Encephalitis in HIV-infected adults in the antiretroviral therapy era.
AIDS
Altered mental status
Confusion
Encephalitis
HIV
Outcomes
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
09
02
2023
accepted:
18
04
2023
revised:
18
04
2023
medline:
17
7
2023
pubmed:
28
4
2023
entrez:
28
4
2023
Statut:
ppublish
Résumé
Encephalitis presents with high morbidity and mortality in both HIV-infected and HIV-negative patients. There are currently no studies comparing HIV-infected and HIV-negative patients admitted to the hospital with acute encephalitis. We conducted a multicenter, retrospective study of adults admitted to the hospital with a diagnosis of encephalitis in Houston, Texas between 2005 and 2020. We describe the clinical manifestations, etiology, and outcomes of these patients with a focus on those infected with HIV. We identified 260 patients with encephalitis, 40 of whom were infected with HIV. Viral etiology was identified in 18 of the 40 HIV-infected patients (45.0%); bacterial in 9 (22.5%); parasitic in 5 (12.5%); fungal in 3 (7.5%); immune-mediated in 2 (5.0%). Eleven cases had unclear etiology (27.5%). More than one disease process was identified in 12 (30.0%) patients. HIV-infected persons were more likely to have neurosyphilis (8/40 vs. 1/220; OR 55; 95%CI 6.6-450), CMV encephalitis [5/18 vs. 1/30; OR 11.2 (1.18-105)], or VZV encephalitis (8/21 vs. 10/89; OR 4.82; 1.62-14.6) compared to the HIV-negative patients. Inpatient mortality was similar in the HIV-infected and HIV-negative patients, 15.0% vs 9.5% [p = 0.4, OR 1.67 (0.63-4.44)], but one-year mortality was higher for the HIV-infected patients, 31.3% vs 16.0% [p = 0.04, OR 2.40 (1.02-5.55)]. This large, multicenter study shows that HIV-infected patients with encephalitis have a distinct pattern of disease when compared with HIV-negative patients, and that this population has nearly twice the odds of mortality in the year following hospitalization.
Identifiants
pubmed: 37115358
doi: 10.1007/s00415-023-11735-w
pii: 10.1007/s00415-023-11735-w
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3914-3933Subventions
Organisme : FIC NIH HHS
ID : D43TW0009340
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW012275
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW0009340
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW012275
Pays : United States
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
George BP, Schneider EB, Venkatesan A (2014) Encephalitis hospitalization rates and inpatient mortality in the United States, 2000–2010. PLoS ONE 9(9):e104169. https://doi.org/10.1371/journal.pone.0104169 . (Published 2014 Sep 5)
doi: 10.1371/journal.pone.0104169
pubmed: 25192177
pmcid: 4156306
Granerod J, Crowcroft NS (2007) The epidemiology of acute encephalitis. Neuropsychol Rehabil 17(4–5):406–428. https://doi.org/10.1080/09602010600989620 . (PMID: 17676528)
doi: 10.1080/09602010600989620
pubmed: 17676528
Huppatz C, Durrheim DN, Levi C, Dalton C, Williams D et al (2009) Etiology of encephalitis in Australia, 1990–2007. Emerg Infect Dis 15:1359–1365
doi: 10.3201/eid1509.081540
pubmed: 19788802
pmcid: 2819877
Granerod J, Ambrose HE, Davies NW (2010) Causes of encephalitis and differences in their clinical presentation in England: a multicenter, population-based prospective study. Lancet Infect Dis 10(12):835–844
doi: 10.1016/S1473-3099(10)70222-X
pubmed: 20952256
Kulkarni MA, Lecocq AC, Artsob H, Drebot MA, Ogden NH (2012) Epidemiology and aetiology of encephalitis in Canada, 1994–2008: a case for undiagnosed arboviral agents? Epidemiol Infect 141:2243–2255
doi: 10.1017/S095026881200252X
pubmed: 23148910
Barbadoro P, Marigliano A, Ricciardi A, D’Errico MM, Prospero E (2012) Trend of hospital utilization for encephalitis. Epidemiol Infect 140(4):753–764. https://doi.org/10.1017/S0950268811001002 . (Epub 2011 Jun 21. PMID: 21733247)
