Table 2.
Opportunistic illnesses of the central nervous system in AIDS
| OI | CD4 | Signs | Focal | CT/MRI | Lumbar Puncture |
|---|---|---|---|---|---|
| Toxoplasmosis | <100 | Fever | Y | Ring-enhancing lesions | Toxoplasma gondii antibody or PCR High specificity/low sensitivity |
| Delirium | Basal ganglia | Other routine CSF studies not generally diagnostic | |||
| Headache | Gray-white junction | ||||
| Seizures | |||||
|
| |||||
| Cytomegalovirus | <50 | Delirium | Y/N | Ventricular enlargement | CMV PCR |
| Infections found at diagnosis | Increased periventricular signal (T2 image) | Variable specificity/variable sensitivity | |||
| Retina | Elevated protein level, pleocytosis, hypoglycorrhachia | ||||
| Blood | |||||
| Adrenal gland | |||||
| Gastrointestinal tract | |||||
|
| |||||
| Cryptococcal meningitis | <100 | Fever | N | Nonspecific | Cryptococcus neoformans, India ink, latex agglutination or PCR |
| Delirium | High specificity/high sensitivity | ||||
| Not universally seen | Other routine CSF studies not generally diagnostic | ||||
| Increased intracranial pressure (50%) | |||||
| Seizures | |||||
|
| |||||
| Progressive multifocal leukoencephalopathy (JCV) | <100 | Mono/hemiparesis Dysarthria | Y | Attenuated signal/(T2 images) | JCV PCR |
| Gait disturbance Sensory deficit Progressive dementia Occasional | Periventricular White matter | High specificity/high sensitivity | |||
| Visual loss Seizures | Other areas: Gray matter | Other routine CSF studies not generally diagnostic | |||
| Brainstem Cerebellum Spinal cord | |||||
|
| |||||
| Central nervous system neoplasm/lymphoma | <100 | Afebrile delirium Seizures (10%) Increased intracranial pressure | Y | Lesions Hypodense/patchy Nodular Enhancing SPECT thallium | EBV PCR |
| differentiates from toxoplasmosis | High specificity/high sensitivity | ||||
| Other routine CSF studies not generally diagnostic | |||||
Abbreviations: CMV, cytomegalovirus; CSF, cerebrospinal fluid; CT, computed tomography; EBV, Epstein-Barr virus; JCV, JC virus; N, no; OI, opportunistic illnesses; PCR, polymerase chain reaction; SPECT, single-photon emission computed tomography; Y, yes.