Abstract
BackgroundHIV-associated subacute meningitis is mostly caused by tuberculosis or cryptococcosis, but often no etiology can be established. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the differential diagnosis.Methodology/Principal FindingsWe performed cerebrospinal fluid real time PCR and serological testing for Toxoplasma gondii in archived samples from a well-characterized cohort of 64 HIV-infected patients presenting with subacute meningitis in a referral hospital in Indonesia. Neuroradiology was only available for 6 patients.At time of presentation, patients mostly had newly diagnosed and advanced HIV infection (median CD4 count 22 cells/mL), with only 17.2% taking ART, and 9.4% PJP-prophylaxis. CSF PCR for T. Gondii was positive in 21 patients (32.8%). Circulating toxoplasma IgG was present in 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 abnormalities were less pronounced. Mortality among patients with a positive CSF T. Gondii PCR was 81%, 2.16-fold higher (95% CI 1.04–4.47) compared to those with a negative PCR.Conclusions/SignificanceToxoplasmosis should be considered in HIV-infected patients with clinically suspected subacute meningitis in settings where neuroradiology is not available.
Highlights
In settings of Africa and Asia, the most common cause of subacute meningitis in patients with advanced HIV infection is either tuberculous or cryptococcal infection [1,2]
Some of the symptoms of cerebral toxoplasmosis may mimic those of subacute meningitis
We retrospectively looked for toxoplasmosis in a cohort of HIV-infected patients presenting with subacute meningitis in an Indonesian hospital, where neuroradiology was not available for most patients
Summary
In settings of Africa and Asia, the most common cause of subacute meningitis in patients with advanced HIV infection is either tuberculous or cryptococcal infection [1,2]. Cerebral toxoplasmosis mostly presents as cerebral mass lesions with headache, confusion, fever, lethargy, seizures, cranial nerve palsies, psychomotor changes, hemiparesis and/or ataxia [10] Some of these symptoms may mimic meningitis, but cerebral toxoplasmosis is generally not considered as a differential diagnosis of subacute meningitis in HIV-infected patients. This is especially the case in low-resource settings where no CT or MRI can be performed. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the differential diagnosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
