Opportunistic neuroinfections in retroviral disease - retrospective hospital-based study from india

Abstract

Background: Patients with retroviral disease are prone for opportunistic infections which are significant cause of mortality and morbidity. Cryptococcosis, tuberculosis and toxoplasma are the commonest infections occurring at all stages of the disease. Objective: This study was undertaken to evaluate the pattern of opportunistic infections and in hospital mortality in AIDS patients. Methods: This retrospective analysis was done in tertiary care hospital from 2001-2014 services. Details of clinical profile and laboratory investigations of patients admitted under neurological services with neuroinfections were studied. Results: There were 167 patients with 131 men and 36 women (ratio 3.63:1). Their age ranged from 16 to 67 years (39.25 ± 8.85). Clinical presentation was acute in 58%, subacute in 32% and chronic in 10%. Fever (65.86%) and headache (86.82%) were common symptoms. Seizures were present in 25% of the patients and altered sensorium in 37%. Among the neuroinfections cryptococcal meningitis was the commonest etiology accounting for 40%. Other infections included tuberculosis (19%), viral (20)%, mixed tubercular and fungal (13%) and toxoplasmosis (6%). PML was seen in 10%. Dyselectrolemia was seen in 16.76% patients. Fifteen patients died during admission (9%) . Twenty patients had cerebral granulomas. Mortality was the highest in cryptococcal meningitis (46.6%) followed mixed infection (26.6%), neurotuberculosis (13.3%) and viral etiology (13.3%). Complication at the onset and during the course consisted of renal dysfunction in 19, uncontrolled seizures in 16 patients, and hepatic dysfunction in 11 patients. Conclusion: Commonest opportunistic infection in AIDS patients is cryptococcal meningitis. Others being neurotuberculosis, progressive multifocal leucoencephalopathy and toxoplasmosis.