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  • Open Access

Toxoplasmosis: a rare cause of IRIS in HIV infected patients. Case series

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BMC Infectious Diseases201313 (Suppl 1) :O7

https://doi.org/10.1186/1471-2334-13-S1-O7

  • Published:

Keywords

  • Viral Load
  • Toxoplasmosis
  • Cryptococcosis
  • Plasmatic Viral Load
  • Toxoplasma Gondii

Background

Cerebral toxoplasmosis is one of the main 3 intracerebral opportunistic infections in HIV positive patients, along with cryptococcosis and tuberculosis. In comparison to these last 2 entities, toxoplasmosis does not provoke or very rarely provokes reconstitution syndromes.

Methods

We analyzed a case series of 3 patients with cerebral toxoplasmosis admitted in the Adults III Department of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş” in 2012-2013.

Results

Three patients, one male and 2 women, aged 55 years old, respectively 41 and 42 year-old, all 3 diagnosed concomitantly with HIV infection (as very late presenters) and cerebral toxoplasmosis, with a CD4 count of 6, 6 and 7/cmm respectively, viral loads (VL) of 254,000, 57,000 and 156,000 copies/mL respectively, and CSF viral load below the plasmatic VL in all 3 cases. We recorded minimal abnormalities of CSF analysis regarding the number of cells and biochemical exams; all had positive PCR for Toxoplasma gondii in the CSF and positive serology (IgG). All 3 had intracerebral lesions (abscesses) and all were biopsied at the neurosurgery department for diagnostic purpose before knowing their HIV-positive status. They received high doses of oral trimethoprim/sulfamethoxazole (T/S) for toxoplasmosis and antiretroviral therapy in the first 2 weeks after the diagnosis. They repeated cerebral imagery (MRI) after 3 weeks of T/S and had no regression of the size of lesions (although with the decreasing of perilesional edema) and new lesions, in two cases without having corresponding symptoms; in all 3 cases the CD4 count increased in the first month more than 100%. The search for another cause for the augmentation of their brain lesions was negative. Maintaining the same medication, the next imagery exams showed improvement in 2 out of 3 cases, in which the outcome was favorable with almost complete neurological recovery. In the remaining case the evolution was unfavorable (death).

Conclusions

In our 3 cases we presumed a paradoxical toxoplasmosis IRIS, with little or no clinical deterioration strictly linked with imagery exams depreciation in 2 out of 3 cases but with a fatal evolution in one case. Even rarely reported, the toxoplasmosis IRIS could be taken into account in some situations.

Authors’ Affiliations

(1)
National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
(2)
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
(3)
Central Universitary Emergency Military Hospital Dr Carol Davila, Bucharest, Romania
(4)
Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babeş”, Bucharest, Romania

Copyright

© Moroti et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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