La clínica en el diagnóstico de la neurotoxoplasmosis / Clinic in the diagnosis of neurotoxoplasmosis

RESUMEN La toxoplasmosis cerebral o neurotoxoplasmosis es una de las infecciones oportunistas más frecuentes en los pacientes positivos al VIH. Se produce aproximadamente en el 10 % de los pacientes con sida no tratados. La localización de la infección, causada por el parásito Toxoplasma gondii, indica inmunodeficiencia severa, con linfocitos T CD4+ menor a 100 cel/mm3. El objetivo de este trabajo fue describir la evolución clínica e imagenológica de un paciente con diagnóstico de neurotoxoplasmosis, atendido en el Hospital Militar Dr. Carlos J. Finlay: hombre de 33 años, con síntomas neurológicos focales, sin factor de riesgo vascular, con estudios de imagen sugestiva de proceso expansivo intracraneal. Durante su ingreso se recibe el resultado de positivo al VIH y se interpreta como una neurotoxoplasmosis. Se empleó tratamiento antiparasitario con mejoría del trastorno neurológico y de las neuroimágenes. Ante un paciente con VIH y síntomas neurológicos focales se debe pensar en una neurotoxoplasmosis. La respuesta al tratamiento en el caso estudiado confirmó el diagnóstico (AU).

ABSTRACT Cerebral toxoplasmosis or neurotoxoplasmosis is one of the most common opportunistic infections in HIV-positive patients. It occurs in approximately 10 % of untreated AIDS patients. The location of the infection, caused by the parasite Toxoplasma gondii, indicates severe immunodeficiency, with CD4+ T lymphocytes less than 100 cell/mm3. The objective of this work was to describe the clinical and imaging evolution of a patient with diagnosis of neurotoxoplasmosis, attended at the Military Hospital Dr. Carlos J. Finlay: 33-year-old man, with focal neurological symptoms, without vascular risk factor, with studies of suggestive imaging of intracranial expansive process. During admission, the HIV positive result is received and interpreted as a neurotoxoplasmosis. Antiparasitic treatment was used with improvement of neurological disorder and neuroimagens. In the case of a patient with HIV and focal neurological symptoms doctors should think about neurotoxoplasmosis. The response to treatment in the case studied confirmed the diagnosis (AU).

Neurotoxoplasmose em pacientes imunocomprometidos e a relevância do diagnóstico por imagem / Neurotoxoplasmosis in immunocompromised patients and the relevance of image diagnosis

Introdução: a toxoplasmose é causada por um protozoário intracelular obrigatório, o Toxoplasma gondii. Felídeos, como gatos domésticos, são hospedeiros definitivos enquanto o homem é hospedeiro intermediário. Normalmente a infecção por T. gondii é assintomática e benigna, mas em indivíduos imunocomprometidos como portadores da AIDS, pode ocorrer reativação da doença crônica. Como o HIV apresenta neurotropismo, a neurotoxoplasmose é a causa predominante de distúrbios neurológicos nesses pacientes. As manifestações clínicas, principalmente os achados em exames de imagem específicos como a tomografia e a ressonância magnética do crânio, constituem a melhor forma de diagnóstico. Objetivo: neste contexto, analisou-se neste estudo a relevância do diagnóstico por imagem na neurotoxoplasmose em pacientes HIV positivos. Método: foi realizada uma revisão sistemática da literatura científica em bases de dados como: Bireme, Scielo, Medline, Google Acadêmico e Pudmed para os seguintes descritores: Diagnóstico por imagem, Neurotoxoplasmose, Sorodiagnóstico da AIDS, Ressonância Magnética e Tomografia Computadorizada. Foram incluídos na seleção artigos, teses, dissertações, atlas, livros, sites e guias em Português e em Inglês, publicados entre os anos de 1977 a 2015. Resultados e discussão: observou-se que dentre os exames de imagem mais utilizados, destacam-se a tomografia computadorizada (TC) com meio de contraste e a ressonância magnética (RM) de encéfalo, que costumam evidenciar múltiplas lesões com hipossinal, com reforço do contraste, envolvendo gânglios da base e córtex cerebral. Conclusão: o desenvolvimento de novas técnicas e critérios de diagnóstico é imprescindível para a exclusão de outras doenças do SNC, principalmente o linfoma e leucoencefalopatia multifocal progressiva, que podem ser confundidas nas imagens, principalmente no caso de lesão única.

