Albrecht H, Skörde J, Arasteh K, Heise W, Stellbrink H J, Grosse G, L'Age M
Department of Internal Medicine, University Clinic Eppendorf, Hamburg, Germany.
Scand J Infect Dis. 1995;27(1):71-4. doi: 10.3109/00365549509018976.
Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.
1986年6月至1992年10月期间，16例艾滋病患者被诊断为播散性弓形虫病。13例在尸检时确诊，所有13例均有多个器官受累。3例为生前诊断。所有3例经适当治疗后存活。提示播散性弓形虫病的临床特征为：16例不明原因发热，体温在39摄氏度至40摄氏度之间；15例有败血症或感染性休克的临床体征，其中10例进展为多器官功能衰竭，6例有弥散性血管内凝血，13例有精神错乱、定向障碍或淡漠，所有16例均未进行系统性卡氏肺孢子虫预防。典型的实验室指标为：16例CD4细胞计数低于100×10⁶/L，16例血清乳酸脱氢酶升高，4/6例肌酸磷酸激酶升高，9/11例C反应蛋白正常或仅轻度升高，15/16例弓形虫IgG抗体阳性，所有16例IgM抗体阴性。仅3/10例接受评估的患者头颅计算机断层扫描显示有提示脑弓形虫病的病变。对于晚期HIV感染且患有全身性疾病的患者，包括上述临床和实验室特征，在鉴别诊断中必须考虑系统性弓形虫感染。对于这些患者，应考虑进行特异性且必要时进行侵入性诊断程序，随后尽早进行积极的治疗干预。
