HERPES ZOSTER

In document Neurologic Urinary and Faecal Incontinence (Page 129-131)

INCONTINENCE IN NEUROPATHIC PATIENTS

FURTHER RESEARCH

XIV. HERPES ZOSTER

2. PATHOLOGY AND DISEASE SPECIFIC LUT PROBLEMS

As already described virtually all parts of the body could by involved in AIDS patients ,either as the primary location of HIV infection or secondary to HIV- related complications.

Among these different manifestations particular attention should be paid to the primary locations as they develop early in the stage of the disease.

HTLV-I associated myelopathy (HAM) affects up to 3% of HIV positive patients and is manifested by slowly progressive spastic paraparesis, including deterioration of bladder problems [4]( LOE 2). Another interesting primary demonstration of HIV infection is lumbosacral polyradiculopathy, described by Matsumoto et al (LOE 3)[5]. In this case report voiding difficulties and lower limb paresis were the primary manifestation of HIV infection.

Also Mahieux et al ( LOE 3) described a case of acute myeloradiculitis due to cytomegalovirus as the initial manifestation of terminal stage [6].

Begara et al (LOE 3) performed urodynamic studies in 10 patients with AIDS and voiding disorders and found that the most common symptom was urge incontinence and the most common urodynamic finding was detrusor-external sphincter dyssynergia [7]. In 3 patients they found demonstrable functional disorders of the LUT (2 patients had detrusor ove- ractivity: one of them had a history of encephalopathy from HIV and the other patient had polyneuritis; the third patient had myelitis and a urodynamically diagnosed sympathetic decentralization. Detrusor areflexia was described in 2 HIV-positive patients by Menendez et al [8](LOE 3). One of them had an ascending myelitis of probable herpetic origin, the other had a cerebral abscess caused by Toxoplasma gondii.

3. DISEASE SPECIFIC DIAGNOSIS AND TREATMENT

Since during the course of the disease all parts of the nervous system can be involved, either as the primary location or secondary to AIDS-related complications, no disease specific diagnosis or treatment can be proposed. It is important to observe that sometimes functional disorders of the LUT can be the first manifestation of the HIV infection.

When managing the patient with HIV infection one must bear in mind that both storage and voiding problems can occur and that both should be treated according to the results of urodynamic studies.

4. GUIDELINES FOR FURTHER RESEARCH

All rapports about HIV and voiding problems are rather anecdotal and no good prospective studies exist. The

need for such studies is particularly important, when realizing that it takes up to 20-30 years from HIV infection to AIDS full manifestation and that new antiviral treatment modalities could prolong the life of a patient with HIV significantly.

Particular attention should be paid to primary nervous system involvement by HIV and to related voiding dysfunction as well as to the voiding dysfunctions that could be the side effects of HIV drug therapy.

5. FAECAL INCONTINENCE

As diarrhoea is common in HIV infected patients, the faecal incontinence can also occur, mostly due to anal sphincter weakness. Again the true incidence of HIV neuropathy relatad faecal incontinence is not known and further studies are needed [9], (LOE 4) CONCLUSIONS

RECOMMENDATIONS

Patients with HIV and nervous system

pathological signs and symptoms should be evaluated towards functional LUT problems ( B)

Due to the variety of LUT functional damage

in HIV patients urodynamic study is essential for tailoring the optimal therapy ( C)

No HIV specific therapy of LUT problems

and faecal incontinence exist. Due to variety of functional damage therapy should be individually tailored, accordingly to the results of functional/imaging studies (C)

HIV can influence the nervous system and

the LUT functions in two ways: as primary infection site or secondary to AIDS related complications (LOE2/3)

Nervous system manifestation of HIV

infection can by the only sign and it is therefore important to take the possibility of HIV infection into consideration when facing unusual signs and symptoms from the LUT without any other obvious cause (LOE 3)

HIV/AIDS is a progressive disease and

dynamic changes to the LUT functions can occur during the evoluation of the disease (LOE 2)

Faecal incontinence in HIV/AIDS patients is

usually associated with diarrhoea, however the true incidence is not known (LOE 4)

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