Clinical characteristics of toxoplasmic encephalopathy in 57 patients with acquired immunodeficiency syndrome / 中国感染与化疗杂志

ABSTRACT

Objective To summarize the clinical features of encephalopathy caused by Toxoplasma gondii in AIDS patients for improving clinical diagnosis and treatment of such cases. Methods The clinical data of patients with AIDS and toxoplasmic encephalopathy were collected retrospectively. The prevalence of toxoplasmic encephalopathy in AIDS patients was analyzed. The anti-toxoplasmic efficacy of trimethoprim-sulfamethoxazole (SMZ-TMP) plus azithromycin was reviewed. Results Toxoplasmic encephalopathy was reported in about 10.0％ of the AIDS patients complicated with central nervous system disorder. Headache, fever, and limb movement disorder were the most common symptoms. Head CT/MRI scan showed that 89.5％ of the patients had multiple lesions, mostly in the parietal lobe, temporal lobe and basal ganglia. Enhancement scan revealed thatcircular enhanced foci in 76.9％ of the patients, nodular enhanced foci in 59.0％ of the patients, and surrounding edema in 79.5％ of the patients. The mean CD4+ T lymphocytes was (65.8±59.3)/μL.Anti-toxoplasmic IgG was positive in 50.0％ of the patients, higher than that of IgM (11.5％) (P＜0.05). The positive rate of IgG antibody specific for Toxoplasma gondii tested by ELISA was higher than that detected by rapid colloidal gold immunoassay (P＜0.05). Increased cerebrospinal fluid pressure was found in 42.6％ of the patients. Increased protein in CSF was identified in 66.0％ of the patients. Most (84.2％) patients were improved after treatment with SMZ-TMP plus azithromycin. Conclusions Toxoplasmic encephalopathy is one common central nervous system disease in AIDS patients. The clinical symptoms are nonspecific. There are some features in imaging examination. Low count of CD4+ T lymphocytes makes patients more susceptible to Toxoplasma infection. The anti-toxoplasmic IgG antibody may be helpful for diagnosis. The results of cerebrospinal fluid examination are not specific. SMZ-TMP in combination with azithromycin promises good treatment effect.