Toxoplasmose do sistema nervoso central em paciente sem evidência de imunossupressäo: relato de caso / Toxoplasmosis of the central nervous system in patiente without immunossupresion: case report

O quadro clínico da toxoplasmose adquirida em pacientes imunocompetentes habitualmente não inclui manifestações neurológicas focais, o que é freqüente em pacientes imunodeprimidos, como aqueles com síndrome da imunodeficiência adquirida. este trabalho tem como objetivo relatar o caso de uma paciente adulta que apresentou abscessos cerebrais por Toxoplasma gondii, sem evidência de qualquer fator causador de imunossupressão

Central nervous system toxoplasmosis in acquired immunodeficiency syndrome: An emerging disease in India.

With the incidence of patients infected with human immuno-deficiency virus (HIV) increasing in India, the central nervous system (CNS) manifestations of the disease will be seen more frequently. The CNS may be primarily afflicted by the virus or by opportunistic infections and neoplasms secondary to the immune suppression caused by the virus. In India, although mycobacterium tuberculosis has been reported to be the most common opportunistic infection, toxoplasmosis may become as common owing to the ubiquitous nature of the protozoan. Since an empirical trial of medical therapy without histopathological diagnosis is recommended, the true incidence of this condition may remain under estimated. The role of ancillary tests such as radiology and serology in the initial diagnosis of this condition remain crucial. This report highlights two patients who were diagnosed to have acquired immuno-deficiency syndrome (AIDS) only after the biopsy of the intracranial lesion was reported as toxoplasmosis. Presently all patients for elective neurosurgery are tested for HIV antigen. The management protocol to be followed in a known patient with AIDS presenting with CNS symptoms is discussed in detail. The value of ancillary tests is also reviewed.

Central nervous system toxoplasmosis in children without human immunodeficiency virus infection

Toxoplasma Encephalitis [TE] is rare in pediatric patients, but it is an emerging opportunistic infection in the increasing number of immunocompromised hosts. It should be considered in patients who present with fever and evolving CNS symptoms. The outcome of these patients is always poor because of delay in diagnosis. We report one case of toxoplasma encephalitis in a child without HIV infection. Clinical presentation, diagnosis and treatment, are discussed

Toxoplasmosis cerebral en pacientes con SIDA / Brain toxoplasmosis in AIDS patients

El presente trabajo abarcó el período comprendido entre el año 1987 y agosto de 1994. Se diagnosticaron 25 pacientes con toxoplasmosis cerebrales (23 hombres y 2 mujeres), con una media de 35 años. Doce fueron heterosexuales y 11 homosexuales, todos en etapa Sida con repercusión general. Las manifestaciones clínicas más frecuentes fueron síndrome neurológico en 19 pacientes (síndrome motor deficitario 12, síndrome arquineocerebeloso 6, síndrome frontal 3, estado confusional l); síndrome febril prolongado 11; síndrome de hipertensión endocraneana 14; síndrome poliadenomegálico 7. La TAC mostró en 24 pacientes imágenes compatibles con toxoplasmosis. Se observaron frecuentemente infecciones asociadas de las cuales 14 fueron marcadoras de etapa evolutiva SIDA; (Candidiasis orofaríngea P pacientes, neumocistosis 6 pacientes), otras infecciones asociadas (lúes, Bk, CMV, herpes). Siete pacientes cursaron con clínica de toxoplasmosis sin otras infecciones intercurrentes. El diagnóstico fue tomográfico, clínico y serológico. No hubo confirmación parasitológica, mediante biopsia cerebral. La determinación de las poblaciones linfocitarias mostró cifras de T4 menores a 200 en 15 pacientes. La serología para toxoplasmosis mostró títulos altos de anticuerpos en 13 pacientes, con IgM positiva en 2 de ellos. La mayor eficacia terapéutica se obtuvo con la combinación de pirimetamina, sulfadiazina y ácido folínico, obteniéndose en 10 pacientes buena respuesta clínica y paraclínica

Toxoplasmosis of the central nervous system in patients with AIDS in Mexico

Toxoplasmosis of the central nervous system (CNS) is the most common cause of intracerebral lesions in patients with AIDS. It is now standard clinical practice to treat empirically, based on clinical and radiographic findings, and to perform a biopsy of the lesion only in those patients who fail to have a clinical and radiographic response after two weeks of therapy. This study describes the presentation and response to therapy of central nervous system toxoplasmosis in patients with AIDS at a private practice in Mexico City. A retrospective chart an radiology view of all patients with AIDS treated empirically for toxoplasmosis between 1988 and 1993 was performed. A total of 177 patients with AIDS were seen, nine (5.1 percent) had toxoplasmosis. Patients with toxoplasmosis were males with a median age of 39 years (range - 65). In two patients, toxoplasmosis of the CNS was the initial manifestation of HIV infection, all others had a prior diagnosis of AIDS with a mean of 10 months between their first AIDS defining event and the diagnosis of toxoplasmosis. The median CD+T-cell count at the time of the diagnosis of toxoplasmosis was 78 cells/µL. Most patients had headache associate with other focal neurological symptoms such as hemiplegia (2), hemiparesis (2) or seizures (4). Only 4 out of 9 patients had fever as part of their initial clinical presentation. Serum IgG antibodies against Toxoplasma gondii were positive in 6 out of 7 patients tested, while IgM antibodies were negative in all patients. On imaging studies (Computerized Tomography or Magnetic Resonance Imaging), 4 patients had a single lesion while the rest had two or more lesions. Two patients were initially treated with pyrimethamine/sulfadiazine and were later changed to pryrimethamine/clindamycin, which was the treatment given from the beginning to all other patients. One patient died of an intralesional hemorrhage two weeks after the diagnosis despite adequate therapy. The probability of surviving 6 months after the diagnosis of toxoplasmosis was 60 percent. The findings of these authors are similar to those reported in other series where toxoplasmosis of the CNS is a late complication of HIV infection associated with a CD4+ cell count of < 100 cells/µL. However, survival was short in spite of good response to therapy

