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Volume 5, Issue 2 (Suppl) J Infect Dis Ther 2017
ISSN: 2332-0877, JIDT an open access journal Infection Congress 2017
May 11-12, 2017
May 11-12, 2017 Barcelona, Spain
4th International Congress on
Infectious Diseases
Monica Pia P Reyes et al., J Infect Dis Ther 2017, 5:2 (Suppl)
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
Along with the increasing number of newly diagnosed Human Immunodeficiency Virus (HIV) patients per day in the Philippines
(26 new cases/day), an increasing number of HIV patients were 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,
cardioembolism 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 ischaemic 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). Vancomycin, ampicillin, cefepime and ganciclovir were empirically started 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 was 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
44.4mIU/L clinching the diagnosis of concomitant CMV-VZV meningoencephalitis in an HIV patient. Magnetic resonance imaging
and angiogram is compatible with viral vasculopathy (figure 2). The pathogenic mechanisms 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 seems to be the first reported case of co-infection of the CMV-VZV-HIV meningoencephalitis and ischemic
stroke.
Biography
Monica Pia P Reyes is a Diplomate of Philippine College of Physicians. She completed her Medical degree at University of the Philippines and; Internal Medicine
Residency training at St. Luke’s Medical Center- Global City, Philippines where she was granted 2016 Excellence in Research Award. She is an incoming Infectious
Disease Fellow at Philippine General Hospital. She has organized research forums and training workshops. Her research interest includes HIV/AIDS, Tuberculosis,
and Critical Care Medicine.