Cerebral Toxoplasmosis in a Treatment Naive HIV Patient with High CD4 Count Responding to Treatment with a Regime of Cotrimoxazole and Pyrimethamine: Do We Need to Start Prophylaxis for Toxoplasmosis at a Higher CD4 Count?

Swami, Abhijit; Thakuria, Riturag; Kharat, Sumit

doi:10.17140/hartoj-2-111

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Pada individu sehat (immunokompeten) parasit ini menyebabkan infeksi kronik persisten yang asimptomatik, namun pada immunocompromised akan terjadi reaktivasi sehingga menimbulkan gejala klinis. 1,2,3 Penularan terhadap manusia terutama terjadi apabila tertelan daging babi atau domba yang mengandung kista jaringan atau apabila menelan sayuran yang terkontaminasi dan dimasak tidak matang. Jika kista jaringan yang mengandung bradizoit atau ookista tertelan pejamu, maka parasit akan terbebas dari kista dalam proses pencernaan.…”

Section: Pendahuluanunclassified

Toxoplasmosis Cerebri Pada HIV AIDS

Derosa

Ahmad²

2018

JKA

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AbstrakToxoplasmosis cerebri merupakan salah satu infeksi oportunistik yang paling sering pada sistem saraf pusat pasien HIV. Infeksi toxoplasma Gondii pada pasien HIV terutama terjadi jika pada kondisi CD4 yang rendah, penurunan produksi sitokin dan interferon gama, dan menurunnya fungsi sel limfosit T sitotoksik sehingga menyebabkan reaktivasi dari infeksi laten T. Gondii. Telah dilaporkan laki-laki 31 tahun menderita HIV AIDS dengan toxoplasmosis cerebri. Pasien dirawat dengan penurunan kesadaran dan hemiparese sinistra, riwayat sakit kepala hebat dan sering berulang, memiliki riwayat menggunakan narkotik suntik dan pemakaian jarum suntik bergantian, tidak ada riwayat hipertensi, tidak ada riwayat tuberkulosis. Dari pemeriksaan fisik didapatkan kesadran apati, pupil isokor, pada mulut terdapat candidiasis oral, tidak ada kaku kuduk, terdapat lateralisasi tungkai ke kiri serta Babinski yang positif pada tungkai kiri. Pada pemeriksaan penunjang didapatkan Rapid test HIV yang positif, CD4 35sel/ul, dan gambaran CT scan otak yang sesuai Toxoplasmosis cerebri. Pasien ditatalaksana dengan pemberian Pirimetamin dan klindamisin selama 6 minggu ditambah steroid sampai pasien sadar. Abstract Cerebral Toxoplasmosis is one of commonest opportunistic infection of thr nervous system in HIV patient. In HIV infected patient opportunistic infection by T. Gondii occurs due to depletion of CD4 cells, decreased production of cytokine and interferon gamma and impaired cytotoxic T-Lymphocyte activity resulting in reactivation of latent infection. Reported a case, male 31 years old HIV AIDS with cerebral toxoplasmosis. Patient admitted to hospital with decreased of consciousness and left hemiparese, history of injecting drug used (IDU), no hypertension, no history of tuberculosis.In physical examination level of consciousness is apathy, pupil was isochor. there is oral candidiasis, absebce of stiffness of the neck, lateralitation to left lower extremity, and babinsky sign positif in left lower extremity. In laboratory found Rapid tes HIV testing was positif, CD4 cell count was 35cell/ul, Ig G anti toxoplasma positif dan brain ct scan suitable for cerebral toxoplasmosis. We treated patient with pyrimethamin, clindamycin for 6 weeks and steroid until conscious level was compos mentis cooperative.

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Section: Pendahuluanunclassified

Toxoplasmosis Cerebri Pada HIV AIDS

Derosa

Ahmad²

2018

JKA

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“…A study states there is a relationship between toxoplasma infection with the appearance of psychotic symptoms resembling schizophrenia. 1 T. gondii is the most intracellular parasite found in toxoplasmosis. Its life cycle can only be completed in cats and rodents, which are the definitive hosts.…”

Section: Introductionmentioning

confidence: 99%

Co-occuring Toxoplasma Infection and Psychotic Symptoms : Case Report

Marchira

Kusumadewi

Wulandari

2020

SciPsy

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Abstract Introduction Schizophrenia is a neuropsychiatric disease that is global and is experienced by 1% of the population in the United States and Europe. This study raises awareness of the role of infectious agents in the initiation of psychotic symptoms in schizophrenia. Case Presentation A 20-year-old man is taken by the family to the emergency department because he has decreased consciousness, and the body suddenly stiffens. Patients begin to experience changes in behavior in the form of difficulty sleeping, when invited to talk quietly, laughing alone and whispering without the other person. TORCH examination found an increase in anti-toxoplasma IgM and IgG. This patient is then given basic life support in the form of ABC (airway, breathing, circulation support) and seizure management. Also given risperidone 2 mg / 12 hours, pyrimethamine 1-II (1x200 mg), pyrimethamine day III-XXI (1x 25 mg), intravenous Cefotaxim 2g / 8 hours, Clindamycin 500 mg / 8 hours. The patient experienced improvement after the second week of treatment. Conclusion Toxoplasmosis causes lesions in the brain that cause changes in brain neurotransmitter pathways, which lead to changes in patient behavior.

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Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS

Duffus,

Chinta,

Patel

et al. 2024

BMJ Case Rep

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A male in his 30s with a medical history of newly diagnosed HIV with a CD4 count of 292 cells/mm3presented with a bilateral frontal headache and left upper and lower extremity weakness and paraesthesias. A few months prior, the patient experienced a desquamating rash on his scalp and a pruritic, papular genital rash, which both self-resolved. CT head without contrast revealed extensive vasogenic oedema involving the right basal ganglia, thalamus, temporal and occipital lobes. MRI of the brain with and without contrast revealed two enhancing masses in the right lentiform nucleus and right temporal-occipital junction with associated vasogenic oedema. Cerebrospinal fluid (CSF) studies confirmed cerebral toxoplasmosis with positive CSF Toxoplasma gondii PCR and neurosyphilis with positive serum rapid plasma reagin and CSF venereal disease research laboratory test. He was treated with trimethoprim/sulfamethoxazole and intravenous penicillin G with the resolution of his symptoms.

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Cerebral Toxoplasmosis in a Treatment Naive HIV Patient with High CD4 Count Responding to Treatment with a Regime of Cotrimoxazole and Pyrimethamine: Do We Need to Start Prophylaxis for Toxoplasmosis at a Higher CD4 Count?

Cited by 3 publications

References 14 publications

Toxoplasmosis Cerebri Pada HIV AIDS

Toxoplasmosis Cerebri Pada HIV AIDS

Co-occuring Toxoplasma Infection and Psychotic Symptoms : Case Report

Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS

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