Jpn. J. Infect. Dis., 57, 160-165, 2004
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Original Article
Toxoplasmosis in HIV/AIDS Patients: A Current Situation
Veeranoot Nissapatorn*, Christopher Lee1, Kia Fatt Quek‚Q, Chee Loon Leong1, Rohela Mahmud and Khairul Anuar Abdullah
Department of Parasitology and 2Department of Social and Preventive Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur and 1Department of Medicine, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
(Received January 7, 2004. Accepted April 19, 2004)
*Corresponding author: Mailing address: Department of Parasitology University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia. Tel: +603-79676618, Fax: +603-79674754, E-mail: nissapat@hotmail.com
SUMMARY: The seroprevalence of toxoplasmosis among 505
of human immunodeficiency virus (HIV)/AIDS patients was 226 (44.8%;
95% CI 42.64 -51.76): 27 (47.4%) and 199 (44.4%) showed Toxoplasma
seropositivity with and without toxoplasmic encephalitis (TE),
respectively (P < 0.05). The majority of these patients
were in the 25-34 age group (44 versus 39%), male (86 versus 76%),
and Chinese (49 versus 53%), though no statistical significance
was found between the two. Significant differences between these
two groups were noted, however, in terms of marital status, occupation,
and present address. The heterosexual exhibited the most frequent
behavior at risk for HIV infection, and accounted for 51 and 59%
of patients with and without TE, respectively. Only 17/260 (6.5%)
and 1/137 (0.7%) of them later acquired TE after receiving primary
chemoprophylaxis (cotrimoxazole) and antiretroviral therapy including
HAART (P < 0.05). Fifty-seven (11.3%) out of those 505
patients were diagnosed with AIDS-related TE. The most common
clinical manifestation was headache (56%). The computed tomography
scan findings showed most lesions to be multiple (96.4%), hypodense
(66.7%), and in the parietal region (39.3%). Twenty-seven (47.4%)
patients had chronic (latent) Toxoplasma infection as evidenced
by seropositivity for anti-Toxoplasma (IgG) antibody. At
the time of diagnosis, the range of CD4 cell count was from 0-239
with a median of 25 cells/cumm. We also found that a CD4 count
of less than 100 cells/cumm was significantly associated with
development of TE (P < 0.05). Clinical outcomes showed
that among those who survived, 21 (36.8%), 16 (28.1%), and 2 (3.5%)
of patients had completed treatment, transferred out, and were
lost to follow up, respectively. Unfortunately, 18 (31.6%) of
the cases were officially pronounced dead. Overall, 7 patients
(12.3%) were detected as recurrent TE in this study.