title: Acute Confusional State: A Manifestation of Toxoplasma and CMV Co-infection in HIV Patient.
abstract: BACKGROUND
  When dealing with a patient with HIV that presents with an altered mental status, there are various infections and disease etiologies a physician has to rule out that may play a role in complicating the inherent complex nature of HIV. Toxoplasma gondii (T. gondii) and cytomegalovirus (CMV) affect a large part of the world's population and lead to a varied and broad symptomatology depending upon the severity of HIV, the CD4 count and how early the infection is diagnosed.
  
  
  METHODS
  We report an HIV+ patient in his early 50s and with a low CD4 count that presented with severe lethargy and confusion. Imaging studies that were performed after stabilizing the patient revealed a ring-enhancing lesion in the brain and after further testing, a diagnosis of reactivated T. gondii with co-infection with CMV was made. Patients infected with T. gondii that are already immune-compromised deteriorate rapidly and the disease diagnosis poses several challenges.
  
  
  CONCLUSIONS
  Clinicians have to be extremely careful about making a prompt diagnosis and initiate treatment without delay before the infection takes a deadly toll on the patient. Since our patient was not on the required prophylactic medication to prevent infection with T. gondii, it was imperative to start treatment in a timely manner and to monitor the patient for any further decline in functioning.
authors.affiliation: Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA.
authors.forename: Waqas
authors.initials: W
authors.lastname: Jehangir
authors.affiliation: Ross University School of Medicine, Portsmouth, Dominica, USA.
authors.forename: Romil
authors.initials: R
authors.lastname: Sareen
authors.affiliation: Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA.
authors.forename: Shuvendu
authors.initials: S
authors.lastname: Sen
authors.affiliation: Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA.
authors.forename: Nazar
authors.initials: N
authors.lastname: Raoof
authors.affiliation: Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA.
authors.forename: Abdalla
authors.initials: A
authors.lastname: Yousif
keywords: Cytomegalovirus; Encephalitis; HIV; Toxoplasmosis