NEUROLOGICAL ASPECTS OF TROPICAL DISEASE: HTLV-1 and HIV infections of the central nervous system in tropical areas

Cerebellar Toxoplasmosis in HIV/AIDS: A Case Report

“…7 In tropical countries, the frequency of TE in necropsy series of AIDS patients is high: 34% in Brazil, 23% in Côte d'Ivoire, and 19% in India. 4 Risk factors for TE are a previous Toxoplasma gondii infection and a CD4+ cell count< 100/mm 3 .…”

“…3 The unique pathogenesis of toxoplasmic encephalitis in patients with AIDS makes intensive primary therapy followed by a lifelong suppressive regimen necessary. 4 In tropical countries where CT is not readily available, the diagnosis may be based on clinical presentation and prompt response to therapeutic trial. 4,5 Most cases of toxoplasmosis occurred in the cerebral hemispheres and the basal ganglia.…”

“…4 In tropical countries where CT is not readily available, the diagnosis may be based on clinical presentation and prompt response to therapeutic trial. 4,5 Most cases of toxoplasmosis occurred in the cerebral hemispheres and the basal ganglia. 6 There are few reports of cerebellar involvement presenting with tremors, ataxia and incoordination.…”

“…Considering large availibility, good tolerance, easy management, and low cost, TMP-SMZ seems a treatment of choice for TE in tropical countries. 4,10 The choice of clindamycin in our patient is based on the high frequency of adverse drug reactions associated with the sulphonamides. In our practice we have observed acceptable side effect profile with pyrimethamine and clindamycin regimen.…”

The neurology of HTLV-1 infection

“…These lesions do not distinguish HAM/TSP patients from neurologically-asymptomatic HTLV-1 infected individuals,50 and there have not been adequate comparisons with HTLV-1 seronegative controls. Spinal cord MR imaging was abnormal in 3/21 (14%) of those with HAM/TSP in a small series49 (spinal cord atrophy has been reported mainly in the thoracic region (fig 5) in selected populations) 40. High-signal intensity and contrast enhancement with or without associated spinal cord swelling is located mainly in the posterior columns, posterior horns, or lateral columns at cervical or thoracic levels51 It has been suggested that patients with a more rapidly progressive disease who are scanned earlier in the disease course are more likely to have spinal cord swelling on MR imaging, possibly because this reflects active cord inflammation 51…”