HIV-related toxoplasma encephalitis: a tertiary care experience

Kurniawan Adi Prabowo; Anak Agung Ayu Yuli Gayatri; Ni Made Dewi Dian Sukmawati; Made Susila Utama; Ketut Agus Somia; Ketut Tuti Parwati Merati

doi:10.15562/ijbs.v15i2.331

HIV-related toxoplasma encephalitis: a tertiary care experience

Kurniawan Adi Prabowo ,

Anak Agung Ayu Yuli Gayatri ,

Ni Made Dewi Dian Sukmawati ,

Made Susila Utama ,

Ketut Agus Somia ,

Ketut Tuti Parwati Merati ,

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DOI: https://doi.org/10.15562/ijbs.v15i2.331 |
Published: 2021-12-27

Abstract

Introduction: Toxoplasma encephalitis (TE) is the most commonly found in HIV patients who have no cotrimoxazole prophylaxis, especially when the CD count is <100 / µL. Therapy is often based on a presumptive diagnosis because definitive diagnosis is difficult, and TE can be life threatening. Aim of this study is to provide a characteristic description of TE in HIV patients who admitted at Sanglah Hospital.

Methods: This is a retrospective descriptive study of 43 adult patients admitted with diagnosis TE at the Sanglah Hospital, Indonesia between January 1^st 2018 to December 31^th 2018.

Results: Most patients were male (69.8%), with the predominant age ranged 31-40 years old (39.5%). Among all patients; 14% on cotrimoxazole prophylaxis, and 23.3% on antiretroviral therapy. The most common clinical manifestation was headache (58.1%). Oral candidiasis was found in 67.4% of patients. CD4 levels <100 cells / µL were found in 62.8% of patients, absolute lymphocytes <500 / µL in 32.6% of patients. Anemia was found in 37.2% of patients. Multiple ring enhancement was the most common feature found on head CT scan, with the profound location was parietal lobe (46.5%). Pyrimethamine + clindamycin is used in 72.1% of cases. The TE mortality rate in HIV patients in this study was 11.6%.

Conclusion: TE in HIV patients was more common on male, younger age and who are not receiving appropriate prophylaxis and/or without antiretroviral therapy. Laboratory study predominantly showed severe immunodeficiency. The most patients making a full recovery with pyrimethamine and clindamycin treatment.

References

Kementerian Kesehatan Republik Indonesia. Laporan perkembangan HIV-AIDS dan PIMS di Indonesia. 2017. Jakarta: Kementerian Kesehatan.
Rajapakse S, Weeratunga P, Rodrigo C, Silva NLD, Fernando SD. Prophylaxis of human toxoplasmosis: a systematic review. Pathog Glob Health. 2011;7:333-342.
Gandhi RT, Bartlett JG, Mitty J. Uptodate. [Online] 2018. [Cited: April 25, 2019.] http://directdownload.info/uptodate/d/topic.htm?path=toxoplasmosis-in-hiv-infected-patients.
Abgrall S, Rabaud C, Costagliola D. Incidence and risk factor for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active antiretroviral therapy era. Infectious Diseases Society of America. 2001;33:1747-1755.
Pohan HT. Toksoplasmosis. [ed.] Alwi I, Sudoyo AW, Simadibrata M, Setiyohadi B, Syam AF Setiati S. Buku Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing, 2015:624-632.
Lee SB, Lee TG. Toxoplasmic encephalitis in patient with acquired immunodeficiency syndrome. Uijeongbu: Brain Tumor Res Treat, 2017.
Wang ZD, Liu HH, Ma ZX, Ma HY, Li ZY, Yang ZB. Toxoplasma gondii infection in immunocompromised patients: a systematic review and meta-analysis. Front Microbiol. 2017;8:389.
Konishi E, Houki Y, Harano K, Mibawani RS, Marsudi J, Alibasah S High prevalence of antibody to toxoplasma gondii among humans in Surabaya , Indonesia. Jpn J infect Dis. 2000;53:238-241.
Luma HN, Tchaleu BCN, Mapoure YN, Temfack E, Doualla MS, Halle MP, dkk.Toxoplasma encephalitis in HIV/AIDS patients admitted in Douala general hospital between 2004 and 2009: a cross sectional study. BMC Research notes. 2013;6:146.
Vidal JE, Vladimir A, Diaz H, Oliveira FAC, Dauar RF, Chioccola VLP. Importance of high IgG anti-tocoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood sample for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study. Elsevier Editora. 2011:356-359.
Meisheri YV, Mehta S, Patel U. A prospective study of seroprevalence of toxoplasmosis in general population, and in HIV/AIDS patients in Bombay, India. Journal of Postgraduate Medicine. 1997;43:93-97.
Hoffman C, Ernst M, meyer P, Wolf E, Rosenkranz T, Plettenberg A dkk. Evolving characteristics of toxoplasmosis in patients infected with human immunodeficiency virus-1: clinical course and Toxoplasma gondii-specific immune responses. European society of clinical microbiology and infectious disease. 2001;13:510-515.
Bartlett JG, Gallant JE. 2005-2006 Medical Management of HIV Infections. Baltimore: Johns Hopkins Medicines. 2005:379-380.
Ogoina D, Obiako RO, Onyemelukwe GC, Musa BO, hamidu AU. Toxoplasma encephalitis in HIV-infected patients from Zaria, Northern Nigeria: A Case Series of 9 patients. 2013.
Leport C, Chene G, Morlat P, Luft BJ, Rousseau F, Pueyo S, dkk. Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized. 1996:91-97.

