Successful Treatment of Pulmonary and Cerebral Toxoplasmosis Associated with Pneumocystis Pneumonia in an HIV Patient

Abstract

In both the post and pre combination antiretroviral therapy (cART) era, Pneumocystis jirovecii and Toxoplasma gondii remain common opportunistic infectious agents. The common manifestations are pneumonia for P. jirovecii and brain abscess for T. gondii. Nevertheless, co-infection remains rare, and pulmonary toxoplasmosis is scarce, or may be underestimated because of its similarity with Pneumocystis jirovecii pneumonia. We reported an uncommon case of an AIDS patient (6 CD4 + T cells/mm3) with both pulmonary and cerebral toxoplasmosis associated with pneumocystis pneumonia. The patient presented with general weakness, fever and dyspnea. Pulmonary toxoplasmosis and pneumocystis were confirmed by microscopic examination and DNA detection in the bronchoalveolar lavage. Computed tomography imaging of the brain revealed a single characteristic cerebral toxoplasmosis lesion of the left capsular area. He was successful treated by trimethoprim/sulfamethoxaxole in conjunction with an early reintroduction of cART, and without IRIS development. During a 3-year follow-up, HIV viral load remained undetectable, and the patient did not relapse for toxoplasmosis or Pneumocystis pneumonia.

Factores socioeconómicos y clínicos asociados con infecciones oportunistas en pacientes con HIV afiliados al sistema de salud

“…Vale la pena mencionar que dado que clínicamente la neumonía por P. jirovecii es similar a la toxoplasmosis pulmonar, el diagnóstico diferencial no es suficientemente claro y la prevalencia de estas enfermedades podría estar subestimada (59).…”

Therapeutic alternatives for the treatment of ocular toxoplasmosis

“…The parasite was first described in 1908 by Nicolle and Mancenaux, who worked in North Africa, and by Splendore in Brazil. Its name is derived from the species of rodents from where the parasite was isolated for the first time, Ctenodactylus gondii (Ho-Yen, 2009;Robert-Gangneux and Dardé, 2012).…”

“…According to Robert-Gangneux and Dardé (2012) and Neves et al (2009), T. gondii shows a complex reproductive cycle, in which the sexed phase (coccidian) occurs in felids (definitive host) and the asexual phase occurs in several warm-blooded hosts, such as birds and mammals including cats. The sexed phase occurs in the small intestine's epithelium of the felids not immune to the parasite.…”

“…In addition to the possibility of infection via food and water, there is a possibility of vertical transmission characterized by congenital toxoplasmosis and solid organ transplants. The intermediate hosts include rodents, cattle, pigs, goats, birds, and mammals, in general, among them humans (Ho-Yen, 2009;Neves et al, 2009;Robert-Gangneux and Dardé, 2012).…”

“…Then, the parasites differentiate into bradyzoites and are enclosed, to avoid their total elimination, leading to the reduction of symptoms and clinical signs of the infection. The ingestion of raw or undercooked meat by humans and the ingestion of meat from intermediate hosts by felids leads to the infection by bradyzoites cysts, which reinitiate their life cycle (Flegr et al, 2014;Ho-Yen, 2009;Neves et al, 2009;Robert-Gangneux and Dardé, 2012).…”