Hyponatremia, acute kidney injury, and mortality in HIV-related toxoplasmic encephalitis

BACKGROUND: There are no reports on hyponatremia and acute kidney injury (AKI) involved in the course of HIV-related toxoplasmic encephalitis (TE). The main objective of this study was to describe the occurrence of hyponatremia and its relationship with AKI and mortality in HIV-related toxoplasmic encephalitis (TE). METHODS: This was a retrospective cohort study on patients with HIV-related TE. AKI was considered only when the RIFLE (risk, injury, failure, loss, end-stage) criterion was met, after the patient was admitted. RESULTS: A total of 92 patients were included, with a mean age of 36 ± 9 years. Hyponatremia at admission was observed in 43 patients (46.7%), with AKI developing in 25 (27.1%) patients during their hospitalization. Sulfadiazine was the treatment of choice in 81% of the cases. Death occurred in 13 cases (14.1%). Low serum sodium level correlated directly with AKI and mortality. Male gender (OR 7.89, 95% CI 1.22-50.90, p = 0.03) and hyponatremia at admission (OR 4.73, 95% CI 1.22-18.30, p = 0.02) were predictors for AKI. Independent risk factors for death were AKI (OR 8.3, 95% CI 1.4-48.2, p < 0.0001) and hyponatremia (or 9.9, 95% ci 1.2-96.3, p < 0.0001). CONCLUSION: AKI and hyponatremia are frequent in TE. Hyponatremia on admission is highly associated with AKI and mortality.

Neurotoxoplasmose: fatores que influenciam o desfecho clínico em pacientes hospitalizados / Neurotoxoplasmosis: influencing factors and clinical outcome in inpatients

A neurotoxoplasmose se encontra entre as infecções oportunistas mais freqüentemente observadas em pacientes com Aids, sendo superada, no Brasil, apenas pela candidíase e pela pneumocistose. O desenvolvimento de infecção do sistema nervoso central tem sido apontado como um dos fatores que influenciam negativamente o prognóstico dos doentes com Aida. Os autores estudaram retrospectivamente 87 pacientes com o diagnóstico de neurotoxoplasmose (8) hospitalizados entre 1990 e 1995 no Hospital Universitário Gaffrée e Guinle, com o objetivo de descrever os pincipais aspectos relacionados a um desfecho clínico desfavorável durante a internação. A média de idade foi de 34,5 anos anos, sendo 67,2 por cento do sexo masculino, 79,3 por cento brancos, 71,3 por cento solteiros e 43,7 por cento homossexuais ou bissexuais masculinos. O valor mediano da contagem de linfócitos em sangue periférico foi de 520/mmü. As infecções oportunistas concomitantes à toxoplasmose mais freqüentemente diagnosticadas foram: candidíase (74,7 por cento), tuberculose (47,1 por cento), herpes simples (24,1 por cento) e criptococose (16,1 por cento). O tempo mediano de internação desses hospitalizados foi de 21,5 dias e a letalidade durante a hospitalização foi de 41,3 por cento. Os pacientes com desfecho fatal eram mais freqüentemente do sexo masculino (Odds Ratio)[OR]=4,7; intervalo com 95 por centro de confiança [IC 95 por centro]=1,2-19,9). Os dados referentes ao não-uso de ácido folínico concomitante ao tratamento específico para toxoplasmose (OR=2,7; IC95 por cento=0,8-8,8) e ao não uso de quimioprofilaxia para a toxoplasmose (OR=1,9; IC 95 por cento=0,6-6,6) apontam para maior risco de evolução para óbito, embora não tenham atingido significância estatística

Toxoplasma encephalitis in AIDS patients in São Paulo during 1988 and 1991: a comparative retrospective analysis

We conducted a retrospective analysis of Toxoplasma encephalitis patients from Instituto de Infectologia Emílio Ribas, the main AIDS hospital of São Paulo, Brazil, during two different stages of the HIV epidemics, in 1988 (38 patients) and 1991 (33 patients). There were AIDS-related demographic differences, but the clinical presentation and diagnostic efficiency were similar, usually based on tomography and clinical response to therapy, with a clear distinction from other CNS infections, based on clinical and laboratory findings. Specific serologic studies were performed less often in 1991, with a high frequency of therapy change. The direct acute death rate from Toxoplasma encephalitis was high during both periods, i.e. 8/38 in 1988 and 10/33 in 1991. The direct acute death rate for the patients from the two periods as a whole was 25.4 percent (18/71), related to the time of HIV infection, absence of fever and presence of meningeal irritation at presentation, blood leukocytes higher than 10,000/mm3 and blood lymphocytes lower than 350/mm3. Toxoplasma encephalitis is a preventable disease when adequate prophylactic therapy is used and is relatively easy to treat in diagnosed HIV patients. Unfortunately, this severe and deadly disorder is the HIV diagnostic disease in several patients, and our data support the need for careful management of these patients, especially in those countries with a high toxoplasmosis prevalence where AIDS is concurrent with economic and public health problems.