toxoplasmosis of the spinal cord in a patient with aids: case report and review

What is the relationship between toxoplasmosis and AIDS?

Toxoplasmosis is the most common central nervous system infection in patients with the acquired immunodeficiency syndrome (AIDS) who are not receiving appropriate prophylaxis [1,2]. This infection has a worldwide distribution and is caused by the intracellular protozoan parasite, Toxoplasma gondii.

Why are people with AIDS vulnerable to toxoplasmosis?

Their epidemiological and clinical aspect in association with HIV-infected patients was reported worldwide. In HIV infection due to immunosuppression, there is reactivation of chronic latent infection resulting in Toxoplasma encephalitis.

Is Toxoplasma gondii fatal for AIDS patients?

Untreated Toxoplasma gondii-infections are often fatal in AIDS-patients.

Can toxoplasmosis cause AIDS?

Toxoplasmosis is the leading cause of focal central nervous system (CNS) disease in AIDS. CNS toxoplasmosis in HIV-infected patients is usually a complication of the late phase of the disease. Typically, lesions are found in the brain and their effects dominate the clinical presentation.

What is the serious effect of toxoplasmosis in immunocompromised individuals?

gondii, you are more likely to develop a severe infection if you become infected. Even if you have a prior infection, with the development of immunodeficiency you may experience a relapse. This relapse can result in symptoms such as headache, confusion, poor coordination, nausea or vomiting, and fever.

Who is at risk for toxoplasmosis?

People who are most likely to develop severe toxoplasmosis include: Infants born to mothers who are newly infected with Toxoplasma gondii during or just before pregnancy.

How is toxoplasmosis diagnosed?

The diagnosis of toxoplasmosis is typically made by serologic testing. A test that measures immunoglobulin G (IgG) is used to determine if a person has been infected.

What causes toxoplasmosis in the brain?

Cerebral toxoplasmosis is usually caused by reactivation of the latent cystic form of T. gondii in the central nervous system (CNS) and it as a major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected patients, particularly in developing countries.

What does toxoplasmosis look like on MRI?

The typical CT and MRI findings in patients with cerebral toxoplasmosis are multiple ring-enhancing lesions in basal ganglia (48%), frontal lobe (37%), and parietal lobe (37%) with surrounding edema. In addition, occipital lobe (19%), temporal lobe (18%), and brain stem/cerebellum (5-15%) can be affected.

What are the symptoms of Toxoplasma encephalitis?

Symptoms of toxoplasmic encephalitis include:Headache.Fever.Muscle weakness.Confusion.Speech and memory problems.Seizures.Personality changes.Dementia.More items...•

How is CNS toxoplasmosis diagnosed?

Diagnosis. Proper diagnosis requires a corresponding clinical syndrome in the setting of a CT or MRI that shows ring enhancing lesions. Serologic testing is also often used to clinch the diagnosis. The vast majority of patients with CNS toxoplasmosis are seropositive for anti-toxoplasma IgG antibodies.

Is toxoplasmosis an immune disease?

Healthy people who become infected with Toxoplasma gondii often do not have symptoms because their immune system usually keeps the parasite from causing illness.

What is the AIDS protozoan?

Toxoplasma gondii is an intracellular protozoan that generally presents in patients with Acquired Immune Deficiency Syndrome (AIDS) as reactivation of latent infection [ 6 ]. It is typically latent and remains asymptomatic in both Human Immunodeficiency Virus-infected patients and immunocompetent individuals [ 1 ]. It is considered as a very common cause of intracranial abscesses in HIV/AIDS patients but appears to be an infrequent cause of spinal cord disease [ 4 ]. The incidence of Toxoplasmosis in adult in USA range from 20%-70%, the two major routes of transmission of Toxoplasmosis to humans are oral and congenital [ 5 ]. A literature review mentions that although Toxoplasmosis is infrequent, it have to be suspected in immunocompromised patients who present with symptoms of acute or sub-acute myelopathy [ 4 ].

Is cerebral toxoplasmosis a neurologic disorder?

Background and Importance: Cerebral Toxoplasmosis is a very common cause of focal neurologic disorder in Acquire d Immune Deficiency Syndrome (AIDS) patients with cerebral lesions, but it seems to be a rare cause of spinal cord disease. If not treated and detected immediately, Toxoplasmosis may cause considerable mortality and morbidity.

Is Toxoplasma gondii a pathogen?

