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[五例HIV阳性患者脑弓形虫病的多样临床谱:潘多拉魔盒里究竟藏着什么?]

[The colorful clinical spectrum of cerebral toxoplasmosis in five HIV positive cases: what comes out of Pandora's box?].

作者信息

Kurne Asli, Ozkaya Gülşen, Karlioğuz Kader, Shorbagi Ali, Ustaçelebi Semsettin, Karabudak Rana, Unal Serhat

机构信息

Hacettepe Universitesi Tip Fakültesi, Nöroloji Anabilim Dali, Ankara.

出版信息

Mikrobiyol Bul. 2006 Jan-Apr;40(1-2):85-92.

PMID:16775962
Abstract

In patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), the most common cause of focal intracranial lesion is Toxoplasma gondii infection. T. gondii encephalitis is an easily and effectively treatable disease, with promising outcomes. T. gondii has the potential to form a focal infection niche anywhere in the central nervous system, thus allowing for a colorful clinical picture. In this report, we attempted to present five HIV/AIDS cases with central nervous system toxoplasmosis demonstrating five different neurological presentations. The ages, gender and clinical findings of the patients who were admitted to our Infectious Diseases Clinics were as follows; 35 years old male patient with delirium, 49 years old male patient with focal dystony, 32 years old female patient with facial paralysis and monoparalysis, 53 years old male patient with Wernicke syndrome, 32 years old male patient with epilepsy. Cerebral toxoplasmosis were diagnosed by clinical findings and imaging techniques. The patients were treated with trimetoprim-sulfametoxazol (TMP-SMZ) and haloperidol, only TMP-SMZ, clindamycin and daraprim, TMP-SMZ and levotiracetam, TMP-SMZ and phenytoin, respectively, with recovery in neurological and radiological symptoms. In conclusion, until proven otherwise, HIV/AIDS patients presenting with focal neurological complaints should be accepted as having central nervous system toxoplasmosis.

摘要

在人类免疫缺陷病毒(HIV)感染和获得性免疫缺陷综合征(AIDS)患者中,颅内局灶性病变最常见的原因是弓形虫感染。弓形虫脑炎是一种易于有效治疗的疾病,预后良好。弓形虫有可能在中枢神经系统的任何部位形成局灶性感染灶,从而呈现出多样的临床表现。在本报告中,我们试图呈现5例患有中枢神经系统弓形虫病的HIV/AIDS病例,展示5种不同的神经学表现。入住我们传染病诊所的患者的年龄、性别和临床表现如下:一名35岁男性患者出现谵妄,一名49岁男性患者出现局灶性肌张力障碍,一名32岁女性患者出现面瘫和单瘫,一名53岁男性患者出现韦尼克综合征,一名32岁男性患者出现癫痫。通过临床表现和影像学技术诊断为脑弓形虫病。患者分别接受甲氧苄啶 - 磺胺甲恶唑(TMP - SMZ)和氟哌啶醇、仅TMP - SMZ、克林霉素和达拉匹林、TMP - SMZ和左乙拉西坦、TMP - SMZ和苯妥英治疗,神经和放射学症状均有改善。总之,在未得到其他证实之前,出现局灶性神经学症状的HIV/AIDS患者应被视为患有中枢神经系统弓形虫病。

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[The colorful clinical spectrum of cerebral toxoplasmosis in five HIV positive cases: what comes out of Pandora's box?].[五例HIV阳性患者脑弓形虫病的多样临床谱:潘多拉魔盒里究竟藏着什么?]
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Recurrent headache as the main symptom of acquired cerebral toxoplasmosis in nonhuman immunodeficiency virus-infected subjects with no lymphadenopathy: the parasite may be responsible for the neurogenic inflammation postulated as a cause of different types of headaches.在无淋巴结病的非人类免疫缺陷病毒感染受试者中,复发性头痛作为获得性脑弓形虫病的主要症状:寄生虫可能是假定为不同类型头痛病因的神经源性炎症的原因。
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