Diagnostic accuracy of HIV-associated central nervous system toxoplasmosis.
Our objective was to examine the accuracy of diagnosis of HIV-associated central nervous system (CNS) toxoplasmosis. Individuals diagnosed with HIV-associated CNS toxoplasmosis and controls were ascertained from a population-based database. Diagnosis was confirmed by response to therapy or by histology. Symptoms, results of anti-Toxoplasma serology and use of Pneumocystis carinii pneumonia (PCP) prophylaxis were recorded. Central nervous system toxoplasmosis was confirmed in 54 (76%) of 75 patients. Reactive anti-Toxoplasma serology was associated with CNS toxoplasmosis (OR=20.4, 95% CI 3.1-175.8). Adjusting for CD4 and use of dapsone or aerosolized pentamidine, trimethoprim-sulphamethoxazole (TMP-SMX) for PCP prophylaxis was associated with lower likelihood of CNS toxoplasmosis (OR 0.3, 95% CI 0.1-0.7). Diagnosis of CNS toxoplasmosis is often incorrect. Another diagnosis is most likely in patients who are anti-Toxoplasma seronegative or who are receiving prophylactic TMP-SMX.
Marra
C M
CM
Department of Neurology, School of Medicine, University of Washington, Seattle, USA. cmarra@u.washington.edu
Krone
M R
MR
Koutsky
L A
LA
Holmes
K K
KK
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D005189:False Positive Reactions; D006801:Humans; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination