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Cerebral Toxoplasmosis

Toxoplasmoses Cerebral


Presentation

  • These nodules were prominent in the cerebellum, midbrain and medulla and also present in the cortex and thalamus. No coagulative necrosis, necrotizing abscesses, or other opportunistic infections were present.[ncbi.nlm.nih.gov]
  • Circulating toxoplasma IgG was present in 77.2% of patients tested, including all in whom the PCR of CSF was positive for T. Gondii.[ncbi.nlm.nih.gov]
  • Abstract Despite the development of serological and molecular methods in recent years, the diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients still presents difficulties.[ncbi.nlm.nih.gov]
  • No clonal type I or II was seen in the present study. In addition, variants were observed at alt SAG2 and SAG3 but BTUB and GRA6 were highly conserved.[ncbi.nlm.nih.gov]
  • AIDS patients presenting with hemorrhagic cerebral lesions should be considered for a trial of presumptive antitoxoplasma treatment.[ncbi.nlm.nih.gov]
Fever
  • On day 83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS.[ncbi.nlm.nih.gov]
  • However, fever of unknown origin continued for 2 weeks, and disseminated histoplasmosis was diagnosed by examination of a blood smear and by the detection of the histoplasma genome in the peripheral blood by means of polymerase chain reaction.[ncbi.nlm.nih.gov]
  • Patient was clinically stable, oriented and his fever settled. He was discharged from hospital on same medication and advised to continue regular follow-up.[ncbi.nlm.nih.gov]
  • He was hospitalized in the Intensive Care Unit because of anemia, fever and hepatosplenomegaly. Chest X-ray showed pneumonia and subsequent blood cultures were positive for Candida albicans.[ncbi.nlm.nih.gov]
  • Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific.[ncbi.nlm.nih.gov]
Collapse
  • Supratentorial hydrocephalus as a result of aqueductal collapse was the only abnormal finding on computed tomography scan. Toxoplasma gondii is the most common pathogen organism in high-risk AIDS's patients with involvement of the CNS.[ncbi.nlm.nih.gov]
Fever of Unknown Origin
  • However, fever of unknown origin continued for 2 weeks, and disseminated histoplasmosis was diagnosed by examination of a blood smear and by the detection of the histoplasma genome in the peripheral blood by means of polymerase chain reaction.[ncbi.nlm.nih.gov]
Difficulty Walking
  • The patient presented with right facial droop, slurred speech and difficulty walking. In addition to receiving methotrexate and infliximab and owning a cat, she had no other obvious risk factors.[ncbi.nlm.nih.gov]
Diplopia
  • On day 83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS.[ncbi.nlm.nih.gov]
Headache
  • Abstract Headache and/or migraine, a common problem in pediatrics and internal medicine, affect about 5% to 10% children and adolescents, and nearly 30% of middle-aged women.[ncbi.nlm.nih.gov]
  • Recently, we found that recurrent headaches in non-HIV-infected subjects were due to acquired cerebral toxoplasmosis (CT).[ncbi.nlm.nih.gov]
  • The clinical picture included headaches, nuchal rigidity, and right-sided hemiparesis during a course of disseminated cutaneous herpes zoster.[ncbi.nlm.nih.gov]
  • Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific.[ncbi.nlm.nih.gov]
  • Headache, strength deficit and fever were the most frequent signs and symptoms throughout the study. Fifty-three patients showed changes consistent with toxoplasmosis in CT or MRI.[ncbi.nlm.nih.gov]
Seizure
  • He had focal seizures for which he was treated as an "epileptic" with herbal preparations. A computerized tomography (CT) head scan revealed the characteristic scan findings in CNS toxoplasmosis.[ncbi.nlm.nih.gov]
  • Classic cerebral toxoplasmosis typically presents with neurologic symptoms such as seizures and mental status changes and histological examination shows focal lesions with necrosis.[ncbi.nlm.nih.gov]
  • Children typically present with seizures and have an excellent prognosis. Neuroimaging demonstrates a single ring or nodular enhancing lesion surrounded by edema.[ncbi.nlm.nih.gov]
  • Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures.[karger.com]
  • Clinical manifestations include SEIZURES, altered mentation, headache, focal neurologic deficits, and INTRACRANIAL HYPERTENSION.[connects.catalyst.harvard.edu]
Ataxia
  • Cerebral toxoplasmosis or Toxoplasmic encephalitis (TE) in most advance stage HIV infected patients composed of fever, headache, alteration of consciousness with focal neurological signs/symptoms such as include hemiparesis, cranial nerve palsies, and ataxia[clinicaltrials.gov]
  • There are very rare reports of neurologic IRIS associated with cerebral toxoplasmosis. 3, 4 A 26-year-old woman with HIV-1 infection for 8 years presented with a 1-month history of ataxia, left-sided weakness, and hyperreflexia.[ajnr.org]
  • Due the most frequently localization of encephalitis lesions by Toxoplasma are in the corticalsubcortical binding of the cerebral hemispheres and basal ganglia, contralateral hemiparesis is the most common focal sign followed by ataxia, as was reported[omicsonline.org]
  • […] mass lesions) History Toxo Headache, confusion, /- fever; focal weakness, seizures; if advanced, dull affect Lymphoma All of above and constitutional symptoms (night sweats, weight loss) PML Rapid neurologic decline (hemiplegia, visual field defects, ataxia[learningradiology.com]
  • He was apparently doing well on anti retro viral therapy until recently when he began to experience symptoms of ataxia and weakness. Magnetic Resonance Imaging (MRI) of the brain revealed several ring enhancing lesions.[ispub.com]
Focal Neurologic Deficit
  • Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific.[ncbi.nlm.nih.gov]
  • Clinical manifestations include SEIZURES, altered mentation, headache, focal neurologic deficits, and INTRACRANIAL HYPERTENSION.[connects.catalyst.harvard.edu]
  • Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures.[karger.com]
  • Clinical manifestations include seizures, altered mentation, headache, focal neurologic deficits, and intracranial hypertension.[icd10data.com]
Confusion
  • Alteration of consciousness, Karnofsky score less than 70, psychomotor slowing, hemoglobin less than 12 mg/dL, mental confusion, Glasgow Coma Scale less than 12 were the main predictors of partial clinical response.[ncbi.nlm.nih.gov]
  • However, for several decades thereafter, toxoplasma was confused with either Sarcosporidia or Encephalitozoon. The first case of congenital toxoplasmosis infection was described in 1923 ( Janku 1923 ).[medlink.com]
  • Primary CNS Lymphoma (EBV) 30% of all brain lesions in AIDS patients (PML, HIV-associated encephalopathy, and CMV encephalitis usually do not cause mass lesions) History Toxo Headache, confusion, /- fever; focal weakness, seizures; if advanced, dull affect[learningradiology.com]

