Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI

Vidal, José Ernesto; Spichler, Anne; Oliveira, Augusto César Penalva de; Lomar, André Villela

doi:10.1590/s1413-86702004000100010

Cited by 3 publications

(3 citation statements)

References 9 publications

(17 reference statements)

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“…Very little is known about the magnitude of the epidemiological impact of T. gondii exposure on epilepsy. Infection with T. gondii may produce epilepsy in some infected individuals; [15][16][17] however, there is scarce information about how frequent people suffering from epilepsy have been exposed to T. gondii. In a recent study on the assessment of the association between postnatal toxoplasmosis and epilepsy in immunecompetent patients, researchers found that this association seemed possible, but only scanty and limited quality literature for the assessment was available.…”

Section: Discussionmentioning

confidence: 99%

“…14 Epilepsy has been observed in patients with human immunodeficiency virus infection suffering from cerebral toxoplasmosis. 15,16 High rates of T. gondii seropositivity and high levels of T. gondii antibodies have been found in cryptogenic epilepsy patients. 17,18 In a Chinese study of patients with unknown central nervous system diseases, the highest seropositivity rate to T. gondii was found in patients with epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico

et al. 2018

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Objectives:This study aimed to determine the association between infection with Toxoplasma gondii and epilepsy in patients attended to in a public hospital in the northern Mexican city of Durango.Methods:We performed an age- and gender-matched case-control study of 99 patients suffering from epilepsy and 99 without epilepsy. Sera of participants were analyzed for anti-T. gondii IgG and IgM antibodies using commercially available enzyme-linked immunoassays. Seropositive samples to T. gondii were further analyzed for detection of T. gondii DNA by polymerase chain reaction.Results:Anti-T. gondii IgG antibodies were found in 10 (10.1%) of the 99 cases and in 6 (6.1%) of the 99 controls (odds ratio = 1.74; 95% confidence interval: 0.60–4.99; p = 0.43). High (> 150 IU/mL) levels of anti-T. gondii IgG antibodies were found in 6 of the 99 cases and in 4 of the 99 controls (odds ratio = 1.53; 95% confidence interval: 0.41–5.60; p = 0.74). Anti-T. gondii IgM antibodies were found in 2 of the 10 IgG seropositive cases, and in 2 of the 6 IgG seropositive controls (odds ratio = 0.50; 95% confidence interval: 0.05–4.97; p = 0.60). T. gondii DNA was not found in any of the 10 anti-T. gondii IgG positive patients. Bivariate analysis of IgG seropositivity to T. gondii and International Statistical Classification of Diseases and related Health Problems, 10th Edition codes of epilepsy showed an association between seropositivity and G40.1 code (odds ratio = 22.0; 95% confidence interval: 2.59–186.5; p = 0.008). Logistic regression analysis showed an association between T. gondii infection and consumption of goat meat (odds ratio = 6.5; 95% confidence interval: 1.22–34.64; p = 0.02), unwashed raw vegetables (odds ratio = 26.3; 95% confidence interval: 2.61–265.23; p = 0.006), and tobacco use (odds ratio = 6.2; 95% confidence interval: 1.06–36.66; p = 0.04).Conclusions:Results suggest that T. gondii infection does not increase the risk of epilepsy in our setting; however, infection might be linked to specific types of epilepsy. Factors associated with T. gondii infection found in this study may aid in the design of preventive measures against toxoplasmosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico

et al. 2018

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“…The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and response to anti-Toxoplasma therapy [2]. Presence of CNS toxoplasma infection without mass lesion is rare.…”

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confidence: 99%

Non tuberculous mycobacteria and toxoplasma co-infection of the central nervous system in a patient with AIDS

