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Clinical and prognostic features of cerebral toxoplasmosis in HIV infected patients – a case series
© Andrei et al; licensee BioMed Central Ltd. 2013
Published: 16 December 2013
Although cerebral toxoplasmosis incidence has declined as a result of antiretroviral treatment (ART), it still is a serious diagnostic and therapeutic problem and a life-threatening condition.
We performed a retrospective study of the medical charts of patients diagnosed with cerebral toxoplasmosis admitted to the Infectious Diseases Hospital of Iaşi in the last 5 years (2008-2012).
Cerebral toxoplasmosis led to the diagnosis of HIV infection in 3/11 patients, and was the AIDS defining disease in 2/11 cases. Most of the patients (9/11) belonged to the historical 1989 cohort; the mean age was 22.5 years, 6/11 were males. The mean CD4+ cell count was 26.7 cells/cmm (95%CI: 5.5-49.7); all the patients were viremic at the time of diagnosis (mean viral load: 1.21x105 copies/mL). The clinical manifestations varied, ranging from mild persistent headache to coma. Neurologic manifestations were seen in 7/11 of cases, 5/11 had convulsions. All patients were seropositive for IgG antibody against Toxoplasma gondii in blood, but only 5/11 had high titers (>300 UI/mL). Cerebral imaging studies (6 CT and 5 IRM) were performed and showed suggestive lesions in all cases. 7/11 patients were receiving ART before diagnosis, and 6/11 had recommendations for co-trimoxazole prophylaxis, but most of them had a low adherence the treatment. Co-trimoxazole was the main anti-toxoplasma drug in all cases; clindamycin or clarithromycin were sometimes associated (2/11). 4/11 patients died, three of them being newly discovered, late presenter HIV cases. 2 patients had relapses and 4/11 neurological sequelae.
Cerebral toxoplasmosis is a rare but serious opportunistic infection, seen more frequently in severely immunocompromised, non-adherent patients, but it can be sometimes seen in previously apparently healthy individuals.
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.