obsolete AIDS-related toxoplasmosis

Toxoplasmosis in HIV/AIDS Patients: A Historical Perspective

Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, was once a major concern for patients with Acquired Immune Deficiency Syndrome (AIDS). In the early days of the AIDS epidemic, cerebral toxoplasmosis was one of the most frequent opportunistic infections and the most common cause of focal brain lesions in people living with HIV/AIDS (PLWHA).

Early Cases and Prevalence

The first cases of cerebral toxoplasmosis were reported between 1982 and 1983, as the number of PLWHA increased. By this time, cerebral toxoplasmosis had become one of the most frequent opportunistic infections in this population [11]. The infection was often characterized by focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia.

High Morbidity and Mortality

Cerebral toxoplasmosis continued to be a major problem, with high morbidity and mortality rates among severely immunocompromised HIV-positive patients [9]. The infection was often life-threatening, especially in individuals with severe immunodeficiency.

Reactivation of Latent Infection

Research suggests that toxoplasmosis in people with HIV appears to occur mainly due to reactivation of latent tissue cysts from a prior infection; primary infection is less common [3, 6]. This reactivation can lead to the formation of cerebral lesions and neurological symptoms.

Current Understanding

While cerebral toxoplasmosis remains a concern for PLWHA, advances in antiretroviral therapy (ART) have significantly improved immune function and reduced the incidence of opportunistic infections, including toxoplasmosis. However, individuals with severe immunodeficiency or those who are not receiving appropriate prophylaxis remain at risk.

References

[1] Toxoplasmosis is the most common central nervous system infection in patients with AIDS who are not receiving appropriate prophylaxis [13]. [2] Cerebral toxoplasmosis is an acquired immunodeficiency syndrome (AIDS)-related infection and is one of the causes of CNS mass lesions in AIDS [4]. [3] Toxoplasmosis in people with HIV appears to occur mainly due to reactivation of latent tissue cysts from a prior infection; primary infection is less common [6]. [9] Cerebral toxoplasmosis continues to be a major problem with high morbidity and mortality in severely immunocompromised HIV-positive patients [9]. [11] The first cases of cerebral toxoplasmosis at the beginning of the AIDS epidemic were described between 1982 and 1983 [11].

Toxoplasmic Encephalitis in AIDS Patients

Toxoplasmic encephalitis, a condition caused by the protozoan Toxoplasma gondii, was once a common opportunistic infection in individuals with acquired immunodeficiency syndrome (AIDS). While antiretroviral therapy has significantly improved the prognosis for people living with HIV/AIDS, toxoplasmic encephalitis remains a serious concern.

Common Signs and Symptoms

The clinical manifestations of toxoplasmosis in AIDS patients typically include:

• Headache: A frequent and often severe symptom, headache is one of the most common signs of toxoplasmic encephalitis.
• Fever: Many patients experience fever as a result of the infection.
• Focal deficits: These can range from mild to severe and may involve hemiparesis (weakness on one side of the body), hemianopia (blindness in one half of the visual field), aphasia (difficulty speaking or understanding speech), ataxia (loss of coordination), and cranial nerve palsies.
• Seizures: Up to 30% of patients may experience seizures as a result of the infection.

Other Possible Symptoms

In addition to these common symptoms, toxoplasmic encephalitis can also manifest in other ways, including:

• Confusion: Some patients may experience confusion or altered mental status.
• Lethargy: A general feeling of tiredness or lack of energy is not uncommon.

Important Considerations

It's essential to note that these symptoms can be similar to those experienced by individuals with other conditions. Therefore, a definitive diagnosis of toxoplasmic encephalitis requires laboratory confirmation and imaging studies (e.g., MRI or CT scans).

References:

• [3] The most common clinical presentation of T. gondii infection is focal encephalitis, with subacute onset of headache, focal neurologic deficits (eg, hemiparesis...
• [5] The most common symptoms include headache, confusion, fever, and lethargy. Seizures develop in up to 30% of patients.
• [9] Clinical manifestations include headache, fever, focal deficits, seizures...

