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Abstract
BackgroundIt is estimated that about a third of the world’s population is chronically infected with Toxoplasma gondii. Toxoplasma encephalitis (TE), which occurs as a reactivation of quiescent chronic infection, is one of the leading causes of central nervous system (CNS) infection in AIDS. Its diagnosis in most centres still remains difficult. We opted to describe the clinical and radiological features of TE as well as in-hospital outcome and its associated factors.MethodsWe carried out a cross sectional study on the clinical case notes of adult patients admitted and treated for TE at the Douala General Hospital, Cameroon between January 1st 2004 to December 31st 2009.ResultsOf 672 patients admitted during the study period, 14.4% (97/672) had TE. The mean age was 36.9 ± 14.1 years and the median CD4 cell count was 68/mm3 (IQR): 43 – 103). Headache and fever were the most common presenting symptoms in 92.8% (90/97) and 87.6% (85/97) of patients. Annular contrast enhanced lesions were the most common brain scan finding in 81.4% (79/97) of patients. In-hospital mortality was 29.9% (29/97). Altered sensorium, presence of focal signs, neck stiffness and low CD4 cell count were factors associated with mortality. Adjusting for low CD4 count, altered sensorium remained strongly associated with fatality, adjusted odd ratio (AOR) 3.5 (95% CI 1.2 – 10.5).ConclusionToxoplasma encephalitis is common among AIDS patients in Douala. Its high case fatality warrants adequate and compliant prophylactic therapy in severely immune depressed patients as well as early initiation of antiretroviral therapy in HIV-infected patients.
Highlights
It is estimated that about a third of the world’s population is chronically infected with Toxoplasma gondii
When a patient presents with clinical signs and/or symptoms relevant to central nervous system (CNS) disease, firstly a computerised tomographic (CT) brain scan is done in search of space occupying lesions and/or signs of raised intracranial pressure (IP)
Characteristics of study population During the study period, 672 HIV infected patients were admitted to the Internal Medicine unit of who 97 fulfilled eligibility for the study, giving a prevalence of toxoplasma encephalitis of 14.4% (97/672)
Summary
It is estimated that about a third of the world’s population is chronically infected with Toxoplasma gondii. Toxoplasma encephalitis (TE), which occurs as a reactivation of quiescent chronic infection, is one of the leading causes of central nervous system (CNS) infection in AIDS. Toxoplasma encephalitis (TE) is the most frequent cause of focal central nervous system (CNS) infection complicating Acquired Immune Deficiency Syndrome (AIDS) [2]. Access to health care is limited, a situation which might underestimate the burden of TE in AIDS. This was the impetus behind this hospital based study whose aim was to define the clinical and radiological features of patients with TE, determine in-hospital outcome and its associated factors
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