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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 CS4 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 disese(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 andradiographic 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.Toxoplasmosis occurs in advanced stages of human imunodeficiency 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 tratment is frequently limited by adverse drug effects. |
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acquired immunodeficiency syndrome
adverse drug reaction
brain biopsy
CAT scan
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central nervous system,infection of
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fever
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opportunistic infection
opportunistic infection,CNS
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review article
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serologic testing
serologic testing,false negative
toxoplasmosis,CNS
treatment of neurologic disorder
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