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Article ; Online: HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease.

Vidal, José Ernesto

Journal of the International Association of Providers of AIDS Care

2019 Volume 18, Page(s) 2325958219867315

Abstract: Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring- ... ...

Abstract	Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.
MeSH term(s)	Anti-Retroviral Agents/therapeutic use ; Antiprotozoal Agents/therapeutic use ; Brain/drug effects ; Brain/parasitology ; Brain/pathology ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/parasitology ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Toxoplasmosis, Cerebral/diagnosis ; Toxoplasmosis, Cerebral/drug therapy ; Toxoplasmosis, Cerebral/virology ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
Chemical Substances	Anti-Retroviral Agents ; Antiprotozoal Agents ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2019-09-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2709037-1
ISSN	2325-9582 ; 2325-9574
ISSN (online)	2325-9582
ISSN	2325-9574
DOI	10.1177/2325958219867315
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Cerebral toxoplasmosis with neurological co-infection in people living with AIDS/HIV: results of a prospective cohort in São Paulo, Brazil.

Telles, João Paulo Marochi / Vidal, José Ernesto

Arquivos de neuro-psiquiatria

2023 Volume 81, Issue 1, Page(s) 33–39

Abstract: Background: Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical ... ...

Title translation	Toxoplasmose cerebral com coinfecção neurológica em pessoas que vivem com HIV/AIDS: resultados de uma coorte prospectiva em São Paulo, Brasil.
Abstract	Background: Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. Methods: We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. Results: We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35-50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15-94) cells/mm Conclusion: Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate.
MeSH term(s)	Humans ; Male ; Adult ; Middle Aged ; Female ; Toxoplasmosis, Cerebral/complications ; Toxoplasmosis, Cerebral/epidemiology ; Toxoplasmosis, Cerebral/diagnosis ; Coinfection ; Hospital Mortality ; Prospective Studies ; Brazil/epidemiology ; Nervous System Diseases/complications ; AIDS-Related Opportunistic Infections ; HIV Infections/complications
Language	English
Publishing date	2023-03-14
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0042-1759758
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Article ; Online: Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up.

Bonato, Flávia Carolina Soares / Rivero, René Leandro Magalhães / Garcia, Hector Hugo / Vidal, José Ernesto

Revista do Instituto de Medicina Tropical de Sao Paulo

2024 Volume 66, Page(s) e15

Abstract: Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed ... ...

Abstract	Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.
MeSH term(s)	Humans ; Toxoplasmosis, Cerebral/complications ; Toxoplasmosis, Cerebral/diagnosis ; Follow-Up Studies ; HIV Infections/complications ; HIV Infections/drug therapy ; Neurocysticercosis/complications ; Neurocysticercosis/diagnosis ; Edema/etiology
Language	English
Publishing date	2024-03-18
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	128928-7
ISSN	1678-9946 ; 0036-4665
ISSN (online)	1678-9946
ISSN	0036-4665
DOI	10.1590/S1678-9946202466015
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Article: Cerebral toxoplasmosis with neurological co-infection in people living with AIDS/HIV: results of a prospective cohort in São Paulo, Brazil

Telles, João Paulo Marochi / Vidal, José Ernesto

Arquivos de Neuro-Psiquiatria

2023 Volume 81, Issue 01, Page(s) 33–39

Abstract	Background: Concomitant neurological diseases in people living with HIV/AIDS (PLWHA) is a challenging subject that has been insufficiently evaluated by prospective clinical studies. The goal of the present study was to identify the clinical characteristics and outcomes of PLWHA with cerebral toxoplasmosis and neurological co-infections. Methods: We conducted a prospective observational cohort study at a tertiary teaching center in São Paulo, Brazil, from January to July 2017. Hospitalized PLWHA aged ≥ 18 years with cerebral toxoplasmosis were consecutively enrolled. A standardized neurological examination was performed at admission and weekly until discharge or death. Diagnosis and treatment followed institutional routines; neuroradiology, molecular diagnosis, neurosurgery, and the intensive care unit (ICU) were available. The main outcomes were neurological coinfections and in-hospital death. Results: We included 44 (4.3%) cases among 1,032 hospitalized patients. The median age was 44 (interquartile range [IQR]: 35–50) years, and 50% (n = 22) of the patients were male. The median CD4+ T lymphocyte count was of 50 (IQR: 15–94) cells/mm 3. Multiple lesions on computed tomography were present in 59% of the cases. Neurological coinfections were diagnosed in 20% (n = 9) of the cases, and cytomegalovirus was the most common etiology (encephalitis: n = 3; polyradiculopathy: n = 2). Longer hospital stays (30 versus 62 days; p = 0.021) and a higher rate of ICU admissions (14% versus 44%; p = 0.045) were observed among PLWHA with neurological coinfections in comparison to those without them. The rate of in-hospital mortality was of 13.6% (n = 6) (coinfection group: 33%; no coinfection group: 8.6%; p = 0.054). Conclusion: Neurological c-infections were common among PLWHA with cerebral toxoplasmosis, and cytomegalovirus was the main copathogen. The group of PLWHA with neurological co-infections underwent longer hospital stays and more frequent intensive care unit admissions. Additionally, this group of patients tended to have higher in-hospital mortality rate.
Keywords	HIV ; Cerebral Toxoplasmosis ; Coinfection ; HIV ; Toxoplasmose Cerebral ; Coinfecção
Language	English
Publishing date	2023-01-01
Publisher	Thieme Revinter Publicações Ltda.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0042-1759758
Database	Thieme publisher's database