Workup

  • An exhaustive diagnostic workup revealed no underlying hematologic disease and no viral infection; a test for autoantibodies had negative results.[jamanetwork.com]
Toxoplasma Gondii
  • The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF).[ncbi.nlm.nih.gov]
  • KEYWORDS: Acquired immunodeficiency syndrome; Central nervous system; Cerebral toxoplasmosis; Cytokines; Immune system; Toxoplasma gondii; Toxoplasmosis[ncbi.nlm.nih.gov]
  • Toxoplasma gondii is the most common pathogen organism in high-risk AIDS's patients with involvement of the CNS.[ncbi.nlm.nih.gov]
  • Toxoplasmosis is an opportunistic infection caused by the parasite Toxoplasma gondii. The infection is severe and difficult to diagnose in patients receiving allogeneic haematopoietic stem cell transplantation (HSCT).[ncbi.nlm.nih.gov]
  • The protozoan parasite Toxoplasma gondii causes severe opportunistic infections. Here, we report an unexpected diagnosis of cerebral toxoplasmosis.[ncbi.nlm.nih.gov]
Candida
  • Chest X-ray showed pneumonia and subsequent blood cultures were positive for Candida albicans. After 3 days of Amphotericin B treatment, the patient was transferred to Infectious Disease Department.[ncbi.nlm.nih.gov]
  • Candida infections were common and nine patients had the opportunistic pneumocystis jirovecii pneumonia (PJP). Of the parasitic infections giardia was the most common.[bmcinfectdis.biomedcentral.com]
Gliosis
  • A stereotactic brain biopsy of the left frontal lobe lesion revealed reactive gliosis, collections of histiocytic giant multinucleated cells, and marked perivascular lymphocytic infiltrates with a predominance of CD8 lymphocytes.[ajnr.org]

Treatment

  • CT, 15 patients (3 blood samples collected one day before Toxoplasma gondii treatment; 7 and 15days during the treatment). P/CT, 5 patients (one blood sample collected at least, one year after the treatment).[ncbi.nlm.nih.gov]
  • Consequently, cotrimoxazole could be a first-line drug regimen for curative treatment and prophylaxis of toxoplasmic encephalitis.[ncbi.nlm.nih.gov]
  • Hemorrhage has only rarely been described and is usually seen following antitoxoplasma treatment.[ncbi.nlm.nih.gov]
  • The patient developed cerebral toxoplasmosis immediately after etanercept treatment with a good outcome.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis.[ncbi.nlm.nih.gov]