Introduction: toxoplasmosis is caused by a mandatory intracellular protozoan, Toxoplasma gondii. Domestic cats are definitive hosts while humans are intermediate. Usually T. gondii infection is asymptomatic and benign, but in immunocompromised individuals as AIDS patients, reactivation of chronic disease may occur. As HIV presents neurotropism, neurotoxoplasmosis is the predominant cause of neurological disorders in these patients. The clinical manifestations, especially the ones found in specific image exams such as tomography and magnetic resonance of the skull are the best form of diagnosis. Objective: in this context, it was analyzed the relevance of image diagnosis in the neurotoxoplasmosis in HIVpositive patients. Methods: it was made a systematic review of the scientific literature in databases such as: Bireme, Scielo, Medline, Google Scholar and Pudmed, for the following descriptors: Image Diagnosis, Neurotoxoplasmosis, AIDS Serodiagnostic, Magnetic Resonance and Computed Tomography. It was included in the selection: articles, theses, dissertations, atlases, books, websites and guides in Portuguese and English, published between 1977 and 2015. Results and discussion: it was observed that among the most commonly used image exams, Computed tomography (CT) was highlighted with contrast medium and magnetic resonance image (MRI) of the encephalon, which usually show multiple hypersignal lesions with contrast medium enhancement, involving basal ganglia and cerebral cortex. Conclusion: the development of new techniques and diagnostic criteria is essential for the exclusion of other CNS diseases, especially lymphoma and progressive multifocal leukoencephalopathy, which can be misunderstood in the images, especially in the case of a single lesion.

Características clínico-epidemiológicas de los pacientes con el Virus de Inmunodeficiencia Humana: Boyeros. 2013 / Patients clinical-epidemiological characteristic with the Human Immunodeficiency Virus: Boyeros. 2013

Introducción: La infección por el VIH continúa siendo un problema de salud mundial y nacional. El proceso de descentralización de la atención de estos pacientes hace que cada día sean más los que se atienden en hospitales de nivel secundario. Objetivo: Caracterizar los pacientes con infección por VIH en el municipio Boyeros. Material y Métodos: Se realizó un estudio descriptivo de corte transversal, de las personas con VIH residentes en el municipio Boyeros hasta el 31 de diciembre de 2013. Se analizaron variables demográficas como edad, sexo, escolaridad, ocupación, enfermedades marcadoras de SIDA, tiempo de diagnóstico, conteo de CD4 y tratamiento antirretroviral. Resultados: El mayor número de casos es del sexo masculino, el grupo de edad más afectado es de 20 a 39 años y predomina el nivel escolar preuniversitario (50 porciento). Existe 30 porciento de casos desocupados. El 80 por ciento de los casos tienen menos de 10 años de diagnóstico, 76 por ciento de los casos se clasificaron SIDA por conteo bajo de CD4 y fue la neurotoxoplasmosis la enfermedad marcadora de SIDA más frecuente. El esquema Zidovudina- Lamivudina- Nevirapina es el más utilizado. Conclusiones: La población VIH es mayoritaria masculina y joven con escolaridad preuniversitaria y un grupo importante sin vinculo laboral. Predomina tiempo de diagnóstico menor de 10 años, los casos con CD4 por encima de 200 células/mm3 y más de la mitad de los casos tienen indicado TARV(AU)

Introduction: Infection by AIDS has being a world and national health problem. Decentralization process of the attention of these patients make possible that every day more patients assist to secondary level hospitals to be treated. Objective: To characterize patients with AIDS infection in Boyeros municipality. Material and Methods: We were carried out a descriptive, cross-sectional study, of people with AIDS residents in Boyeros municipality up to December 31 2013. Demographic variables analyzed, were age, sex, occupation, AIDS markers illnesses, time of diagnosis, CD4 count and antiretroviral treatment. Results: The biggest number of cases are of masculine sex. Most affected age groups are 20 to 39 years old and of pre-university educational level. There are 30 porciento of cases are unemployed persons. 80 porciento of the cases have less than 10 years of been diagnosed, 76 porciento were classified as AIDS with CD4 low count. More frequent AIDS illness was neurotoxoplasmosis. Zidovudina-Lamivudina-Nevirapina is the most antiretroviral treatment utilized. Conclusions: AIDS population in Boyeros is by majority masculine and young people. There is an important group of unemployed persons. The CD4 cells count is above 200 cells/mm3 and more than a half of cases have a suitable ARVT(AU)

