Cerebrospinal fluid in acquired immunodeficiency syndrome

THESES

CEREBROSPINAL FLUID IN ACQUIRED IMMUNODEFICIENCY SYNDROME (Abstract)^*. THESIS. SÃO PAULO, 1997.

HÉLIO RODRIGUES GOMES^**

Central nervous system (CNS) involvement occurs early in the course of human immunodeficiency virus (HIV) infection. The main objective of this study is the interpretation of cerebrospinal fluid (CSF) findings in acquired immunodeficiency syndrome (AIDS). 2,327 CSF samples presenting anti-HIV antibodies, from 1,404 patients, were analysed.

Opening pressure, cytomorphological patterns, total proteins concentration, glucose rate, gamma globulin content, enzymatic activity of lactic dehydrogenase (LDH), glutamic-oxalacetic transaminase (GOT) and adenosine-deaminase (ADA) were studied. 2,219 samples (95.3%) presented abnormalities and 108 (4.7%) were normal.

Opening pressure was measured in 2,201 samples, and it was increased in 501 (22.7%). From all samples, 1,094 (47.0%) presented cell number above reference limit, proteins concentration was increased in 1,657 (72.0%) and glucose rate was decreased in 93 (4.0%). Gamma globulin increase was observed in 1,596 samples (73.9%) from 2,157 in which it was studied. Enzymatic activities of GOT and LDH were assessed in 1,172 samples. GOT activity was increased in 305 (26.0%) and LDH activity in 832 (71.0%). ADA enzymatic activity was determined in 1,210 samples being increased in 823 (68.0%). Oligoclonal bands were detected in 417 samples (19.3%).

A unique associated pathology was observed in 1,027 samples (44.2%); the association of more than one pathology was observed in 477 samples (20.4%). In 715 samples (30.7%) there was no evidence of opportunistic infection and/or neoplastic complication.

Observed in 513 samples (22.0%), cryptococcosis was the most frequent pathology, followed by toxoplasmosis in 419 samples (18.0%), cytomegalovirus infection in 246 (10.6%), syphilis in 117 (5.0%), lymphoma in 83 (3.6%), tuberculosis in 47 (1.9%) and herpes virus infection in 38 (1.6%).

Thereafter, the samples were divided into three different groups: the first group formed by samples in which the pathologic agent was identified (tuberculosis and cryptococcosis); the second group formed by those samples in which IgG antibodies were detected (toxoplasmosis, cytomegalovirus infection, syphilis and herpes virus infection); and the third group formed by samples in which cells with neoplastic features (lymphoma) were observed. The pathologies were analysed in isolated and in associated ways. The univariate analysis displayed that number of cells and protein concentration were statistically higher in every pathology except syphilis; variable neutrophils was higher in tuberculosis and in herpes virus infection; tuberculosis, cryptococcosis and lymphoma presented glucose rate statistically decreased; LDH activity was higher in cytomegalovirus infection, lymphoma and tuberculosis. Oligoclonal bands frequency was statistically higher in syphilis and cytomegalovirus infection (univariate analysis) and herpes virus infection (multivariate analysis). By multivariate analysis, hypercytosis presents significance level in: tuberculosis, cytomegalovirus infection and lymphoma; neutrophils participation is significative in tuberculosis and cytomegalovirus infection. Enzymatic activity of GOT is frequently increased in lymphoma. Interferences among pathologies are analysed as well as risk probabilities related to the variables.

KEY WORDS: cerebrospinal fluid, nervous system, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), opportunistic infections, lymphoma.

**Address; Praça Amadeu Amaral 47 / 33, 01327-010 São Paulo SP, Brasil.

*

O líquido cefalorraqueano na síndrome da imunodeficiência adquirida (Resumo). Tese de Doutorado, Faculdade de Medicina da Universidade de São Paulo (Área: Neurologia). Orientador: José Luiz Dias Gherpelli.

Publication Dates

• Publication in this collection
  17 Nov 2000
• Date of issue
  Mar 1998