Amogne Wondwossen, Teshager Getnet, Zenebe Guta
Addis Ababa University, Medical Facility, Department of Internal Medicine.
Ethiop Med J. 2006 Apr;44(2):113-20.
Toxoplasmosis is identified as one of the major central nervous system (CNS) opportunistic infections in AIDS patients. Sero-epidemiological surveys done among Ethiopian patients indicated a very high prevalence rate. This study was conducted to describe the clinical course of the disease in Ethiopians with AIDS.
Three hundred and twenty three patients with AIDS and CNS Toxoplasmosis that were consecutively admitted and treated with Sulfadoxine Pyrimethamine (SP) at the Tikur Anbessa Specialized Referral Hospital were reviewed. The diagnosis CNS Toxoplasmosis was made based on clinical features or neuroradiologic findings and response to treatment. In over 80% of the cases the dose of Pyrimethamine used was 100 mgs for two days and then 25 mgs daily PO.
The male to female ratio was one to one. The median age was 34 years (range 18 - 75). The most common presenting symptoms were headache 293 (91%), fever 269 (83%), and abnormal level of consciousness in 201 (62%) of the cases. Focal neuralgic deficits were seen in 203 (63%) of the cases. The diagnosis of CNS toxoplasmosis was based on clinical features and response to treatment in 186 (58%) of the cases and on CT scan findings and clinical response in 54 (17%) of the cases. Among the 248 (78%) of the cases that had responded favorably to SP, 53% had improvement on the 7th day, while the rest had improvement on the 14th day of treatment. Major treatment related adverse reactions, which required changing treatment, were seen in 68 (20%) of the cases. Among patients who survived the first episode of toxoplasmosis, the median follow up was for 29 days (range 15-1800).
Toxoplasmosis had been the most AIDS defining event in the study group and clinical response to empiric treatment was essentially diagnostic. In our study group the outcome seen with SP as compared to the standard recommended treatment yielded comparable results. Tolerance to treatment was better and the adverse effects warranting change in treatment were fewer despite that only few patients received folinic acid supplements. We recommend a well-designed prospective study to establish the efficacy and optimal dose of SP in the treatment of CNS toxoplasmosis.
弓形虫病被认为是艾滋病患者主要的中枢神经系统（CNS）机会性感染之一。在埃塞俄比亚患者中进行的血清流行病学调查显示患病率极高。本研究旨在描述埃塞俄比亚艾滋病患者中该病的临床病程。
回顾了在提库尔·安贝萨专科医院连续收治并接受磺胺多辛 - 乙胺嘧啶（SP）治疗的323例艾滋病合并中枢神经系统弓形虫病患者。中枢神经系统弓形虫病的诊断基于临床特征、神经放射学检查结果及对治疗的反应。超过80%的病例中，乙胺嘧啶的剂量为100毫克，连用两天，然后每日口服25毫克。
男女比例为1:1。中位年龄为34岁（范围18 - 75岁）。最常见的症状为头痛293例（91%）、发热269例（83%），201例（62%）有意识水平异常。203例（63%）有局灶性神经功能缺损。186例（58%）中枢神经系统弓形虫病的诊断基于临床特征及对治疗的反应，54例（17%）基于CT扫描结果及临床反应。在对SP治疗反应良好的248例（78%）病例中，53%在第7天病情改善，其余在治疗第14天改善。68例（20%）出现需要更改治疗方案的主要治疗相关不良反应。在弓形虫病首次发作存活的患者中，中位随访时间为29天（范围15 - 1800天）。
在研究组中，弓形虫病是最具艾滋病特征的事件，对经验性治疗的临床反应基本具有诊断意义。在我们的研究组中，与标准推荐治疗相比，SP的治疗效果相当。尽管只有少数患者接受了亚叶酸补充剂，但对治疗的耐受性更好，需要更改治疗方案的不良反应更少。我们建议进行一项设计良好的前瞻性研究，以确定SP治疗中枢神经系统弓形虫病的疗效和最佳剂量。
