The utility of clinical and radiographic features in the diagnosis of cytomegalovirus central nervous system disease in AIDS patients

Background: Polymerase chain reaction (PCR) assays of cerebrospinal fluid ( CSF) for cytomegalovirus (CMV) DNA have facilitated the diagnosis of CMV-as sociated central nervous system disease in AIDS patients. We attempt to cor relate clinical and radiographic features that are associated with CMV PCR- positivity in CSF from AIDS patients with neurologic disease. Methods and Results: A retrospective case controlled comparison was made of CMV PCR-positive and PCR-negative patients, Results: CMV PCR-positive patients were significantly more likely to have n ystagmus, prior CMV retinitis, and CSF protein levels >90 mg/dL, Of patient s with 0, 1, and greater than or equal to 2 of these features, 5.6%, 55.2%, and 88.9%, respectively, were PCR positive. Ependymal enhancement was pres ent by magnetic resonance imaging in 9 of 12 PCR-positive, and in 8 of 30 P CR-negative patients. Conclusion: These clinical and radiographic features may serve as useful ad juncts toward the establishment of the diagnosis of CMV-associated neurolog ic disease in AIDS patients.