Skip to main content

Advertisement

Log in

Central nervous system toxoplasmosis in HIV pathogenesis, diagnosis, and therapy

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

In patients with HIV, Toxoplasma gondii is the most frequent infectious cause of focal brain lesions. Particularly in advanced HIV disease, it can cause significant morbidity and mortality. Current clinical practice involves empiric therapy with pyrimethamine and sulfadiazine, upon a presumptive diagnosis of toxoplasmic encephalitis, based on serologic, clinical, and radiological features. This approach continues to evolve, as new diagnostic strategies, such as the use of immunoglobulin G antibody titers and polymerase chain reaction, prophylaxis against opportunistic infections, and highly active antiretroviral therapy—HAART—come into play. Primary and secondary prophylaxis are the mainstay of treatment. There remains a continuing need for development of new anti-Toxoplasma therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Luft BJ, Hafner R, Korzun A, et al.: Toxoplasmic encephalitis in patients with the Acquired Immunodeficiency Syndrome. N Engl J Med 1993, 329:995–1000.

    Article  PubMed  CAS  Google Scholar 

  2. Wallace MR, Rossetti RJ, Olsen PE:Cats and toxoplasmosis risk in HIV-infected adults. JAMA 1993, 269:76–77.

    Article  PubMed  CAS  Google Scholar 

  3. Israelski DM, Chmiel JS, Poggensee L, et al.: Prevalence of Toxoplasma infection in a cohort of homosexual men at risk of AIDS and toxoplasmic encephalitis. J Acquir Immune Defic Syndr Hum Retrovirol 1993, 6:414–418.

    CAS  Google Scholar 

  4. Mariuz P, Bosler EM, Luft BJ: Toxoplasma. Curr Ther Infect Dis 1995, 562–566.

  5. Richards FO, Kovacs JA, Luft BJ. Preventing Toxoplasmic Encephalitis in Persons Infected with Human Immunodeficiency Virus. Clin Infect Dis 1995, 21(suppl I):S49-S56. This article offers a comprehensive review of primary and secondary prophylaxis against toxoplasmic encephalitis in HIV patients.

    PubMed  Google Scholar 

  6. Pelloux H, Dupouy-Camet J, Derouin F. A multicentre prospective study for the polymerase chain reaction detection of Toxoplasma gondii DNA in blood samples from 186 AIDS patients with suspected toxoplasmic encephalitis. AIDS 1997, 11:1888–1890.

    Article  PubMed  CAS  Google Scholar 

  7. Porter SB, Sande MA: Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Eng J Med 1992, 327:1643–1648.

    Article  CAS  Google Scholar 

  8. Derouin F, Leport C, Pueyo S, et al.: Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients. AIDS 1996, 10:1521–1527. This article demonstrates significantly associates IgG titers with occurrence of toxoplasmic encephalitis.

    Article  PubMed  CAS  Google Scholar 

  9. Holliman RE, Johnson JD, Savva D: Diagnosis of cerebral toxoplasmosis in association with AIDS using the polymerase chain reaction. Scand J Infect Dis 1990, 22:243–244.

    PubMed  CAS  Google Scholar 

  10. Van de ven E, Melchers W, Galama J, et al.: Identification of Toxoplasma gondii infections by B1 gene amplification. J Clin Microbiol 1991, 29:2120–2124.

    PubMed  CAS  Google Scholar 

  11. Grover CM, Thulliez P, Remington JS, Boothroyd JC: Rapid prenatal diagnosis of congenital Toxoplasma infection by using polymerase chain reaction and amniotic fluid. J Clin Microbiol 1990, 28:2297–2301.

    PubMed  CAS  Google Scholar 

  12. Dupouy-Camet J, Lavareda De Souza S, Bougnoux ME, et al.: Preventing congenital toxoplasmosis. Lancet 1990, 336:1018.

    Google Scholar 

  13. Brezin AP, Silveira C, Thulliez P, et al.: Analysis of aqueous humor in ocular toxoplasmosis. N Engl J Med 1991, 324:699.

    PubMed  CAS  Google Scholar 

  14. Gianotti N, Cinque P, Castagna A, et al.: Diagnosis of toxoplasmic encephalitis in HIV infected patients. AIDS 1997, 11:1529–1530.

    PubMed  CAS  Google Scholar 

  15. Novati R, Castagna A, Morsica G, et al.: Polymerase chain reaction for Toxoplasma gondii DNA in the cerebrospinal fluid of AIDS patients with focal brain lesions. AIDS 1994, 8:1691–1694.

    Article  PubMed  CAS  Google Scholar 

  16. Dupon M, Cazenave J, Pellegrin JL, et al.: Detection of Toxoplasma gondii by PCR and Tissue culture in Cerebrospinal Fluid and Blood of Human Immunodeficiency Virus Seropositive Patients. J Clin Microbiol 1995, 33:2421–2426.

    PubMed  CAS  Google Scholar 

  17. Rodriguez JC, Martinez MM, Martinez AR, Royo G: Evaluation of different techniques in the diagnosis of Toxoplasma encephalitis. J Med Microbiol 1997, 46:597–601.

    PubMed  CAS  Google Scholar 

  18. Antinori A, Ammassari A, De Luca, et al.: Diagnosis of AIDS related focal brain lesions: a decision making analysis based on clinical and neuroradiological characteristics combined with polymerase chain reaction assay in cerebrospinal fluid. Neurology 1997; 48:687–694.

    PubMed  CAS  Google Scholar 

  19. Luft BJ, Remington JS: Toxoplasmic Encephalitis in AIDS. Clin Infect Dis 1992, 15:211–222. This article reviews the current approach to diagnosis and therapy of toxoplasmic encephalitis in HIV infected patients.

