Intracerebral mass lesions in patients affected by AIDS

Abstract

"Toxoplasma gondii" cerebral abscess is a common opportunistic infection in patients affected by AIDS. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in AIDS patients because of the lack of specificity of serological data and neuroradiological findings. Brain biopsy is the only procedure which enables a reliable diagnosis to be made a trial of specific medical therapy for toxoplasmosis in patients affected by AIDS and intracranial mass lesion can be advisable before performing brain biopsy. The authors report the cases of three patients affected by AIDS and cerebral toxoplasmosis. Tissue diagnosis was made in the first patient from autopsy material while a presumptive diagnosis was made in the other two cases since specific medical therapy resulted in a dramatic improvement of the neurological status. Despite the good possibilities in the treatment of this complication AIDS, however, carries a poor prognosis.

Inhibition and Structure of Toxoplasma gondii Purine Nucleoside Phosphorylase

“…Approximately 1 billion people worldwide, including 22.5% of the population in the United States, are seropositive for T. gondii (2). Toxoplasmosis affects immunocompromised individuals, such as AIDS patients, organ transplant recipients, and the fetuses of newly infected mothers (2,(39)(40)(41). Although the incidence of congenital and AIDS-associated toxoplasmosis has been decreasing, recent waterborne outbreaks have shown that toxoplasmosis in immunocompetent individuals is more common than initially realized.…”

Intracranial Toxoplasma gondii granuloma in a cat

“…Because of variability in clinical signs and likely variability in appearance with advanced imaging such as MRI, information beyond imaging is needed to make a diagnosis of CNS toxoplasmosis. As in human patients, a presumptive diagnosis can be made based on clinical signs in an immune-compromised host with serologic evidence of recent or active infection if there is clinical response to empirical treatment for toxoplasmosis (Piazza et al 1986, Ciricillo and Rosenblum 1990, Vyas and Ebright 1996, Pruitt 2003). Further supporting evidence would be resolution of lesions on MRI.…”

“…Clinical and radiologic improvement have been seen in human patients with mass lesions attributable to toxoplasmosis that are treated medically without surgical debulking (Piazza et al 1986, Ciricillo and Rosenblum 1990, Vyas and Ebright 1996, Pruitt 2003). Because of the paucity of documented cases, the success rate of medical management alone for feline CNS toxoplasma granuloma is not known.…”