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

ABSTRACT

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