Sheybani Fereshte, van de Beek Diederik, Brouwer Matthijs C
Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centres (UMC), University of Amsterdam, Amsterdam, Netherlands.
Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Front Neurol. 2021 Sep 17;12:741884. doi: 10.3389/fneur.2021.741884. eCollection 2021.
To study the differential diagnosis of HIV-infected patients with suspected central nervous system (CNS) infections and the association of CD4 counts with the final diagnosis. We analyzed HIV-infected patients from a prospective cohort study on the diagnostic accuracy of clinical and laboratory characteristics in adults with suspected CNS infections in an academic hospital in Amsterdam, the Netherlands, who underwent cerebrospinal fluid (CSF) examination. Thirty-four (9.4%) out of 363 patients with suspected CNS infections were HIV-positive of whom 18 (53%) were diagnosed to have CNS infection, with median CD4 counts of 255 cells/μl. The spectrum of CNS infections consisted of progressive multifocal leukoencephalopathy in three patients (17%); cryptococcal meningoencephalitis, toxoplasma encephalitis, angiostrongylus eosinophilic meningitis, and HIV encephalitis each in two (11%); and cytomegalovirus encephalitis, neurosyphilis, tuberculous meningoencephalitis, histoplasma encephalitis, and varicella-zoster virus meningitis each in one (6%). Clinical characteristics and blood parameters did not differ between HIV-infected patients with CNS infections and other diagnoses. The best predictor for CNS infections was the CSF leukocyte count (AUC = 0.77, 95 CI% 0.61-0.94). The diagnosis of CNS infection was not associated with the CD4 count (median 205 vs. 370, = 0.21). Two patients (11%) with CNS infections died and two (11%) had neurological sequelae. Half of the patients with suspected CNS infections are diagnosed with a CNS infection, and this was not related to CD4 counts. The best predictor for CNS infections was the CSF leukocyte count.
研究人类免疫缺陷病毒（HIV）感染且疑似中枢神经系统（CNS）感染患者的鉴别诊断以及CD4细胞计数与最终诊断的相关性。我们对来自荷兰阿姆斯特丹一家学术医院的前瞻性队列研究中的HIV感染患者进行了分析，该研究针对疑似CNS感染的成年人临床和实验室特征的诊断准确性，这些患者均接受了脑脊液（CSF）检查。363例疑似CNS感染患者中有34例（9.4%）HIV呈阳性，其中18例（53%）被诊断为CNS感染，CD4细胞计数中位数为255个/μl。CNS感染谱包括3例（17%）进行性多灶性白质脑病；2例（11%）分别为隐球菌性脑膜脑炎、弓形虫脑炎、广州管圆线虫嗜酸性脑膜炎和HIV脑炎；1例（6%）分别为巨细胞病毒性脑炎、神经梅毒、结核性脑膜脑炎、组织胞浆菌性脑炎和水痘-带状疱疹病毒性脑膜炎。HIV感染且患有CNS感染的患者与其他诊断患者的临床特征和血液参数无差异。CNS感染的最佳预测指标是CSF白细胞计数（曲线下面积[AUC]=0.77，95%置信区间[CI] 0.61 - 0.94）。CNS感染的诊断与CD4细胞计数无关（中位数分别为205和370，P=0.21）。2例（11%）患有CNS感染的患者死亡，2例（11%）有神经后遗症。半数疑似CNS感染患者被诊断为CNS感染，且这与CD4细胞计数无关。CNS感染的最佳预测指标是CSF白细胞计数。
