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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Molecular diagnosis of central nervous system opportunistic infections in HIV-infected zambian adults
Clinical Infectious Diseases, Volume 58, No. 12, Year 2014
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Description
Background. Knowledge of central nervous system (CNS) opportunistic infections (OIs) among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa is limited.Methods. We analyzed 1 cerebrospinal fluid (CSF) sample from each of 331 HIV-infected adults with symptoms suggestive of CNS OI at a tertiary care center in Zambia. We used pathogen-specific primers to detect DNA from JC virus (JCV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) types 1 and 2, Mycobacterium tuberculosis, and Toxoplasma gondii via real-time polymerase chain reaction (PCR).Results. The patients' median CD4+ T-cell count was 89 cells/μL (interquartile range, 38-191 cells/μL). Of 331 CSF samples, 189 (57.1%) had at least 1 pathogen. PCR detected DNA from EBV in 91 (27.5%) patients, M. tuberculosis in 48 (14.5%), JCV in 20 (6.0%), CMV in 20 (6.0%), VZV in 13 (3.9%), HSV-1 in 5 (1.5%), and HSV-2 and T. gondii in none. Fungal and bacteriological studies showed Cryptococcus in 64 (19.5%) patients, pneumococcus in 8 (2.4%), and meningococcus in 2 (0.6%). Multiple pathogens were found in 68 of 189 (36.0%) samples. One hundred seventeen of 331 (35.3%) inpatients died during their hospitalization. Men were older than women (median, 37 vs 34 years; P =. 01), more recently diagnosed with HIV (median, 30 vs 63 days; P =. 03), and tended to have a higher mortality rate (40.2% vs 30.2%; P =. 07).Conclusions. CNS OIs are frequent, potentially treatable complications of AIDS in Zambia. Multiple pathogens often coexist in CSF. EBV is the most prevalent CNS organism in isolation and in coinfection. Whether it is associated with CNS disease or a marker of inflammation requires further investigation. More comprehensive testing for CNS pathogens could improve treatment and patient outcomes in Zambia. © 2014 The Author.
Authors & Co-Authors
Siddiqi, Omar Khalik
United States, Boston
Beth Israel Deaconess Medical Center
Zambia, Lusaka
University of Zambia School of Medicine
Ghebremichael, Musie S.
United States, Boston
Harvard Medical School
Dang, Xin
United States, Boston
Beth Israel Deaconess Medical Center
Atadzhanov, Masharip
Zambia, Lusaka
University of Zambia School of Medicine
Kaonga, Patrick
Zambia, Lusaka
University of Zambia School of Medicine
Khoury, Michael N.
United States, Boston
Beth Israel Deaconess Medical Center
Koralnik, Igor Jerome
United States, Boston
Beth Israel Deaconess Medical Center
Statistics
Citations: 72
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1093/cid/ciu191
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Genetics And Genomics
Health System And Policy
Infectious Diseases
Study Locations
Zambia
Participants Gender
Male
Female