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Article ; Online: AIDS-related gastrointestinal cytomegalovirus end-organ disease: A retrospective cohort study at a tertiary center in São Paulo, Brazil.

Reis Schneider, Gustavo Arthur / Bogoni, Giuliane / Castanheira, Nidyanara Francine / Lucas Júnior, Rodovaldo Moraes / Vidal, José Ernesto

International journal of STD & AIDS

2023 Volume 35, Issue 5, Page(s) 365–373

Abstract: Background: Current information about AIDS-related gastrointestinal cytomegalovirus end-organ disease (CMV-EOD) is scarce. The objectives of this study were to identify the prevalence and main features of gastrointestinal CMV-EOD in patients with ... ...

Abstract	Background: Current information about AIDS-related gastrointestinal cytomegalovirus end-organ disease (CMV-EOD) is scarce. The objectives of this study were to identify the prevalence and main features of gastrointestinal CMV-EOD in patients with advanced HIV disease. Methods: Retrospective cohort study carried-out at a tertiary-care center in São Paulo, Brazil, from January to December 2019. We included hospitalized people living with HIV with gastrointestinal CMV-EOD, CD4 + count ≤100 cells/µL, and ≥ one quantitative detection of CMV DNA in plasma. Results: Ten (3.8%) of 261 cases had gastrointestinal CMV-EOD. Nine (90%) cases were men, age median (IQR) was 44 (38-54) years, and CD4 + cell count median (IQR) was 6 (7-39) cells/µL. The 10 cases had positive quantitative detection of CMV DNA in plasma with median (IQR) of 572 (103-2 981) IU/mL. The main presenting condition was esophagitis ( Conclusions: The prevalence of gastrointestinal CMV-EOD was 3.8%, similar to described in pre-combined antiretroviral therapy studies. Among cases with gastrointestinal CMV-EOD, all had positive quantitative detection of CMV-DNA in plasma but the values varied; esophagitis was the most common presentation, and all but one were discharged from the hospital.
MeSH term(s)	Male ; Humans ; Adult ; Female ; Cytomegalovirus ; Acquired Immunodeficiency Syndrome ; Brazil ; Retrospective Studies ; Cytomegalovirus Infections ; HIV Infections/epidemiology ; Gastrointestinal Diseases ; DNA ; Esophagitis ; CD4 Lymphocyte Count
Chemical Substances	DNA (9007-49-2)
Language	English
Publishing date	2023-12-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1018089-8
ISSN	1758-1052 ; 0956-4624
ISSN (online)	1758-1052
ISSN	0956-4624
DOI	10.1177/09564624231222962
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Article: Chronic disseminated cryptococcosis without meningeal involvement in a severely immunosuppressed HIV-infected patient successfully treated with fluconazole.

Yonekura, Tatiane da Silveira / Macedo, Soraya Devi / Moya, Fernanda Gonçalves / Vidal, José Ernesto

Medical mycology case reports

2022 Volume 38, Page(s) 30–32

Abstract: A 43-year-old female with advanced HIV infection presented with two chronic skin lesions. Cutaneous cryptococcosis was confirmed and pulmonary cryptococcosis was suspected. The patient was neurologically asymptomatic and the cerebrospinal fluid ... ...

Abstract	A 43-year-old female with advanced HIV infection presented with two chronic skin lesions. Cutaneous cryptococcosis was confirmed and pulmonary cryptococcosis was suspected. The patient was neurologically asymptomatic and the cerebrospinal fluid cryptococcal antigen lateral flow assay was negative. She received oral fluconazole and had resolution of the skin lesions and significant improvement of the lung lesions. We report a person with AIDS with chronic disseminated cryptococcosis without meningeal involvement successfully treated with oral fluconazole.
Language	English
Publishing date	2022-10-28
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2670415-8
ISSN	2211-7539
ISSN	2211-7539
DOI	10.1016/j.mmcr.2022.10.001
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Article ; Online: Diagnostic and therapeutic approach to chronic meningitis in Brazil: a narrative review.

Silva, Guilherme Diogo / Guedes, Bruno Fukelmann / Junqueira, Ióri Rodrigues / Gomes, Hélio Rodrigues / Vidal, José Ernesto

Arquivos de neuro-psiquiatria

2022 Volume 80, Issue 11, Page(s) 1167–1177

Abstract: Background: Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce.: Objective: To critically review ... ...

