Diagnostic value of real-time PCR of brain mass lesion in HIV-associated toxoplasmic encephalitis: a case series

Bo Liang,Xing-Huan Ding,Hong-Xin Zhao,Ting-Yu Liang,Fang Wang,Jia-Min Chen,Si-Yuan Yang,En-Shan Feng

doi:10.1186/s13071-020-04443-1

Bo Liang, Xing-Huan Ding + Show 6 more

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https://doi.org/10.1186/s13071-020-04443-1

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Abstract

BackgroundToxoplasmic encephalitis (TE) is a leading cause of brain mass lesions (BML) in human immunodeficiency viruses (HIV)-infected patients. Yet, so far, no accurate diagnostic approach for TE has been developed. Herein, we presented a case series (9 HIV-infected patients with TG confirmed by RT-PCR of BML) to assess the diagnostic value of reverse transcription-polymerase chain reaction (RT-PCR) on TE.MethodsA total of 9 HIV-infected patients with TE confirmed by RT-PCR of BML were included in this study. Clinical data, including clinical symptoms, blood and CSF analysis, neuroimaging features, histopathological characteristics, treatment, and prognosis, were assessed in all patients. According to the results of RT-PCR of BML, all the patients received oral administration of trimethoprim-sulfamethoxazole combined with antiretroviral therapy (ART). Patients were followed up by telephone or outpatient service.ResultsThere were 8 male and 1 female patients; their age ranged from 26 to 56 years-old. The main symptom was intracranial hypertension (6/9). Six patients presented multiple brain lesions, which were mainly located in the supratentorial area (7/9). CD4+ count ranged from 11 to 159 cells/μl (median 92 cells/μl), and serological HIV viral load 0–989190 copies/ml (median 192836 copies/ml). IgG and IgM against serum TG were positive in 7 and 1 patients, respectively. Moreover, regarding CSF, IgG against TG was positive in 3 patients, while all patients were negative for IgM. The neuroimaging features on MRI showed no specificity. Four patients were diagnosed with TE by histopathological findings. After receiving anti-Toxoplasma therapy, 8 (8/9) patients improved clinically to a considerable extent.ConclusionsThe application of RT-PCR of BML, together with conventional methods, may significantly improve the diagnostic efficiency of TE.Graphical

Highlights

Toxoplasmic encephalitis (TE) is a leading cause of brain mass lesions (BML) in human immunodefi‐ ciency viruses (HIV)-infected patients
Laboratory examination CD4+ count ranged from 11 to 159 cells/μl; HIV viral load in serum ranged between 0–989,190 copies/ml and 20–181,805 copies/ml in the cerebrospinal fluid (CSF), with 5 patients available
The white blood cell (WBC) counts ranged between 2.64 × 109–11.37 × 109/l in blood and 5 × 106–48 × 106/l in the CSF

Summary

Introduction

Toxoplasmic encephalitis (TE) is a leading cause of brain mass lesions (BML) in human immunodefi‐ ciency viruses (HIV)-infected patients. No accurate diagnostic approach for TE has been developed. We presented a case series (9 HIV-infected patients with TG confirmed by RT-PCR of BML) to assess the diagnostic value of reverse transcription-polymerase chain reaction (RT-PCR) on TE. Toxoplasmic encephalitis (TE) is an opportunistic infection caused by the obligate intracellular protozoan Toxoplasma gondii (TG). It usually affects the central nervous system of immunocompromised patients or organ transplant recipients and is a leading cause of brain mass lesions (BML) in HIV-infected patients [1]. Patients with TE usually have no obvious clinical manifestation, Liang et al Parasites Vectors (2020) 13:564.

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