Molecular Diagnosis of Central Nervous System Opportunistic Infections in HIV-Infected Zambian Adults
Molecular Diagnosis of Central Nervous System Opportunistic Infections in HIV-Infected Zambian Adults
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DOI：
10.1093/cid/ciu191
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发表时间：
2014-06-15
影响因子：
11.8
通讯作者：
Koralnik, Igor J.
中科院分区：
文献类型：
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作者：
Siddiqi, Omar K.;Ghebremichael, Musie;Koralnik, Igor J.
背景。对撒哈拉以南非洲人类免疫缺陷病毒 (HIV) 感染者中枢神经系统 (CNS) 机会性感染 (OI) 的了解有限。方法.a欧洲积分 我们分析了赞比亚三级护理中心 331 名具有 CNS OI 症状的 HIV 感染者，每人 1 份脑脊液 (CSF) 样本。我们使用病原体特异性引物，通过实时聚合酶链式反应 (PCR) 检测 JC 病毒 (JCV)、水痘带状疱疹病毒 (VZV)、巨细胞病毒 (CMV)、EB 病毒 (EBV)、单纯疱疹病毒 (HSV) 1 型和 2 型、结核分枝杆菌和弓形虫的 DNA。 结果.aEuro 积分 患者中位 CD4(+) T细胞计数为89个细胞/AμL（四分位数范围，38-191个细胞/AμL）。在 331 个脑脊液样本中，189 个（57.1%）含有至少 1 种病原体。 PCR 检测到 91 例 (27.5%) 患者中的 EBV DNA、48 例 (14.5%) 例结核分枝杆菌、20 例 (6.0%) 例 JCV、20 例 (6.0%) 例 CMV、13 例 (3.9%) 例 VZV、5 例 (1.5%) 例 HSV-1、5 例 (1.5%) 例 HSV-2 和弓形虫。真菌和细菌学研究显示，64 名患者 (19.5%) 感染隐球菌，8 名患者 (2.4%) 感染肺炎球菌，2 名患者 (0.6%) 感染脑膜炎球菌。 189 个样本中的 68 个（36.0%）发现了多种病原体。 331 名住院患者中有 117 名（35.3%）在住院期间死亡。男性比女性年龄更大（中位数为 37 岁 vs 34 岁；P = .01），最近被诊断出感染 HIV 的时间更长（中位数为 30 天 vs 63 天；P = .03），并且死亡率往往更高（40.2% vs 30.2%；P = .07）。 结论。aEuro 积分 CNS OIs 是赞比亚艾滋病常见的、可能可治疗的并发症。脑脊液中常有多种病原体共存。 EBV 是分离和合并感染中最流行的中枢神经系统微生物。它是否与中枢神经系统疾病或炎症标志物有关，需要进一步研究。对中枢神经系统病原体进行更全面的检测可以改善赞比亚的治疗和患者预后。
Background. Knowledge of central nervous system (CNS) opportunistic infections (OIs) among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa is limited.Methods.aEuro integral We analyzed 1 cerebrospinal fluid (CSF) sample from each of 331 HIV-infected adults with symptoms suggestive of CNS OI at a tertiary care center in Zambia. We used pathogen-specific primers to detect DNA from JC virus (JCV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) types 1 and 2, Mycobacterium tuberculosis, and Toxoplasma gondii via real-time polymerase chain reaction (PCR).Results.aEuro integral The patients' median CD4(+) T-cell count was 89 cells/A mu L (interquartile range, 38-191 cells/A mu L). Of 331 CSF samples, 189 (57.1%) had at least 1 pathogen. PCR detected DNA from EBV in 91 (27.5%) patients, M. tuberculosis in 48 (14.5%), JCV in 20 (6.0%), CMV in 20 (6.0%), VZV in 13 (3.9%), HSV-1 in 5 (1.5%), and HSV-2 and T. gondii in none. Fungal and bacteriological studies showed Cryptococcus in 64 (19.5%) patients, pneumococcus in 8 (2.4%), and meningococcus in 2 (0.6%). Multiple pathogens were found in 68 of 189 (36.0%) samples. One hundred seventeen of 331 (35.3%) inpatients died during their hospitalization. Men were older than women (median, 37 vs 34 years; P = .01), more recently diagnosed with HIV (median, 30 vs 63 days; P = .03), and tended to have a higher mortality rate (40.2% vs 30.2%; P = .07).Conclusions.aEuro integral CNS OIs are frequent, potentially treatable complications of AIDS in Zambia. Multiple pathogens often coexist in CSF. EBV is the most prevalent CNS organism in isolation and in coinfection. Whether it is associated with CNS disease or a marker of inflammation requires further investigation. More comprehensive testing for CNS pathogens could improve treatment and patient outcomes in Zambia.