Title translation	Abordagem diagnóstica e terapêutica da meningite crônica no Brasil: uma revisão narrativa.
Abstract	Background: Chronic meningitis (CM) is characterized by neurological symptoms associated with the evidence of cerebrospinal fluid pleocytosis lasting > 4 weeks. Studies on the management of CM in Brazil are scarce. Objective: To critically review the literature on CM and propose a rational approach in the Brazilian scenario. Methods: Narrative literature review discussing the epidemiology, clinical evaluation, basic and advanced diagnostic testing, and empirical and targeted therapy for the most relevant causes of CM. The present review was contextualized with the local experience of the authors. In addition, we propose an algorithm for the management of CM in Brazil. Results: In Brazil, tuberculosis and cryptococcosis are endemic and should always be considered in CM patients. In addition to these diseases, neurosyphilis and other endemic conditions should be included in the differential diagnosis, including neurocysticercosis, Baggio-Yoshinari syndrome, and endemic mycosis. After infectious etiologies, meningeal carcinomatosis and autoimmune diseases should be considered. Unbiased and targeted methods should be used based on availability and clinical and epidemiological data. Conclusion: We propose a rational approach to CM in Brazil, considering the epidemiological scenario, systematizing the etiological investigation, and evaluating the timely use of empirical therapies.
MeSH term(s)	Humans ; Brazil/epidemiology ; Meningitis/diagnosis ; Meningitis/epidemiology ; Meningitis/therapy ; Syndrome ; Neurocysticercosis/complications ; Neurosyphilis/complications
Language	English
Publishing date	2022-12-28
Publishing country	Germany
Document type	Review ; Journal Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0042-1758645
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Article ; Online: Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists.

Henriques, Bárbara Labella / Vidal, José Ernesto / Gamba, Cristiano / Avelino-Silva, Vivian Iida

Sao Paulo medical journal = Revista paulista de medicina

2022

Abstract: Background: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture ...

Abstract	Background: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. Objective: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. Design and setting: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. Methods: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. Results: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. Conclusion: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.
Language	English
Publishing date	2022-08-29
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	1203171-9
ISSN	1806-9460 ; 1516-3180 ; 0035-0362
ISSN (online)	1806-9460
ISSN	1516-3180 ; 0035-0362
DOI	10.1590/1516-3180.2021.0744.R1.03032022
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Article ; Online: Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian center.

Santana, Monize Nascimento / Ferrari, Raphaela / Macedo, Arthur Cassa / Marcusso, Rosa Maria Nascimento / Fernandes, Ruan de Andrade / Vidal, José Ernesto

Arquivos de neuro-psiquiatria

2023 Volume 81, Issue 10, Page(s) 883–890

Abstract: Background: Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries.: Objective: To describe the ... ...

Title translation	Síndrome inflamatória de reconstituição imune da leucoencefalopatia multifocal progressiva associada à síndrome da imunodeficiência adquirida: prevalência, principais características e desfecho em um hospital brasileiro.
Abstract	Background: Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries. Objective: To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil. Methods: We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Results: We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27-50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30-70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive. Conclusion: The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries.
MeSH term(s)	Male ; Humans ; Adult ; Middle Aged ; Female ; Leukoencephalopathy, Progressive Multifocal/epidemiology ; Acquired Immunodeficiency Syndrome/complications ; Acquired Immunodeficiency Syndrome/drug therapy ; Brazil/epidemiology ; Immune Reconstitution Inflammatory Syndrome/epidemiology ; Immune Reconstitution Inflammatory Syndrome/diagnosis ; Retrospective Studies ; Prevalence
Language	English
Publishing date	2023-10-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	418916-4
ISSN	1678-4227 ; 0004-282X
ISSN (online)	1678-4227
ISSN	0004-282X
DOI	10.1055/s-0043-1772831
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Article ; Online: Septic shock, hyperferritinemic syndrome, and multiple organ dysfunction without respiratory failure in a patient with disseminated histoplasmosis and advanced HIV disease.

Silva, Jussemara Souza da / Ernandes, Bruno Correia / Fernandes, Carol Lee Luna / Correia, Ademir Silva / Ponce, Cesar Cilento / Sztajnbok, Jaques / Rodrigues, Camila / Vidal, José Ernesto

Revista do Instituto de Medicina Tropical de Sao Paulo

2023 Volume 65, Page(s) e28

Abstract: AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental ... ...

Abstract	AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.
MeSH term(s)	Male ; Humans ; Adult ; Histoplasmosis/complications ; Histoplasmosis/diagnosis ; Histoplasmosis/drug therapy ; HIV Infections/complications ; Shock, Septic ; Multiple Organ Failure/etiology ; Histoplasma ; Respiratory Insufficiency/etiology
Language	English
Publishing date	2023-04-14
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	128928-7
ISSN	1678-9946 ; 0036-4665
ISSN (online)	1678-9946
ISSN	0036-4665
DOI	10.1590/S1678-9946202365028
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