Poster Abstracts Wednesday, November 9, 2005 $313

Kenji Miki ~, Katsuhiro Komase z, Ryuta Kawanishi 1, Toshiaki Takasu ~, Tomohiko Mizutani 1. 1Department of Neurology, Nihon University of School of Medicine, Tokyo, Japan; 2Division of Research and Development, Research Center for Biologicals, The Kitasato Institute, Tokyo, 7apan

Background: A very high incidence of subacute sclerosing panence- phaliris (SSPE) has been reported in Papua New Guinea (PNG), being 56 per million population below the age of 20 years. In a more recent study, we have confirmed this mmsual high incidence for Eastern Highlands Province (EHP) of PNG. In the study, it was observed that the vaccination rate among SSPE patients registered at Goroka Base General Hospital (GBGH) in EHP was higher than that of other infants in the province in recent years. Method: To identify the measles virus (MV) responsible for SSPE in EHP, sequence analysis o f hypervariable region of the N gene was performed from 13 MV genomes: 2 amplified from clinical specimens of SSPE patients, and 11 fi'om acute measles patients. Results: In 2 cases among the 11 with acute measles, nucleotide sequence of the entire H gene derived from isolated viruses was determined. Both nucleofide sequence and phylogenetic tree analyses showed that the amplified MV cDNAs were closely related to one another and belonged to the D3 genotype, though they were different from any previously reported MV sequences.

No genome sequences of vaccine strains were detected. Conclusion: These findings suggest that the MV strains prevailing in the highlands of P N G belong to the genotype D3 of the MV, and this wild type MV rather than the vaccine strains was likely to be responsible for SSPE in these patients.

0836 Inddenee and progression of Cenlral Nervous System AIDS-defining Opportunistic Intections (CNS-OI) abet Inlroduction of Highly Active Anfxetroviral Therapy (HAART)

Moretti, F 1, Casari, S 1, Zollo, G 1, Patroni, A 1, Locatelli, p2, Paraninfo, G 1, Bertelli, D ~, Costarelli, S 1, Chrisrini, G ~, Carosi, G 1 1Dpt Of Infectious And Tropical Diseases, General Hospital of Brescia, Italy; 2Neurology Unit, General Hospital of Brescia, Italy

Background: The HAART was introduced in the late 1996 and after this Survival and progression to AIDS among HIV-pts was improved. The advent o f HAART could also result in reduction of frequency of CNS-OI. Objective: To point-out the change of the Incidence of CNS-OI in a cohort of HIV-pts after the introduction of HAART. Methods: We have retrospectively analysed a cohort of pts with a first diagnosis of CNS-OI, observed in our Infectious Diseases Department from 1986 to 2004. Diagnosis, follow-up, death and treatment were compared in pre-HAART (1986-1996-Group A) and post-HAART (1997-2004-Group B) Era. Statistical analysis was performed by Ciff z test. Results: 2400 AIDS-pts were observed; 950 pts developed CNS-OI. 703 (74%) developed disease before 1996, 247 (26%) after 1996. Mortality was 90% in Group-A (633 pts) and 38% in Group-B (194 pts) (p < 0.000). Only 49 (17%) of Group-A pts had HAART after 1996 vs 198 (80%) of Group-B pts (p < 0.000). The prevalence of Neurotoxoplasmosis decreased significantly in the HAART Era (1254 pts, 36% vs 53 pts, 22"/0, p - 0.0001). Aids Dementia Complex and Criptococcal Meningo-encephalitis did not shown a significant reduction of Incidence in the second period (1271 pts, 38.5% vs 99 pts, 40% p - 0.6775; 123 pts, 17.5% vs 22 pts, 22% p - 0.1188). On the other hand, Progressive Multifocal Leuco- encephalitis incidence increased after 1996 (156 pts, 8% vs 39 pts, 16% p -- 0.0003). The increase of tiffs diagnosis could be due to the larger availability of PCR test for JC Virus in CRF during the last years.

Conclusion: Our data support a reduction in mortality during HAART Era even in pts with CSN-OI but a lower Incidence only for a part of these.

0837 Pattern and outcome of Neurological manifestations of HIV/AIDS- a review of 154 cases in a Nigerian university teaching hospital - a preliminary report

Ogun, y1, Ojini, F 2, Kubadejo, N 2, Danesi, M 2, Kolapo, K 1, Osaiffsi, T 1, Boyle, B 3. lOlabisi Onabanjo University Teaching Hospital; 2Lagos University Teaching Hospital; Lagos; Nigeria; 3University of Cornell and Columbia; New York

Background: The HIV is neurotropic and clinicians need to be aware of its myriad neurologic manifestations, as these may be the only clinical presentation. Tiffs study aims to evaluate the clinical spectrmn and outcome of the neurologic manifestations in patients with HI-V/AIDS over a ten year period. Method: This was a case-note based retrospective follow-up study of patients attending the HIV outpatient clinic and medical in-patients with AIDS, at the Olabisi Onabm~jo University Teaching Hospital Sagamu; Nigeria. Treatment was symptomatic in all patients and where appropriate, specific treatment was adininistered for indicator diseases. HAART was not administered. Patients were followed-up for 6 months. Results: A total of 362 patients with HIV/AIDS were reviewed over a ten-year period, of which 154 patients, (42.5"/o) had neurological manifestations. Forty-five (29"/o) patients had Herpes zoster, 40 (126"/o) had TB meningitis (TBM), 19 (12%) had vacuolar myelopathy (VM), another 19 (12%) had AIDS dementia complex (ADC), 15 (9.7%) had toxoplasma encephalitis, 10 (6.5%) had distal sensory polyneuropathy, 4 (2.6%) had inflammatory demyelinating polyneuropathy, and 2 (1.3%) had subacute combined degeneration of the spinal cord. An overall 6-months mortality of 45% was recorded with ADC, VM and TBM as predictors of high mortality. Conclusion: Herpes zoster is the commonest neurological manifestation amongst HIV-infected patients while Tuberculous meningitis is the commonest AIDS defining illness. Our experience shows that unusual neurological manifestations could be the first manifestation of HI-V/ AIDS and there is need for physician's awareness of these entities.

0838 Diffusion-weighted MR Imaging for evaluation of adult onset bacterial nletfingitis

Oguri, T 1, Yuasa, H 2, Mitake, S 2, Ojika, K 1. 2Nagoya City University Graduate School of Medical Sciences Department of Neurology and Neuroseienee; ~Tosei General Hospital Department Of Neurology

Background and Purpose: It has been shown that the thick exudates in subarachnoid space and ventricles in patients with bacterial meningitis represent high signals in diffusion-weighted M R Imaging (DWI). However, the meaning and usefulness of these M R findings in clinical practices remains uncertain. In tiffs study, we intended to verify the clinical features of those patients with or without these MR findings, substantiating the usefulness of DWI for bacterial meningitis. Methods: M R studies and the clinical features of 11 adult patients with bacterial meningitis were retrospectively reviewed. Results: In 6 of 11 patients, DWI showed high signals in subarachnoid space and ventricles. Those patients with high signals comprised the older age, lower GCS, and poorer outcome than those patients without these M R findings. In 2 patients who had poor outcome, these high signals had markedly increased within 48 hours from the onset. In another patient who had favorable outcome, these high signals had gradually decreased.