John Cunningham virus: Difference between revisions

Latest revision as of 20:23, 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

@@ Line 1: / Line 1: @@
-* 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==
 ===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==
-* MRI head: white matter changes
+*MRI head: white matter changes
-* CSF: fairly nonspecific, with mild pleocytosis, slightly elevated protein, and normal glucose
+*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%
+**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
+*JC virus PCR of CSF or brain biopsy
 ==Treatment==
-* Antiretroviral therapy for HIV
+*Antiretroviral therapy for HIV
 [[Category:HIV]]