Tuberculoma cerebral como manifestaçäo neurológica no curso de uma infecçäo pelo HIV: relato de caso e revisäo da literatura / Tuberculomas of the CNS in HIV-infection: case report and review of literature

À medida que a sobrevida dos doentes com infecção pelo HIV aumenta, as complicações neurológicas tornam-se mais prevalentes. O reconhecimento imediato de algumas destas é muito importante visto que a demora do diagnóstico e do início do tratamento são fatores que pioram sua evolução. Descrevemos um caso de tuberculoma cerebral em paciente HIV positivo que vinha em profilaxia com isoniazida. A evolução desfavorável em vigência do tratamento para toxoplasmose e os achados liquóricos foram os indícios mais importantes de que as lesões cerebrais eram tuberculomas. Comparamos as lesões antes e após o tratamento para tuberculoses através da ressonância magnética nuclear, documentando sua melhora. Os autores revisam ainda as manifestações neurológicas focais da síndrome da imunodeficiência adquirida, enfocando principlamente a tuberculose cerebral. Concluímos que os tuberculomas cerebrais devem sempre ser lembrados naqueles pacientes com lesões encefálicas focais que não respondem adequadamente ao tratamento para toxoplasmose cerebral, tanto pela forte prevalência da tuberculose em nosso meio quanto pelas implicações prognósticas desfavoráveis se o diagnóstico e a terapêutica forem retardados.

Toxoplasmosis cerebral

Presentamos una revisión de la literatura sobre la toxoplasmosis en general y principalmente los efectos a nivel del sistema nervioso central, a propósito del caso de un paciente diagnosticado y tratado en nuestro hospital, se describe el caso clínico, estudios complementarios, para relievar el cuadro polimorfo de presentación y que puede confundir con otras afecciones del sistema nervioso central.

Sudden appearance of multiple brain lesions in Aids after a cerebral biopsy. Case report

A unique case of cerebral toxoplasmosis which had an acute appearance of multiple discrete lesions following a biopsy and its neuroradiological findings are reported in detail. Possible pathophysiological mechanism are presented

Behçet's syndrome, AIDS, cerebral toxoplasmosis: an unusual association

Há raras descriçöes da AIDS associadas a manifestaçöes sugestivas de síndrome de Behçet. Apresentamos o caso de uma jovem senhora que apresentou progressivamente no período de sete anos, critérios clínicos para o diagnóstico de síndrome de Behçet e que ao desenvolver meningoencefalite linfomonocitária recidivante, obserou-se estar infectada com o virus HIV-1. A terapêutica imunodepressora com glicocorticóides em altas doses näo foi satisfatória e a paciente veio a falecer por toxoplasmose cerebral, suspeita por ressonância magnética e confirmada por necrópsia, após sua terceira internaçäo. Níveis baixos de CD4 e da relaçäo CD4/CD8, algumas vezes observadas na síndrome de Behçet ativa, no entanto, mais altos do que comumente se observa na presença desta complicaçäo oportuísta grave, foram elementos que nos levaram a dificuldades diagnósticas, alertando o clínico para a necessidade de interpretar com restriçöes os achados laboratoriais. A falta de conhecimento definitivo do período no qual se infectou pelo HIV-1 possibilita as seguintes consideraçöes: ou estamos diante de síndrome de superposiçäo de distintas enfermidades; ou, entäo, de uma forma inusitada de apresentaçäo evolutiva, mimetizando a síndrome de Behçet, numa enferma infectada por este vírus, que posteriormente, desenvolveu AIDS

Toxoplasmosis encefálica en pacientes con síndrome de inmunodeficiencia adquirida (SIDA) / Encephalic toxoplasmosis in patients with acquired immunodeficiency syndrome (AIDS)

La toxoplasmosis es la causa más frecuente de lesiones focales del sistema nervioso central (SNC) en el SIDA. De 10 pacientes estudiados en el Servicio y Clínica de enfermedades infecciosas con cuadro clínico-tomográficos compatibles con el diagnóstico de toxoplasmosis encefálica, en 7 se reafirmó el diagnóstico etiológico con la prueba terapéutica. Otros 3 fallecieron por agravación de su enfermedad neurológica sin recibir el tratamiento adecuado; de ellos, 2 fueron tratados sólo con cotrimoxazol y otro no recibió tratamiento. Se destaca la importancia diagnóstica del estudio tomográfico de cráneo y la necesidad de continuar administrando la medicación después de la remisión de la enfermedad. En ninguno de los pacientes referidos, así como tampoco en los otros enfermos con inmunodepresión por el VIH que se estudiaron hasta la fecha, se pudo demostrar reactivación de la infección toxoplásmica fuera del SNC