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[Cerebral toxoplasmosis in immunosuppressed patients: diagnosis and treatment]
Central nervous system toxoplasmosis was diagnosed in 12 immunosuppressed patients, eleven of whom had AIDS. Fever (9/12), confusion (7/12) and focal neurological manifestations (6/12) were the main clinical signs. Lumbar puncture yielded abnormal cerebrospinal fluid in 6/6 cases. Cerebral computed tomographic scan abnormalities, homogenous (2/12) or ring-like (9/12) contrast-enhancing mass lesions and/or low density lesions (6/12), were present in all patients. Brain biopsy confirmed T. gondii infection in 7/8 cases. The combination pyrimethamine-sulfadiazine accounted for complete resolution (4/8) or partial improvement (4/8) in eight out of 12 patients. Mean duration of therapy was 6.5 months (1-21.5 months) in 11 patients. No relapse was observed. In three cases spiramycin was ineffective in the prevention of neurotoxoplasmosis.
Central nervous system toxoplasmosis was diagnosed in 12 immunosuppressed patients, eleven of whom had AIDS. Fever (9/12), confusion (7/12) and focal neurological manifestations (6/12) were the main clinical signs. Lumbar puncture yielded abnormal cerebrospinal fluid in 6/6 cases. Cerebral computed tomographic scan abnormalities, homogenous (2/12) or ring-like (9/12) contrast-enhancing mass lesions and/or low density lesions (6/12), were present in all patients. Brain biopsy confirmed T. gondii infection in 7/8 cases. The combination pyrimethamine-sulfadiazine accounted for complete resolution (4/8) or partial improvement (4/8) in eight out of 12 patients. Mean duration of therapy was 6.5 months (1-21.5 months) in 11 patients. No relapse was observed. In three cases spiramycin was ineffective in the prevention of neurotoxoplasmosis.