Clinical, brain imaging and therapeutic evaluation of toxoplasma encephalitis in HIV-infected patients in Yaounde

Introduction

Toxoplasma encephalitis is very common in patients with AIDS. The diagnosis is based mainly on the response to medical treatment.

Objectives

To evaluate clinical diagnosis, CT-scan findings, therapy and evolution of AIDS patients with toxoplasmic encephalitis.

Material and methods

It was a descriptive cohort study with a prospective and a retrospective phase. Neurologic deficit was scored by using the NIHSS (National Institute of Health Stroke Scale).

Results

Sixty consenting patients were recruited, the mean age was 38.7 ± 9.7 years. The F/M sex ratio was 1.6. The mean CD4 cell was 53.5 ± 42.6 /µl. The main presenting complaints were motor deficits (65 %), seizures (40 %), headaches (31.7 %), language and the speech disturbances (35 %). Signs of meningeal irritation and raised intracranial pressure were found in 21 % and 10 % of the cases respectively.

The brain lesions were all heterogeneous with contrast enhancement in 80.8 % of cases. Most lesions were supratentorial in 92.3 % of cases, and multilobar in 69.2 %of cases. Abscesses were multiple in 51.7 % of cases, and associated with brain herniation in 61.5 % and hydrocephalus in 30.8 %.

With adequate treatment, 61.7% had complete resolution and 13.3 % of the patients, had persistence of neurologic signs at the end of the intensive treatment period. The neurologic deficits improved by 50 % by the 7th day of treatment and even more by the 14th day. The most encountered treatment options with comparable outcomes were sulfadiazine-pyrimethamine in 61.7 % of the cases, followed by Trimethoprime-sulfamethoxazole in 31.1 %.

Conclusion

Focal neurologic deficits of progressive onset, with or without headache and seizures, are the signs and symptoms that alert the suspicion of toxoplasma encephalitis in HIV-infected patients. Adequate treatment leads to improvement in neurologic deficits from the first week of treatment, measured with the NIHSS.