients the scans were negative. In general, CT scans underrepresented the number of lesions eventually documented pathologically. Double-dose contrast administration and preliminary experience with magnetic resonance imaging suggested that these techniques were superior to standard CT scanning in detecting Toxoplasma lesions. All patients were seropositive for IgG antibody against Toxoplasma gondii in blood, both before the onset of illness and at the time of presentation, although titers in some patients were as low as 1:8 and most patients did not exhibit rising titers. Prompt therapy resulted in rapid clinical improvement, documented by CT scan, associated with the development of an organizing tissue response in the host and elimination of free organisms. Response to treatment was sufficiently rapid in most patients to allow a trial of therapy as the favored approach to diagnosis. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY ; Adult ; Biopsy ; Brain Diseases/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY/RADIOGRAPHY ; Case Report ; Central Nervous System/*PATHOLOGY/RADIOGRAPHY ; Clindamycin/THERAPEUTIC USE ; Human ; Male ; Middle Age ; Pyrimethamine/ THERAPEUTIC USE ; Serology ; Sulfonamides/THERAPEUTIC USE ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed ; Toxoplasmosis/ *COMPLICATIONS/DRUG THERAPY/PATHOLOGY/RADIOGRAPHY SO - Ann Neurol 1986 Mar;19(3):224-38 47 UI - 86185356 AU - Ryder JW ; Croen K ; Kleinschmidt-DeMasters BK ; Ostrove JM ; Straus SE ; Cohn DL TI - Progressive encephalitis three months after resolution of cutaneous zoster in a patient with AIDS. AB - A 37-year-old homosexual man with the acquired immune deficiency syndrome (AIDS) developed progressive, ultimately fatal, neurological deficits 12 weeks after a course of cutaneous zoster. Premortem radiological procedures and cerebrospinal fluid analyses were nondiagnostic. At postmortem examination, several opportunistic infections associated with AIDS were recognized. Throughout the brain, necrotic and demyelinative lesions were present, suggestive of progressive multifocal leukoencephalopathy. However, light microscopical examination showed numerous Cowdry type A intranuclear inclusions in astrocytes, oligodendrocytes, and neurons near the periphery of the lesions. Herpes zoster encephalomyelitis was diagnosed and confirmed by electron microscopy, peroxidase-antiperoxidase staining, and by Southern blot analysis of DNA extracted from brain tissue. This case provides insight into the pathogenesis of zoster-associated encephalomyelitis and suggests another agent to be considered in the differential diagnosis of encephalopathy in patients with AIDS and other disorders of immunological impairment. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY ; Adult ; Brain/*PATHOLOGY ; Case Report ; Encephalomyelitis/*COMPLICATIONS/ DIAGNOSIS/PATHOLOGY ; Herpes Zoster/*COMPLICATIONS/DIAGNOSIS/PATHOLOGY ; Human ; Male ; Microscopy, Electron ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. SO - Ann Neurol 1986 Feb;19(2):182-8 48 UI - 86177586 AU - Stoner GL ; Ryschkewitsch CF ; Walker DL ; Webster HD TI - JC papovavirus large tumor (T)-antigen expression in brain tissue of acquired immune deficiency syndrome (AIDS) and non-AIDS patients with progressive multifocal leukoencephalopathy. AB - Progressive multifocal leukoencephalopathy (PML) is a JC papovavirus infection of the central nervous system in immunocompromised patients. It is well established that demyelination in PML is caused by JC virus infection of oligodendroglia, but whether the nonstructural regulatory protein, large tumor (T) antigen, is detectable in infected human tissue was not known. Using a modification of the peroxidase-antiperoxidase technique, we found T antigen expressed in the nuclei of cells in virus-infected sites in five cases of PML studied, including two with acquired immune deficiency syndrome (AIDS). PML occurs in AIDS at a much higher frequency than in other immunosuppressive