Cimino C, Lipton R B, Williams A, Feraru E, Harris C, Hirschfeld A
Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
Arch Intern Med. 1991 Jul;151(7):1381-4.
In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.
在患有获得性免疫缺陷综合征且出现占位性病变的患者中，对于是经验性治疗弓形虫病还是进行脑活检存在两难选择。我们提供的数据进一步明确了进行脑活检与经验性治疗的指征。我们回顾了59例患有获得性免疫缺陷综合征相关疾病和脑占位性病变患者的病历。32例患者符合弓形虫病的诊断标准。贝叶斯分析表明，计算机断层扫描出现强化（概率为0.68）以及弓形虫抗体滴度大于1:64（概率为0.81）会增加弓形虫病的先验概率。与弓形虫病概率降低相关的特征包括计算机断层扫描未出现强化（概率为0.29）以及弓形虫抗体滴度小于或等于1:64（概率为0.14）。10%的患者出现了脑活检并发症。接受乙胺嘧啶和磺胺嘧啶治疗的患者中，29%出现并发症，8%出现严重并发症。这些数据表明，对于具有典型弓形虫病特征的患者，倾向于经验性治疗；对于具有非典型特征的特定患者亚组，则倾向于进行脑活检。
