Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey.
A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcome. During the 33-month survey, 199 cases were collected. The prevalence of ECT in patients with AIDS can be estimated at 1.5%-2%. Age, sex, and HIV risk factors were similar to those of the general AIDS population in France. Extracerebral toxoplasmosis appeared mainly in HIV-infected patients with advanced immunosuppression: the mean CD4+ lymphocyte count was 57/mm3(+/- 99). The localizations observed were: eyes (50% of patients); lung (26%); disseminated (at least 2 extracerebral visceral localizations) (11.5%); peripheral blood (acute febrile syndrome with isolated positive parasitemia) (3%); heart (3%); bone marrow (3%); bladder (1%); and isolated cases of rhinopharynx, skin, liver, lymph nodes, conus medullaris, and pericardium. In this survey, muscular and pancreatic localizations were always associated with other extracerebral localizations. A cerebral localization was diagnosed in 41% of cases. Serologic data provided little information. Ocular fundus examination, bronchoalveolar lavage, tissue biopsy, and search for parasitemia were the main diagnostic procedures. Treatment was the same as for cerebral toxoplasmosis. A clinical response was observed in 64% of cases; 19% relapsed. Death occurred in 106 (53%) cases and was related to ECT in 34% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Rabaud
C
C
Department of Infectious and Tropical Diseases, University Hospital, Nancy, France.
May
T
T
Amiel
C
C
Katlama
C
C
Leport
C
C
Ambroise-Thomas
P
P
Canton
P
P
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000328:Adult; D000368:Aged; D000818:Animals; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013411:Sulfadiazine / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D014122:Toxoplasma / Q000302:isolation & purification; D014123:Toxoplasmosis / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology
D013411:Sulfadiazine; D002981:Clindamycin; D011739:Pyrimethamine