Struillou L, Raffi F
Service de médecine interne, CHU Nantes, Hôtel-Dieu.
Rev Prat. 1994 Oct 15;44(16):2187-94.
Opportunistic infections of the central nervous system, frequent in AIDS, present essentially in 4 clinical pictures: brain mass lesion(s), meningitis, diffuse encephalitis or prolonged fever. Toxoplasmosis is by far the most frequent cause of brain mass lesion. Therefore, for patients presenting with a brain mass lesion it is recommended to start presumptive antitoxoplasmic therapy with the combination of pyrimethamine and sulfadiazine. Other etiologies (lymphoma and progressive multifocal leukoencephalopathy) should be considered only after failure of this treatment. The other infectious processes are much more uncommon (cryptococcoma, tuberculoma, Candida, Nocardia abscesses). In case of meningitis, cryptococcosis must be searched for, in addition to classic causes of meningitis. Diffuse febrile encephalitis should lead to consider presumptive antitoxoplasmic therapy. Finally, prolonged fever can be the only expression of cerebral toxoplasmosis or cryptococcal meningitis.
中枢神经系统的机会性感染在艾滋病患者中很常见，主要表现为4种临床症状：脑肿块病变、脑膜炎、弥漫性脑炎或长期发热。弓形虫病是脑肿块病变最常见的病因。因此，对于出现脑肿块病变的患者，建议开始使用乙胺嘧啶和磺胺嘧啶联合进行抗弓形虫病的经验性治疗。只有在这种治疗失败后才应考虑其他病因（淋巴瘤和进行性多灶性白质脑病）。其他感染过程则更为罕见（隐球菌瘤、结核瘤、念珠菌、诺卡菌脓肿）。对于脑膜炎患者，除了经典的脑膜炎病因外，还必须排查隐球菌病。弥漫性发热性脑炎应考虑进行抗弓形虫病的经验性治疗。最后，长期发热可能是脑弓形虫病或隐球菌性脑膜炎的唯一表现。
