Focal Brain Lesions in HIV Infected Children India

Abstract

Background: There is paucity of published literature on the HIV-associated focal brain lesions (HFBL) in children. In HIV infected adults HFBL are caused by opportunistic infections, neoplasms, or cerebrovascular diseases. In developed countries, cerebral toxoplasmosis is the most frequent cause, followed by primary CNS lymphoma. Guidelines based on these causes however are poorly suited to developing countries, where treatable infections predominate as causes of HFBL. Aim: To study the clinical profile laboratory finding, the CT scan findings and response to treatment in HIV infected children with focal brain lesions on CT scan to determine their causes that would aid in developing a practical approach to the management of HFBL in developing countries. Design and methods: Case series. The clinical presentation, laboratory findings including radiological studies and response to treatment in 9 HIV infected were with focal brain lesions were reviewed to establish the presumed diagnosis of the focal brain lesions. The etiology of the focal brain lesions was determined by collating information from CT scans, CSF and blood studies, concurrent non-neurological illness. Results: There were 9 (9.4%) cases including 5 males and 4 females from among the 96 cases who had a CT scan done for suspected focal brain pathology based on their clinical presentation. The principal presumed cause of HFBL was Tuberculosis (67%), Neurocysticercosis (33%) and Toxoplasmosis (11%). Conclusion: In developing countries, infections are the predominant cause of HFBL, the principal causes being infections that are endemic to the populations being studied. Empiric treatment based on limited investigations should be directed according to the nature of such infections.