Enfermedades oportunistas en pacientes VIH/sida con debut de sida que reciben tratamiento antirretroviral / Opportunistic diseases observed in HIV/aids patients with onset of aids and antiretroviral treatment

INTRODUCCIÓN: el debut del sida es una forma de presentación de la enfermedad caracterizada por alteración del estado general, síndrome de desgaste, graves infecciones oportunistas, neoplasias y alteraciones neurológicas. El tratamiento con antirretrovirales ha aumentado la esperanza de vida de estos pacientes. OBJETIVOS: identificar las enfermedades oportunistas, asociadas a la condición clínica de los pacientes bajo estudio, y su relación con el conteo de linfocitos T CD4+ y la carga viral así como, evaluar la mortalidad en el grupo de pacientes estudiados y su relación con las enfermedades oportunistas. MÉTODOS: se realizó un estudio observacional prospectivo de corte transversal. El tamaño de la muestra estuvo condicionado al universo total de pacientes VIH/sida del servicio de Medicina del Instituto de Medicina Tropical "Pedro Kourí". La muestra (55 pacientes) se seleccionó, se tuvo en cuenta los sujetos que fueron diagnosticados con debut de sida y presentaron enfermedades oportunistas durante un año. RESULTADOS: las enfermedades oportunistas infecciosas como neurotoxoplasmosis 21,8 % y neumonía por Pneumocystis jirovecii 12,7 % fueron los eventos definitorios de sida predominantes. No hubo asociación estadística significativa, con el conteo bajo de linfocitos T CD4+ bajos y carga viral elevada. En los pacientes mayores de 50 años con más de una enfermedad oportunista el riesgo de morir fue 4,72 veces mayor que para el resto. CONCLUSIONES: las enfermedades oportunistas infecciosas como neurotoxoplasmosis y Pneumocystis jirovecii,fueron los eventos definitorios de sida predominantes. La mortalidad asociada a sida en los pacientes mayores de 50 años aumentó en los individuos que presentaron más de una enfermedad oportunista. Estos resultados son útiles para el diseño de estrategias de tratamiento que disminuyan la aparición de las enfermedades oportunistas y mejoren aun más, la supervivencia de los pacientes VIH/sida.

INTRODUCTION: onset of aids is a form of presentation of the disease that is characterized by altered general condition, wornout syndrome, serious opportunistic infections, neoplasias and neurological alterations. The antiretroviral treatment has increased the life expectancy of these patients. OBJECTIVES: to identify the opportunistic diseases associated to the clinical condition under study and their linking to the CD4+ T lymphocyte count and the viral load as well as to evaluate the mortality in the studied group and its relationship with opportunistic diseases. METHODS: prospective, observational and cross-sectional study of a sample of 55 patients. The size of the sample depended on the total universe of HIV/aids patients in the medicine service of "Pedro Kouri" Tropical Medicine Institute. The study took into account those subjects who were diagnosed with onset of aids and presented with opportunistic diseases during one year. RESULTS: infectious opportunistic diseases such as neurotoxoplasmosis (21.8 %) and pneumonia caused by Pneumocystis jirovecii (12.7 %) were the predominant defining events of aids. There was no statistically significant association with low CD4+ T lymphocyte count and high viral load. In patients over 50 years of age with more than one opportunistic disease, the risk of dying was 4.72 times higher than in the rest of the group. CONCLUSIONS: infectious opportunistic diseases as neurotoxoplasmosis and Pneumocystis jirovecii were the prevailing defining events of aids. Aids-associated mortality in patients aged over 50 years increased in individuals who presented more than one opportunistic disease. These results are useful for the design of treatment strategies that reduce the occurrence of opportunistic diseases and improve even more the survival of HIV/aids patients.

Neurotoxoplasmose em paciente imunocompetente: relato de caso / Neurotoxoplasmosis in an Immunocompetent Patient: Case Report

A toxoplasmose é uma doença causada pelo protozoário Toxoplasma gondii e é a principal causa de lesão com efeito de massa no sistema nervoso central (SNC) em pacientes imunodeprimidos, causando sintomas neurológicos significativos. Em pacientes imunocompetentes, a evolução clínica da toxoplasmose é habitualmente benigna e a infecção é, na maioria das vezes, assintomática. O diagnóstico da neurotoxoplasmose é presuntivo, baseado nos achados de tomografia computadorizada (TC) ou de ressonância magnética (RM), e emcasos inconclusivos, pode-se utilizar a biópsia cerebral estereotáxica. O paciente relatado apresentava lesões sugestivas de neurotoxoplasmose na RM de encéfalo, porém era imunocompetente, e a sorologia para neurotoxoplasmose era negativa para o IgM. Foi submetido então a biópsia estereotáxica como extensão de propedêutica. O presente trabalho visa, a partir do relato de um caso raro, discutir sobre as formas de diagnóstico e tratamento de uma infecção em paciente previamente sadio, cuja evolução foi benigna devido ao diagnóstico e tratamento precoces.