doi: 10.1017/S0950268811001002
pubmed: 21733247
Hasbun R, Rosenthal N, Balada-Llasat JM, Chung J, Duff S, Bozzette S, Zimmer L, Ginocchio CC (2017) Epidemiology of meningitis and encephalitis in the United States, 2011–2014. Clin Infect Dis 65(3):359–363. https://doi.org/10.1093/cid/cix319 . (PMID: 28419350)
doi: 10.1093/cid/cix319
pubmed: 28419350
Glaser CA, Gilliam S, Schnurr D (2003) In search of encephalitis etiologies: diagnostic challenges in the California encephalitis project, 1998–2000. Clin Infect Dis 36:731–742
doi: 10.1086/367841
pubmed: 12627357
Granerod J, Tam CC, Crowcroft NS, Davies NWS, Borchert M, Thomas SL (2010) Challenge of the unknown. A systematic review of acute encephalitis in non-outbreak situations. Neurology 75(September (10)):924–932
doi: 10.1212/WNL.0b013e3181f11d65
pubmed: 20820004
Antinori A, Arendt G, Becker JT et al (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–1799
doi: 10.1212/01.WNL.0000287431.88658.8b
pubmed: 17914061
Saylor D et al (2016) HIV-associated neurocognitive disorder-pathogenesis and prospects for treatment. Nat Rev Neurol 12(4):234–248
doi: 10.1038/nrneurol.2016.27
pubmed: 26965674
pmcid: 4937456
Heaton R et al (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER study. Neurology 75(23):2087–2096
doi: 10.1212/WNL.0b013e318200d727
pubmed: 21135382
pmcid: 2995535
Lucas SB et al (2021) HIV-associated CD8 encephalitis: a UK case series and review of histopathologically confirmed cases. Front Neurol 12:628296–628296 (Web)
doi: 10.3389/fneur.2021.628296
pubmed: 33868143
pmcid: 8047670
Zarkali A, Gorgoraptis N, Miller R et al (2017) CD8+ encephalitis: a severe but treatable HIV-related acute encephalopathy. Pract Neurol 17:42–46
doi: 10.1136/practneurol-2016-001483
pubmed: 27803046
Lescure FX, Moulignier A, Savatovsky J, Amiel C, Carcelain G, Molina JM, Gallien S, Pacanovski J, Pialoux G, Adle-Biassette H, Gray F (2013) CD8 encephalitis in HIV-infected patients receiving cART: a treatable entity. Clin Infect Dis 57(1):101–108. https://doi.org/10.1093/cid/cit175 . (Epub 2013 Mar 20. PMID: 23515205)
doi: 10.1093/cid/cit175
pubmed: 23515205
Rakhmanova AG, Giaurgieva OKh (1999) Klinicheskoe techenie kriptokokkoza pri BICh-infektsii [Clinical course of cryptococcosis in HIV infection]. Klin Med (Mosk) 77(1):39–42 (Russian. PMID: 10097505)
pubmed: 10097505
Baradkar V, Mathur M, De A, Kumar S, Rathi M (2009) Prevalence and clinical presentation of Cryptococcal meningitis among HIV seropositive patients. Indian J Sex Transm Dis AIDS 30(1):19–22. https://doi.org/10.4103/0253-7184.55474 . (PMID: 21938109; PMCID: PMC3168034)
doi: 10.4103/0253-7184.55474
pubmed: 21938109
pmcid: 3168034
Pereira-Chioccola VL, Vidal JE, Su C (2009) Toxoplasma gondii infection and cerebral toxoplasmosis in HIV-infected patients. Future Microbiol 4(10):1363–1379. https://doi.org/10.2217/fmb.09.89 . (PMID: 19995194)
doi: 10.2217/fmb.09.89
pubmed: 19995194
Chrétien F, Bélec L, Hilton DA, Flament-Saillour M, Guillon F, Wingertsmann L, Baudrimont M, de Truchis P, Keohane C, Vital C, Love S, Gray F (1996) Herpes simplex virus type 1 encephalitis in acquired immunodeficiency syndrome. Neuropathol Appl Neurobiol 22(5):394–404. https://doi.org/10.1111/j.1365-2990.1996.tb00909.x . (PMID: 8930949)
doi: 10.1111/j.1365-2990.1996.tb00909.x
pubmed: 8930949
Gray F, Bélec L, Lescs MC, Chrétien F, Ciardi A, Hassine D, Flament-Saillour M, de Truchis P, Clair B, Scaravilli F (1994) Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Brain 117(Pt 5):987–999. https://doi.org/10.1093/brain/117.5.987 . (PMID: 7953606)
doi: 10.1093/brain/117.5.987
pubmed: 7953606
Berger JR, Chauhan A, Galey D, Nath A (2001) Epidemiological evidence and molecular basis of interactions between HIV and JC virus. J Neurovirol 7(4):329–338. https://doi.org/10.1080/13550280152537193 . (PMID: 11517412)
doi: 10.1080/13550280152537193
pubmed: 11517412
