Magnetic resonance imaging, thallium-201 SPET scanning, and laboratory analyses for discrimination of cerebral lymphoma and toxoplasmosis in AIDS.

Miller, R F; Hall-Craggs, M. A.; Costa, Durval C.; Brink, Nicola S.; Salvatore, Francesco; Lucas, Sebastian; Wilkinson, Iain D.; Ell, PJ; Kendall, B. E.; Harrison, M. J. G.

doi:10.1136/sti.74.4.258

Cited by 56 publications

(25 citation statements)

References 29 publications

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“…Although in many case series, single lesions are more likely to be due to lymphoma, 1 here you have the additional evidence from FDG PET scanning to support the diagnosis of toxoplasmosis. The assessment of response to empirical therapy would be based on clinical defervescence, neurological improvement, and reduction in size of the lesion on repeat cranial imaging.…”

Section: Discussant (Dr R Miller)mentioning

confidence: 92%

Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors

Pao

Watson²,

Peters

et al. 2001

Sexually Transmitted Infections

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Section: Discussant (Dr R Miller)mentioning

confidence: 92%

Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors

Pao

Watson²,

Peters

et al. 2001

Sexually Transmitted Infections

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“…Although certain radiographic characteristics favor lymphoma over toxoplasmosis, such as presence of a solitary lesion, location adjacent to the ventricle, subependymal spread, and homogenous rather than ring enhancement, considerable overlap occurs. Thus, the constellation of symptoms, physical findings, and findings of laboratory and neuroimaging studies is not sufficiently specific to reliably differentiate toxoplasmosis from CNS lymphoma [105,116,118,119]. An additional limitation on routine neuroimaging techniques is the fact that often 11 process occurs simultaneously in patients with AIDS.…”

Section: Neuroimagingmentioning

confidence: 96%

“…Several studies have evaluated the utility of thallium-201 SPECT in distinguishing cerebral lymphoma from toxoplasmic encephalitis in patients with AIDS (table 5) [119,[133][134][135][136][137][138][139][140][141][142][143][144]. Although initial studies of thallium-201 SPECT showed a high sensitivity and specificity for the diagnosis of CNS lymphoma in patients with AIDS [133,134], subsequent reports reported lower diagnostic accuracy.…”

Section: Thallium-201 Single-photon Emission Ct (Spect)mentioning

confidence: 98%

Focal Neurological Disease in Patients with Acquired Immunodeficiency Syndrome

Skiest

2002

Clinical Infectious Diseases

142

128

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Focal neurological disease in patients with acquired immunodeficiency syndrome may be caused by various opportunistic pathogens and malignancies, including Toxoplasma gondii, progressive multifocal leukoencephalopathy (PML), cytomegalovirus (CMV), and Epstein-Barr virus-related primary central nervous system (CNS) lymphoma. Diagnosis may be difficult, because the findings of lumbar puncture, computed tomography (CT), and magnetic resonance imaging are relatively nonspecific. Newer techniques have led to improved diagnostic accuracy of these conditions. Polymerase chain reaction (PCR) of cerebrospinal fluid specimens is useful for diagnosis of PML, CNS lymphoma, and CMV encephalitis. Recent studies have indicated the diagnostic utility of new neuroimaging techniques, such as single-photon emission CT and positron emission tomography. The combination of PCR and neuroimaging techniques may obviate the need for brain biopsy in selected cases. However, stereotactic brain biopsy, which is associated with relatively low morbidity rates, remains the reference standard for diagnosis. Highly active antiretroviral therapy has improved the prognosis of several focal CNS processes, most notably toxoplasmosis, PML, and CMV encephalitis.

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“…The diagnosis of Toxoplasma encephalitis usually involves a CT scan or MRI of the brain. However, Toxoplasmaassociated brain abnormalities may be indistinguishable from AIDS-related cerebral lymphoma (64,392) or cerebral Chagas' disease (121,429). Therefore, microscopy, molecular techniques, and/or parasite cultivation should be employed for a definitive diagnosis (428,583).…”

Section: Toxoplasma Gondiimentioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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SUMMARY There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

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Magnetic resonance imaging, thallium-201 SPET scanning, and laboratory analyses for discrimination of cerebral lymphoma and toxoplasmosis in AIDS.

Cited by 56 publications

References 29 publications

Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors

Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors

Focal Neurological Disease in Patients with Acquired Immunodeficiency Syndrome

Importance of Nonenteric Protozoan Infections in Immunocompromised People

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