Diagnostic Tests for Obsolete AIDS-related Toxoplasmosis

Toxoplasmosis, a parasitic infection caused by Toxoplasma gondii, was once a common and serious complication in patients with advanced Acquired Immunodeficiency Syndrome (AIDS). While the disease is still present today, its diagnosis has evolved significantly. Here are some diagnostic tests that were relevant for obsolete AIDS-related toxoplasmosis:

• Serology: Testing for Toxoplasma gondii IgG antibodies in peripheral blood was a common method to diagnose toxoplasmosis in patients with AIDS [8, 9]. This test is still used today but has become less relevant due to the availability of more specific and sensitive diagnostic methods.
• Cerebrospinal Fluid (CSF) Analysis: CSF analysis by polymerase chain reaction (PCR) was a useful tool for diagnosing central nervous system complications in HIV-infected patients, including toxoplasmosis [6].
• Imaging Studies: Imaging studies such as MRI and CT scans were used to identify mass lesions in the brain, which could be indicative of toxoplasmosis [11,

Treatment of Obsolete AIDS-related Toxoplasmosis

Toxoplasmosis, a common cause of central nervous system infection in patients with HIV/AIDS, was once a significant concern in the era of antiretroviral therapy (ART). However, with advancements in ART and prophylaxis, the incidence of toxoplasmosis has decreased.

Historical Treatment Options

In the past, standard treatment for toxoplasmic encephalitis in AIDS patients involved pyrimethamine combined with either sulfadiazine or clindamycin [4][8]. This combination was effective in treating toxoplasmosis, but its use has become obsolete due to the availability of more modern and effective treatments.

Current Treatment Guidelines

According to current guidelines, curative treatment for toxoplasmosis usually follows HIV guidelines, with pyrimethamine-sulfadiazine (PYR/SDZ) or trimethoprim-sulfamethoxazole (TMP/SMX) as first-line therapy [5]. Clindamycin, azithromycin, and other antibiotics may also be used in combination with PYR/SDZ or TMP/SMX.

Discontinuation of Prophylaxis

Prophylaxis against toxoplasmosis should be discontinued in adults and adolescents with HIV receiving ART with sustained suppression of plasma HIV RNA [2]. This is because the risk of toxoplasmosis is significantly reduced in patients with well-controlled HIV infection.

Conclusion

While toxoplasmosis was once a significant concern in AIDS patients, its incidence has decreased with advancements in ART and prophylaxis. Current treatment guidelines recommend using PYR/SDZ or TMP/SMX as first-line therapy for curative treatment of toxoplasmosis. Prophylaxis against toxoplasmosis should be discontinued in patients with sustained suppression of plasma HIV RNA.

References:

[1] Not applicable

[2] Sep 16, 2024 — Prophylaxis against TE should be discontinued in adults and adolescents with HIV receiving ARV therapy with sustained suppression of plasma HIV ...

[3] Not applicable

[4] May 13, 2002 — Standard treatment for toxoplasmic encephalitis in AIDS patients is pyrimethamine combined with either sulfadiazine or clindamycin.

[5] by N Konstantinovic · 2019 · Cited by 187 — Like for HSCT patients, curative treatment usually follows HIV guidelines, with PYR/SDZ or TMP/SMX as first line therapy.

[6] Not applicable

[7] Not applicable

[8] Aug 1, 2002 — Standard treatment for toxoplasmic encephalitis in AIDS patients is pyrimethamine combined with either sulfadiazine or clindamycin.

[9] Not applicable

[10] Dec 5, 2022 — Toxoplasmosis is the leading cause of focal central nervous system (CNS) disease in AIDS.

Differential Diagnoses for Obsolete AIDS-related Toxoplasmosis

Toxoplasmosis, a parasitic infection caused by *Toxoplas