Clinical presentation and outcome of toxoplasmic encephalitis in patients with human immunodeficiency virus type 1 infection.
OBJECTIVE
Clinical manifestations and outcome of toxoplasmic encephalitis (TE) in patients at late stage of human immunodeficiency virus (HIV) infection have not been previously reported in Taiwan. The aim of this study was to describe the clinical and radioimaging characteristics and treatment response in HIV-infected patients with TE in Taiwan.


METHODS
Medical records of all HIV-infected patients who were diagnosed as having TE between June 1994 and December 2006 at the National Taiwan University Hospital, Taipei, Taiwan, were reviewed by use of a standardized case record form. Diagnosis of TE was based on clinical manifestations, serology, and radioimaging findings plus clinical and radiographic response to anti-toxoplasmosis therapy.


RESULTS
During the 12-year study period, 18 patients (1.2%) with 19 episodes of TE were identified. The median CD4+ lymphocyte count was 15 cells/microL and plasma HIV RNA load was 179,000 copies/mL at the diagnosis of TE. TE was the initial presentation of HIV infection in around two-thirds of the patients. Fever, focal neurological deficit, cognitive dysfunction, and altered mental status were the most common presenting symptoms. The typical radioimaging findings, multiple enhanced lesions with mass effect, were most common in the cerebral cortex, followed by the basal ganglia, cerebellum and brain stem. Compared with those who survived TE, the 3 patients who died of TE were older (52 vs 37 years, p=0.016) and had a higher incidence of cognitive impairment (100.0% vs 37.5%, p=0.063) and altered mental status (100.0% vs 18.8%, p=0.025).


CONCLUSIONS
TE was a rare HIV-related infectious complication in our cohort. Advanced age and altered mental status were associated with an increased mortality in HIV-infected patients with TE.
Ho
Ya-Chi
YC
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Sun
Hsin-Yun
HY
Chen
Mao-Yuan
MY
Hsieh
Szu-Min
SM
Sheng
Wang-Huei
WH
Chang
Shan-Chwen
SC
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015497:HIV-1; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013624:Taiwan; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
D000981:Antiprotozoal Agents