Universidad Peruana Cayetano Heredia

Clinical and Metagenomic Characterization of Neurological Infections of People With Human Immunodeficiency Virus in the Peruvian Amazon.

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dc.contributor.author Steinberg, Hannah E.
dc.contributor.author Ramachandran, Prashanth S.
dc.contributor.author Diestra Calderon, Andrea Jackeline
dc.contributor.author Pinchi, Lynn
dc.contributor.author Ferradas Carrillo, Cusi
dc.contributor.author Kirwan, Daniela E.
dc.contributor.author Diaz, Monica M.
dc.contributor.author Sciaudone, Michael
dc.contributor.author Wapniarski, Annie
dc.contributor.author Zorn, Kelsey C.
dc.contributor.author Calderón Sánchez, Maritza Mercedes
dc.contributor.author Cabrera, Lilia
dc.contributor.author Pinedo-Cancino, Viviana
dc.contributor.author Wilson, Michael R.
dc.contributor.author Asayag, Cesar Ramal
dc.contributor.author Gilman, Robert H.
dc.contributor.author Bowman, Natalie M.
dc.coverage.spatial Loreto, Perú
dc.date.accessioned 2023-12-05T17:47:58Z
dc.date.available 2023-12-05T17:47:58Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14617
dc.description.abstract BACKGROUND: Neurological opportunistic infections cause significant morbidity and mortality in people with human immunodeficiency virus (HIV) but are difficult to diagnose. METHODS: One hundred forty people with HIV with acute neurological symptoms from Iquitos, Peru, were evaluated for cerebral toxoplasmosis with quantitative polymerase chain reaction (qPCR) of cerebrospinal fluid (CSF) and for cryptococcal meningitis with cryptococcal antigen test (CrAg) in serum or CSF. Differences between groups were assessed with standard statistical methods. A subset of samples was evaluated by metagenomic next-generation sequencing (mNGS) of CSF to compare standard diagnostics and identify additional diagnoses. RESULTS: Twenty-seven participants were diagnosed with cerebral toxoplasmosis by qPCR and 13 with cryptococcal meningitis by CrAg. Compared to participants without cerebral toxoplasmosis, abnormal Glasgow Coma Scale score (P = .05), unilateral focal motor signs (P = .01), positive Babinski reflex (P = .01), and multiple lesions on head computed tomography (CT) (P = .002) were associated with cerebral toxoplasmosis. Photophobia (P = .03) and absence of lesions on head CT (P = .02) were associated with cryptococcal meningitis. mNGS of 42 samples identified 8 cases of cerebral toxoplasmosis, 7 cases of cryptococcal meningitis, 5 possible cases of tuberculous meningitis, and incidental detections of hepatitis B virus (n = 1) and pegivirus (n = 1). mNGS had a positive percentage agreement of 71% and a negative percentage agreement of 91% with qPCR for T gondii. mNGS had a sensitivity of 78% and specificity of 100% for Cryptococcus diagnosis. CONCLUSIONS: An infection was diagnosed by any method in only 34% of participants, demonstrating the challenges of diagnosing neurological opportunistic infections in this population and highlighting the need for broader, more sensitive diagnostic tests for central nervous system infections. en_US
dc.language.iso eng
dc.publisher Oxford University Press
dc.relation.ispartofseries Open Forum Infectious Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Clinical and Metagenomic Characterization en_US
dc.subject Neurological Infections en_US
dc.subject Human Immunodeficiency en_US
dc.subject Virus en_US
dc.subject Peruvian Amazon en_US
dc.subject.mesh Manifestaciones Neurológicas
dc.subject.mesh VIH
dc.subject.mesh Ecosistema Amazónico
dc.title Clinical and Metagenomic Characterization of Neurological Infections of People With Human Immunodeficiency Virus in the Peruvian Amazon. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1093/ofid/ofad515
dc.relation.issn 2328-8957


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