Bacterial

Mycobacterium tuberculosis

Mycobacterium avium-intracellulare

Treponema pallidum

Nocardia

Salmonella

Listeria monocytogenes VIRAL

Cytomegalovirus Herpes simplex viruses 1 and 2 Varicella zoster virus JC virus

Epstein-Barr virus FUNGI

Cryptococcus neoformans Candida

Coccicioides immitis Aspergillus

Histoplasma capsulatum PROTOZOA

Toxoplasma gondii Trypanosoma cruzi Acanthamoeba

Modified from Marra CM: Opportunistic infections in AIDS, Infections of the Nervous System II. Minneapolis, MN, American Academy of Neurology, 1997, pp 234-259

TABLE 44-14 -- CORRELATION BETWEEN CENTRAL NERVOUS SYSTEM DISEASE SUSCEPTIBILITY AND PERIPHERAL BLOOD CD4 COUNT

CD 4+ count, cells/muL

TABLE 44-14 -- CORRELATION BETWEEN CENTRAL NERVOUS SYSTEM DISEASE SUSCEPTIBILITY AND PERIPHERAL BLOOD CD4 COUNT

CD 4+ count, cells/muL

>500

500-200

<200

<100

Toxoplasma encephalitis

X

X

Cryptococcal meningitis

X

X

Syphilitic meningitis

X

X

X

X

Tuberculous meningitis

X

X

X

Coccidioidal meningitis

X

X

Cytomegalovirus encephalitis or polyradiculopathy

X

Progressive multifocal leukoencephalopathy

X

Modified from Marra CM: Opportunistic infections in AIDS, Infections of the Nervous System II. Minneapolis, MN, American Academy of Neurology, 1997, pp 234-260.

severely immunosuppressed, and like PCNSL, is linked etiopathologically to Epstein-Barr virus. Non-Hodgkin's lymphoma often presents as an aggressive tumor, and there is a propensity for CNS metastasis. Approximately one third to one half of patients with non-Hodgkin's lymphoma develop metastatic CNS disease. Leptomeningeal involvement is common, with extension along the Virchow-Robins spaces, the cranial and spinal nerve sheaths, and the CSF pathways. Clinical features include mental status changes, seizures, cranial neuropathies and radiculopathies, and paraspinal masses. ;s3] Neuroimaging studies often reveal hydrocephalus with basilar meningeal enhancement. Diffuse leptomeningeal and cortical enhancement may also occur. CSF studies show depressed glucose levels. Lymphoma cells may be seen on cytological studies. Combination chemotherapy regimens have not been as successful in prolonging life in patients with AIDS-associated non- Hodgkin's lymphoma as they have in non-AIDS-non- Hodgkin's lymphoma patients. The poor response and short survival may be due to severe immunosuppression and the occurrence of OIs.

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