Toxoplasma gondii is an intracellular pathogen that contracts a major proportion of the world population. Also, it is a well-known cause of sickness among persons with Acquired Immune Deficiency Syndrome (AIDS) [ 1 ]. Although brain has been the major site for Toxoplasma infection in Acquired Immune Deficiency Syndrome (AIDS) patients, spinal cord involvement by Toxoplasma has been seldom reported. Spinal cord Toxoplasmosis may present as severe outset weakness in both lower limbs correlating with both sensory and bladder dysfunction [ 2 ]. On the other hand, progression of cerebral infection may produce seizures, ataxia, confusion, aphasia, hemianopsia, hemiparesis, drowsiness, and cranial nerve palsies [ 1 ]. Congenital Toxoplasmosis is an illness caused by intrauterine transmission of the parasite Toxoplasma gondii to the fetus. A pregnant woman may acquire this parasite during gestation. Toxoplasma gondii can be found in up to 50% of the world population [ 3 ]. Approximately 10% of patients with Acquired Immune Deficiency Syndrome (AIDS) show some kind of neurological deficit as their primary complaint, and around 80% will have Central Nervous System (CNS) involvement during the course of their illness [ 1, 4, 5 ]. The retina and the lungs are the major sites of extracerebral manifestation of Toxoplasmosis, and such manifestations may happen with/without concomitant Encephalitis [ 1 ]. Here we present a case report and review of the literature on Toxoplasmosis in Acquired Immune Deficiency Syndrome (AIDS) patients.

Is intramedullary spinal cord lesion a differential diagnosis?

The differential diagnosis of intramedullay spinal cord lesions is wide and may be difficult to assess. We present an undiagnosed patient with Acquired Immune Deficiency Syndrome (AIDS) that presented with Toxoplasmosis and Intramedullary spinal cord lesion, successfully treated with partial resection, Anti Toxoplasma and Antiretroviral medical therapy.

What are the most common spinal cord disorders?

AIDS-related spinal cord disorders include neoplasms, infections (including HIV itself), vascular disease, and other undefined etiologies. Toxoplasmosis and lymphoma are the two most common intracranial lesions, and both have been reported in increasing frequency in the spinal cord [ 1 ]. Myelopathy is usually under-diagnosed, probably because of the occurrence of coexisting conditions such as AIDS dementia complex (ADC), cerebral lesions of varying etiologies, vacuolar myelopathy, lumbosacral myelopathy, or peripheral neuropathy that may mask the clinical signs suggestive of myelopathy [ 5, 9, 10 ]. Other causes of myelopathy appear to be less common than toxoplasmosis and include tuberculoma, cytomegalovirus, varicella-zoster virus, and, possibly, lymphoma [ 4, 10 ]. Postmortem histopathology examination has resulted in a definitive diagnosis of myelopathy in the majority of patients [ 7 ].

What happened to a Hispanic man who was found unconscious?

A 40-year-old Hispanic man was admitted to the hospital after being found unconscious. He had a 2-day history of disorientation that manifested itself as his being unable to recognize family members. Upon admission he regained consciousness, becoming alert and oriented, but developed urinary retention and was unable to move or feel his lower extremities. He had no history of systemic illness, but mentioned having been treated for herpes zoster approximately 3 years prior. He denied having a history of fever, chills, nausea, vomiting, rash, seizures, or other constitutional symptoms. He had not traveled recently, and his HIV status was unknown at the time of admission.

Is myelopathy a complication of AIDS?

Although spinal cord abnormalities in patients with acquired immunodeficiency syndrome (AIDS) have been infrequently reported in the literature, myelitis is a known complication of AIDS and is occasionally the initial complaint. The incidence of myelopathy may be as high as 20%, with 50% of the cases reported post-mortem [ 3, 5 ]. Toxoplasmosis is the most common cause of intracranial lesions responsible for neurological deficits in AIDS patients, occurring in 3–10% of patients in the United States and in up to 50% of AIDS patients in Europe, Latin America, and Africa [ 6, 10 ]. A review of existing literature suggests that although Toxoplasmic myelitis is uncommon, it should be suspected in immunocompromised patients who present with symptoms of acute or sub-acute myelopathy [ 7 ]. The initial evaluation should aid in differentiating between other reported causes of myelopathy (such as vacuolar myelopathy, lymphoma, tuberculosis, and viral infections including cytomegalovirus infection, herpes zoster, and herpes simplex) in AIDS patients [ 2, 4 ]. Since 1986, 18 cases of apparent toxoplasmosis of the spinal cord have been described [ 4, 7, 11, 12 ]. A case report and pertinent literature were reviewed, leading to the diagnosis and management options discussed below.

Keywords

Background and Importance

Clinical Presentation

Discussion

• Toxoplasma gondii is an intracellular protozoan that generally presents in patients with Acquired Immune Deficiency Syndrome (AIDS) as reactivation of latent infection [6]. It is typically latent and remains asymptomatic in both Human Immunodeficiency Virus-infected patients and immunocompetent individuals [1]. It is considered as a very common cau...

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Conclusion

Acknowledgment

References