and Inflammatory Diseases
NS Brink, Y Sharvell, MR Howard, et al (Univ College London)
Detection of Epstein-Barr Virus and Kaposi’s Sarcoma-associated Herpesvirus DNA in CSF From Persons Infected with HIV Who had Neurological Disease.
J Neurol Neurosurg Psychiatry 65: 191-195, 1998
Epstein-Barr Virus (EBV) is associated with lymphoproliferative disorders in immunocompromised patients. The authors investigated the frequency and clinical relevance of EBV and Kaposi’s sarcoma-associated herpesvirus (KSHV) DNA detection in CSF from patients with HIV infection.
Out of 115 consecutive HIV-infected patients undergoing lumbar puncture, the CSF supernatant of 18 patients showed EBV DNA, including all patients with primary CNS lymphoma, or a combination of systemic and CNS lymphoma.
EBV DNA was not found in CSF supernatant of any patient with systemic but not CNS lymphoma.
EBV DNA was detected in the supernatant of another 9 patients with no lymphoma diagnosis at the time of lumbar puncture. In two of these patients, CNS lymphoma SUBSEQUENTLY developed.
Hence the authors conclude that CNS lymphoma is strongly correlated with the presence of EBV DNA in CSF.
In the absence of clinical and radiological features of CNS lymphoma, the detection of EBV DNA in CSF may predict subsequent tumour development.
In the present study KSHV DNA is rare in CSF and uncorrelated with lymphoma or other neurologic disease.
JR Berger, RM Levy, D Flomenhoft, et al (Uni of Kentucky, Lexington; Northwestern Univ, Chicago.
Predictive Factors for Prolonged Survival in Acquired Immunodeficiency Syndrome: Associated Progressive Multifocal Leukoencephalopathy.
Ann Neurol 44; 341-349, 1998.
Progressive multifocal leukoencephalopathy (PML), a serious complication of AIDS, often leads to death within 6 months of symptom onset. A few patients may survive for more than one year, often with remission of the clinical manifestations.
The factors predicting prolonged survival, in patients with biopsy proved AIDS related PML, were investigated.
It was found that the following factors predicted long-term survival with AIDS related PML
(1) PML was the initial manifestations of AIDS.
(2) High CD4 T-Lymphocyte count at disease onset.
(3) CT or MRI lesion enchancement
(4) Evidence of neurologic function recovery.
CD Hall, and the AIDS Clinical Trials Group 243 Team (Univ of North Carolina, Chapel Hill; Harvard School of Public Health, Boston; Mount Sinai School of Medicine, New York, et al )
Failure of Cytarabine in Progressive Multifocal Leukoencephalopathy Associated with Human Immunodeficiency Virus Infection.
N Engl J Med 338: 1345-1351, 1998.
About 4% of patients with AIDS syndrome have progressive multifocal leukoencephalopathy (PML). No therapy has been proven effective for PML – survival after its diagnosis averages 3 months.
In a study of 57 patients it was found that neither intrathecal nor intravenous cytarabine halted progression of PML better than antiretroviral therapy alone. Antiretroviral therapy itself offers no improvement in PML to these patients.
L Origgi, M Vanoli, A Carbone, et al [ Univ of Milan, Italy ]
Central Nervous System Involvement in Patients with HCV-related Cry-oglobulinema.
Am J Med Sci 315: 208-210, 1998.
Mixed cryoglobulinemia [MC] is strongly associated with chronic hepatitis C virus [HCV] infection. Patients with MC typically have a peripheral neuropathy, but only a few of them have CNS involvement.
Three patients with MC who had CNS symptoms related to HCV infection have been studied.
A male 52 years had diffuse arthralgias and hyperreflexic tetraparesis.
A 55 year old lady had impaired equilibrium and motor co-ordination.
A 54 year old lady recurrent dizziness after a lett hemiparesis. All three patients were non-smokers with normal cholesterol levels and mild hypertension.
Other CNS deficts included dysmetria, nystagmus, bilateral Babinski’s signs, defective proprioception, upper limb motor dysco-ordination, mild Right Facial nerve palsy and mild hemiparesis of the left limbs.
In every patient, MRI showed multiple lacunar infarctions in various areas viz. mesencephalon, the thalamus, the basal ganglion, and parts of the white matter of both cerebral hemispheres. The involvement of small caliber cerebral arteries suggested ischemia.
Multifocal perivascular swelling and localized inflammatroy infiltrates are also possible causes.
Hence, it would be worthwhile evaluating the MRI of patients with chronic HCV infection, to identify any organic CNS involvement.
M Jensenius,B Myrvang, G Storvold, et al [Aker Univ, Oslo, Norway; Ulleval Univ. Oslo, Norway; Baerum Hosp, Norway; et al]
Herpes Simplex Virus Type 2 DNA Detected in Cerebrospinal Fluid of 9 Patients with Mollarets Meningitis
Acta Neurol Scand 98 : 209-212, 1998
Nine patients, aged 31 to 56 years, of Mollarets meningitis were studied. This clinical entity is characterized by recurrent self limiting episodes of aseptic meningitis in otherwise healthy persons. HSV-2-DNA virus was detected in the CSF of all 9 patients. The value of recombinant HSV-2 vaccination for selected patients in reducing the number of attacks of recurrent HSV-2 meningitis is not known.
Prior to this study, in 1991, Mollarets meningitis was reported in 3 women with histories or genital herpes. In that report, treatment with acyclovir eliminated the spells suffered by these women. As prophylactic therapy with acyclovir prevents the meningitis, it is postulated that availability of a vaccine for HSV-2 may eliminate Mollarets meningitis completely.
O Nyren, JK McLaughlin, L Yin, et al [Karolinska Inst, Stockholm; Internatl Epidemiology Inst, Rockville, Md; Natl Board of Health and Welfare, Stockholm, Sweden; et al]
Breast Implants and Risk of Neurologic Disease : A Population-based Cohort Study in Sweden
Neurology 50: 956-961, 1998, Pg. 96
Records of 7,433 with breast implants listed in the Swedish hospital discharge register between 1965 and 1993 were examined for a diagnosis of a neurologic disease.
These were compared with results of 3351 women listed in the same register who underwent breast REDUCTION surgery during the same period – this was the control group.
The study concludes that breast implants do NOT increase the risk of neurologic disorders.
J P OBeirne, S R Cairns
Drug Points: Cholestatic Hepatitis in Association with Celecoxib
BMJ Vol. 7303, 7 July 2001; Pg. 23
Non-steroidal anti-inflammatory drugs, particularly diclofenac sodium, have been associated with serious hepatotoxicity.
In a review of controlled clinical trials involving 7400 patients, hepatic dysfunction occurred in 0.8% of those treated with celecoxib compared with 0.9% treated with placebo and 3.7% treated with diclofenac sodium.
Nimesulide, another non-steroidal anti-inflammatory drug with cyclo-oxygenase-2 selectivity, has been reported to cause fulminant hepatic failure, and celecoxib has been associated with hepatitis and pancreatitis.