Neuropsychiatry Manifestations In Patients Presenting Cryptococcal Meningitis

L de F Ibanez-Valdes; H. Foyaca-Sibat; K. Mfenyana; J. Chandia; H. Gonzalez-Aguilera

摘要

Background: Little is known about the prognostic value of some neuropsychiatry manifestation (npm) in hiv-patients with crytococcal meningitis (cm).Objectives: to determine the prognostic value of some npm associated with cm and other neurological complications.Patients and method: a retrospective analysis of 142 patients fulfilling the diagnostic criteria for cm and severe immune suppression (cd4<100 cell/mm3) was done. We identified clinical manifestations of depression, delirium, mania, anxiety, psychosis and dementia. Results: the commonest npm on this series was delirium (47%) and manic episodes (33 %) followed by depression and anxiety (19 and 16 %). Dementia was not identified on this group.Conclusions: serial lumbar punctures contributed to improve npm such as: delirium and mania however similar patients with an associated decrease level of consciousness (stupor/coma) for more than 48 hours or associated hydrocephalus had fatal prognosis (p<0.001) Introduction Background and objectives: the incidence of crytococcal meningitis (cm), formerly a relatively rare disease, has markedly increased in recent years due to the frequent occurrence of the opportunistic infection in human immunodeficiency virus (hiv)-positive patients1 mainly in places where protease inhibitor, nucleoside reverse transcriptase, and non-nucleoside reverse transcriptase drugs remains unavailable. The fungus is acquired by inhalation and causes the initial lesion in the lungs; the pulmonary stage of infection is usually a symptomatic. The fungus disseminates in debilitated patients, usually involving the meninges. In hiv-negative patient's incidence of cm is related to immunosuppressive drugs used to prevent allograft rejection in organ transplanted recipients, and particularly steroids therapy seems to be associated with an increased risk factor for cm2 Neuropsychiatry manifestations (npm) may be conditions that are directly attributed to hiv infection but sometimes these conditions existed before a person becomes hiv-positive and both contribute to increase level of unemployment, poverty, homeless and unhappiness. Patients presenting these conditions (npm-hiv) are more prompt to develop complications because most of them have limited access to health care, hiv primary care, new antiretroviral medications and poor compliance therefore they will have shortened hiv-related survival, severely impaired quality of life and worst prognosis compared with hiv patients without npm1. In places where traditional believes and stigmas are strong enough to modify the environment of these patients the prognosis is even worst. We recognize that despite all the scientific progress observed in the last century, the npm, epilepsies, and cognitive disorders are still surrounded by a mysterious mist for the majority of the population, mainly in developing countries,3,4,5,6 we also agree that it is abominable see at the beginning of the third millennium; npm and epilepsy are still being considered as symptom of devilish possession by some alternative therapists, adherent to distinct creeds in many societies around the world7 Based on our previous knowledge of this problem we selected a number of record from patients diagnosed as cm and hiv/aids with the aim to identify their npm and to determine any possible correlation between npm, complications, and clinical prognosis. Material And Method A total of 142 patients with cm presenting npm, admitted in medical wards of Umtata general hospital between December 09, 2003 and December 09, 2004 were selected retrospectively. The detailed clinical history of the patients regarding age, sex, clinical diagnosis, and drug therapy were recorded.All patients were diagnosed as hiv/aids by Elisa test for HIV and all of them were in a late stage of hiv/aids being their cd4 count ranged between 97 and 2 cell/mm3. As a routine procedure, the purpose of each investigation or medical procedure was explained to each patient before consent was r

机译：背景：对于患有球菌性脑膜炎（cm）的HIV患者，某些神经精神病学表现（npm）的预后价值知之甚少。回顾性分析了142例符合cm诊断标准和严重免疫抑制（cd4 <100细胞/ mm3）的患者。我们确定了抑郁、,妄，躁狂，焦虑，精神病和痴呆的临床表现。结果：该系列中最常见的npm是ir妄（47％）和躁狂发作（33％），其次是抑郁和焦虑（19％和16％）。结论：连续的腰椎穿刺有助于改善npm，例如：man妄和躁狂症，但是类似的患者，其意识水平（木昏/昏迷）持续48小时以上或伴有脑积水的患者预后很差（ p <0.001）引言背景和目的：近年来，由于人类免疫缺陷病毒（hiv）阳性患者中机会性感染的频繁发生，以前相对罕见的疾病-球菌性脑膜炎（cm）的发病率显着增加1在蛋白酶抑制剂，核苷逆转录酶和非核苷逆转录酶药物仍不可用的地方。真菌是通过吸入获得的，并在肺部引起最初的病变。肺部感染通常是有症状的。真菌在衰弱的患者中传播，通常涉及脑膜。在艾滋病毒阴性患者中，cm的发生与用于器官移植受体中预防同种异体移植排斥的免疫抑制药物有关，尤其是类固醇治疗似乎与cm2的危险因素增加有关神经精神病学表现（npm）可能是直接归因的疾病感染艾滋病毒，但有时这些状况在一个人感染艾滋病毒之前就已经存在，并且两者都助长了失业，贫穷，无家可归和不幸的程度。患有这些疾病（npm-hiv）的患者更容易发生并发症，因为他们中的大多数人获得医疗保健，艾滋病毒初级保健，新的抗逆转录病毒药物和依从性差，因此他们会缩短艾滋病毒相关的生存期，严重损害患者的质量。与没有npm1的HIV病人相比，生命和最坏的预后。在传统信仰和耻辱足以改变这些患者环境的地方，预后甚至更差。我们认识到，尽管在上个世纪观察到了所有科学进步，但是npm，癫痫病和认知障碍仍然对大多数人口（主要是在发展中国家，3、4、5、6）仍然笼罩着神秘的雾气。同意在第三个千年伊始看到这是可恶的; npm和癫痫病仍被一些替代治疗师认为是魔鬼拥有的症状，它们遵循世界上许多社会的不同信条7。基于我们对这个问题的先前了解，我们从被诊断为cm和HIV /艾滋病的患者中选择了许多记录目的是确定其npm并确定npm，并发症和临床预后之间的任何可能关联。材料与方法回顾性选择2003年12月9日至2004年12月9日在Umtata综合医院内科住院的142例出现npm cm的患者。记录患者的年龄，性别，临床诊断和药物治疗的详细临床病史。所有患者均通过Elisa HIV检测被诊断为HIV /艾滋病，所有患者均处于CD4的HIV /艾滋病晚期。计数范围介于97和2格/ mm3之间。作为常规程序，在征得患者同意之前，应向每位患者解释每次检查或医疗程序的目的

Neuropsychiatry Manifestations In Patients Presenting Cryptococcal Meningitis

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