Steinberg, HE;
Ramachandran, PS;
Diestra, A;
Pinchi, L;
Ferradas, C;
Kirwan, DE;
Diaz, MM;
Sciaudone, M;
Wapniarski, A;
Zorn, KC;
et al.
Steinberg, HE; Ramachandran, PS; Diestra, A; Pinchi, L; Ferradas, C; Kirwan, DE; Diaz, MM; Sciaudone, M; Wapniarski, A; Zorn, KC; Calderón, M; Cabrera, L; Pinedo-Cancino, V; Wilson, MR; Asayag, CR; Gilman, RH; Bowman, NM; Toxoplasmosis Working Group in Peru
(2023)
Clinical and Metagenomic Characterization of Neurological Infections of People With Human Immunodeficiency Virus in the Peruvian Amazon.
Open Forum Infect Dis, 10 (11).
ofad515.
ISSN 2328-8957
https://doi.org/10.1093/ofid/ofad515
SGUL Authors: Kirwan, Daniela Elisa
Abstract
BACKGROUND: Neurological opportunistic infections cause significant morbidity and mortality in people with human immunodeficiency virus (HIV) but are difficult to diagnose. METHODS: One hundred forty people with HIV with acute neurological symptoms from Iquitos, Peru, were evaluated for cerebral toxoplasmosis with quantitative polymerase chain reaction (qPCR) of cerebrospinal fluid (CSF) and for cryptococcal meningitis with cryptococcal antigen test (CrAg) in serum or CSF. Differences between groups were assessed with standard statistical methods. A subset of samples was evaluated by metagenomic next-generation sequencing (mNGS) of CSF to compare standard diagnostics and identify additional diagnoses. RESULTS: Twenty-seven participants were diagnosed with cerebral toxoplasmosis by qPCR and 13 with cryptococcal meningitis by CrAg. Compared to participants without cerebral toxoplasmosis, abnormal Glasgow Coma Scale score (P = .05), unilateral focal motor signs (P = .01), positive Babinski reflex (P = .01), and multiple lesions on head computed tomography (CT) (P = .002) were associated with cerebral toxoplasmosis. Photophobia (P = .03) and absence of lesions on head CT (P = .02) were associated with cryptococcal meningitis. mNGS of 42 samples identified 8 cases of cerebral toxoplasmosis, 7 cases of cryptococcal meningitis, 5 possible cases of tuberculous meningitis, and incidental detections of hepatitis B virus (n = 1) and pegivirus (n = 1). mNGS had a positive percentage agreement of 71% and a negative percentage agreement of 91% with qPCR for T gondii. mNGS had a sensitivity of 78% and specificity of 100% for Cryptococcus diagnosis. CONCLUSIONS: An infection was diagnosed by any method in only 34% of participants, demonstrating the challenges of diagnosing neurological opportunistic infections in this population and highlighting the need for broader, more sensitive diagnostic tests for central nervous system infections.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) |
Journal or Publication Title: |
Open Forum Infect Dis |
ISSN: |
2328-8957 |
Language: |
eng |
Dates: |
Date | Event |
---|
November 2023 | Published | 27 October 2023 | Published Online | 26 October 2023 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
|
PubMed ID: |
37965640 |
Web of Science ID: |
WOS:001104463500010 |
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Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/116051 |
Publisher's version: |
https://doi.org/10.1093/ofid/ofad515 |
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