Toxoplasmosis is a disease caused by the protozoan Toxoplasma Gondii and is the leading cause of injury with mass effect on the central nervous system (CNS) in immunocompromised patients, that causes significant neurological symptoms. In immunocompetent patients, the clinical course of toxoplasmosis is usually benign and the infection is most often asymptomatic. The presumptive diagnosis of toxoplasmosis is based on findings of computed tomography (CT) or magnetic resonance imaging (MRI), and inconclusive cases, can use stereotactic brain biopsy . The reported patient had lesions suggestive of cerebral toxoplasmosis in brain MRI, but was immunocompetent and toxoplasmosis serology was negative for IgM. The, he underwent a stereotactic biopsy as an extension of workup. The present work aims, from a rare case description, discuss ways of diagnosing and treating an infection in a previously healthy patient whose evolution was benign diagnosis because early treatment.

Neurotoxoplasmosis diagnosticada por tomografía axial computarizada en un paciente con sida / Neurotoxoplasmosis Diagnosed by Computed Tomography in a Patient with AIDS

La neurotoxoplasmosis es una de las infecciones oportunistas más frecuentes en el paciente infectado por el virus de inmunodeficiencia humana y se presenta con diversidad de manifestaciones clínicas en el huésped inmunoafectado; se considera además una enfermedad definitoria de sida en aproximadamente el 5 % en los pacientes infectados por este virus. Se presentó un paciente de 24 años de edad, con antecedentes de VIH, ingresado con fiebre, cefalea intensa y vómitos. El test de toxoplasma fue positivo. La tomografía axial computarizada tras la administración endovenosa de contraste mostró la presencia de dos imágenes nodulares isodensas con realce anular una de 16 x 12 mm parietal derecha y otra de 26 x 22 mm parietal izquierda, concluyéndose como una toxoplasmosis cerebral. Las técnicas de neuroimagen tienen valor para su diagnóstico, las más empleadas son la TAC y la imagen de resonancia magnética. El diagnóstico diferencial debe realizarse en estos casos con los linfomas y tumores primarios del sistema nervioso central, las metástasis cerebrales y los infartos cerebrales. El pronóstico de los pacientes con esta afección depende de un diagnóstico precoz y un tratamiento eficaz.

The neurotoxoplasmosis (NTX) is one of the most common opportunistic infections in patients infected with human immunodeficiency virus and is presented with diverse clinical manifestations in immunocompromised host; it is also considered an AIDS-defining illness in approximately 5 % of patients infected with this virus. A patient of 24 years with a history of HIV, admitted with fever, severe headache and vomiting was presented. The toxoplasma test was positive. Computed tomography (CT) after intravenous administration that showed the presence of two nodular ring enhancement isodense with a 16 x 12 mm right parietal and a 26 x 22 mm left parietal, concluding as a cerebral toxoplasmosis. Neuroimaging techniques are valuable for diagnosis; the most used are CT and magnetic resonance. The differential diagnosis should be made in these cases with lymphoma and primary central nervous system tumors, brain metastases and stroke. The prognosis of patients with this condition depends on early diagnosis and effective treatment.

Caracterización de los pacientes en fase sida con infecciones del sistema nervioso central / Characterization of aids patients with infections of the central nervous system

Se realizó un estudio descriptivo y transversal de 44 pacientes seropositivos al VIH/sida, atendidos en el Centro de Atención a Personas con VIH y en la consulta provincial de pacientes con VIH/sida del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 1992 hasta diciembre de 2012, a fin de determinar la incidencia de las infecciones del sistema nervioso central y sus características clínicas en estos afectados. En la serie predominó el deterioro intelectual asociado a fiebre y cefalea. En los afectados con conteo bajo de linfocitos CD4 primaron la neurotoxoplasmosis, la meningitis por cryptococus, así como la combinación de ambas; para la primera resultó significativa la deficiencia motora y en la segunda no prevalecieron los signos meníngeos. A pesar de la respuesta positiva al tratamiento la neurotoxoplasmosis fue la infección que más recidivó.

