Toxoplasma Encephalitis in Patients with Acquired Immune Deficiency Syndrome: Diagnosis and Response to Therapy

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  • * George Washington University Medical Center and Washington Hospital Center, Washington, DC
  • | ** University of Southern California Medical Center, Los Angeles, California
  • | Stanford University, Stanford, California
  • | Clinical Center, National Institute of Allergy and Infectious Diseases
  • | § National Cancer Institute, National Institutes of Neurology, Communicative Diseases, and Stroke, National Institutes of Health, Bethesda, Maryland

Although Toxoplasma gondii is the most commonly recognized cause of central nervous system mass lesions in patients with acquired immune deficiency syndrome, published investigations have provided little information about criteria for diagnosis of toxoplasmosis or the response to therapy. In this series the method of diagnosis and response to therapy were assessed in 14 patients who had evidence for toxoplasmosis based on routine histopathology, immunoperoxidase staining, or mouse inoculation. These patients presented with clinical and radiologic findings that did not clearly distinguish them from patients with other infectious or neoplastic processes. Excisional biopsies usually showed tachyzoites on routine histology, but needle biopsies were usually negative unless mouse inoculation or immunoperoxidase staining was employed. Response to pyrimethamine and sulfadiazine therapy was often prompt, but therapy had to be continued for long periods of time to maintain a clinical response, and no alternative regimen of one or more drugs appeared to be effective in patients unable to tolerate both pyrimethamine and sulfadiazine.