Background and Methods. Toxo-plasmic encephal itis is the most common opportunistic infection of the central nervous system in Human Immunodeficiency Virus infected patients. Patients with toxoplasmic encephalitis today usually do not take antiretroviral therapy or are unaware of their HIV status. In order to investigate its clinical course we reviewed the records of patients with HIV and toxoplasmic encephalitis treated at the Infectious Diseases Centre of Vilnius University Hospital Santariskiu Clinics Affiliate Infectious Diseases and Tuberculosis Hospital between 2007 and 2013.
Results. Of the 8 cases studied, 5 patients had the first eptsode of toxo-plasmosis, and 3 were relapses. None of the patient had received antiretroviral therapy before hospitalization. For 4 out of 5 patients, toxoplasmic encephalitis was the first AIDS-defintng event. The most common presenting symptoms were headache, fever and asymmetric limb weakness. On physical examination, focal neurologic deficits were identified in all patients, mostly hemipa-resis and sensory def-cits. All patients had severe immunodeficiency: their CD4 count was between 0.12/mm3 and 74/mm3. All 5 patients were positive for serum antitoxoplasma IgG antibodies and negative for IgM. Radiographic testing - computed tomography and/or magnetic resonance imaging of the brain - featured multiple, ring-enhancing brain lesions associated with edema in all cases. Definitive diagnosis of toxoplasmic encephalitis was established for 2 patients, presumptive - for 3 patients. One of 5 patients had complete response to therapy, 4 patients died durtng the first year after diagnosis.
Conclusions: Toxoplasmic encephalitis is severe and potentially life threatening AIDS opportunistic infection. The diagnosis must be considered as a differential diagnosis in patients presenting with multiple brain lesions even those without acknowledged past history of HIV infection. All efforts are required for early HIV identification and timely antiretroviral therapy.
