Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: Clinical and neuropathological findings in 27 patients

Abstract

We reviewed the clinical, neuroradiological, and serological findings in 27 patients with cerebral toxoplasmosis complicating the acquired immune deficiency syndrome, 19 of whom were also analyzed neuropathologically. The clinical manifestations of this disorder varied, ranging from headache and fever to coma. However, the characteristic presentation included focal neurological symptoms and signs, usually of subacute onset. In addition, two-thirds of the patients exhibited more generalized cerebral dysfunction with confusion and lethargy. The computed tomographic (CT) scan most commonly revealed ring contrast enhancement, which appeared to correlate best with the histological presence of vascular proliferation and inflammation surrounding the abscesses. However, in 5 patients the CT scan revealed either homogeneous enhancement or no enhancement, and in 3 patients the scans were negative. In general, CT scans underrepresented the number of lesions eventually documented pathologically. Double-dose contrast administration and preliminary experience with magnetic resonance imaging suggested that these techniques were superior to standard CT scanning in detecting Toxoplasma lesions. All patients were seropositive for IgG antibody against Toxoplasma gondii in blood, both before the onset of illness and at the time of presentation, although titers in some patients were as low as 1:8 and most patients did not exhibit rising titers. Prompt therapy resulted in rapid clinical improvement, documented by CT scan, associated with the development of an organizing tissue response in the host and elimination of free organisms. Response to treatment was sufficiently rapid in most patients to allow a trial of therapy as the favored approach to diagnosis.

Serological study of the prevalence of toxoplasmosis in asymptomatic patients infected with human immunodeficiency virus

“…American studies indicate that 30 % of AIDS patients previously exposed to toxoplasma suffer a cerebral reactivation [4]. Consequently, it may be calculated that 8 % of AIDS patients in South East England will experience a lifethreatening episode of cerebral disease following secondary reactivation of toxoplasmosis.…”

“…By comparison, in countries such as France, where the incidence of toxoplasmosis is high, a larger proportion of central nervous system toxoplasma infections are associated with a primary infection [2]. The risk of an AIDS patient with serological evidence of previous exposure to toxoplasma developing cerebral infection has been estimated as 30% [4]. Occasional cases of cerebral toxoplasmosis have been reported [5] but there have been few studies of this disease in the UK.…”

Hemicoréia-hemibalismo associado a granuloma criptocócico em paciente com SIDA: relato de caso

“…Tais desordens podem ser a primeira manifestação de infecções oportunísticas, ou mesmo o sintoma inicial de SIDA 1,2,4,5 . São descritos HC-HB, mioclonia, tremor, acatisia, distonia e parkinsonismo [1][2][3][4][5][12][13][14] . A HC-HB é o distúrbio mais comum nestes pacientes, ao contrário de indivíduos sem infecção por HIV, em que tal quadro é muito mais raro 3 .…”

“…A RM é o exame mais acurado na demonstração anatômica de lesões dos gânglios da base em pacientes com SIDA. Navia et al revisaram os aspectos clínicos e neuropatológicos de 27 pacientes com SIDA e toxoplasmose cerebral, encontrando 2 casos com coréia 5 . Em estudo semelhante com amostra de 50 pacientes, Maggi et al encontraram 3 casos de hemicoreoatetose (6%) que responderam ao tratamento antiparasitário 13 .…”

Parkinsonian Symptoms as an Initial Manifestation in a Japanese Patient with Acquired Immunodeficiency Syndrome and Toxoplasma Infection.

“…Parkinsonian symptomsare relatively rare in patients with AIDS (1)(2)(3)(4)(5)(6). According to a nationwide survey of AIDSin Japan, from January to March 1994, only one of 578 AIDS patients had parkinsonism (5).…”