Toxoplasmic Encephalitis in Patients with Acquired Immunodeficiency Syndrome. Four Case Reports.

Abstract

Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. Magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. Toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.

Drinking water source and human Toxoplasma gondii infection in the United States: a cross-sectional analysis of NHANES data

“…Because the clinical symptoms of anemia and inflammation were observed only among seropositive foreign-born NHANES participants, perhaps those born outside the United States acquired toxoplasmosis from more virulent strains. Following ingestion, T. gondii parasites invade the gastrointestinal wall, disseminate, and elicit a strong immune response that triggers significant ancillary pathologies; anemia and eosinophilia have been reported in clinically severe cases of toxoplasmosis [33-37]. …”

High-intensity signals in the basal ganglia from gadolinium-enhanced T1-weighted MRI as an early change in toxoplasma encephalitis in an AIDS patient

“…Clinical and radiological improvements are achieved in more than 70% of patients treated with TMP-SMX, but TE remains a life-threatening disease in the advanced stages of AIDS. Accordingly, prophylaxis and early diagnosis of TE may lead to a dramatic improvement in the survival of AIDS patients [2].…”

Toxoplasmic Encephalitis in Patient with Acquired Immunodeficiency Syndrome

“…TE is generally diagnosed using a toxoplasma antibody titer, but negative serum anti-toxoplasma antibody response has been observed in about 10% of patients with TE related AIDS. Therefore, TE cannot be ruled out in AIDS patients even if serum anti-toxoplasma antibody test is negative [16]. In the case of our patient, T. gondii IgG antibody was positive in the serologic test, but T. gondii IgM antibody was negative.…”