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Volume 5, Issue 6(Suppl)

J Infect Dis Ther, an open access journal

ISSN: 2332-0877

Euro Infectious Diseases 2017

September 07-09, 2017

September 07-09, 2017 | Paris, France

Infectious Diseases

Euro-Global Conference on

Cytomegalovirus

-Varicella zoster meningoencephalitis and ischemic stroke in an HIV-AIDS patient:

A case report

Monica Pia P Reyes

and

Ryan M Llorin

St. Luke’s Medical Center-Global City, Philippines

long with the increasing number of newly diagnosed human immunodeficiency virus (HIV) patients per day in Philippines

(26 new cases/day) is an increasing number of HIV patients diagnosed with central nervous system infection (CNSI) and

stroke. A study shows that the risk of ischemic stroke was higher among those with HIV infection compared with uninfected

people (hazard ratio 1.17). Mechanisms of ischemic stroke include HIV-associated vasculopathy, opportunistic infections

or neoplasia, cardio-embolism and coagulopathy. This case report aims to present a CNS co-infection of the three most

documented viruses that causes stroke:

Cytomegalovirus

(CMV), Varicella zoster Virus (VZV) and HIV. The inflammatory

cascade in these infections promotes atherosclerosis, plaque rupture and thrombosis, leading to ischemic stroke. A 35-year-

old male with HIV who was non-compliant with anti-retroviral therapy and who had recent untreated shingles was brought

in with decreased sensorium, signs of meningeal irritation and right-sided neurologic deficit. Computed tomography scan

revealed acute to sub-acute infarct, left middle cerebral artery territory (Figure 1). He was admitted and started empirically

on vancomycin, ampicillin, cefepime and ganciclovir for central nervous system infection. HIV work-up revealed a CD4 of

11 cells/mm3 and HIV-1 RNA of 1, 124, 215 copies/mL. CMV IgG is positive at 65 U/mL. Lumbar tap done had an elevated

opening pressure with elevated cerebrospinal fluid (CSF) protein, low-normal CSF glucose and pleocytosis with lymphocytic

predominance. Viral panel showed CMV viral load of 634,000 copies/mL and VZV IgG 44.4 mIU/L clinching the diagnosis of

concomitant CMV-VZV meningoencephalitis in this HIV patient. Magnetic resonance imaging and angiogram is compatible

with viral vasculopathy (Figure 2).The pathogenicmechanisms of VZV reactivation in the CNS include neuronal and glial direct

infection and immune-mediated lesions including vasculitis and demyelinization while CMV infection of vascular smooth

muscle cells induces production of powerful pro-inflammatory cytokines which accelerate atherosclerosis development. This

might be the first reported case of co-infection of the CMV- VZV-HIV meningoencephalitis and ischemic stroke.

J Infect Dis Ther 2017, 5:6(Suppl)

DOI: 10.4172/2332-0877-C1-033