Diagnostic difficulties in local brain lesion in patients with HIV-associated toxoplasmosis
https://doi.org/10.18705/2782-3806-2022-2-3-25-37
Abstract
Toxoplasma gondii is a widespread parasitic infection, the activation of which is closely associated with the subsequent immune response. In HIV-infected patients, toxoplasmosis is one of the most common causes of brain damage, causing focal and cerebral symptoms, which can be difficult to diagnose, especially in cases where patients do not inform the doctor about HIV infection. The article presents clinical observations of patients with HIV-associated toxoplasmosis affecting the brain. Diagnostic difficulties arose due to the lack of reliable information about HIV infection in most patients. In the clinical picture, many patients had a multifocal brain lesion, which caused difficulties in recognizing the disease (metastases? encephalitis? Lymphoma?), and with an increase in hypertension-hypertension syndrome, an intracerebral tumor was assumed. To clarify the diagnosis, in case of detected volumetric brain lesions, surgical treatment was required, which was carried out in the volume of a stereotaxic biopsy in the compensated state of patients or emergency surgical intervention in decompensated patients to eliminate the dislocation syndrome.
About the Authors
L. N. Maslova
Polenov Neurosurgical Research Institute, branch of the Almazov National Medical Research Centre
Russian Federation
Russian Federation
candidate of medical sciences, neurologis
S. S. Kiiashko
Polenov Neurosurgical Research Institute, branch of the Almazov National Medical Research Centre
Russian Federation
Russian Federation
candidate of medical sciences, neurologis
N. E. Ivanova
Polenov Neurosurgical Research Institute, branch of the Almazov National Medical Research Centre
Russian Federation
Russian Federation
doctor of medical sciences, head of the scientific department, professor of the department of neurology and psychiatry
References
1. Montoya JG. Toxoplasmosis / J. G. Montoya, O. Liesenfeld // Lancet. — 2004. — Vol. 363. — P. 1965– 1976.
2. The use of sulfamethoxazole / trimethoprim for effective control of toxoplasma infection in HIV-infected patients with toxoplasma encephalitis / M. A. Ivanova, E. M. Blatun, S. A. Drakina [et al.] // Recipe. — 2013. — No. 2 (88). — P. 67–75. In Russian [Использование сульфаметоксазола/триметоприма для эффективного контроля над токсоплазменной инфекцией у ВИЧ-инфицированных пациентов с токсоплазменным энцефалитом / М. А. Иванова, Е. М. Блатун, С. А. Дракина [и др.] // Рецепт. — 2013. — № 2(88). — С. 67–75.]
3. Yakovlev NA. Neurospeed. Neurological disorders in HIV infection / AIDS / N. A. Yakovlev, N. M. Zhulev, T. A. Slyusar // Textbook. — M.: MIAYU, 2005. — P. 101-105. In Russian [Яковлев Н.А. Нейроспид. Неврологические расстройства при ВИЧ-инфекции / СПИДе / Н. А. Яковлев, Н. М. Жулев, Т. А. Слюсарь // Учебное пособие. — М.: МИАЮ, 2005. — С. 101–105.]
4. Luft BJ, Hafner R, Korzun AH, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team. N Engl J Med. 1993;329(14):995–1000.
5. Schlüter D, Barragan A. Advances and challenges in understanding cerebral toxoplasmosis. Front Immunol. 2019;10:242.
6. Pittman KJ. Long-term relationships: the complicated interplay between the host and the developmental stages of toxoplasma gondii during acute and chronic infections / K. J. Pittman // Microbiol. Mol. Biol. Rev. — 2015. — Vol. 79. — P. 387–401.
7. Sonneville R, Magalhaes E, Meyfroidt G. Central nervous system infections in immunocompromised patients. Curr Opin Crit Care. 2017;23(2):128–133.
8. Human Immunodeficiency Virus — Medicine: A Guide for Physicians / Ed. N. A. Belyakova, A. G Rakhmanova. — 2nd edition. — St. Petersburg: Baltic Medical Educational Center, 2011. 656 p. In Russian [Вирус Иммунодефицита Человека — медицина: Руководство для врачей / Под ред. Н. А. Белякова, А. Г. Рахмановой. — 2-е изд. — СПб.: Балтийский медицинский образовательный центр, 2011. 656 с.]
9. Kornienko VM. Diagnostic neuroradiology. / V. M. Kornienko, I. N. Pronin. — M.: Moscow, 2009. — P.172–175. In Russian [Корниенко В.М. Диагностическая нейрорадиология. / В. М. Корниенко, И. Н. Пронин. — М.: Москва, 2009. — С.172–175.]
10. Pereira-Choccola VL. Toxoplazma gondii infection and cerebral toxoplasmosis in HIV-infected patients / V. L. Pereira-Choccola, J. E. Vidal, C. Su // Future Microbiol. — 2009. — Vol.4. — P. 1363–1379.
11. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease José Ernesto Vidal. J Int Assoc Provid AIDS Care.2019 Jan-Dec; 18: 2325958219867315. Published online 2019 Aug 20. DOI: 10.1177/2325958219867315.
12. Gildenberg PL, Gathe JC, Jr, Kim JH. Stereotactic biopsy of cerebral lesions in AIDS. Clin Infect Dis. 2000;30(3):491–499.
13. Zhang J, Liu X, Fu K, et al. Diagnostic value and safety of stereotactic biopsy in acquired immune deficiency syndrome patients with intracranial lesions: systematic review and meta-analysis. World Neurosurg. 2017;98:790–799.
14. Dunay IR, Gajurel K, Dhakal R, Liesenfeld O, Montoya JG. Treatment of toxoplasmosis: historical perspective, animal models, and current clinical practice. Clin Microbiol Rev. 2018;31(4):pii:e00057–17.
15. Dannemann B. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine / В. Dannemann et al. // Annals of Internal Medicine. — 1992. Vol. 116(1). — P. 33–43.
16. Randomized controlled trial of pyrimethamine plus sulfadiazine versus trimethoprim plus sulfamethoxazole for treatment of toxoplasmic encephalitis in AIDS patients. Kongsaengdao S, Samintarapanya K, Oranratnachai K, Prapakarn W, Apichartpiyakul C.J Int Assoc Physicians AIDS Care (Chic). 2008 Jan-Feb;7(1):11–6. DOI: 10.1177/1545109707301244. Epub 2007 May 21.
17. A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprimsulfamethoxazole a real option? Hernandez AV, Thota P, Pellegrino D, Pasupuleti V, Benites-Zapata VA, Deshpande A, Penalva de Oliveira AC, Vidal JE.HIV Med. 2017 Feb;18(2):115–124. DOI: 10.1111/hiv.12402. Epub 2016 Jun 28.
18. Voinov NE, Ulitin AYu, Chitanaeva TV, Sklyar SS, Petrov AV. Primary lymphomas of the central nervous system. Issues of epidemiology and treatment. Clinical example of an interdisciplinary approach in therapy. Translational medicine. 2022;9(1): 49–59. In Russian [Воинов Н.Е., Улитин А.Ю., Читанаева Т.В., Скляр С.С., Петров А.В. Первичные лимфомы центральной нервной системы. Вопросы эпидемиологии и лечения. Клиничеcкий пример междисциплинарного подхода в терапии. Трансляционная медицина. 2022;9(1): 49–59.]
Review
For citations:
Maslova L.N., Kiiashko S.S., Ivanova N.E. Diagnostic difficulties in local brain lesion in patients with HIV-associated toxoplasmosis. Russian Journal for Personalized Medicine. 2022;2(5):25-37. (In Russ.) https://doi.org/10.18705/2782-3806-2022-2-3-25-37
Views:
3990
Email this article 