Cerebral Toxoplasmosis Mimicking Subacute Meningitis in HIV-Infected Patients; a Cohort Study from Indonesia.docVIP
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Cerebral Toxoplasmosis Mimicking Subacute Meningitis in HIV-Infected Patients; a Cohort Study from Indonesia
CerebralToxoplasmosisMimickingSubacuteMeningitis
inHIV-InfectedPatients;aCohortStudyfromIndonesia
A.RizalGaniem1,SofiatiDian1,AgnesIndriati2,LidyaChaidir3,RudiWisaksana4,PatrickSturm5,
WillemMelchers5,AndrevanderVen6,IdaParwati2,ReinoutvanCrevel6*
1Department of Neurology, Hasan Sadikin Hospital, Bandung, Indonesia, 2Department of Clinical Pathology, Hasan Sadikin Hospital, Bandung, Indonesia, 3Health
Research Unit, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, 4Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia,
5DepartmentofMedicalMicrobiology,RadboudUniversityMedicalCentre,Nijmegen,TheNetherlands,6DepartmentofMedicine,RadboudUniversityMedicalCentre,
Nijmegen,TheNetherlands
Abstract
Background:HIV-associatedsubacutemeningitisismostlycausedbytuberculosisorcryptococcosis,butoftennoetiology
can be established. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the
differentialdiagnosis.
Methodology/PrincipalFindings:WeperformedcerebrospinalfluidrealtimePCRandserologicaltestingforToxoplasma
gondiiinarchivedsamplesfromawell-characterizedcohortof64HIV-infectedpatientspresentingwithsubacutemeningitis
in a referral hospital in Indonesia. Neuroradiology was only available for 6 patients. At time of presentation, patients
mostlyhadnewlydiagnosedandadvancedHIVinfection(medianCD4count22cells/mL),withonly17.2%takingART,and
9.4%PJP-prophylaxis.CSFPCRforT.Gondiiwaspositivein21patients(32.8%).CirculatingtoxoplasmaIgGwaspresentin
77.2% of patients tested, including all in whom the PCR of CSF was positive for T. Gondii. Clinically, in the absence of
neuroradiology, toxoplasmosis was difficult to distinguish from tuberculosis or cryptococcal meningitis, although CSF
abnormalitieswerelesspronounced.MortalityamongpatientswithapositiveCSFT.GondiiPCRwas81%,2.16-foldhigher
(95%CI1.04–4.47)comparedtothosewithanegativePCR.
Conclusions/Significance:ToxoplasmosisshouldbeconsideredinHIV-infectedpatient
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