et al. 2009

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New-onset seizures are frequent manifestations in patients infected with Human Immunodeficiency Virus (HIV). We describe the clinical and radiological findings in an 25yr old AIDS patient presenting with new onset seizures as the primary manifestation of cerebral toxoplasmosis and Non Tuberculous Mycobacterial [NTM] co-infection. Cranial computed tomography showed a subtle ventricular dilatation whereas magnetic resonance imaging disclosed prominent temporal horn. Toxoplasma tachyzoites and rapidly growing mycobacteria were recovered from CSF. Seizures were complex partial in nature and refractory to antiepileptic therapy. Key-Words: Non tuberculous Mycobacteria, toxoplasmosis, HIV, seizures. Case ReportA 25 year old male came into the fold of our care in May 2008, in an unconscious state along with involuntary movements and complex partial seizures involving the right upper limb and the right side of face, for the past 3 days. History revealed presence of low grade evening fever with remission during the night spread over the last 6 months. He was treated for pulmonary tuberculosis 3 years back and the ATD regimen was duly completed. He had a history of exposure to commercial sex. There was no history of weight loss, oral or genital ulcers, headache, vomiting or visual disturbances and no past history suggestive of a seizure disorder.The general survey revealed enlarged cervical lymph nodes and hyperpigmented papules and plaques, distributed over all four limbs (Figure 1). All his vitals were within normal range. A detailed CNS examination revealed rigidity of both right upper and lower limbs. The deep reflexes were exaggerated on the right side while the plantar response was bilaterally flexor. There was no involvement of the cranial nerves, sensory or autonomic systems. The bladder and bowel control was unaffected. Ophthalmoscopy was within normal limits. Meningeal signs were positive. Abdominal exam revealed a firm nontender hepatomegaly. All other systems were apparently unaffected.Baseline investigations documented normal haemogram, blood sugar, urea and creatinine values. The Liver Function Test showed a serum bilirubin level of 0.6mg/dL (direct bilirubin of 0.4mg/dL), total protein of 8.3mg/dL (albumin 3.7mg/dL, globulin 4.3mg/dL), SGOT 108IU, SGPT 76IU and Alkaline Phosphate 430 IU. An ultrasound of abdomen revealed enlarged liver size with normal echo-texture. He was tested positive for Anti HIV -1 antibodies (ELISA),which was confirmed by western blot. His CD4 count was 46 cells / cumm. CT and MRI scans were essentially normal except for enlarged ventricles (Figures 2 and 3). The CSF study revealed a cell count of 5 cells/ cumm (all lymphocytes). The sugar and protein level in CSF were 38mg/dL and 84 mg/dL respectively. A smear drawn from CSF showed plenty of acid fast bacilli by ZN staining and toxoplasma tachyzoites on Giemsa stain.We initiated CAT 2 antitubercular regimen along with pyrimethamine and co-trimoxazole. He was also started on IV phenytoin and oral oxcarbamazepine was added to his anti...

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The Diagnostic Value of Brain Magnetic Resonance Imaging in Detecting CNS Diseases Among Advanced AIDS Patients

Zhao¹,

Sun²,

Tian³

et al. 2014

Infection International

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Objective To investigate the diagnostic value of brain magnetic resonance imaging in detecting central nervous system diseases among AIDS patients of different levels of T cells. Methods Total of 164 AIDS patients who did not receive antiviral treatment were divided into 2 groups according to their baseline CD4+ T cell counts. Group A had CD4+ T cell below or equal to 50 cells/μl (n = 81) and group B had CD4+ T cells over 50 cells/μl (n = 83). All patients underwent brain MRI scan. Imaging analysis and the prevalence of the central nervous system disorders were compared between two groups. Results Among them 48 cases were found of abnormal brain MRI, group A was higher than group B (35.8% vs. 22.9%) although without statistical significance (P = 0.065). Altogether 48 cases were diagnosed as AIDS related central nervous system disorders based on clinical symptoms, signs and laboratory findings. The prevalence of CNS disorders was higher in group A than in group B (41.9% vs. 16.8%) with statistical significance (P < 0.01). Conclusions The patients with CD4+ T cell count less than or equal to 50 cells/μl had high prevalence of CNS diseases. Brain MRI plays an important role in the diagnosis and differentiation of CNS diseases in advanced AIDS patients. This study suggests patients with low CD4+ T cell count (≤ 50/μl) should routinely undergo MRI examination.

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Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI

Cited by 3 publications

References 9 publications

Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico

Toxoplasma gondii exposure and epilepsy: A matched case-control study in a public hospital in northern Mexico

Non tuberculous mycobacteria and toxoplasma co-infection of the central nervous system in a patient with AIDS

The Diagnostic Value of Brain Magnetic Resonance Imaging in Detecting CNS Diseases Among Advanced AIDS Patients

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