Cerebral toxoplasmosis in patients with acquired immune deficiency syndrome in the neurological emergency department of a tertiary hospital
Highlights • Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;. • Headache, strength deficit and fever were the most reported signs and symptoms;. • The most common MRI or CT findings were multiple lesions and perilesional edema;. • CSF analysis revealed positive IgM and I...
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| Published in: | Clinical neurology and neurosurgery Vol. 150; pp. 23 - 26 |
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| Abstract | Highlights • Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;. • Headache, strength deficit and fever were the most reported signs and symptoms;. • The most common MRI or CT findings were multiple lesions and perilesional edema;. • CSF analysis revealed positive IgM and IgG for T. gondii in 34 (60.7%) patients. |
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| AbstractList | Highlights • Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;. • Headache, strength deficit and fever were the most reported signs and symptoms;. • The most common MRI or CT findings were multiple lesions and perilesional edema;. • CSF analysis revealed positive IgM and IgG for T. gondii in 34 (60.7%) patients. Introduction Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible for high rates of morbidity and mortality worldwide. Materials and methods This study consists of a case series of 56 patients diagnosed with cerebral toxoplasmosis whose clinical features, brain imaging and cerebrospinal fluid aspects were analyzed. Results Cerebral toxoplasmosis led to the diagnosis of infection by the human immunodeficiency virus (HIV) in 27 (48.2%) of the patients, while 29 (51.2%) others already knew to be HIV seropositive. However, at the time of diagnosis of cerebral toxoplasmosis, only 9 (16.6%) reported being under antiretroviral therapy and 5 (8.9%) were receiving primary prophylaxis for toxoplasmosis. Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI. Thirty-four (60.7%) CSF samples were positive in the indirect haemagglutination test and for the reaction of Toxoplasma gondii IgG ELISA, while 31 (55.4%) were positive in the direct haemagglutination test. Fifty (89.3%) patients underwent first-line treatment for toxoplasmosis. Conclusion Cerebral toxoplasmosis is still a very relevant neurological disease in individuals with AIDS admitted to neurology emergency departments. Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. Introduction Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible for high rates of morbidity and mortality worldwide. Materials and methods This study consists of a case series of 56 patients diagnosed with cerebral toxoplasmosis whose clinical features, brain imaging and cerebrospinal fluid aspects were analyzed. Results Cerebral toxoplasmosis led to the diagnosis of infection by the human immunodeficiency virus (HIV) in 27 (48.2%) of the patients, while 29 (51.2%) others already knew to be HIV seropositive. However, at the time of diagnosis of cerebral toxoplasmosis, only 9 (16.6%) reported being under antiretroviral therapy and 5 (8.9%) were receiving primary prophylaxis for toxoplasmosis. Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI. Thirty-four (60.7%) CSF samples were positive in the indirect haemagglutination test and for the reaction ofToxoplasma gondiiIgG ELISA, while 31 (55.4%) were positive in the direct haemagglutination test. Fifty (89.3%) patients underwent first-line treatment for toxoplasmosis. Conclusion Cerebral toxoplasmosis is still a very relevant neurological disease in individuals with AIDS admitted to neurology emergency departments. Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible for high rates of morbidity and mortality worldwide. This study consists of a case series of 56 patients diagnosed with cerebral toxoplasmosis whose clinical features, brain imaging and cerebrospinal fluid aspects were analyzed. Cerebral toxoplasmosis led to the diagnosis of infection by the human immunodeficiency virus (HIV) in 27 (48.2%) of the patients, while 29 (51.2%) others already knew to be HIV seropositive. However, at the time of diagnosis of cerebral toxoplasmosis, only 9 (16.6%) reported being under antiretroviral therapy and 5 (8.9%) were receiving primary prophylaxis for toxoplasmosis. Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI. Thirty-four (60.7%) CSF samples were positive in the indirect haemagglutination test and for the reaction of Toxoplasma gondii IgG ELISA, while 31 (55.4%) were positive in the direct haemagglutination test. Fifty (89.3%) patients underwent first-line treatment for toxoplasmosis. Cerebral toxoplasmosis is still a very relevant neurological disease in individuals with AIDS admitted to neurology emergency departments. Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. INTRODUCTIONCerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible for high rates of morbidity and mortality worldwide.MATERIALS AND METHODSThis study consists of a case series of 56 patients diagnosed with cerebral toxoplasmosis whose clinical features, brain imaging and cerebrospinal fluid aspects were analyzed.RESULTSCerebral toxoplasmosis led to the diagnosis of infection by the human immunodeficiency virus (HIV) in 27 (48.2%) of the patients, while 29 (51.2%) others already knew to be HIV seropositive. However, at the time of diagnosis of cerebral toxoplasmosis, only 9 (16.6%) reported being under antiretroviral therapy and 5 (8.9%) were receiving primary prophylaxis for toxoplasmosis. Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI. Thirty-four (60.7%) CSF samples were positive in the indirect haemagglutination test and for the reaction of Toxoplasma gondii IgG ELISA, while 31 (55.4%) were positive in the direct haemagglutination test. Fifty (89.3%) patients underwent first-line treatment for toxoplasmosis.CONCLUSIONCerebral toxoplasmosis is still a very relevant neurological disease in individuals with AIDS admitted to neurology emergency departments. Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. •Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;.•Headache, strength deficit and fever were the most reported signs and symptoms;.•The most common MRI or CT findings were multiple lesions and perilesional edema;.•CSF analysis revealed positive IgM and IgG for T. gondii in 34 (60.7%) patients. Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible for high rates of morbidity and mortality worldwide. This study consists of a case series of 56 patients diagnosed with cerebral toxoplasmosis whose clinical features, brain imaging and cerebrospinal fluid aspects were analyzed. Cerebral toxoplasmosis led to the diagnosis of infection by the human immunodeficiency virus (HIV) in 27 (48.2%) of the patients, while 29 (51.2%) others already knew to be HIV seropositive. However, at the time of diagnosis of cerebral toxoplasmosis, only 9 (16.6%) reported being under antiretroviral therapy and 5 (8.9%) were receiving primary prophylaxis for toxoplasmosis. Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI. Thirty-four (60.7%) CSF samples were positive in the indirect haemagglutination test and for the reaction of Toxoplasma gondii IgG ELISA, while 31 (55.4%) were positive in the direct haemagglutination test. Fifty (89.3%) patients underwent first-line treatment for toxoplasmosis. Cerebral toxoplasmosis is still a very relevant neurological disease in individuals with AIDS admitted to neurology emergency departments. Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. |
| Author | de Melo, Fábio Lopes Ferreira, Eduardo Caetano Brandão da Silva, Maria Almerice Lopes Wanderley, Leandro Batista da Cunha Correia, Carolina de Medeiros, Zulma Maria de Araújo, Paulo Sérgio Ramos Filho, José Luiz Lima Santos, Alfredo Henrique Cecílio Marins de Oliveira, Gabriela Brito |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27573702$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1056/NEJM199803263381301 10.1212/WNL.56.2.257 10.1007/s00234-006-0123-y 10.1016/0730-725X(90)90212-K 10.1002/ana.410190303 10.1016/S0966-842X(03)00205-1 10.1016/j.bjid.2012.10.030 10.1056/NEJM199309303291403 10.2214/ajr.140.5.861 10.1093/clinids/15.2.211 10.1086/322622 10.1080/13550280290101094 10.1086/339752 10.1016/j.diagmicrobio.2011.07.008 10.1056/NEJM199212033272306 10.1007/s100960100494 10.1016/j.seizure.2007.05.017 10.1016/S0090-3019(03)00379-3 10.1001/jama.1984.03350070031018 10.1212/WNL.50.1.21 10.1086/324350 10.1111/j.1468-1293.2011.00944_1.x 10.1212/WNL.55.8.1194 10.1086/424877 10.1590/S0037-86822004000600010 10.1212/WNL.54.9.1856 10.1128/JCM.42.10.4765-4768.2004 |
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| Snippet | Highlights • Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;. • Headache, strength deficit and fever were the most reported signs... •Twenty-seven (48.2%) patients were diagnosed with HIV at the emergency room;.•Headache, strength deficit and fever were the most reported signs and... Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is responsible... Introduction Cerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is... INTRODUCTIONCerebral toxoplasmosis is the most common cause of space occupying brain lesion in patients with HIV/AIDS in Brazil. In the post-HAART era, it is... |
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| SubjectTerms | Acquired immune deficiency syndrome Acquired immunodeficiency syndrome Acquired Immunodeficiency Syndrome - diagnosis Acquired Immunodeficiency Syndrome - epidemiology Adult AIDS Cerebral toxoplasmosis Comorbidity Emergency medical care Emergency Service, Hospital Female HIV HIV Infections - diagnosis HIV Infections - epidemiology HIV Seropositivity - diagnosis HIV Seropositivity - epidemiology Human immunodeficiency virus Humans Lentivirus Male Middle Aged Mortality Neurology Neurosurgery Retroviridae Tertiary Care Centers Toxoplasma gondii Toxoplasmosis, Cerebral - diagnosis Toxoplasmosis, Cerebral - epidemiology Young Adult |
| Title | Cerebral toxoplasmosis in patients with acquired immune deficiency syndrome in the neurological emergency department of a tertiary hospital |
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