Cerebral Infections in Immunocompromised patients

Question 1

Often a solitary lesion located in the periventricular or periepindymal area or in the corpus callosum
Can be difficult to distinguish from toxoplasma

Answer 1

Lymphoma ( primary CNS or B Cell Lymphoma)

Brain Biopsy is diagnostic, biopsy lesions that have failed toxoplasma treatment after 2 weeks

Question 2

Rapidly progressive dementia

CD4 count less than 50

Answer 2

Progressive Multifocal Leukoencephalopathy
PCR of CSF positive for JC virus
Brian biopsy diagnostic

Question 3

Headache, fever, AMS, CD4 count less than 100

Answer 3

Crytpococcus
Elevated opening pressure
Get Culture or Antigen test from CSF

Question 4

Basilar Meningitis with Cranial Nerve Abnormalities

Answer 4

Mycobacterium TB

Culture and PCR of CSF are diagnostic

Question 5

Diffuse Encephalitis and Fever

CD4 less than 50

Answer 5

CMV

CSF PCR , brian biopsy diagnostic

Question 6

What CSF findings are typical of Neurosyphilis

Answer 6

Elevated CSF Protein, Lymphocytic Pleocytosis
Positive serum RPR or VDRL, FTA -ABS and MHA TP
Postive CSF VDRL

Question 7

What is the treatment for Toxoplasmosis

Answer 7

Sulfadiazine, Prymethamine and folic acid

treat patient with immuno suppression indefinitely