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.

[Cerebral toxoplasmosis during AIDS in Tunisia: epidemic logical, clinical and therapeutic aspects]

Cerebral toxoplasmosis [CT] is a severe parasitic disease during HIV infection. It is the most frequent opportunistic infection of central nervous system in AIDS. To study epidemiological and clinical data, and to discuss therapeutic strategy during this disease. This is a multicenter retrospective study from the Tunisian departments of infectious diseases. All medical charts of patients admitted for CT from 1st January 1985 to 31[th] December 2004 were reviewed in order to investigate epidemiologic, clinical and therapeutic data. During the study period,78 cases were collected with an incidence of 9.75%. There were 65 men [83.3%] and 13 women [16.7%], with mean age of 34.5 years [range: 18-52 years]. CT was the first AIDS-defining illness in 30 patients [38.5%]. Heterosexuality was the main risk factor for HIV infection [41%]. Headache, fever and neurologic disorders were the main clinical signs. Toxoplasmic antibodies [IgG] were found in 88.4%. Median CD4 cell count was at 33/mm[3]. Diagnosis of CT was based on neuro-imaging data [CT-scan and/or magnetic resonance imaging] wich shows multiple lesions [59%] associated to cerebral oedema. Pyrimethamine-sulfadiazine or pyrimethamine-clindamycine were the 2 main regimen for treatment, associated in some cases to steroids. Improvement was observed in 50% of cases. Thirty three patients [42.3%] died during the first episode of CT. The severity of CT in AIDS requires early diagnosis and treatment to improve prognosis. Early detection of HIV infection and improvement of immunologic status of patients under antiretroviral treatment are necessary to decrease incidence of this opportunistic infection