Mattie Ryan, McCormick Zack, Huie Henry
Department of Physical Medicine & Rehabilitation, Stanford University, Stanford, CA(∗).
Feinberg School of Medicine, Northwestern University, Chicago, IL(†).
PM R. 2016 Jun;8(6):602-6. doi: 10.1016/j.pmrj.2016.01.006. Epub 2016 Jan 22.
Toxoplasma gondii is an opportunistic infection that often presents in the setting of acquired immunodeficiency syndrome. The infection can cause severe and potentially fatal encephalitis because of the reactivation of latent infections in the setting of immune suppression. Diagnosing toxoplasmosis encephalitis (TE) in immunocompromised patients often is difficult because the signs and symptoms can be nonspecific, but making a diagnosis of TE is even more challenging in a patient who is not known to have human immunodeficiency virus/acquired immunodeficiency syndrome and shows no other signs of being immunocompromised. Early diagnosis and treatment can result in rapid radiologic and clinical improvement; however, no studies exist that evaluate the utility of functional rehabilitation for patients diagnosed with TE. Although previous studies report a good prognosis for patients who receive antibiotic treatment, they do not discuss the extent to which functional abilities lost during the infection are returned after their treatment. We discuss a case of stroke-like presentation of cerebral TE in a patient whose human immunodeficiency virus status was previously unknown and report the functional improvements that were made during acute inpatient rehabilitation.
弓形虫是一种机会性感染,常在获得性免疫缺陷综合征的背景下出现。由于免疫抑制状态下潜伏感染的重新激活,该感染可导致严重且可能致命的脑炎。在免疫功能低下的患者中诊断弓形虫脑炎(TE)往往很困难,因为其体征和症状可能不具特异性,但对于未知感染人类免疫缺陷病毒/获得性免疫缺陷综合征且无其他免疫功能低下迹象的患者,诊断TE则更具挑战性。早期诊断和治疗可使影像学和临床症状迅速改善;然而,尚无研究评估功能康复对诊断为TE的患者的效用。尽管先前的研究报告接受抗生素治疗的患者预后良好,但并未讨论感染期间丧失的功能能力在治疗后恢复的程度。我们讨论了一例先前未知人类免疫缺陷病毒状态的患者出现类似中风表现的脑TE病例,并报告了急性住院康复期间取得的功能改善情况。