disorders, and PML in AIDS may represent a more severe form of JC virus infection of the central nervous system. MH - Acquired Immunodeficiency Syndrome/IMMUNOLOGY/*MICROBIOLOGY ; Antigens, Viral, Tumor/*ANALYSIS ; Brain/IMMUNOLOGY/*MICROBIOLOGY ; Cell Transformation, Viral ; Fixatives ; Human ; JC Virus/*IMMUNOLOGY ; Leukoencephalopathy, Progressive Multifocal/IMMUNOLOGY/*MICROBIOLOGY ; Polyomaviruses/*IMMUNOLOGY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. SO - Proc Natl Acad Sci USA 1986 Apr;83(7):2271-5 49 UI - 86170569 AU - Bahls F ; Sumi SM TI - Cryptococcal meningitis and cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome. AB - A 34-year-old homosexual male developed cryptococcal meningitis as the initial manifestation of Acquired Immune Deficiency Syndrome (AIDS). With antifungal therapy he improved. Six weeks later he developed focal motor seizures and progressive hemiplegia. Computer assisted tomography revealed multiple, ring-enhancing, low density lesions. The patient expired and at necropsy he was found to have multiple toxoplasma brain abscesses as well as chronic cryptococcal meningitis. This case demonstrates that in a patient with AIDS with pre-existing central nervous system infection who develops new neurological symptoms the possibility of a second and potentially treatable infection must be considered and its diagnosis pursued vigorously. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY ; Adult ; Brain/*PATHOLOGY ; Brain Diseases/*COMPLICATIONS ; Case Report ; Cryptococcosis/*COMPLICATIONS/PATHOLOGY ; Human ; Male ; Meningitis/ *COMPLICATIONS/PATHOLOGY ; Toxoplasmosis/*COMPLICATIONS/PATHOLOGY SO - J Neurol Neurosurg Psychiatry 1986 Mar;49(3):328-30 50 UI - 86159979 AU - Beresford TP ; Blow FC ; Hall RC TI - AIDS encephalitis mimicking alcohol dementia and depression. AB - The authors report a case of encephalitis occurring in a setting consistent with acquired immune deficiency syndrome (AIDS). They point out that AIDS and its complications can mimic psychiatric syndromes, including depression and dementia, or delirium related to illnesses such as alcoholism. Acting out behavior, seen in the present case, may also be mistaken as a symptom of sociopathy. MH - Acquired Immunodeficiency Syndrome/*DIAGNOSIS ; Adult ; Alcoholism/ *DIAGNOSIS ; Case Report ; Dementia/*CHEMICALLY INDUCED ; Depressive Disorder/*DIAGNOSIS ; Diagnostic Errors ; Encephalitis/*DIAGNOSIS ; Human ; Male SO - Biol Psychiatry 1986 Apr;21(4):394-7 51 UI - 86142149 AU - Beckham MM ; Rudy EB TI - Acquired immunodeficiency syndrome: impact and implication for the neurological system. AB - Acquired immunodeficiency syndrome (AIDS) has reached epidemic proportions throughout the world. Because at least 40% of AIDS victims are neurologically symptomatic, the neuroscience nurse must be prepared to care for increasing numbers of these patients. This article will define the syndrome, identify risk groups, and discuss the possible etiology. An explanation of the immune system will facilitate understanding of AIDS and its impact on the neurological system. The role of the nurse will be considered, with emphasis on the psychosocial implications of the syndrome for its victims. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY/NURSING/ TRANSMISSION ; Attitude of Health Personnel ; Central Nervous System Diseases/ETIOLOGY/IMMUNOLOGY ; Fear ; Human ; Immunity ; Nervous System Diseases/*ETIOLOGY/IMMUNOLOGY/NURSING ; Nurses/PSYCHOLOGY ; Nursing Assessment ; Risk SO - J Neurosci Nurs 1986 Feb;18(1):5-10 52 UI - 86138293 AU - Sharer LR ; Epstein LG ; Cho ES ; Joshi VV ; Meyenhofer MF ; Rankin LF ; Petito CK TI - Pathologic features of AIDS encephalopathy in children: evidence for LAV/HTLV-III infection of brain. AB - The neuropathologic findings in 11 children with a new CNS disorder that occurs in children with the acquired immunodeficiency syndrome (AIDS) and is postulated to be due to LAV/HTLV-III, the virus that causes AIDS, are reported. The children, who