Two cases of cerebral toxoplasmosis in AIDS patients mimicking HIV-related dementia

Abstract

Two unusual cases of cerebral toxoplasmosis in AIDS patients are presented. Two homosexual males aged 33 and 52 years in CDC stage IV C1 complained of memory loss during the past 6 months, as well as weight loss and mild fever. They showed severe intellectual deterioration and discrete basal ganglia dysfunction. Motor performance and cognitive function as well as the conventional EEG findings were grossly abnormal. MRI was normal in the younger patient but showed signal-intensive zones in the basal ganglia and cortical atrophy in the older one. CSF and serological antibody tests were normal; immunological function was severely impaired. The patients were diagnosed as late "HIV-related dementia". Both deteriorated rapidly and died within a few weeks. Neuropathological examination revealed histologically severe Toxoplasma gondii encephalitis, involving the basal ganglia in particular. It is concluded that in AIDS patients with a severely impaired immune status cerebral opportunistic infection may present as dementia with mild basal ganglia impairment in the absence of other focal neurological signs or the characteristic radiological findings.

Acquired infection with Toxoplasma gondii in adult mice results in sensorimotor deficits but normal cognitive behavior despite widespread brain pathology

“…Infection is found throughout the world in the tissues of food animals [2]. While infection with T. gondii has generally thought to be primarily asymptomatic in immune competent humans, recent studies have suggested that infection may contribute to the development of various neurological and psychiatric symptoms [3-10] and that negative outcomes resulting from initial or chronic infection may be under-diagnosed [10-13]. These studies in humans are, however, associative and cannot prove if infection causes the behavior or the behavior increases the risk of infection.…”

An exploratory study of long-term neurocognitive outcomes following recovery from opportunistic brain infections in HIV+ adults

“…The effects of the lesions caused by these CNS-OIs on neurobehavioral functioning varies widely. CM has been associated with mania (Johannessen & Wilson, 1988), TE has been found to mimic HIV-associated dementia (Arendt et al, 1991) and to be associated with alexia (Luscher & Horber, 1992), and PML has been associated with integrative agnosia (Butter & Trobe, 1994). Thus, these conditions can result in focal or generalized neuropsychological abnormalities, as well as alterations in psychiatric functioning.…”

Epidemiology, Pathophysiology, Diagnosis, and Management of Cerebral Toxoplasmosis

“…Uncommonly, patients may present with an encephalitic illness rather than discrete brain abscesses. These individuals may present with fever, meningeal signs, such as headache, stiff neck and photophobia, and encephalopathy that is rapidly fatal (161,162). Similar clinical manifestations and course have been reported in people with necrotizing ventriculitis due to T. gondii (163).…”