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Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome.
N Engl J Med 1992; 327(23):1643-8NEJM

Abstract

BACKGROUND AND METHODS

Toxoplasmosis is the most common opportunistic infection of the central nervous system in patients with the acquired immunodeficiency syndrome (AIDS). To investigate its clinical course, we reviewed the records of 115 patients with AIDS and central nervous system toxoplasmosis treated at San Francisco General Hospital between 1981 and 1990.

RESULTS

The most common presenting symptoms were headache (in 55 percent), confusion (52 percent), and fever (47 percent). Focal neurologic deficits were present in 79 patients (69 percent). The median CD4 cell count at presentation was 50 per cubic millimeter (50 x 10(6) per liter). Thirteen of 80 patients with clinical toxoplasmosis (16 percent) and 4 of 18 patients with pathologically proved disease (22 percent) had undetectable antitoxoplasma IgG antibodies by indirect immunofluorescence assay. Of 103 patients, 94 (91 percent) had enhancing lesions on CT. Single lesions were seen in 28 of 103 patients (27 percent) on CT, and such lesions were seen in 3 of 21 patients (14 percent) on magnetic resonance imaging. Over 90 percent of patients who eventually had clinical and radiographic improvement had evidence of improvement by day 14 of therapy. Adverse drug reactions occurred in 71 patients (62 percent) and led to a change in therapy in 50 patients (43 percent). Among the patients who survived a first episode of toxoplasmosis, the median survival was 265 days.

CONCLUSIONS

Toxoplasmosis occurs in advanced stages of human immunodeficiency virus infection, and the absence of antitoxoplasma antibodies on immunofluorescence assay does not exclude the diagnosis. The clinical and radiographic response to therapy is usually rapid, but treatment is frequently limited by adverse drug effects.

Authors+Show Affiliations

Medical Service, San Francisco General Hospital, CA 94110.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1359410

Citation

Porter, S B., and M A. Sande. "Toxoplasmosis of the Central Nervous System in the Acquired Immunodeficiency Syndrome." The New England Journal of Medicine, vol. 327, no. 23, 1992, pp. 1643-8.
Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med. 1992;327(23):1643-8.
Porter, S. B., & Sande, M. A. (1992). Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. The New England Journal of Medicine, 327(23), pp. 1643-8.
Porter SB, Sande MA. Toxoplasmosis of the Central Nervous System in the Acquired Immunodeficiency Syndrome. N Engl J Med. 1992 Dec 3;327(23):1643-8. PubMed PMID: 1359410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. AU - Porter,S B, AU - Sande,M A, PY - 1992/12/3/pubmed PY - 1992/12/3/medline PY - 1992/12/3/entrez SP - 1643 EP - 8 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 327 IS - 23 N2 - BACKGROUND AND METHODS: Toxoplasmosis is the most common opportunistic infection of the central nervous system in patients with the acquired immunodeficiency syndrome (AIDS). To investigate its clinical course, we reviewed the records of 115 patients with AIDS and central nervous system toxoplasmosis treated at San Francisco General Hospital between 1981 and 1990. RESULTS: The most common presenting symptoms were headache (in 55 percent), confusion (52 percent), and fever (47 percent). Focal neurologic deficits were present in 79 patients (69 percent). The median CD4 cell count at presentation was 50 per cubic millimeter (50 x 10(6) per liter). Thirteen of 80 patients with clinical toxoplasmosis (16 percent) and 4 of 18 patients with pathologically proved disease (22 percent) had undetectable antitoxoplasma IgG antibodies by indirect immunofluorescence assay. Of 103 patients, 94 (91 percent) had enhancing lesions on CT. Single lesions were seen in 28 of 103 patients (27 percent) on CT, and such lesions were seen in 3 of 21 patients (14 percent) on magnetic resonance imaging. Over 90 percent of patients who eventually had clinical and radiographic improvement had evidence of improvement by day 14 of therapy. Adverse drug reactions occurred in 71 patients (62 percent) and led to a change in therapy in 50 patients (43 percent). Among the patients who survived a first episode of toxoplasmosis, the median survival was 265 days. CONCLUSIONS: Toxoplasmosis occurs in advanced stages of human immunodeficiency virus infection, and the absence of antitoxoplasma antibodies on immunofluorescence assay does not exclude the diagnosis. The clinical and radiographic response to therapy is usually rapid, but treatment is frequently limited by adverse drug effects. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/1359410/Toxoplasmosis_of_the_central_nervous_system_in_the_acquired_immunodeficiency_syndrome_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199212033272306?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -