eMedicine Specialties > Neurology > Neurological Infections

HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis

Author: Niranjan N Singh, MD, DNB, Assistant Professor of Neurology, University of Missouri Columbia
Coauthor(s): Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Contributor Information and Disclosures

Updated: Feb 23, 2007

Introduction

Background

Toxoplasmosis is the leading cause of focal CNS disease in AIDS. Usually, it is a complication of the late phase of the disease.

Typically, lesions are found in the brain and dominate the clinical presentation. Rarely, intraspinal lesions need to be considered in the differential diagnosis of myelopathy.

Pathophysiology

CNS toxoplasmosis results from infection by the intracellular parasite Toxoplasma gondii. It is usually due to reactivation of old CNS lesions or to hematogenous spread of a previously acquired infection.

Occasionally, it results from primary infection. CNS disease occurs during advanced HIV infection when CD4+ counts are less than 200 cells/µL.

Frequency

United States

Clinical CNS toxoplasmosis occurs in 3-10% of patients with AIDS in the US. Some clinically silent lesions come to diagnosis only at autopsy.

In 5% of patients, it is the presenting opportunistic infection of AIDS.

The incidence rate has decreased due to highly active antiretroviral therapy (HAART) and prophylactic treatment of Pneumocystis carinii infections.

International

Clinical CNS toxoplasmosis occurs in as many as 50% of patients in Europe and Africa.

Clinical

History

The natural history of CNS toxoplasmosis includes the following:

  • Initially, constitutional symptoms and headache
  • Later, confusion and drowsiness, seizures, focal weakness, and language disturbance
  • Without treatment, progression to coma in days to weeks

Physical

  • Personality and mental status changes are noted.
  • Seizures, hemiparesis, hemianopia, aphasia, ataxia, and cranial nerve palsies may be observed.
  • Occasionally, symptoms and signs of a radiculomyelopathy predominate.

More on HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis

Overview: HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis
Differential Diagnoses & Workup: HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis
Treatment & Medication: HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis
Follow-up: HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis
Multimedia: HIV-1 Associated Opportunistic Infections - CNS Toxoplasmosis
References
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References

  1. AAN Quality Standards Subcommittee. Evaluation and management of intracranial mass lesions in AIDS. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jan 1998;50(1):21-6. [Medline].

  2. Behbahani R, Moshfeghi M, Baxter JD. Therapeutic approaches for AIDS-related toxoplasmosis. Ann Pharmacother. Jul-Aug 1995;29(7-8):760-8. [Medline].

  3. Bertschy S, Opravil M, Cavassini M, et al. Discontinuation of maintenance therapy against toxoplasma encephalitis in AIDS patients with sustained response to anti-retroviral therapy. Clin Microbiol Infect. 2006;12(7):666-71. [Medline].

  4. Dedicoat M, Livesley N. Management of toxoplasmic encephalitis in HIV-infected adults (with an emphasis on resource-poor settings). Cochrane Database Syst Rev. 2006;3:CD005420. [Medline].

  5. Fung HB, Kirschenbaum HL. Treatment regimens for patients with toxoplasmic encephalitis. Clin Ther. Nov-Dec 1996;18(6):1037-56; discussion 1036. [Medline].

  6. Klepser ME, Klepser TB. Drug treatment of HIV-related opportunistic infections. Drugs. Jan 1997;53(1):40-73. [Medline].

  7. Marra MC. Infections of the central nervous sytem in patients infected with human immunodeficiency virus. Continuum. 2006;12:111-32.

  8. Offiah CE, Turnbull IW. The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clinical Radiology. 2006;61:393-401. [Medline].

  9. Verma A. Neurological manifestations of human immunodeficiency virus infection in adults. In: Neurology in Clinical Practice. Vol 2. 2004:1581-1601.

  10. Walker M, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts. Clin Infect Dis. Apr 1 2005;40(7):1005-15. [Medline].

  11. de Gans J, Portegies P. Neurological complications of infection with human immunodeficiency virus type 1. A review of literature and 241 cases. Clin Neurol Neurosurg. 1989;91(3):199-219. [Medline].

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Further Reading

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Keywords

acquired immunodeficiency syndrome, AIDS, intracellular parasite, Toxoplasma gondii, T gondii, CNS disease in AIDS, HIV infection, complication of HIV, complication of AIDS, advanced HIV infection

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Contributor Information and Disclosures

Author

Niranjan N Singh, MD, DNB, Assistant Professor of Neurology, University of Missouri Columbia
Niranjan N Singh, MD, DNB is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Coauthor(s)

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard J Caselli, MD, Professor, Department of Neurology, Mayo Medical School, Rochester, MN; Chair, Department of Neurology, Mayo Clinic of Scottsdale
Richard J Caselli, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, American Neurological Association, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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