title: Clinical presentation and diagnosis of toxoplasmic encephalitis in Japan.
abstract: Distinguishing life-threatening toxoplasmic encephalitis (TE) from brain lymphoma in patients with acquired immunodeficiency syndrome (AIDS) may be difficult. Empiric anti-toxoplasmosis treatment is often initiated because of the reluctance in performing brain biopsies, which may delay the diagnosis and treatment of brain lymphoma in Japan. In this study, we retrospectively examined the clinical characteristics of 13 AIDS patients with TE in Japan, including magnetic resonance imaging and thallium 201 (201TI) single photon emission computed tomography (SPECT) findings, cerebral spinal fluid analysis, serology, and polymerase chain reaction (PCR) results. All patients improved on anti-toxoplasmosis treatment. Of the 11 patients who underwent serological testing, 6 (55%) had a positive serological result. Of the 7 patients who underwent PCR testing, 3 (42.9%) had a positive PCR result. Nine of 11 patients with TE (81.8%) had multiple lesions. Analysis of the sites of TE lesions did not reveal a difference in site predilection between TE and brain lymphoma. Uptake was negative in all 9 patients who underwent 201Tl SPECT. The study findings suggest that toxoplasma serostatus and PCR may be used to discriminate TE from brain lymphoma. No focal accumulation of 201TI is strongly suggestive of TE in patients with AIDS in Japan.
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan. Electronic address: tmaeda@ndmc.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Mikita
authors.affiliation: Division of Preparedness and Emerging Infections, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kato
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yanagisawa
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suganuma
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Imamura
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Fukumi
authors.initials: F
authors.lastname: Nakamura-Uchiyama
authors.affiliation: Department of Global Infectious Diseases and Tropical Medicine, National Defense Medical College, Saitama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyahira
authors.affiliation: Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawana
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohnishi
authors.affiliation: Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ajisawa
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001921:Brain / Q000469:parasitology / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000473:pathology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008223:Lymphoma / Q000150:complications / Q000473:pathology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*
chemical_list: D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D015725:Fluconazole
keywords: AIDS; PCR; SPECT; Toxoplasmic encephalitis; Toxoplasmosis