Sakamoto Naoya, Maeda Takuya, Mikita Kei, Kato Yasuyuki, Yanagisawa Naoki, Suganuma Akihiko, Imamura Akifumi, Nakamura-Uchiyama Fukumi, Miyahira Yasushi, Kawana Akihiko, Ohnishi Kenji, Ajisawa Atsushi
Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Parasitol Int. 2014 Oct;63(5):701-4. doi: 10.1016/j.parint.2014.05.007. Epub 2014 Jun 11.
Distinguishing life-threatening toxoplasmic encephalitis (TE) from brain lymphoma in patients with acquired immunodeficiency syndrome (AIDS) may be difficult. Empiric anti-toxoplasmosis treatment is often initiated because of the reluctance in performing brain biopsies, which may delay the diagnosis and treatment of brain lymphoma in Japan. In this study, we retrospectively examined the clinical characteristics of 13 AIDS patients with TE in Japan, including magnetic resonance imaging and thallium 201 (201TI) single photon emission computed tomography (SPECT) findings, cerebral spinal fluid analysis, serology, and polymerase chain reaction (PCR) results. All patients improved on anti-toxoplasmosis treatment. Of the 11 patients who underwent serological testing, 6 (55%) had a positive serological result. Of the 7 patients who underwent PCR testing, 3 (42.9%) had a positive PCR result. Nine of 11 patients with TE (81.8%) had multiple lesions. Analysis of the sites of TE lesions did not reveal a difference in site predilection between TE and brain lymphoma. Uptake was negative in all 9 patients who underwent 201Tl SPECT. The study findings suggest that toxoplasma serostatus and PCR may be used to discriminate TE from brain lymphoma. No focal accumulation of 201TI is strongly suggestive of TE in patients with AIDS in Japan.
在获得性免疫缺陷综合征（AIDS）患者中，区分危及生命的弓形虫性脑炎（TE）和脑淋巴瘤可能很困难。由于不愿进行脑活检，经验性抗弓形虫病治疗常常被启动，这可能会延误日本脑淋巴瘤的诊断和治疗。在本研究中，我们回顾性研究了日本13例患有TE的AIDS患者的临床特征，包括磁共振成像和铊201（201TI）单光子发射计算机断层扫描（SPECT）结果、脑脊液分析、血清学以及聚合酶链反应（PCR）结果。所有患者经抗弓形虫病治疗后病情均有改善。在接受血清学检测的11例患者中，6例（55%）血清学结果呈阳性。在接受PCR检测的7例患者中，3例（42.9%）PCR结果呈阳性。11例患有TE的患者中有9例（81.8%）有多处病灶。对TE病灶部位的分析未显示出TE和脑淋巴瘤在部位偏好上的差异。在接受201Tl SPECT检查的所有9例患者中摄取均为阴性。研究结果表明，弓形虫血清状态和PCR可用于区分TE和脑淋巴瘤。在日本，201TI无局灶性聚集强烈提示AIDS患者患有TE。