ranged in age from 4 months to 11 years, died of AIDS complicated by progressive encephalopathy. Ten of the children either had positive serum antibody for LAV/HTLV-III or had received blood products from donors later found to be antibody-positive. Examination of the brains of these children at autopsy revealed a unique constellation of findings, including varying degrees of diminished brain weight in all cases, inflammatory cell infiltrates in nine brains, multinucleated cells in eight, three of which also contained multinucleated giant cells, vascular calcification in ten, vascular and perivascular inflammation in five, and white matter changes in nine. Inflammatory and vascular lesions were most prominent in basal ganglia and pons. LAV/HTLV-III retroviral particles, associated with multinucleated giant cells, were observed in two brains on electron microscopic examination. These two and one additional brain had evidence of the LAV/HTLV-III genome by hybridization studies. Only one brain had a recognizable opportunistic infection. MH - Acquired Immunodeficiency Syndrome/MICROBIOLOGY/*PATHOLOGY ; Antibodies, Viral/ANALYSIS ; Atrophy/PATHOLOGY ; Autopsy ; Base Sequence ; Blood Transfusion/ADVERSE EFFECTS ; Brain/BLOOD SUPPLY/MICROBIOLOGY/*PATHOLOGY ; Case Report ; Child ; Child, Preschool ; Encephalitis/MICROBIOLOGY/ *PATHOLOGY ; Female ; Human ; Human T-Cell Leukemia Virus/GENETICS/ IMMUNOLOGY/*ULTRASTRUCTURE ; Infant ; Inflammation/PATHOLOGY ; Lymphatic Diseases/*MICROBIOLOGY ; Male ; Microscopy, Electron ; Retrovirus Infections/MICROBIOLOGY ; Virion/ULTRASTRUCTURE SO - Hum Pathol 1986 Mar;17(3):271-84 53 UI - 86134315 AU - Anders K ; Steinsapir KD ; Iverson DJ ; Glasgow BJ ; Layfield LJ ; Brown WJ ; Cancilla PA ; Verity MA ; Vinters HV TI - Neuropathologic findings in the acquired immunodeficiency syndrome (AIDS). AB - The acquired immunodeficiency syndrome (AIDS) is characterized by a severe idiopathic deficiency in T-cell mediated immunity. Homosexuals, intravenous drug abusers and Haitians are predominantly affected, predisposing them to opportunistic infections and neoplasms. In this study, the central nervous system (CNS) was examined at autopsy in 29 AIDS patients. Significant CNS complications occurred in 55%, mainly related to opportunistic infections similar to those seen in patients with other causes of immunosuppression. Progressive multifocal leukoencephalopathy (three cases), cytomegalovirus (CMV) encephalitis (five cases), cryptococcal meningitis (four cases), Mycobacterium avium-intracellulare (three cases), and toxoplasmosis (one case) were found. Widespread microglial nodules were observed in 20 patients, 80% of whom had CMV inclusions elsewhere at autopsy. Primary cerebral lymphoma (one case) and lymphomatoid granulomatosis (one case) were present. Subarachnoid (five cases) and intraparenchymal (three cases) hemorrhage was seen although these were not usually clinically significant. A single case of embolic arterial obstruction with cortical infarction was due to non-bacterial thrombotic endocarditis. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY ; Adult ; Brain/*PATHOLOGY ; Brain Diseases/*COMPLICATIONS ; Human ; Lymphoma/ COMPLICATIONS ; Lymphomatoid Granulomatosis/COMPLICATIONS ; Male ; Middle Age ; Mycoses/COMPLICATIONS ; Protozoan Infections/COMPLICATIONS ; Sarcoma, Kaposi's/COMPLICATIONS ; Support, Non-U.S. Gov't ; Virus Diseases/COMPLICATIONS SO - Clin Neuropathol 1986 Jan-Feb;5(1):1-20 54 UI - 86128605 AU - Zuger A ; Louie E ; Holzman RS ; Simberkoff MS ; Rahal JJ TI - Cryptococcal disease in patients with the acquired immunodeficiency syndrome. Diagnostic features and outcome of treatment. AB - Between 1 January 1981 and 1 December 1984, 34 of 396 patients with the acquired immunodeficiency syndrome (AIDS) developed cryptococcal infections. Twenty-six cases are reviewed. Twenty-two patients had brain or meningeal disease; the others had pulmonary disease (2 patients), pericarditis (1 patient), and antigenemia (1 patient). During treatment, 3 patients died of cryptococcosis and 3 died of other causes. Fifteen patients were followed for more than 6 weeks after treatment. Of 8 patients who received no additional amphotericin B, 4 had relapses and died of cryptococcosis within 6 months, 3 died of other causes, and 1 survived. Of 7 patients who received maintenance therapy with amphotericin B, none had relapses, 3 died of other causes, and 4 survived. Our data suggest that maintenance therapy with amphotericin may be needed to prevent relapse in patients with AIDS. