Nissapatorn Veeranoot, Lee Christopher, Quek Kia Fatt, Leong Chee Loon, Mahmud Rohela, Abdullah Khairul Anuar
Department of Parasitology, University of Malaya Medical Centre, 50603 Kauala Lumpur, Malaysia.
Jpn J Infect Dis. 2004 Aug;57(4):160-5.
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 (12.3%) patients were detected as recurrent TE in this study.
在505例人类免疫缺陷病毒（HIV）/艾滋病患者中，弓形虫病的血清阳性率为226例（44.8%；95%可信区间42.64 - 51.76）：分别有27例（47.4%）和199例（44.4%）在有和无弓形虫性脑炎（TE）的情况下弓形虫血清呈阳性（P<0.05）。这些患者大多数在25 - 34岁年龄组（分别为44%和39%），男性（分别为86%和76%），以及中国人（分别为49%和53%），不过两组之间未发现统计学差异。然而，在婚姻状况、职业和现住址方面，这两组之间存在显著差异。异性性行为是最常见的HIV感染风险行为，分别占患有和未患有TE患者的51%和59%。在接受初级化学预防（复方新诺明）和包括高效抗逆转录病毒治疗（HAART）在内的抗逆转录病毒治疗后，他们中分别仅有17/260（6.5%）和1/137（0.7%）后来患上了TE（P<0.05）。在这505例患者中，有57例（11.3%）被诊断为艾滋病相关的TE。最常见的临床表现是头痛（56%）。计算机断层扫描结果显示，大多数病变为多发性（96.4%）、低密度（66.7%），且位于顶叶区域（39.3%）。27例（47.4%）患者有慢性（潜伏性）弓形虫感染，抗弓形虫（IgG）抗体血清阳性可证明。在诊断时，CD4细胞计数范围为0 - 239，中位数为25个细胞/立方毫米。我们还发现，CD4计数低于100个细胞/立方毫米与TE的发生显著相关（P<0.05）。临床结果显示，在存活的患者中，分别有21例（36.8%）、16例（28.1%）和2例（3.5%）完成了治疗、转出并失访。不幸的是，有18例（31.6%）病例被正式宣告死亡。总体而言，在本研究中检测到7例（12.3%）患者为复发性TE。
