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Disseminated toxoplasmosis in the acquired immunodeficiency syndrome
1Department of Pathology, Los Angeles County-University of Southern California Medical Center.
Abstract:
Fourteen cases of toxoplasmosis in subjects at autopsy with acquired immunodeficiency syndrome are reviewed. Death was related to toxoplasmosis in four cases: in three from central nervous system complications and in one case from myocarditis. In six cases the infection was identified outside of the central nervous system and in only two cases was infection disseminated to multiple extracerebral organs. Review of clinical history and laboratory data revealed no specific risk factors or laboratory indicators associated with toxoplasmosis in acquired immunodeficiency syndrome. Though inflammatory cell infiltrates often accompanied disseminated infections, diagnosis could be made with certainty only by finding characteristic Toxoplasma organisms, either as free tachyzoites, pseudocysts, or as true parasitic cysts. We found immunohistochemical staining to have limited usefulness for diagnosis in extracerebral sites. Characteristic Toxoplasma organisms were most readily identified in central nervous system tissues in our acquired immunodeficiency syndrome population, making this the most useful site for diagnosis.
Insights
Toxoplasmosis caused death in four acquired immunodeficiency syndrome (AIDS) patients, primarily due to central nervous system issues. Diagnosis was most reliable by identifying Toxoplasma organisms in central nervous system tissues.
Area of Science:
- Medical Science
- Pathology
- Infectious Diseases
Background:
- Acquired immunodeficiency syndrome (AIDS) increases susceptibility to opportunistic infections.
- Toxoplasmosis is a significant opportunistic infection in AIDS patients.
Purpose of the Study:
- To review autopsy cases of toxoplasmosis in AIDS patients.
- To identify patterns of infection, mortality, and diagnostic challenges.
Main Methods:
- Retrospective review of 14 autopsy cases of toxoplasmosis in AIDS patients.
- Analysis of clinical history, laboratory data, and autopsy findings.
Main Results:
- Toxoplasmosis was the cause of death in 4 cases (3 CNS, 1 myocarditis).
- Extracerebral infections occurred in 6 cases, with dissemination to multiple organs in only 2.
- No specific risk factors or laboratory indicators for toxoplasmosis in AIDS were identified.
- Diagnosis relied on identifying characteristic Toxoplasma organisms; immunohistochemistry was limited for extracerebral sites.
Conclusions:
- Central nervous system tissue is the most reliable site for diagnosing toxoplasmosis in AIDS patients.
- Characteristic Toxoplasma organisms are key for definitive diagnosis.
- Extracerebral toxoplasmosis in AIDS is often localized, not widely disseminated.