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Etiology of central nervous system (CNS) disease in HIV-infected Tanzanian patients.
Beiser C; Lallinger G; Rwiza H; Shao J; Laukamm-Josten U; Mwakyusa D;
December 30, 1992
Int Conf AIDS. 1992 Jul 19-24;8(2):B179 (abstract no. PoB 3552). Unique

OBJECTIVES: To characterize and determine the etiology of CNS disease in hospitalized HIV+ patients in Tanzania. METHODS: All sequential patients aged 15-55 admitted to two medical wards at MMC with CNS dysfunction were evaluated. Exclusions were head trauma, severe hypertension, cerebral malaria, and known metabolic derangements. All patients underwent history and physical with detailed neurologic examination. Blood was sent for HIV, blood counts, electrolytes, thick film, cryptococcal antigen, Toxoplasma antibodies, and VDRL. Spinal fluid was sent for routine studies as well as India Ink, acid-fast bacilli (AFB) smear, fungal culture, AFB culture, cryptococcal antigen, and VDRL. RESULTS: Sixty-nine patients were recruited over 4 months: 45 were HIV+ (22 men, 23 women) and 24 were HIV- (16 men, 8 women). Diagnoses in the HIV+ patients included meningitis in 19 (7 tuberculous [TB], 6 cryptococcal, 3 aseptic, 2 pneumococcal, and 1 meningococcal), delirium in 10, dementia in 8, probable mass lesion in 6, stroke in 1, and vascular headache in 1. One of the patients with TB meningitis and 1 with delirium also had neurosyphilis. Diagnoses in the HIV- patients included meningitis in 15 (4 meningococcal, 4 aseptic, 3 pneumococcal, 2 unknown bacterial, and 2 TB), delirium in 4, dementia in 2, probable mass lesion in 2, and stroke in 1. One of the patients with aseptic meningitis also had neurosyphilis. Of the 9 patients with TB meningitis, the diagnosis was clinically suspected in only 4. Toxoplasma antibodies were present in 16/45 HIV+ patients (6/6 with probable mass lesion) and 6/24 HIV- patients. CONCLUSIONS: The seroprevalence of HIV is high among hospitalized African patients with CNS disease. TB and cryptococcal meningitis are common causes of CNS disease in HIV+ African patients and toxoplasmosis is probably common. TB meningitis is difficult to diagnose clinically and should be considered in all HIV+ patients who present with CNS disease.

Adolescence Adult AIDS Dementia Complex/*COMPLICATIONS/DIAGNOSIS/EPIDEMIOLOGY Central Nervous System Diseases/*COMPLICATIONS/DIAGNOSIS/ EPIDEMIOLOGY Cross-Sectional Studies *Developing Countries Female Human HIV Seropositivity/*COMPLICATIONS/DIAGNOSIS/EPIDEMIOLOGY Incidence Male Mass Screening Meningitis/COMPLICATIONS/DIAGNOSIS/EPIDEMIOLOGY Middle Age Neurologic Examination Neuropsychological Tests Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS/EPIDEMIOLOGY South Africa/EPIDEMIOLOGY ABSTRACT