Clinical presentation and diagnosis of toxoplasmic encephalitis in Japan |
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| Affiliation: | 1. Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan;2. Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan;3. Division of Preparedness and Emerging Infections, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan;4. Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;5. Department of Global Infectious Diseases and Tropical Medicine, National Defense Medical College, Saitama, Japan;1. Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada;2. Duke Clinical Research Institute, Durham, NC, USA;3. Saint Louis University Health Sciences Center, St. Louis, MO, USA;1. Laboratório de Biologia Celular e Tecidual, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense, 28013-602 Campos dos Goytacazes, RJ, Brazil;2. Laboratório de Tecnologia em Bioquímica e Microscopia, Setor Laboratorial, Centro Universitário Estadual da Zona Oeste, Avenida Manuel Caldeira de Alvarenga, 1203, Campo Grande, Rio de Janeiro, 21070-200 RJ, Brazil;1. Parasitology Laboratory, Department of Zoology, Centre for Advanced Studies, Visva-Bharati University, Santiniketan 731235, West Bengal, India;2. National Institute of Pharmaceutical Education and Research (NIPER), 4, Raja S.C. Mullick Road, Jadavpur, Kolkata 700032, West Bengal, India;1. Microbiology National Center, Instituto de Salud Carlos III, Cra. Majadahonda-Pozuelo Km. 2, Majadahonda, 28220 Madrid, Spain;2. Faculty of Medicine, Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt |
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| Abstract: | Distinguishing life-threatening toxoplasmic encephalitis (TE) from brain lymphoma in patients with acquired immunodeficiency syndrome (AIDS) may be difficult. Empiric anti-toxoplasmosis treatment is often initiated because of the reluctance in performing brain biopsies, which may delay the diagnosis and treatment of brain lymphoma in Japan. In this study, we retrospectively examined the clinical characteristics of 13 AIDS patients with TE in Japan, including magnetic resonance imaging and thallium 201 (201TI) single photon emission computed tomography (SPECT) findings, cerebral spinal fluid analysis, serology, and polymerase chain reaction (PCR) results. All patients improved on anti-toxoplasmosis treatment. Of the 11 patients who underwent serological testing, 6 (55%) had a positive serological result. Of the 7 patients who underwent PCR testing, 3 (42.9%) had a positive PCR result. Nine of 11 patients with TE (81.8%) had multiple lesions. Analysis of the sites of TE lesions did not reveal a difference in site predilection between TE and brain lymphoma. Uptake was negative in all 9 patients who underwent 201Tl SPECT. The study findings suggest that toxoplasma serostatus and PCR may be used to discriminate TE from brain lymphoma. No focal accumulation of 201TI is strongly suggestive of TE in patients with AIDS in Japan. |
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