title: Cerebral toxoplasmosis mimicking subacute meningitis in HIV-infected patients; a cohort study from Indonesia.
abstract: BACKGROUND
  HIV-associated subacute meningitis is mostly caused by tuberculosis or cryptococcosis, but often no etiology can be established. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the differential diagnosis.
  
  
  RESULTS
  We performed cerebrospinal fluid real time PCR and serological testing for Toxoplasma gondii in archived samples from a well-characterized cohort of 64 HIV-infected patients presenting with subacute meningitis in a referral hospital in Indonesia. Neuroradiology was only available for 6 patients. At time of presentation, patients mostly had newly diagnosed and advanced HIV infection (median CD4 count 22 cells/mL), with only 17.2% taking ART, and 9.4% PJP-prophylaxis. CSF PCR for T. Gondii was positive in 21 patients (32.8%). Circulating toxoplasma IgG was present in 77.2% of patients tested, including all in whom the PCR of CSF was positive for T. Gondii. Clinically, in the absence of neuroradiology, toxoplasmosis was difficult to distinguish from tuberculosis or cryptococcal meningitis, although CSF abnormalities were less pronounced. Mortality among patients with a positive CSF T. Gondii PCR was 81%, 2.16-fold higher (95% CI 1.04-4.47) compared to those with a negative PCR.
  
  
  CONCLUSIONS
  Toxoplasmosis should be considered in HIV-infected patients with clinically suspected subacute meningitis in settings where neuroradiology is not available.
authors: Department of Neurology, Hasan Sadikin Hospital, Bandung, Indonesia.
authors: A Rizal
authors: AR
authors: Ganiem
authors: Sofiati
authors: S
authors: Dian
authors: Agnes
authors: A
authors: Indriati
authors: Lidya
authors: L
authors: Chaidir
authors: Rudi
authors: R
authors: Wisaksana
authors: Patrick
authors: P
authors: Sturm
authors: Willem
authors: W
authors: Melchers
authors: Andre
authors: A
authors: van der Ven
authors: Ida
authors: I
authors: Parwati
authors: Reinout
authors: R
authors: van Crevel
mesh_terms: D000328:Adult; D000913:Antibodies, Protozoan / Q000097:blood; D002555:Cerebrospinal Fluid / Q000469:parasitology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007214:Indonesia; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000473:pathology*; D016133:Polymerase Chain Reaction; D016019:Survival Analysis; D014122:Toxoplasma / Q000302:isolation & purification* / Q000472:pathogenicity; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G