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Amphotericin B/*THERAPEUTIC USE ; Brain Diseases/CEREBROSPINAL FLUID/ETIOLOGY/ RADIOGRAPHY ; Cryptococcosis/DIAGNOSIS/ETIOLOGY/MORTALITY/*THERAPY ; Drug Therapy, Combination ; Female ; Flucytosine/THERAPEUTIC USE ; Human ; Injections, Intravenous ; Injections, Intraventricular ; Male ; Meningitis/CEREBROSPINAL FLUID/ETIOLOGY ; Middle Age ; Prognosis ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed SO - Ann Intern Med 1986 Feb;104(2):234-40 55 UI - 86097293 AU - Polsky B ; Gold JW TI - The acquired immune deficiency syndrome. AB - Although the etiologic agent of AIDS has been identified, clinicians are still left with treating the complications of this immune deficiency, that is, the unusual neoplasms such as KS and the myriad of opportunistic infections. Efforts at immune reconstitution, including bone marrow transplantation from a normal identical twin to his brother with AIDS, have been unsuccessful. The transplanted lymphocytes are as likely to become infected as the patient's own. Therefore, future efforts must be directed at defining the natural history and infectivity of individuals showing evidence of HTLV III or LAV infection and toward specific antiviral therapy for those with infection and a vaccine for those at high risk for HTLV III infection and, consequently, AIDS. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY/THERAPY ; Bacterial Infections/ETIOLOGY ; Candidiasis/ETIOLOGY ; Cryptococcosis/ ETIOLOGY ; Cryptosporidiosis/ETIOLOGY ; Cytomegalic Inclusion Disease/ ETIOLOGY ; Encephalitis/ETIOLOGY ; Female ; Herpes Simplex/ETIOLOGY ; Human ; Leukoencephalopathy, Progressive Multifocal/ETIOLOGY ; Male ; Mycobacterium Infections, Atypical/ETIOLOGY ; Pneumonia, Pneumocystis Carinii/ETIOLOGY ; Review ; Salmonella Infections/ETIOLOGY ; Sarcoma, Kaposi's/ETIOLOGY ; T Lymphocytes/IMMUNOLOGY ; Toxoplasmosis/ETIOLOGY SO - Surg Annu 1986;18:280-95 56 UI - 86068923 AU - Post MJ ; Sheldon JJ ; Hensley GT ; Soila K ; Tobias JA ; Chan JC ; Quencer RM ; Moskowitz LB TI - Central nervous system disease in acquired immunodeficiency syndrome: prospective correlation using CT, MR imaging, and pathologic studies. AB - A prospective study compared the abilities of high-resolution computed tomography (HRCT) and magnetic resonance (MR) imaging in detection and evaluation of central nervous system disease in neurologically symptomatic patients with acquired immunodeficiency syndrome (AIDS). Eighteen CT scans and 19 MR images in 14 patients were compared. HRCT images with contrast material enhancement were superior to unenhanced 0.35-T MR images for differentiating a lesion from surrounding edema, discriminating between lesions in close proximity, locating lesions for biopsy, judging lesion activity, detecting small cortical lesions with minimal edema, and spatial resolution. MR imaging was superior to CT scanning in evaluation of white-matter lesions and detection of small lesions surrounded by edema. MR imaging exhibited higher contrast resolution and greater sensitivity. Complementary uses of MR and CT imaging are suggested. MH - Acquired Immunodeficiency Syndrome/*COMPLICATIONS ; Adult ; Brain/ PATHOLOGY ; Brain Diseases/COMPLICATIONS/*DIAGNOSIS/PATHOLOGY/RADIOGRAPHY ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Nuclear Magnetic Resonance/DIAGNOSTIC USE ; Prospective Studies ; Tomography, X-Ray Computed SO - Radiology 1986 Jan;158(1):141-8