Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey

Medicine (Baltimore). 1994 Nov;73(6):306-14. doi: 10.1097/00005792-199411000-00004.

Abstract

A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcome. During the 33-month survey, 199 cases were collected. The prevalence of ECT in patients with AIDS can be estimated at 1.5%-2%. Age, sex, and HIV risk factors were similar to those of the general AIDS population in France. Extracerebral toxoplasmosis appeared mainly in HIV-infected patients with advanced immunosuppression: the mean CD4+ lymphocyte count was 57/mm3(+/- 99). The localizations observed were: eyes (50% of patients); lung (26%); disseminated (at least 2 extracerebral visceral localizations) (11.5%); peripheral blood (acute febrile syndrome with isolated positive parasitemia) (3%); heart (3%); bone marrow (3%); bladder (1%); and isolated cases of rhinopharynx, skin, liver, lymph nodes, conus medullaris, and pericardium. In this survey, muscular and pancreatic localizations were always associated with other extracerebral localizations. A cerebral localization was diagnosed in 41% of cases. Serologic data provided little information. Ocular fundus examination, bronchoalveolar lavage, tissue biopsy, and search for parasitemia were the main diagnostic procedures. Treatment was the same as for cerebral toxoplasmosis. A clinical response was observed in 64% of cases; 19% relapsed. Death occurred in 106 (53%) cases and was related to ECT in 34% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / epidemiology*
  • AIDS-Related Opportunistic Infections / microbiology
  • Adult
  • Aged
  • Animals
  • Clindamycin / administration & dosage
  • Clindamycin / therapeutic use
  • Drug Therapy, Combination
  • Female
  • France / epidemiology
  • HIV Seropositivity / epidemiology
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Pyrimethamine / administration & dosage
  • Pyrimethamine / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Sulfadiazine / administration & dosage
  • Sulfadiazine / therapeutic use
  • Survival Rate
  • Toxoplasma / isolation & purification
  • Toxoplasmosis / drug therapy
  • Toxoplasmosis / epidemiology*
  • Toxoplasmosis / parasitology

Substances

  • Sulfadiazine
  • Clindamycin
  • Pyrimethamine