    PubMed  CAS  Google Scholar 

  20. Ramsey RG, Gean AD: Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am 1997, 7(2):171–186.

    PubMed  CAS  Google Scholar 

  21. O’Doherty MJ, Barrington SF, Campbell M, et al.: PET scanning and the human immunodeficiency virus positive patient. J Nucl Med 1997, 38:1575–1583.

    PubMed  CAS  Google Scholar 

  22. Ammassari A, Scoppettuolo G, Murri R, et al.: Changing disease patterns in Focal Brain Lesion-Causing disorders in AIDS. J Acquir Immune Defic Syndr Hum Retrovirol 1998, 18:265–371. Clinically important study.

    Google Scholar 

  23. Bishburg E, Eng RH, Slim J, Perez G, et al.: Brain lesions in patients with acquired immunodeficiency syndrome. Arch Internal Med 1989, 149:941–943.

    Article  CAS  Google Scholar 

  24. Raffi F, Aboulker JP, Michelet C, et al.: A prospective study of criteria for the diagnosis of toxoplasmic encephalitis in 186 AIDS patients. AIDS 1997, 11:177–184. These authors propose an algorithm for the probability of Toxoplasmic encephalitis in the HIV patient based on neuroradiologic finding, serology against Toxoplasma gondii, and antiprotozoal prophylaxis.

    Article  PubMed  CAS  Google Scholar 

  25. Girard PM, Landman R, Gaudebout C, et al.: Dapsonepyrimethamine compared with aerosolized pentamidine as primary prophylaxis against Pneumocystic carinii pneumonia and toxoplasmosis in HIV infection. N Engl J Med 1993, 328:1514–1520.

    Article  PubMed  CAS  Google Scholar 

  26. Antinori A, Murri R, Ammassari A, et al.: Aerosolized pentamidine, cotrimoxazole and dapsone-pyrimethamine for primary prophylaxis of Pneumocystic carinii pneumonia and toxoplasmosis in HIV infection. AIDS 1995, 9:1343–1350.

    Article  PubMed  CAS  Google Scholar 

  27. Wong SY, Remington J: Toxoplasmosis in the setting of AIDS. In Medical Management of AIDS. Edited by Broder S, Merigan TC Jr, Bolognesis D. Baltimore: Williams and Wilkins; 1994:223–258.

    Google Scholar 

  28. Gatti G, Malena M, Casazza R, et al.: Penetration of Clindamycin and Its Metabolite N-Demethylclindamycin into Cerebrospinal fluid following intravenous infusion of clindamycin phosphate in patients with AIDS. Antimicrob Agents Chemother 1998, 42:3104–117.

    Google Scholar 

  29. 1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus. Washington DC: US Department of Health and Human Services; 1999 48:RR-10. Very useful guidelines.

  30. Torre D, Casari S, Speranza F, et al.: Randomized trial of Trimethroprim-Sulfamethoxazole versus Pyrimethamine-Sulfadiazine for Therapy of Toxoplasmic Encephalitis in Patients with AIDS. Antimicrob Agents Chemother 1998, 42:1346–1349.

    PubMed  CAS  Google Scholar 

  31. Ribera E, Fernandez-Sola A, Juste C, et al.: Comparison of High and Low doses of Trimethroprim-Sulfamethoxazole for Primary Prevention of Toxoplasmic Encephalitis in Human Immunodeficiency Virus-Infected Patients. Clin Infect Dis 1999, 29:1461–1466.

    Article  PubMed  CAS  Google Scholar 

  32. Cantin L, Chamberland S: In vitro evaluation of the activities of azithromycin alone and combination with pyrimethamine against Toxoplasma gondii. Antimicrob Agents Chemother 1993, 37:1993–1996.

    PubMed  CAS  Google Scholar 

  33. Fernandez JM, Leport C, Molart P, et al.: Pyrimethamineclarithromycin combination for therapy of acute Toxoplasma encephalitis in patients with AIDS. Antimicrob Agents Chemother 1991, 35:2049–2052.

    Google Scholar 

  34. Djurkovid-Djakovic O, Nikolic T, Robert-Gangneux F, et al.: Synergistic effect of Clindamycin and Atovaquone in Acute Murine Toxoplasmosis. Antimicrob Agents Chemother 1999, 43:2240–2244.

    Google Scholar 

  35. Khan A, Slifer T, Araujo F, et al.: Quinupristin-Dalfopristin is active against Toxoplasma gondii. Antimicrob Agents Chemother 1999, 43:2043–2045.

    PubMed  CAS  Google Scholar 

  36. Khan A, Slifer T, Araujo F, et al.: Trovafloxin is active against Toxoplasma gondii. Antimicrob Agents Chemother 1996, 40:1855–1859.

    PubMed  CAS  Google Scholar 

  37. Estes R, Vogel N, Mack D, Mcleod R: Paclitaxel arrests growth of intracellular Toxoplasma gondii. Antimicrob Agents Chemother 1998, 42:2036–2040.

    PubMed  CAS  Google Scholar 

  38. Berens R, Krug E, Nash P, Curiel T: Selection and Characterization of Toxoplasma gondii mutants resistant to Artemisin. J Infect Dis 1998, 177:1128–1131.

    Article  PubMed  CAS  Google Scholar 

  39. Torres R, Weinberg W, Stansell J, et al.: Atovaquone for Salvage Treatment and Suppression of Toxoplasmic Encephalitis in Patients with AIDS. Clin Infect Dis 1997, 24:422–429.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luft, B.J., Chua, A. Central nervous system toxoplasmosis in HIV pathogenesis, diagnosis, and therapy. Curr Infect Dis Rep 2, 358–362 (2000). https://doi.org/10.1007/s11908-000-0016-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-000-0016-x

Keywords

Navigation