CEREBRAL TOXOPLASMOSIS IN THE PATTERN OF CENTRAL NERVOUS SYSTEM LESION IN HIV-INFECTED PATIENTS

Objective. To define the incidence of cerebral toxoplasmosis (CT) among all brain lesions in HIV-infected patients and its clinical and diagnostic criteria. Subjects and methods. 458 patients with Stage 4B HIV infection (AIDS) with central nervous system involvement were followed up for 7 years (2003-2009). The authors used cerebrospinal fluid microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies, by using the indirect immunofluorescence test and enzyme immunoassay; brain magnetic resonance imaging was carried out. Results. In patients with late-stage HIV infection, the principal cause of neurological diseases was CT (34.7% of brain lesion cases). In 11.5% of the patients, it ran as a generalized process involving the brain, lung, heart, liver, and eyes. There was commonly CT concurrent with CMV infection, as well as with tuberculosis and other secondary lesions. Conclusion. Of concern in the diagnosis of CT are magnetic resonance imaging data in addition to the major clinical evidence suggesting this diagnosis, rather than pathognomonic signs. T. gondii IgG at high and average serum concentrations is of diagnostic value, which may be used as an auxiliary method to confirm the diagnosis.

HIV infection, central nervous system lesion, cerebral toxoplasmosis