Clinical features, outcome and survival from cerebral toxoplasmosis in Edinburgh AIDS patients.
Nineteen cases of cerebral toxoplasmosis (CTOX) are reported from a group of Edinburgh AIDS patients. All patients were severely immunodeficient at the time of presentation with CD4 count < 50 cells/mm3. Thirteen patients had suffered a previous AIDS-defining illness. In Edinburgh, CTOX has developed in 48% of patients who are seropositive for toxoplasma and have a CD4 count < 50 cells/mm3. It is estimated that at least half of the toxoplasma seropositive patients will develop CTOX if they survive for 21 months after reaching a time in their illness when the CD4 count = 50 cells/mm3. The incidence of CTOX in toxoplasma-seronegative patients with a CD4 count < 50 cells/mm3 is 1.3%. All patients showed improvement on treatment and there was no correlation between clinical or radiological features and patient survival. Those patients unable to tolerate first choice anti-toxoplasma therapy had a significantly shorter survival than the remainder but there was no single therapeutic regimen which conferred a survival advantage. Eighteen patients had died at the time of study and the median survival following diagnosis of cerebral toxoplasmosis was 10 months (range 3-38 months). Postmortem examination of the brain was available in 8, 4 of whom had concomitant cerebral lymphoma. The survival from AIDS or CD4 count = 50 cells/mm3 did not differ significantly between those with treated CTOX and a control group who had no toxoplasma infection, suggesting that treatment is reasonably effective. CTOX is a disease associated with severe HIV-related immunodeficiency and, in those with a CD4 count < 50 cells/mm3, occurs more than 35 times as frequently in toxoplasma-seropositive than toxoplasma-seronegative patients. Treatment is effective but the outcome of treated disease cannot be predicted from presenting clinical or radiological features. Concomitant space-occupying cerebral pathology is evident in 50% of post-mortem examinations.
Laing
R B
RB
Regional Infectious Diseases Unit, City Hospital, Edinburgh, UK.
Flegg
P J
PJ
Brettle
R P
RP
Leen
C L
CL
Burns
S M
SM
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D053626:Atovaquone; D001344:Autopsy; D017963:Azithromycin / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D018791:CD4 Lymphocyte Count; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009285:Naphthoquinones / Q000627:therapeutic use; D011739:Pyrimethamine / Q000627:therapeutic use; D012189:Retrospective Studies; D013411:Sulfadiazine / Q000627:therapeutic use; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000935:Antifungal Agents; D009285:Naphthoquinones; D013411:Sulfadiazine; D002981:Clindamycin; D017963:Azithromycin; D053626:Atovaquone; D011739:Pyrimethamine