Tata Laksana Ensefalitis Toksoplasma pada Penyandang HIV

Abstract

Ensefalitis toksoplasma (toxoplasma encephalitis atau TE) adalah infeksi oportunistik intrakranial tersering pada penyandang HIV. Manifestasi TE akibat reaktivasi infeksi laten terjadi jika imunitas seluler menurun (CD4+ <100 sel/mm3). Diagnosis presumtif berdasarkan klinis (manifestasi lesi desak ruang dan defisit neurologis fokal progresif dengan awitan subakut), radiologis (lesi multipel fokal berbentuk cincin dengan edema di sekitarnya), dan respons klinis serta radiologis terhadap terapi empiris anti-toksoplasma dalam 2 minggu pertama. Terapi akut lini pertama adalah kombinasi pyrimethamine, sulfadiazine, dan leucovorin selama minimal 6 minggu. Terapi ARV (anti-retrovirus) biasanya dimulai 2 - 3 minggu setelah terapi akut dimulai, harus dilanjutkan dengan terapi rumatan sebagai profilaksis sekunder hingga kriteria penghentian dicapai. Toxoplasma encephalitis is the most prevalent intracranial opportunistic infection amongst HIV population. TE manifestations are due to a reactivation of latent infection because of decreased cellular immunity (CD4+ <100 cells/mm3). Presumptive diagnosis is based on clinical syndrome (mass effect signs and symptoms and progressive focal neurological deficit with subacute onset), imaging (multiple focal ring-enhancing lesions with surrounding edema), and clinical and radiological response to anti-toxoplasma empiric therapy in the first 2 weeks of administration. The first line treatment for acute therapy is combination of pyrimethamine, sulfadiazine, and leucovorin for a minimum of 6 weeks. ART (anti-retroviral therapy) is usually started 2 - 3 weeks after acute therapy; followed by maintenance therapy as secondary prophylaxis until criteria for discontinuation it is fulfilled.