Samannodi M, Hansen M, Hasbun R (2019) Lack of accuracy of the international classification of disease, ninth (ICD-9) codes in identifying patients with encephalitis. J Neurol 266(4):1034–1035
doi: 10.1007/s00415-019-09229-9
pubmed: 30729315
Venkatesan A, Tunkel AR, Bloch KC (2013) Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis. Consortium Clin Infect Dis 57(October (8)):1114–1128
doi: 10.1093/cid/cit458
pubmed: 23861361
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173:676–682. https://doi.org/10.1093/aje/kwq433
doi: 10.1093/aje/kwq433
pubmed: 21330339
Gonzalez H, Koralnik IJ, Marra CM (2019) Neurosyphilis. Semin Neurol 39(4):448–455
doi: 10.1055/s-0039-1688942
pubmed: 31533185
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26(11):1793–1800. https://doi.org/10.1097/00003246-199811000-00016
doi: 10.1097/00003246-199811000-00016
pubmed: 9824069
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829 (PMID: 3928249)
doi: 10.1097/00003246-198510000-00009
pubmed: 3928249
Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R (1976) Predicting outcome in individual patients after severe head injury. Lancet 1(7968):1031–1034. https://doi.org/10.1016/s0140-6736(76)92215-7 . (PMID: 57446)
doi: 10.1016/s0140-6736(76)92215-7
pubmed: 57446
R Core Team (2021) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https://www.R-project.org/
Tunkel AR, Glaser CA, Bloch KC (2008) The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 47(August (3)):303–327
doi: 10.1086/589747
pubmed: 18582201
Solomon T, Michael BD, Smith PE (2012) Management of suspected viral encephalitis in adults —Association of British Neurologists and British Infection Association National Guidelines. J Infect 64:347–373
doi: 10.1016/j.jinf.2011.11.014
pubmed: 22120595
Britton PN, Eastwood K, Brew BJ, Nagree Y, Jones CA (2015) Consensus guidelines for the investigation and management of encephalitis. Med J Aust 202:576–577
doi: 10.5694/mja14.01042
pubmed: 26068688
Stahl JP, Azouvi P, Bruneel F, De Broucker T (2017) Guidelines on the management of infectious encephalitis in adults. Med Mal Infect 47:179–194
doi: 10.1016/j.medmal.2017.01.005
pubmed: 28412044
Boucher A, Herrmann JL, Morand P et al (2017) Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect 47:221–235
doi: 10.1016/j.medmal.2017.02.003
pubmed: 28341533
Venkatesan A, Murphy OC (2018) Viral Encephalitis. Neurol Clin 36(4):705–724. https://doi.org/10.1016/j.ncl.2018.07.001 . (Epub 2018 Sep 20. PMID: 30366550)
doi: 10.1016/j.ncl.2018.07.001
pubmed: 30366550
Quereda C, Corral I, Laguna F et al (2000) Diagnostic utility of a multiplex herpesvirus PCR assay performed with cerebrospinal fluid from human immunodeficiency virus-infected patients with neurological disorders. J Clin Microbiol 38(8):3061–3067. https://doi.org/10.1128/JCM.38.8.3061-3067.2000
doi: 10.1128/JCM.38.8.3061-3067.2000
pubmed: 10921978
pmcid: 87185
Pahud BA, Glaser CA, Dekker CL, Arvin AM, Schmid DS (2011) Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine. J Infect Dis 203(3):316–323. https://doi.org/10.1093/infdis/jiq066 . (Epub 2010 Dec 21. PMID: 21177308; PMCID: PMC3071104)
doi: 10.1093/infdis/jiq066
pubmed: 21177308
pmcid: 3071104
Marra CM, Tantalo LC, Maxwell CL, Dougherty K, Wood B (2004) Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals. Neurology 63(1):85–88. https://doi.org/10.1212/01.wnl.0000131902.69113.34 . (PMID: 15249615)
doi: 10.1212/01.wnl.0000131902.69113.34
pubmed: 15249615
Marra CM, Maxwell CL, Smith SL, Lukehart SA, Rompalo AM, Eaton M, Stoner BP, Augenbraun M, Barker DE, Corbett JJ, Zajackowski M, Raines C, Nerad J, Kee R, Barnett SH (2004) Cerebrospinal fluid abnormalities in patients with syphilis: association with clinical and laboratory features. J Infect Dis 189(3):369–376. https://doi.org/10.1086/381227 . (Epub 2004 Jan 27. PMID: 14745693)
doi: 10.1086/381227
pubmed: 14745693