[Toxoplasmosis encephalitis in patients with AIDS]

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Acquired immunodeficiency syndrome (AIDS) is associated with opportunistic infections affecting the central nervous system.
• Toxoplasmosis encephalitis is a significant opportunistic infection in AIDS patients, presenting with diverse neurological symptoms.

Purpose of the Study:

• To describe the clinical presentation, diagnostic findings, and treatment outcomes of toxoplasmosis encephalitis in three male homosexuals with AIDS.
• To highlight the importance of considering toxoplasmosis encephalitis in the differential diagnosis of organic mental syndromes in AIDS patients.

Main Methods:

• Case series involving three male homosexual patients diagnosed with AIDS and suspected toxoplasmosis encephalitis.
• Clinical evaluation, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and computed tomography (CT) scans were performed.
• Treatment administered included pyrimethamine and sulfamethoxydiazine.

Main Results:

• Patients presented with organic mental syndrome, with two developing focal neurological signs.
• EEG showed generalized changes with focal signs; CSF findings and toxoplasmosis titres were not diagnostic.
• CT scans revealed multiple hypodense lesions in the cortex and cerebellum.
• Treatment led to rapid clinical improvement and CT lesion regression within weeks.
• One patient experienced a recurrence and died; autopsy confirmed toxoplasma pseudocysts.

Conclusions:

• Toxoplasmosis encephalitis should be strongly considered in AIDS patients presenting with an organic mental syndrome.
• Diagnosis may rely on response to a therapeutic trial of antiparasitic treatment, as conventional diagnostic methods can be inconclusive.
• Prompt treatment with pyrimethamine and sulfamethoxydiazine is effective in managing toxoplasmosis encephalitis in AIDS patients.