Prognosis

  • In this study, we aimed to characterize the prognosis of patients with HIV infection with severe forms of cerebral toxoplasmosis and to investigate the effects of adjunctive steroids on outcomes.[ncbi.nlm.nih.gov]
  • Although ST treatment was interrupted because of adverse reactions, her prognosis was favorable. The Toxoplasma 18S rDNA gene was detected by nested-polymerase chain reaction (PCR) from blood and cerebrospinal fluid.[ncbi.nlm.nih.gov]
  • Early diagnosis and initiation of empiric treatment and antiretroviral therapy are important for good prognosis. Copyright 2016 Elsevier B.V. All rights reserved.[ncbi.nlm.nih.gov]
  • Children typically present with seizures and have an excellent prognosis. Neuroimaging demonstrates a single ring or nodular enhancing lesion surrounded by edema.[ncbi.nlm.nih.gov]
  • Ischemic Visual Loss 235 1335 Orbital Manifestations 236 1343 LargeVessel Vasculitis 237 135 Laboratory Investigations in GCA 238 1352 CReactive Protein 239 1355 Anemia 240 1361 Temporal Artery Biopsy 241 1363 Role of Ultrasound 243 137 Treatment and Prognosis[books.google.com]

Etiology

  • Idiophatic pneumonia syndrome (IPS) is a term used to describe lung injury following hematopoietic stem cell transplantation (HSCT) without an infectious etiology.[ncbi.nlm.nih.gov]
  • BACKGROUND: HIV-associated subacute meningitis is mostly caused by tuberculosis or cryptococcosis, but often no etiology can be established.[ncbi.nlm.nih.gov]
  • For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities.[ncbi.nlm.nih.gov]
  • 274 1541 Myohistological Investigations 275 155 Treatment 276 1552 Symptomatic Treatment 277 156 Differential Diagnosis 278 1563 Congenital Fibrosis of the Extraocular Muscles 279 Treatment of Specific Types of Nystagmus 283 161 Introduction 284 16211 Etiology[books.google.com]

Epidemiology

  • Full Text Dear Editor, Highly active antiretroviral therapy (HAART) significantly reduced the cerebral toxoplasmosis incidence in HIV-infected patients from high-income countries. 1 However, there is scarce epidemiological information about this neurological[bjid.org.br]
  • This chapter presents a review of the biology of this infection including the life cycle, transmission, epidemiology, parasite strains, and the host immune response.[books.google.com]
  • Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev. 2012; 25 (2): 264-96[ DOI ][ PubMed ] 4. Nissapatorn V, Lee C, Quek KF, Leong CL, Mahmud R, Abdullah KA. Toxoplasmosis in HIV/AIDS patients: a current situation.[archcid.com]
  • Lanska DJ: Epidemiology of human immunodeficiency virus infection and associated neurologic illness. Semin Neurol 1999;19:105-111. Author Contacts Dr.[karger.com]
  • Ramírez-Crescencio MA,Velásquez-Pérez L, Ramírez-Crescencio MA, Velásquez-Pérez L (2013) Epidemiology and trend of neurological diseases associated to HIV/AIDS. Experience of Mexican patients 1995-2009. ClinNeurolNeurosurg 115: 1322-1325.[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • Currently suggested pathophysiological mechanisms of the disease are mostly derived from stroke cases. Although rare, cerebral toxoplasmosis may strengthen the pathophysiologic mechanism of disease.[ncbi.nlm.nih.gov]

Prevention

  • No case of cerebral toxoplasmosis was noted in patients receiving co-trimoxazole in prevention. Presumptive treatment of cerebral toxoplasmosis with co-trimoxazole was effective in all patients with a significant clinical improvement in 83.3%.[ncbi.nlm.nih.gov]
  • In the presence of risk factors, such as cGVHD, prophylactic treatment for toxoplasmosis should be reinstituted; Trimethoprim-sulfamethoxasole most probably prevented earlier reactivation of toxoplasmosis in our patient.[ncbi.nlm.nih.gov]
  • In the absence of IFN-gamma-producing non-T cells, T cells cannot prevent TE. Interleukin-12, Bcl-3, NF-kappaB(2), and CD40-CD40L ligand interaction are important for up-regulation of IFN-gamma production.[ncbi.nlm.nih.gov]
  • To evaluate the effectiveness of pyrimethamine (given with leucovorin calcium versus placebo (an inactive substance) for the primary prophylaxis (prevention) of cerebral toxoplasmosis in HIV-infected patients.[clinicaltrials.gov]
  • Further studies are needed to determine the percentage of the population at risk of immunosuppression and its long-term consequences as well as new actions to prevent infections.[ncbi.nlm.nih.gov]

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