00:01
Now, we have CNS infection
being caused by HIV.
00:05
We call this aseptic meningitis.
00:07
Aseptic.
00:08
It’s a virus.
00:10
One to two weeks of
seroconversion in about 10%.
00:14
Now, what about HIV?
Now, this is a big
topic, isn’t it?
So from microbiology, we have
plenty, plenty of questions
that are always being
bombarded to you on HIV.
00:24
And once you’re in that
immunocompromised state,
there are all kinds of
issues that might take place
either in a form of
microbiology, or with cancers.
00:34
Invasion of the nervous system has been
shown to be mild lymphocytic meningitis.
00:40
We could have perivascular type of
inflammation and some myelin loss.
00:44
Let’s talk about HIV
meningoencephalitis.
00:49
Dementia, ataxia,
incontinence, and seizures.
00:53
At first, we have vacuolar
myelopathy found in AIDS patient.
00:58
What happened?
Microscopically resembles
subacute, combined degeneration.
01:03
Remember vitamin B12 deficiency
and subacute combined.
01:07
What do you mean by combined?
You could have issues
with the dorsal column.
01:12
So you have problems with touch,
vibration and proprioception.
01:15
You could have your lateral
corticospinal tract being affected.
01:19
And of course, your spinal
cerebellar resulting in ataxia.
01:24
Keep that in mind with AIDS patient,
who behaves like your B12-deficient
subacute combined degeneration.
01:31
AIDS-associated
peripheral neuropathy.
01:34
Demyelinating polyneuropathy.
01:38
Distal symmetric.
01:39
Polyradiculopathy, and
mononeuritis multiplex with AIDS.
01:45
Basically, you have
multiple, multiple nerves
that are being affected
undergoing severe neuropathy.
01:50
Peripheral, peripheral.
01:52
So we have vacuolar myelopathy
and we have AIDS-associated
peripheral neuropathies.
02:00
You’ve been with me long
enough to know that
whatever that I give you has
to be properly integrated.
02:06
You’ve been with me long enough where I’m
always, always reinforcing organization
and what the big picture is.
02:13
The reason that I bring
this to your attention
and you also had been with me long
enough where I’m always giving you
the clinical picture of your patient
so that your able to quickly
identify your
pathology, correct?
No exception here.
02:26
This is AIDS-associated
myopathy.
02:31
Don’t get upset with me right
now, just bear with me.
02:35
So you’re reading a stem of a question
and in the stem of a question,
the patient is having
proximal weakness, pain,
elevated levels of
serum creatine kinase.
02:45
Stop there and truly
understand that statement.
02:49
What’s my topic for
this entire section?
It’s CNS infections.
02:54
CNS infection.
02:56
Brain.
02:57
But yet here, I’m
talking about muscle?
Yes.
03:01
Because you’re reading a
stem of a question or
the clinical presentation of a
patient walking through the door.
03:07
When they have AIDS,
there is no part of the body that
is spared including the muscle.
03:14
So you’re reading a stem of a question
or you’re a chart of your patient,
and you realize the
patient has AIDS.
03:20
There is muscle weakness.
03:21
You find serum creatine
kinase to be elevated.
03:24
The patient has neuropathy, maybe wrist
drop, foot drop, so on and so forth.
03:30
Or might have some of the CNS issues
that we’ve talked about earlier.
03:34
You put all of these together and make sure
that you then choose the correct answer
or in clinical practice,
choose the proper management of
what you’re trying to address.
03:47
Am I clear?
So here, we have
AIDS-associated myopathy.
03:52
In the spectrum of AIDS, you
could have muscle issues.
03:57
Microscopically, what
are you going to find?
Muscle fiber necrosis,
interstitial infiltration
of HIV,
cytoplasmic bodies.
04:06
We have something
called nemaline rods.
04:08
And ragged red fibers,
AZT myopathy.
04:14
Is this clear?
It has to be.
04:17
Why is this here?
Because with AIDS, you truly cannot
talk about AIDS, infection of the brain
without talking about just as a
brief note AIDS infection of –
or HIV infection of your muscle.