AEGiS-13IAC: Toxoplasmic encephalitis (T.E.) in AIDS. Review of 100 cases seen over two years in two hospitals of KwaZulu-Natal, South Africa.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Toxoplasmic encephalitis (T.E.) in AIDS. Review of 100 cases seen over two years in two hospitals of KwaZulu-Natal, South Africa.

Int Conf AIDS 2000 Jul 9-14; 13:42 (abstract no.. LbPeB7039)

Kocheleff P, Thembela B, Ndabaneze E, Dewar J, Borggreve GC, Sinevici C, Stoker A, Nys P
Edendale Hospital, Pietermaritzburg, South Africa. Fax: +27 33 347 14 96, E-mail: aklex@mweb.co.za.

BACKGROUND: In developed countries, T.E. is the most frequent aetiology of cerebral masses among AIDS patients. Information from developing countries is scarce. In KwaZulu-Natal, HIV prevalence reaches 33%. We have studied retrospectively the clinical, radiological. and response to therapy of T.E.

METHOD: Review of AIDS patients' files who presented a CT compatible with T.E, from January 1998 until December 1999; review of the anti toxoplasma IgG of patients attending the HIV clinics.Entry criteria: positive HIV serology and/or total lymphocytes count below 1000/ml. and/or elevated gamma globulins and low albumin, associated with a suggestive CT.

RESULTS: Anti toxoplasma IgG positive: 26% 100 CT compatible with T.E. T.E. was the sole and first AIDS defining condition in 40%. None of the 60% with previous O.I. was on prophylaxis. Clinical manifestations: focal motor deficit (65%), confusion (44%), epilepsy (33%), fever (22%), motor deficit with epilepsy (18%), abnormal movements (1%). Confusion and severe headache were the only manifestation in 12 and 2% respectively. CT

FINDINGS: multiple ring enhancing lesions (66%), solitary ring enhancing (34%), oedema (25%), mass effect (23%). HIV serology was positive in 48%. In 52% the HIV test was not done for various reasons but patients were clinically and/or biologically immunocompromised. In 1998, treatment was sulfadiazine-pyrimethamine; in 1999, TMP-SMZ. In hospital mortality was high (43%) and follow up poor.

CONCLUSION: T.E. is frequent in our context of very high HIV prevalence (33%) and moderately high toxoplasma IgG prevalence (26%). Clinical and radiological findings were classic but acute outcome and follow up were poor. Recommendations: to develop a policy of large scale primary and secondary prophylaxis; to start anti toxoplasmosis treatment in AIDS patients on clinical grounds.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Encephalitis, Toxoplasmosis, Sulfadiazine, HIV Infections, Pyrimethamine, Toxoplasma, Tomography, X-Ray Computed, South Africa, Animal, Human, radiography, AIDS
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