[1983年至1994年间随访的399例HIV感染患者脑弓形虫病的流行病学特征]

[Epidemiologic characteristics of cerebral toxoplasmosis in 399 HIV-infected patients followed between 1983 and 1994].

作者信息

Bossi P, Caumes E, Astagneau P, Li T S, Paris L, Mengual X, Katlama C, Bricaire F

机构信息

Service de maladies infectieuses et tropicales, Hôpital de la Pitié-Salpêtrière, Paris, France.

出版信息

Rev Med Interne. 1998 May;19(5):313-7. doi: 10.1016/s0248-8663(98)80100-8.

DOI:10.1016/s0248-8663(98)80100-8

PMID:9775164

Abstract

OBJECTIVE

To describe the epidemiological characteristics of toxoplasmic encephalitis in HIV-infected patients with a more than 12-year follow-up.

METHODS

From a data base of 1,628 AIDS subjects hospitalized from 1983 to 1994, we studied the epidemiological characteristics of 399 patients with toxoplasmic encephalitis. Diagnosis of toxoplasmic encephalitis was based on the association of central neurological disorders, typical lesions on CT scan or MRI, and favorable outcome under appropriate toxoplasmosis therapy.

RESULTS

Four hundred sixty-four cases of toxoplasmic encephalitis were reported in 399 patients (24.5% of the patients with AIDS). The overall incidence was 20.5 per 100 patients-year. Toxoplasmic encephalitis was the first AIDS defining event in 51% of the cases and revealed HIV infection in 13% of the cases. In the remaining 49%, the mean delay from AIDS diagnosis to toxoplasmic encephalitis was 13 months (range: 1-71 months). At the time of diagnosis, mean CD4 count was 44/mm3 (range: 0-408/mm3). Antibodies to Toxoplasma gondii were found in 97% of the cases. Before the first episode of toxoplasmic encephalitis, 58% of the patients were given antiretroviral therapy (mean: 17.8 months; range: 1-64 months). Of the 399 patients with toxoplasmic encephalitis, 366 (92%) did not receive any primary toxoplasmosis prophylaxis. Among them, 205 (56%) did not receive any drug prophylaxis, and 161 (44%) had Pneumocystis carinii pneumonia prophylaxis alone (aerosolized pentamidine). Thirty-three failures were observed (8%) with cotrimoxazole: 14 cases (3%) were considered to have irregular compliance. Sixty-five relapses were observed in 52 patients. At the end of the study 334 patients had died (84%). The median survival was 11.4 months (95% confidence interval, range: 10.4-12.4 months).

CONCLUSIONS

Toxoplasmic encephalitis incidence has decreased since the introduction of appropriate drug prophylaxis.

摘要

目的

描述对人类免疫缺陷病毒（HIV）感染患者进行超过12年随访的弓形虫性脑炎的流行病学特征。

方法

从1983年至1994年住院的1628例艾滋病患者的数据库中，我们研究了399例弓形虫性脑炎患者的流行病学特征。弓形虫性脑炎的诊断基于中枢神经系统疾病、CT扫描或MRI上的典型病变以及适当的弓形虫病治疗下的良好预后之间的关联。

结果

399例患者中报告了464例弓形虫性脑炎病例（占艾滋病患者的24.5%）。总体发病率为每100患者年20.5例。弓形虫性脑炎在51%的病例中是首个艾滋病定义事件，在13%的病例中揭示了HIV感染。在其余49%的病例中，从艾滋病诊断到弓形虫性脑炎的平均延迟时间为13个月（范围：1 - 71个月）。诊断时，平均CD4细胞计数为44/mm³（范围：0 - 408/mm³）。97%的病例中发现了抗弓形虫抗体。在首次发生弓形虫性脑炎之前，58%的患者接受了抗逆转录病毒治疗（平均：17.8个月；范围：1 - 64个月）。在399例弓形虫性脑炎患者中，366例（92%）未接受任何原发性弓形虫病预防措施。其中，205例（56%）未接受任何药物预防，161例（44%）仅接受了卡氏肺孢子虫肺炎预防（雾化喷他脒）。观察到33例（8%）复方新诺明治疗失败：14例（3%）被认为依从性不佳。52例患者中观察到65例复发。研究结束时334例患者死亡（84%）。中位生存期为11.4个月（95%置信区间，范围：10.4 - 12.4个月）。