[1] Kementerian Kesehatan Republik Indonesia. Laporan perkembangan HIV-AIDS dan PIMS di Indonesia. 2017. Jakarta: Kementerian Kesehatan.

[2] Rajapakse S, Weeratunga P, Rodrigo C, Silva NLD, Fernando SD. Prophylaxis of human toxoplasmosis: a systematic review. Pathog Glob Health. 2011;7:333-342.

[3] Gandhi RT, Bartlett JG, Mitty J. Uptodate. [Online] 2018. [Cited: April 25, 2019.] http://directdownload.info/uptodate/d/topic.htm?path=toxoplasmosis-in-hiv-infected-patients.

[4] Abgrall S, Rabaud C, Costagliola D. Incidence and risk factor for toxoplasmic encephalitis in human immunodeficiency virus-infected patients before and during the highly active antiretroviral therapy era. Infectious Diseases Society of America. 2001;33:1747-1755.

[5] Pohan HT. Toksoplasmosis. [ed.] Alwi I, Sudoyo AW, Simadibrata M, Setiyohadi B, Syam AF Setiati S. Buku Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing, 2015:624-632.

[6] Lee SB, Lee TG. Toxoplasmic encephalitis in patient with acquired immunodeficiency syndrome. Uijeongbu: Brain Tumor Res Treat, 2017.

[7] Wang ZD, Liu HH, Ma ZX, Ma HY, Li ZY, Yang ZB. Toxoplasma gondii infection in immunocompromised patients: a systematic review and meta-analysis. Front Microbiol. 2017;8:389.

[8] Konishi E, Houki Y, Harano K, Mibawani RS, Marsudi J, Alibasah S High prevalence of antibody to toxoplasma gondii among humans in Surabaya , Indonesia. Jpn J infect Dis. 2000;53:238-241.

[9] Luma HN, Tchaleu BCN, Mapoure YN, Temfack E, Doualla MS, Halle MP, dkk.Toxoplasma encephalitis in HIV/AIDS patients admitted in Douala general hospital between 2004 and 2009: a cross sectional study. BMC Research notes. 2013;6:146.

[10] Vidal JE, Vladimir A, Diaz H, Oliveira FAC, Dauar RF, Chioccola VLP. Importance of high IgG anti-tocoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood sample for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study. Elsevier Editora. 2011:356-359.

[11] Meisheri YV, Mehta S, Patel U. A prospective study of seroprevalence of toxoplasmosis in general population, and in HIV/AIDS patients in Bombay, India. Journal of Postgraduate Medicine. 1997;43:93-97.

[12] Hoffman C, Ernst M, meyer P, Wolf E, Rosenkranz T, Plettenberg A dkk. Evolving characteristics of toxoplasmosis in patients infected with human immunodeficiency virus-1: clinical course and Toxoplasma gondii-specific immune responses. European society of clinical microbiology and infectious disease. 2001;13:510-515.

[13] Bartlett JG, Gallant JE. 2005-2006 Medical Management of HIV Infections. Baltimore: Johns Hopkins Medicines. 2005:379-380.

[14] Ogoina D, Obiako RO, Onyemelukwe GC, Musa BO, hamidu AU. Toxoplasma encephalitis in HIV-infected patients from Zaria, Northern Nigeria: A Case Series of 9 patients. 2013.

[15] Leport C, Chene G, Morlat P, Luft BJ, Rousseau F, Pueyo S, dkk. Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized. 1996:91-97.

HIV-related toxoplasma encephalitis: a tertiary care experience

Abstract

References

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