A descriptive and cross sectional study of 44 seropositive patients to HIV/aids, assisted in the Center for Care to people with HIV and in the provincial department of patients with HIV/aids from "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January, 1992 to December, 2012, in order to determine the incidence of infections to the central nervous system and their clinical characteristics in these affected patients. In the series the intellectual deterioration prevailed associated to fever and migraine. In those affected patients with low count of lymphocytes CD4, the neurotoxoplasmosis, meningitis due to cryptococus, as well as the combination of both prevailed; for the first one the motor deficiency was significant and in the second one the meningeal signs didn't prevail. In spite of the positive response to the treatment neurotoxoplasmosis was the most recurrent infection.

Sistema de acciones para la prevención de la neurotoxoplasmosis en personas con VIH y SIDA / System of actions to prevent neurotoxoplasmosis in persons with HIV and AIDS

La neurotoxoplasmosis está asociada a la inmunodeficiencia y su expresión es mayoritariamente entre personas con VIH y SIDA, es la infección oportunista que con mayor frecuencia afecta el sistema nervioso en personas inmunodeprimidas por lo que todo acercamiento a la prevención desde la metodología de pares permite la reducción de riesgos y la reducción de daños. Se desarrolló un sistema de acciones para la prevención de la neurotoxoplasmosis en personas con VIH y SIDA. Se describe la etapa de capacitación de capacitadores, que se inició con un diagnóstico de actitudes basada en los conocimientos y prácticas que indican la percepción de riesgo a la infección por Toxoplasma gondii. Las personas con VIH que se formaron como capacitadores tienen actitudes positivas para reconocerse en riesgo ante la neurotoxoplasmosis como enfermedad oportunista y disponerse a multiplicar el aprendizaje pues accionaron como educadores pares. La implementación de las tres primeras etapas del sistema de acciones por parte de los voluntarios profesionalizados en el tema facilita las acciones de los profesionales de salud en el camino para la prevención secundaria y terciaria. El propósito de desarrollar un sistema de acciones para la prevención primaria, detección temprana y tratamiento oportuno de la neurotoxoplasmosis en personas con VIH y SIDA se logró a través de representantes de equipos de ayuda mutua del país. Resultó de gran valor identificar las actitudes ante la neurotoxoplasmosis como enfermedad oportunista en personas con VIH y SIDA, todo lo que facilita el camino a la prevención secundaria a través de la terapéutica específica.

Neurotoxoplasmosis is associated to immunodeficiency and it expresses mainly in persons with HIV and AIDS; it is the opportunistic infection that more frequently affects the nervous system in inmunodepressed persons so any approach to its prevention from the methodology of pairs allows decreasing risks and damages. We developed a system of actions for preventing neurotoxoplasmosis in persons with HIV and AIDS. We describe the capacitation of trainers which began with the diagnosis of attitudes based in knowledge and practices indicating the risk perception of the Toxoplasma gondii infection. Persons with HIV formed as trainers have positive attitudes for recognizing the risk of neurotoxoplasmosis as opportunistic disease and being ready to multiply knowledge because they acted as pair educators. The implementation of the three first stages of the action system by volunteers professionalized in the theme facilitates the health professionals’ actions in the way for the secondary and tertiary prevention. The purpose of developing a system of actions for the neurotoxoplasmosis primary prevention, early detection and opportune treatment in persons with HIV and AIDS was achieved through representers of the mutual help teams of the country. Identifying attitudes toward neurotoxoplasmosis as opportunistic disease in persons with HIV and AIDS was of great value, as it makes easy the way to the secondary prevention through the specific therapeutic.

Evaluation of seroepidemiological toxoplasmosis in HIV/AIDS patients in the south of Brazil / Avaliação soroepidemiológica de toxoplasmose em pacientes HIV/SIDA no sul do Brasil

