Toxoplasmosis Cerebri Pada HIV AIDS

Abstract

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.

A case report of a successful alternative regiment therapy for toxoplasma encephalitis in AIDS patients

“…Toxoplasma encephalitis is an opportunistic infection that frequently affects the brain and causes space-occupying lesions in AIDS patients. Infection of Toxoplasma gondii in the nervous system occurs in 30–70% of AIDS patients, and neuropathological abnormalities are detected in 90% of post-mortem tissues [ 3 , 6 ].…”

“…More than 50% of AIDS patients with toxoplasma encephalitis exhibit intracerebral symptoms and motoric function abnormalities. Headache (38–93%), focal neurologic deficit (22–80%), fever (35–88%), mental confusion (15–52%), seizures (19%–58%), behavioral and psychomotor changes (37%–42%), cranial nerve palsy (12–28%), ataxia (2–30%), and visual disturbances (8–19%) are the most common clinical manifestations in HIV patients with toxoplasma encephalitis [ 3 ].…”

“…T. gondii has infected 50% of the world's human population. Approximately 10–45% of AIDS patients develop toxoplasma encephalitis [ 3 ]. Southeast Asia has a high incidence of toxoplasmosis, with Malaysia having the greatest prevalence.…”

Tata Laksana Ensefalitis Toksoplasma pada Penyandang HIV

“…Tampak abses serebri multipel. 15 Gambar 2. MRI non-kontras (A) sekuens T1; (B) FLAIR ( uid-attenuated inversion recovery); dan (C) sekuens T2.…”

“…Analisis CSS kurang membantu diagnosis TE karena biasanya ditemukan normal atau hanya sedikit berubah, yakni peningkatan protein, penurunan kadar glukosa, dan pleositosis dengan dominasi sel mononuklear. 12,15 TE biasanya merupakan diagnosis presumptif berdasarkan kombinasi klinis, temuan radiologis, hasil serologis, serta respons terhadap terapi.…”