Important note: Information in this article was accurate in 1986. The state of the art may have changed since the publication date.
Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients.
Ann Neurol. 1986 Mar;19(3):224-38. Unique Identifier : AIDSLINE MED/86185367 Navia BA; Petito CK; Gold JW; Cho ES; Jordan BD; Price RW
Abstract:
We reviewed the clinical, neuroradiological, and serological findings in 27 patients with cerebral toxoplasmosis complicating the acquired immune deficiency syndrome, 19 of whom were also analyzed neuropathologically. The clinical manifestations of this disorder varied, ranging from headache and fever to coma. However, the characteristic presentation included focal neurological symptoms and signs, usually of subacute onset. In addition, two-thirds of the patients exhibited more generalized cerebral dysfunction with confusion and lethargy. The computed tomographic (CT) scan most commonly revealed ring contrast enhancement, which appeared to correlate best with the histological presence of vascular proliferation and inflammation surrounding the abscesses. However, in 5 patients the CT scan revealed either homogeneous enhancement or no enhancement, and in 3 patients the scans were negative. In general, CT scans underrepresented the number of lesions eventually documented pathologically. Double-dose contrast administration and preliminary experience with magnetic resonance imaging suggested that these techniques were superior to standard CT scanning in detecting Toxoplasma lesions. All patients were seropositive for IgG antibody against Toxoplasma gondii in blood, both before the onset of illness and at the time of presentation, although titers in some patients were as low as 1:8 and most patients did not exhibit rising titers. Prompt therapy resulted in rapid clinical improvement, documented by CT scan, associated with the development of an organizing tissue response in the host and elimination of free organisms. Response to treatment was sufficiently rapid in most patients to allow a trial of therapy as the favored approach to diagnosis.
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY Adult Biopsy Brain Diseases/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY/RADIOGRAPHY Case Report Central Nervous System/*PATHOLOGY/RADIOGRAPHY Clindamycin/THERAPEUTIC USE Human Male Middle Age Pyrimethamine/THERAPEUTIC USE Serology Sulfonamides/THERAPEUTIC USE Support, Non-U.S. Gov't Tomography, X-Ray Computed Toxoplasmosis/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY/RADIOGRAPHY JOURNAL ARTICLE
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1986. The state of the art may have changed since the publication date.
