Contini C
Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, Italy.
Parassitologia. 2008 Jun;50(1-2):45-50.
With the advent of the highly active antiretroviral therapy (HAART), the natural course of HIV infection has markedly changed and opportunistic infections including toxoplasmosis have declined and modified in presentation, outcome and incidence. However, TE is a major cause of morbidity and mortality especially in resource-poor settings but also a common neurological complication in some countries despite the availability of HAART and effective prophylaxis. In most cases toxoplasmosis occurs in brain and toxoplasmic encephalitis (TE) is the most common presentation of toxoplasmosis in immunocompromised patients with or without AIDS. The need of a definitive diagnosis is substantial because other brain diseases could share similar findings. Rapid and specific diagnosis is thus crucial as early treatment may improve the clinical outcome. Classical serological diagnosis is often inconclusive as immunodeficient individuals fail to produce significant titres of specific antibodies. Polymerase chain reaction (PCR) has a high diagnostic value in the acute disease, but like many 'in-house' PCR assays, suffers from lack of standardization and variable performance according to the laboratory. Molecular diagnosis of toxoplasmosis can be improved by performing real-time PCR protocols. This article summarises the clinical manifestations, diagnostic procedures and management strategies for this condition.
随着高效抗逆转录病毒疗法（HAART）的出现，HIV感染的自然病程发生了显著变化，包括弓形虫病在内的机会性感染在表现、结局和发病率方面均有所下降和改变。然而，弓形虫脑病（TE）仍然是发病和死亡的主要原因，尤其是在资源匮乏地区，而且在一些国家，尽管有HAART和有效的预防措施，它仍是一种常见的神经并发症。在大多数情况下，弓形虫病发生在脑部，弓形虫性脑炎（TE）是免疫功能低下患者（无论是否患有艾滋病）中弓形虫病最常见的表现形式。由于其他脑部疾病可能有相似的表现，因此明确诊断非常必要。快速且特异性的诊断至关重要，因为早期治疗可能改善临床结局。经典的血清学诊断往往无法得出明确结论，因为免疫缺陷个体无法产生显著滴度的特异性抗体。聚合酶链反应（PCR）在急性疾病中具有较高的诊断价值，但与许多“内部”PCR检测方法一样，缺乏标准化，且不同实验室的检测结果存在差异。通过实施实时PCR方案可以改善弓形虫病的分子诊断。本文总结了这种疾病的临床表现、诊断方法和管理策略。
