John Cunningham virus: Difference between revisions

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* CNS infection with JC virus, usually in the context of HIV infection
+
*CNS infection with JC virus, usually in the context of HIV infection
   
 
==Background==
 
==Background==
 
===Epidemiology===
 
===Epidemiology===
* HIV patients
 
   
 
*HIV patients
==Clinical Presentation==
 
  +
* '''Classic PML'''
 
 
==Clinical Manifestations==
** Subacute onset of focal central neurological lesions
 
  +
** Asymmetric, well-demarcated, nonenchancing subcortical white matter lesions on MRI
 
  +
*'''Classic progressive multifocal leukoencephalopathy (PML)'''
* '''PML-IRIS'''
 
** Focal central neurological lesions following immune recovery
+
**Subacute onset of focal central neurological lesions
 
**Asymmetric, well-demarcated, nonenchancing subcortical white matter lesions on MRI
** Contrast enhancing lesions with or without mass effect on MRI
 
 
*'''PML-IRIS'''
* '''JCV granule cell neuropathy'''
 
  +
**Focal central neurological lesions following immune recovery
** Chronic cerebellar dysfunction
 
 
**Contrast enhancing lesions with or without mass effect on MRI
** Cerebellar atrophy on MRI
 
* '''JCV encephalitis'''
+
*'''JCV granule cell neuropathy'''
 
**Chronic cerebellar dysfunction
** Subacute onset of encephalopathy
 
** Cortical lesions on MRI
+
**Cerebellar atrophy on MRI
* '''JCV meningitis'''
+
*'''JCV encephalitis'''
 
**Subacute onset of encephalopathy
** Chronic headaches
 
** Ventriculomegaly on MRI
+
**Cortical lesions on MRI
  +
*'''JCV meningitis'''
 
**Chronic headaches
  +
**Ventriculomegaly on MRI
   
 
==Investigations==
 
==Investigations==
  +
* MRI head: white matter changes
+
*MRI head: white matter changes
  +
*CSF: fairly nonspecific, with mild pleocytosis, slightly elevated protein, and normal glucose
  +
**PCR of CSF has sensitivity 58% with ART or 72-92% without, and specificity 92-100%
   
 
==Diagnosis==
 
==Diagnosis==
  +
* JC virus PCR
 
  +
*JC virus PCR of CSF or brain biopsy
   
 
==Treatment==
 
==Treatment==
  +
* Antiretroviral therapy for HIV
+
*Antiretroviral therapy for HIV
   
 
[[Category:HIV]]
 
[[Category:HIV]]

Latest revision as of 16:23, 14 August 2020

  • CNS infection with JC virus, usually in the context of HIV infection

Background

Epidemiology

  • HIV patients

Clinical Manifestations

  • Classic progressive multifocal leukoencephalopathy (PML)
    • Subacute onset of focal central neurological lesions
    • Asymmetric, well-demarcated, nonenchancing subcortical white matter lesions on MRI
  • PML-IRIS
    • Focal central neurological lesions following immune recovery
    • Contrast enhancing lesions with or without mass effect on MRI
  • JCV granule cell neuropathy
    • Chronic cerebellar dysfunction
    • Cerebellar atrophy on MRI
  • JCV encephalitis
    • Subacute onset of encephalopathy
    • Cortical lesions on MRI
  • JCV meningitis
    • Chronic headaches
    • Ventriculomegaly on MRI

Investigations

  • MRI head: white matter changes
  • CSF: fairly nonspecific, with mild pleocytosis, slightly elevated protein, and normal glucose
    • PCR of CSF has sensitivity 58% with ART or 72-92% without, and specificity 92-100%

Diagnosis

  • JC virus PCR of CSF or brain biopsy

Treatment

  • Antiretroviral therapy for HIV