Toxoplasmic Encephalitis in an AIDS Patient with Normal CD4 Count: A Case Report
AbstractToxoplasmic encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage in AIDS patients. A 40 yr old female patient was admitted to Razi Hospital of Qaemshahr City in north of Iran, in Nov 2015, with complaint of headache, blurring of vision, dysarthria and acute left-side hemiplegia and right-side ptosis. Magnetic Resonance Imaging (MRI) was performed with intravenous contrast that showed a ring enhancement lesion in the right basal ganglia showing toxoplasmic encephalitis. Anti-Toxoplasma IgG was positive. HIV antibody test was positive, as well. She was treated successfully with antiparasitic and Anti-HIV drugs and eventually was discharged from hospital. T. gondii infection is commonly detected by serologic tests. Even if in this patient, brain imaging is essential for suitable diagnosis and supervision, its results are not pathognomonic.
Omar K, Siddiqi and Igor J, Koralnik. Neurologic diseases caused by Human immunodeficiency virus type 1 and opportunistic infections. In: Bennett JE, Dolin R, Blaser MJ: Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8th ed, Vol 2,New York: Elsevier Saunders; 2015. Chapter 127; P.1578.
Rogers G, Anne M, Alan B. Signs and symptoms of chronic HIV disease. HIV, viral hepatitis and STIs. 2008:63-70.
Mamidi A, DeSimone JA, Pomerantz RJ. Central nervous system infections in individuals with HIV-1 infection. J Neurovirol. 2002;8(3):158-67.
Leport C, Ambroise-Thomas P, Bazin C et al. Risk factors of the occurrence of cerebral toxoplasmosis in patients with HIV infection. Definition of indications of primary prevention. Proposals of the toxoplasmosis and other protozoan infections group. Coordinated action N. 5-1996. Presse Med. 1996; 25(11):519-20.
Cohen BA. Neurologic manifestations of toxoplasmosis in AIDS. Semin Neurol. 1999; 19(2):201-11.
George SM, Malik AK, Al Hilli F. Cerebral toxoplasmosis in an HIV positive patient: a case report and review of pathogenesis and laboratory diagnosis. Bahrain Med Bull. 2009;31(2):1-5.
Assmar M, Amirkhani A, Piazak N, Hovanesian A, Kooloobandi A, Etessami R. Toxoplasmosis in Iran. Résultats d’une étude séroépidémiologique. Bull Soc Pathol Exot. 1997;90(1):19-21.
Gharavi M, Rahnama N, Jahani M. Seroepidemiological survey of Toxoplasma infections of mentally retarded children. Iran J Public Health. 2005;34(1):19-22.
Ertug S, Okyay P, Turkmen M, Yuksel H. Seroprevalence and risk factors for Toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health. 2005;5:66.
Nascimento LV, Stollar F, Tavares LB, Cavasini CE, Maia IL, Cordeiro JA, Ferreira MU. Risk factors for toxoplasmic encephalitis in HIV-infected patients: a case-control study in Brazil. Ann Trop Med Parasitol. 2001; 95(6):587-93.
Baratloo A, Hashemi B, Rouhipour A, Haroutunian P, Mahdlou M. Review of Toxoplasmic Encephalitis in HIV Infection; a Case Study. Arch Neurosci. 2015;2(2).
Emeka EU, Ogunrin AO, Olubunmi A. Cerebellar toxoplasmosis in HIV/AIDS: a case report. West Afr J Med. 2010; 29(2):123-6.
Luma HN, Tchaleu BC, Mapoure YN, Temfack E, Doualla MS, Halle MP, Joko HA, Koulla-Shiro S. Toxoplasma encephalitis in HIV/AIDS patients admitted to the Douala general hospital between 2004 and 2009: a cross sectional study. BMC Res Notes. 2013;(12).6:146.
Skiest DJ. Focal neurological disease in patients with acquired immunodeficiency syndrome. Clinical infectious diseases. Clin Infect Dis. 2002;34(1):103-15.
Nissapatorn V, Lee C, Quek KF, Leong CL, Mahmud R, Abdullah KA. Toxoplasmosis in HIV/AIDS patients: a current situation. Jpn J Infect Dis. 2004;57(4):160-5.
Antinori A, Larussa D, Cingolani A et al. Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy. Clin Infect Dis. 2004; 39(11):1681-91.
Babatunde O, Ojo OJ, Atoyebi OA, Ekpo DS, Ogundana AO, Olaniyan TO, Owoade JA. Seven year review of retention in HIV care and treatment in federal medical centre Ido-Ekiti. Pan Afr Med J. 2015; 22:139.