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Neurological Complications in HIV Infection/AIDS

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Neurological Complications in HIV Infection/AIDS Dr.K.Bujji Babu, MD., HIV Physician Consultant Bujji Babu HIV Clinic Kanuru Vijayawada Introduction Deadly DUO in HIV ... – PowerPoint PPT presentation

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Title: Neurological Complications in HIV Infection/AIDS


1
Neurological Complications in HIV Infection/AIDS
  • Dr.K.Bujji Babu, MD., HIV Physician
  • Consultant
  • Bujji Babu HIV Clinic
  • Kanuru
  • Vijayawada

2
Introduction
  • Deadly DUO in HIV infection
  • --Opportunistic infections
  • -- Neoplasms
  • Team effort
  • -- HIV physician
  • -- Neurologist
  • -- Radiologist, Microbiologist
  • Pathologist

3

AIMS
  • Discuss patient profiles in AIDS
  • Diagnostic dilemmas
  • Treatment Options, Complications, Limitations

4
Epidemiology
  • Duration 2 years
  • Total no HIV/AIDS cases 490
  • No of patients with neurological complications50
  • MaleFemale 3119
  • Age group 25-55 years

5
Patient Profile
  • Clinical examinations
  • Laboratory Investigations
  • Confirmation of serological status by ELISA/W.B
  • Hb, TC, DC, ESR, VDRL, Hep A,B C, S.Bilirubin,
    S.Creatinine, S.Amylase, Serum IgG for Toxo,
    Montoux, CXR, USG abdomen, Urine examination
  • CD4 for Immunological status

6
CNS Examination
  • Clinical Examination
  • Examination of fundus
  • Laboratory study
  • CSF Study
  • Chemical Analysis, AFB, Gramstain, Culture
    sensitivity, KOH, VDRL, Indian Ink Preparation
    for Crypto, Cryptococcal antigen, PCR.
  • MRI study

7
Tubercular meningitis
  • No. of Patients 8 (MF-53)
  • Clinical Features Fever, Headache Vomiting
  • CSF Analysis
  • AFB Positive for 3 (1F, 2 M)
  • AFB Negative for 5 (1F, 4M)
  • CD4 count
  • Mortality One patient died in advanced stage,
    even after shunting for TBM with hydrocephalous

8
TB Spine
  • No. of Patients 2 (MF-11)
  • Clinical Features Fever, Backache, Loss of
    weight
  • Diagnosis MRI spine
  • Treatment ATT followed by ART
  • ResultsTherapeutic response very good both TBM
    TB spine when the CD4 gt 150

9
Cryptococcal Meningitis
  • No. of patients 8 MF- 53
  • Clinical features Throbbing Headache, Fever,
    Occasional Convulsions.
  • CD4 lt 150
  • CSF High Pressure, Clear Fluid
  • Indian ink for Cryptococcus ve (5 cases)
  • Cryptococcal antigen ve (3 cases)
  • Treatment Fluconazole 200mg IV BD, Amphotericin
    B 0.7mg/kg followed by ART
  • Mortality 2 MF-11

10
Toxoplasmosis
  • No. of Patients 6 ( MF- 51)
  • Clinical Features Fever Seizures
  • Diagnosis Serum IgG Toxo, MRI
  • CD4 lt 200
  • Treatment Anti TOXO
    Alternative Clindamycin Dapsone
  • Followed by ART
  • Mortality 1

11
PML
  • No. of Patients 6 (MF- 42)
  • Clinical features Loss of memory, irrelevant
    speech, insomnia
  • Diagnosis MRI
  • CD4 lt150
  • Treatment Symptomatic ART
  • Mortality 1

12
Cerebral Atrophy
  • No. of Patients 3 (MF-21)
  • Clinical Features
  • Loss of memory,irrelevant speech,insomnia
  • insomnia
  • Diagnosis MRI
  • CD4 lt 150
  • Treatment Symptomatic ART

13
Pneumococcal Meningitis
  • No. of patients 2 (M)
  • Clinical Features Fever, Headache and vomiting
  • Diagnosis CSF analysis, Gram stain / CultureRx
  • Treatment standard ART
  • Results 1 patient died, CD4 27, one patient
    survive CD4 150

14
HIV Myelopathy with Myopathy
  • 1 (F) patient
  • Clinical Features Tingling sensation weakness
    in lower limbs
  • CD4110
  • Treatment ART

15
Facial Palsy due to Herpes-Zoster
  • No. of cases 6 (MF-42)
  • Diagnosis Clinical
  • CD4 lt 200
  • Treatment Acyclovir , Famcyclovir ,
    Valcyclovir
  • Physiotherapy

16
Peripheral Neuropathy
  • No. of Patients 5 (MF- 3 2)
  • Cause Mainly drug induced
  • Clinical Features Numbness, tingling sensations
    weakness in lower limbs
  • CD4 50 150
  • Diagnosis Clinical and NCS
  • Treatment Vitamin supplements

17
Spinal Masses Other than KOCHs
  • No. of Patients 3 (MF- 21)
  • Clinical Features Fever, Paraplegia,Urinary
    retention, Bowel incontinence
  • CD4 lt 100
  • Diagnosis MRI Biopsy
  • Results 1(M) Secondary from renal cell Ca. -
    died
  • 1(M) NHL operated - doing well
  • 1(F) Spinal inflammatory/Neoplastic lesions
    nature not known (died because neutropenia)

18
Conclusion
  • TBM , Crypto, Toxo CD4 lt 200
  • Cerebral atrophy PML
  • Neoplasms common CD4 lt100
  • Neuro AIDS
  • -- More common
  • -- high morbidity
  • -- Very high mortality
  • -- ART

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