Toxoplasmosis is considered one of the opportunistic infections for individuals with the Acquired Immunodeficiency Syndrome (AIDS), and is also a major cause of morbidity and mortality. The aim of this study was to evaluate the prevalence of neurotoxoplasmosis, ocular toxoplasmosis and antibodies for Toxoplasma gondii in HIV-positive patients attending the SAE (Specialized Assistance Service for HIV/AIDS), as well as to associate their serological profile with epidemiological and clinical data. A total of 250 patients participated in the study from December, 2009 to November, 2010. Serological analysis was performed using the indirect immunofluorescent technique; epidemiological data were gathered by a questionnaire, and clinical history was based on the analysis of medical charts. Prevalence of seropositivity was 80%, with history of neurotoxoplasmosis in 4.8% and of ocular toxoplasmosis in 1.6% of the patients. The Highly Active Antiretroviral Treatment (HAART) was not used by 32% of the patients, 18.4% of the patients had CD4+ T- lymphocyte count less than 200 cells/mm³ and 96.8% of them were not aware of the modes of disease transmission. These findings led us to conclude that the study population is at high risk of clinical toxoplasmosis, because of both reactivation of infection in the seropositive patients who do not make a regular use of HAART, and primo-infection in seronegative patients worsened by an unawareness of the modes of infection reported in this study.

A toxoplasmose é considerada uma das infecções oportunistas em indivíduos com a Síndrome da Imunodeficiência Adquirida (SIDA), constituindo importante causa de morbidade e mortalidade. Este trabalho objetivou conhecer a prevalência de neurotoxoplasmose, toxoplasmose ocular e de anticorpos para Toxoplasma gondii, em pacientes HIV positivos em atendimento no SAE (Serviço de Assistência Especializada em HIV/AIDS) além de correlacionar seu perfil sorológico com dados epidemiológicos e clínicos. Foram analisados 250 pacientes no período de dezembro de 2009 a novembro de 2010. A análise sorológica foi realizada pela técnica de imunofluorescência indireta, os dados epidemiológicos foram obtidos pela aplicação de um questionário e o histórico clínico, pela análise dos prontuários. A prevalência de soropositividade foi de 80%, com histórico de neurotoxoplasmose em 4,8% e de toxoplasmose ocular em 1,6%. Observou-se que 32% dos pacientes não faziam uso regular de HAART, 18,4% apresentaram contagem de linfócitos T CD4+ inferior a 200 céls/mm³ e 96,8% desconheciam os modos de transmissão da doença. Conclui-se que o risco de toxoplasmose clínica grave é alto na população estudada, tanto por reativação da infecção nos soropositivos que não fazem uso regular do HAART, quanto por primoinfecção dos soronegativos, agravado pela desinformação sobre as formas de infecção constatada na pesquisa.

Neurotoxoplasmosis en enfermos con VIH/SIDA: revisión bibliográfica / Neurotoxoplasmosis in patients with HIV/AIDS: bibliographical review

La neurotoxoplasmosis es la infección oportunista más frecuente del sistema nervioso central en pacientes con VIH / SIDA. Esta ocurre generalmente cuando el conteo de CD4 es inferior a 200/µL. Patológicamente se presenta como centros necróticos a nivel del encéfalo, en especial de los ganglios basales y unión de corteza y sustancia blanca. Clínicamente las presentaciones varían de disfunciones neurológicas focales y no focales. Estos incluyen síndromes neurológicos como encefalopatía, meningoencefalitis y lesiones tumorales. Histológicamente se pueden observar los parásitos en diferentes formas evolutivas. El diagnóstico se realiza con técnicas de inmunofluorescencia con anticuerpos específicos. En la serología predomina la IgG, que añadida a un conteo de CD4 bajo e imágenes en anillo de captación en la TAC y RMN, serán datos suficientes para iniciar la terapia antitoxoplásmica, la que muchas veces verificará el diagnóstico. El diagnóstico diferencial deberá hacerse con linfoma primario, tuberculoma, criptococosis, chagas e incluso con citomegalovirus.

Neurotoxoplasmosis is the most frequent opportunist infection of the central nervous system in patients with HIV/AIDS. This occurs generally when CD4 count is lower than 200/ µL. It’s pathologically presented as necrotic areas at encephalon, especially in basal ganglia and the union of cortex and white substance. Clinically the cases differ from focal and non focal neurological dysfunctions. These include neurological syndromes such as encephalopathy, meningoencephalitis, and tumoral lesions. Parasites can be histologically observed in different evolutive forms. Diagnose is made with inmunofluorescence techniques using specific antibodies. IgG prevails in serology that added to a low CD4 count with TAC and NMR images will provide enough data to initiate anti-toxoplasma therapy which will verify diagnosis most of the times Differential diagnose should be done with primary lymphoma, tuberculoma, cryptococcosis, Chagas and even with cytomegalovirus.