Ocular pathology in acquired immunodeficiency syndrome (original) (raw)
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Detection of cytomegalovirus in vitreous, aqueous and conjunctiva by polymerase chain reaction (PCR)
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005
To evaluate the diagnostic value of polymerase chain reaction (PCR) performed on vitreous, aqueous and conjunctiva for the detection of cytomegalovirus in AIDS patients with a clinical diagnosis of cytomegalovirus retinitis. PCR-based assay was used to detect cytomegalovirus DNA in vitreous, aqueous and conjunctival samples from 24 patients with the acquired immunodeficiency syndrome (AIDS) who had untreated clinically diagnosed cytomegalovirus retinitis and from 15 immunocompetent patients, including 11 with retinal detachment, 2 with macular hole and 2 with vitreous hemorrhage. Cytomegalovirus DNA was detected in 16, 9 and 3 of 24 vitreous, aqueous and conjunctival samples, respectively, from patients with AIDS, untreated clinically diagnosis of cytomegalovirus retinitis; and in one patient out of 15 vitreous, aqueous and conjunctival samples from immunocompetent patients with vitreoretinal diseases. The use of PCR in the detection of cytomegalovirus in vitreous, aqueous and conju...
Molecular Diagnosis, 1999
Background: Polymerase chain reaction (PCR) assays of cerebrospinal fluid (CSF) for cytomegalovirus (CMV) DNA have facilitated the diagnosis of CMVassociated central nervous system disease in AIDS patients. We attempt to correlate clinical and radiographic features that are associated with CMV PCR-positivity in CSF from AIDS patients with neurologic disease. Methods and Results: A retrospective case controlled comparison was made of CMV PCR-positive and PCR-negative patients. Results: CMV PCR-positive patients were significantly more likely to have nystagmus, prior CMV retinitis, and CSF protein levels >90 mg/dL. Of patients with 0, 1, and >2 of these features, 5.6%, 55.2%, and 88.9%, respectively, were PCRpositive. Ependymal cnhancement was present by magnetic resonance imaging in 9 of 12 PCR-positivc, and in 8 of 30 PCR-negalive patients. Conclusion: Thcsc clinical and radiographic features may serve as useful adjuncts toward the establishment of the diagnosis of CMV-associated neurologic disease in AIDS patients.
Graefe's Archive for Clinical and Experimental Ophthalmology, 1993
Rapid and sensitive techniques with a high degree of accuracy are necessary for the diagnosis and management of cytomegalovirus (CMV) retinitis presenting with atypical clinical manifestations. Light microscopy and immunohistochemical studies have limitations in the identification of this virus, but in situ DNA hybridization offers a rapid, highly specific, and easily interpretable means of identifying CMV. A new procedure of enzymatic amplification of DNA in vitro, called the polymerase chain reaction (PCR), has yielded excellent results in the identification of various viruses. In the study described herein, we evaluated the diagnostic usefulness of PCR and compared its reliability with that of in situ DNA hybridization for the detection of CMV in ocular tissues. We found that the reliability of the PCR method is similar to in situ DNA hybridization for the detection of CMV, although morphologic correlation is provided only by the latter technique. Falsenegative results can occur in PCR if the correct primer is not used.
Journal of NeuroVirology, 2005
JC virus (JCV) is a human polyomavirus that exists in at least eight different genotypes as a result of coevolution with different human populations all over the world. Well adapted to its host, it usually persists in the kidneys and possibly the brain. If the host becomes immunodeficient, JCV can cause the fatal demyelinating disease progressive multifocal leukoencephalopathy (PML). There is increasing evidence that JCV is transactivated by cytomegalovirus (CMV) and the human immunodeficiency virus (HIV). Both CMV and HIV can infect the retina of acquired immunodeficiency syndrome (AIDS) patients, causing severe necrosis in the case of CMV retinitis or a mild HIV-associated vasculopathy, with bleeding and cotton wool spots. The authors therefore investigated by polymerase chain reaction (PCR) whether DNA of these three viruses was detectable in paraffin-embedded eyes of AIDS patients with a clinical history of CMV retinitis. From a total of 65 eyes, JCV was detected in 21 (32%). Thirtysix (55%) were positive for CMV and 6 (9%) for proviral DNA of HIV. JCV and CMV were found in 13 eyes, JCV and HIV in 3 eyes, CMV and HIV in 1 eye, and DNA from all three viruses in 1 eye. The JCV genotypes were types 1A, 2A, 2E, 3, and 4. In 21 eyes of patients without AIDS, only one sample was JCV positive. In conclusion, JCV DNA can be detected in ocular tissue of AIDS patients at a significantly higher level than in eyes of nonimmunosuppressed patients. Further investigations will help to decide if JCV contributes to the retinopathy caused by CMV and HIV.
European Journal of Clinical Microbiology & Infectious Diseases, 1997
A retrospective evaluation was conducted in patients with AIDS and an autopsy diagnosis of cytomegalovirus (CMV) encephalitis to determine the relevance of clinical and laboratory findings in establishing a diagnosis. On autopsy of 100 patients, CMV encephalitis was diagnosed in 13 patients; eight had periventricular CMV encephalitis, four micronodular CMV encephalitis, and one both conditions. Seven patients had had a CMV infection previously (6 cases of retinitis, 1 case of colitis), and at the onset of encephalitis all of them were receiving a maintenance dose of ganciclovir. Examination of the CSF showed specific changes in patients with periventricular encephalitis. CT revealed no characteristic findings, while MRI showed an increased signal intensity on T2 weighted images. CMV DNA amplification by nested PCR was performed in nine patients with CMV encephalitis; PCR was positive in eight patients whose CSF was collected during CMV encephalitis, and negative in one patient whose CSF was collected six months before death. In conclusion, some clinical findings suggest a presumptive diagnosis, especially of periventricular encephalitis, and nested PCR appears to be a reliable and rapid technique for making an antemortem diagnosis.
Revista do Instituto de Medicina Tropical de São Paulo
Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69%) were men. At admission all patients were aware of their HIV status and only four (31%) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62%) patients. The neurologic syndromes identified were diffuse ...
Diagnosis of Cytomegalovirus in Immunocompromised Persons
Cytomegalovirus is the leading viral cause of congenital disease, often producing serious neurological deficits. CMV attacks the developing central nervous system (CNS) resulting in serious brain disorders that include microencephaly, epilepsy, deafness, microgyria, mental retardation, sensory loss, motor problems, and psychiatric disturbances. In addition, CMV is a clinically important opportunistic virus that can lead to serious neurological disease in AIDS patients. The present application addresses basic mechanisms of viral spread into the brain, and once in the brain, spread by intracellular transport or extracellular diffusion to other brain cells. The hypothesis that CMV can be spread through axonal transport will be studied with in vitro and in vivo models. Although CMV appears to have no absolute host cell preference in the brain, the hypothesis that CMV shows relative cellular preferences will be tested in living brain slices at different developmental ages. Using a mouse model of immunosuppression, parallel to AIDS, we will test the hypothesis that cell-mediated immunity protects neurons in vivo from CMV proliferation. Neuronal activity plays an important role in establishing the correct circuitry during brain development. The hypothesis that early infection by CMV can generate disturbances in the electrophysiological activity of developing neurons will be tested with whole cell patch clamp recording using current and voltage clamp electrophysiology, and with calcium digital imaging, using primary mouse neuron cultures and brain slices. Virus mediated changes in intracellular ion levels, ion currents, transmitter responses, and membrane properties will be compared in CMV infected and control cells.