Diagnostic utility of a multiplex herpesvirus PCR assay performed with cerebrospinal fluid from human immunodeficiency virus-infected patients with neurological disorders

We used a multiplex nested-PCR assay for the simultaneous detection in cerebrospinal fluid (CSF) of five human herpesviruses (HVs) (cytomegalovirus [CMV], Epstein-Barr virus [EBV], varicella-zoster virus [VZV], herpes simplex virus [HSV], and human herpesvirus 6 [HHV-6]) in a clinical evaluation of human immunodeficiency virus (HIV)-infected patients with neurological disorders. This method, which has the advantages of being rapid and economical, would be of particular interest for the diagnosis of neurological syndromes caused by more than one HV. We studied 251 CSF samples from 219 patients. HV DNA was demonstrated in 93 (37%) of the CSF samples (34% of the patients). CMV was the HV most frequently detected in our patients (25%), while EBV, VZV, HSV, and HHV-6 DNAs were present in significantly fewer cases (7, 4, 3, and 1%, respectively). When results were compared with the final etiological diagnoses of the patients, the multiplex HV PCR showed high specificity for the diagnosis of CMV and VZV neurological diseases and for cerebral lymphoma (0.95, 0.97, and 0.99, respectively). The sensitivity of the assay was high for CMV disease (0.87), was low for cerebral lymphoma (0.33), and was not evaluable for VZV disease due to the small number of patients with this diagnosis. Nevertheless, detection of VZV DNA had possible diagnostic value in four of the nine cases, and EBV DNA amplification always predicted the diagnosis of cerebral lymphoma in patients with cerebral masses. Detection of HSV DNA was frequently associated with CMV amplification and fatal encephalitis. HHV-6 was not considered to have a pathogenetic role in the three cases in which it was detected. This multiplex HV PCR assay is a specific and clinically useful method for the evaluation of HIV-infected patients with neurological disorders related to HV.

Pseudotumoral appearance of cytomegalovirus esophagitis and gastritis in AIDS patients

Cytomegalovirus (CMV) is frequently isolated from patients with acquired immunodeficiency syndrome (AIDS), and often causes disseminated disease. Gastrointestinal CMV involvement is recognized with increased frequency in AIDS patients. It can involve the entire alimentary tract and usually produces mucosal ulceration. Pseudotumoral lesions develop very infrequently. We report two unusual detailed cases of biopsy-proven CMV esophagitis and gastritis resembling carcinoma, in patients with human immunodeficiency virus infection. In AIDS patients, the gastrointestinal CMV involvement could show pseudotumoral appearance.

Tuberculous meningitis with acellular cerebrospinal fluid in AIDS patients

OBJECTIVE

To describe the clinical manifestations of tuberculous meningitis in HIV-positive patients with acellular cerebrospinal fluid (CSF).

DESIGN

Retrospective analysis of case reports.

METHODS

Four HIV-positive patients with acellular CSF and tuberculous meningitis are reported.

RESULTS

Clinical presentation did not indicate meningeal infection in three of the four cases, and CSF tests were unusual in all cases. Two patients were diagnosed only after death.

CONCLUSIONS

Acellular CSF may obstruct the diagnosis of tuberculous meningitis in AIDS patients.