Joundishapour Infectious and Tropical Diseases Research Center, Infectious Disease Ward, Razi Hospital, Joundishapour University of Medical Sciences, No. 52 West 11 Avenue, Kianabad, Ahvaz, Iran.
Int J Infect Dis. 2010 Sep;14 Suppl 3:e67-9. doi: 10.1016/j.ijid.2009.11.015. Epub 2010 Mar 2.
Lymphadenitis is one of the presenting signs of toxoplasmosis. Co-trimoxazole (CTM) has a good therapeutic effect on ocular and cerebral infections caused by Toxoplasma gondii. Since this infection is endemic in Ahvaz and because of the lack of investigations into the therapeutic effects of CTM in toxoplasmic lymphadenitis (TL), this study was performed from 2005 to 2007 to determine the therapeutic effects of CTM on TL in Ahvaz.
Forty-six patients with TL were enrolled in this randomized, double-blind, placebo-controlled trial study. Diagnosis was based on clinical examination, serological tests (chemiluminescent), and histopathological examinations. Palpable lymph nodes, IgM >8IU, and follicular hyperplasia were defined as positive findings. Patients were randomly assigned to the comparison groups (23 patients in each group). The CTM patients were treated with 48 mg/kg/day CTM divided into two doses, for 1 month. The placebo patients were treated with placebo for 1 month. The primary endpoint for treatment response was 1 month. Follow-up with physical and serological examinations occurred at 6 months. The secondary endpoint was at 6 months. Clinical response was defined as no palpable lymph nodes and serological response as IgM <6IU; a patient was cured if the lymph nodes were no longer palpable and IgM was <6IU. Results were analyzed using SPSS software and the Chi-square test.
At the end of treatment, a clinical response was observed in 15 (65.2%) in the CTM group and five (21.7%) in the placebo group. A serological response was seen in 65.2% of the CTM group and 13.0% of the placebo group. The cure rate was 65.2% in the CTM group and 13.1% in the placebo group. There was a significant difference in therapeutic effect between the two groups (52.2%, 95% confidence interval 32.1-72%, p<0.001). There was no difference in the site of infection between the two groups (p>0.05).
CTM has a good therapeutic effect in TL and may be used in selected patients for whom treatment is required.
淋巴结炎是弓形虫病的表现之一。复方磺胺甲噁唑（CTM）对弓形虫引起的眼脑感染具有良好的治疗作用。由于这种感染在阿瓦士流行，并且由于缺乏对 CTM 治疗弓形虫淋巴结炎（TL）的疗效的调查，因此，本研究于 2005 年至 2007 年进行，以确定 CTM 在阿瓦士 TL 中的治疗效果。
本随机、双盲、安慰剂对照试验纳入了 46 例 TL 患者。诊断基于临床检查、血清学检测（化学发光）和组织病理学检查。可触及的淋巴结、IgM>8IU 和滤泡增生定义为阳性发现。患者被随机分配到对照组（每组 23 例）。CTM 患者接受 48mg/kg/天 CTM 治疗，分为两次剂量，持续 1 个月。安慰剂患者接受安慰剂治疗 1 个月。治疗反应的主要终点为 1 个月。6 个月时进行体格检查和血清学检查。次要终点为 6 个月。临床反应定义为无可触及的淋巴结，血清学反应为 IgM<6IU；如果淋巴结不再触诊且 IgM<6IU，则患者被治愈。结果采用 SPSS 软件和卡方检验进行分析。
治疗结束时，CTM 组 15 例（65.2%）患者出现临床反应，安慰剂组 5 例（21.7%）患者出现临床反应。CTM 组 65.2%的患者和安慰剂组 13.0%的患者出现血清学反应。CTM 组的治愈率为 65.2%，安慰剂组为 13.1%。两组治疗效果差异有统计学意义（52.2%，95%置信区间 32.1-72%，p<0.001）。两组感染部位无差异（p>0.05）。
CTM 在 TL 中有良好的治疗效果，可用于需要治疗的选择患者。
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