The predictive value of cytomegalovirus retinitis for cytomegalovirus encephalitis in acquired immunodeficiency syndrome
S. S. Bylsma, C. L. Achim, C. A. Wiley, C. Gonzalez, B. D. Kuppermann, C. Berry and W. R. Freeman
Department of Ophthalmology, University of California-San Diego, La Jolla.
Cytomegalovirus (CMV) infection of the brain, optic nerves, and retinas
from 47 consecutive autopsies of patients with acquired immunodeficiency
syndrome (AIDS) were examined. Immunocytochemistry demonstrated CMV
infection in 11 (23%) brains, two (2%) of 94 optic nerves, and 38 (40%) of
94 retinas. Ten (91%) of 11 patients with CMV encephalitis had concurrent
retinitis. While 10 (42%) of 24 patients with CMV retinitis had CMV
encephalitis, when the retinitis included the peripapillary region, 75% had
encephalitis. Usually, the optic nerve parenchyma was not infected
histologically despite extensive peripapillary retinitis. The strength of
these associations suggests that CMV retinitis defines a group of patients
with AIDS at risk for development of CMV encephalitis (relative risk, 9.5),
particularly when the retinitis involves the peripapillary region (relative
risk, 13). Furthermore, in patients with AIDS without CMV retinitis,
central nervous system symptoms are unlikely to be attributable to CMV
encephalitis.
