Abstract
Effective diagnosis and treatment of cytomegalovirus infection of the nervous system in AIDS patients has been limited by a lack of sensitive diagnostic measures. Retrospective series suggest a poor prognosis for cytomegalovirus encephalitis with rapid mortality. Polymerase chain reaction amplification of cytomegalovirus DNA allows detection in CSF that appears specific for CNS infection. In this series of seven patients with CNS cytomegalovirus infection in AIDS, four patients responded to therapy. Serial determinations of cytomegalovirus DNA in CSF in five patients revealed persistent detection in two treatment failures and absence of detection in three responders on subsequent CSF samples. A prospective trial to determine optimal therapy and to confirm the utility of cytomegalovirus DNA in CSF as a marker of the course of cytomegalovirus infection in the CNS is warranted and should consider prior therapy for cytomegalovirus, prior opportunistic infections, and leukoencephalopathy as potential prognostic variables.
Publication types
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Case Reports
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Research Support, U.S. Gov't, P.H.S.
MeSH terms
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AIDS-Related Opportunistic Infections / diagnosis
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AIDS-Related Opportunistic Infections / drug therapy*
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Acyclovir / therapeutic use
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Adult
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Antiviral Agents / therapeutic use*
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Base Sequence
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Cerebrospinal Fluid / virology
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Cytomegalovirus / genetics
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Cytomegalovirus / isolation & purification*
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Cytomegalovirus Infections / cerebrospinal fluid
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Cytomegalovirus Infections / diagnosis*
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Cytomegalovirus Infections / drug therapy*
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DNA Primers
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Encephalitis / diagnosis*
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Encephalitis / drug therapy
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Encephalitis / virology
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Foscarnet / therapeutic use
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Ganciclovir
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Genes, Immediate-Early
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HIV Seropositivity
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Humans
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Male
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Meningitis / diagnosis*
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Meningitis / drug therapy
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Meningitis / virology
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Molecular Sequence Data
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Polymerase Chain Reaction / methods
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Prognosis
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Sensitivity and Specificity
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Spinal Cord Diseases / diagnosis
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Spinal Cord Diseases / drug therapy
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Spinal Cord Diseases / virology
Substances
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Antiviral Agents
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DNA Primers
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Foscarnet
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Ganciclovir
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Acyclovir