From the Guidelines
Toxoplasmosis encephalopathy is characterized by extrapyramidal symptoms and signs, seizures, hemiparesis, and cranial nerve abnormalities, with clinical features that can be nonfocal, focal, or a mixture of both, depending on the underlying condition of the patient, such as AIDS or malignancies. The condition primarily affects immunocompromised patients, especially those with AIDS, and can lead to severe necrotizing encephalitis if acquired intrauterine 1. Clinical manifestations may include convulsions, chorioretinitis in congenital toxoplasmosis, and a range of neurological symptoms 1.
Key Features
- Extrapyramidal symptoms and signs
- Seizures
- Hemiparesis
- Cranial nerve abnormalities
- Nonfocal, focal, or mixed clinical features depending on the patient's condition
- Reactivation of disease in immunocompromised patients, especially those with AIDS
Diagnosis and Treatment
Diagnosis of Toxoplasmosis encephalopathy involves serum IgG to define those at risk for reactivation disease, and CSF PCR, although the latter has limited sensitivity and standardization 1. MRI is a critical diagnostic tool, showing multiple ring-enhancing lesions in patients with AIDS, and hydrocephalus and calcifications in congenital toxoplasmosis 1. The first-line treatment recommended is pyrimethamine plus either sulfadiazine or clindamycin, with alternative regimens including trimethoprim-sulfamethoxazole 1.
Management Considerations
Management of Toxoplasmosis encephalopathy should prioritize the reduction of morbidity, mortality, and improvement of quality of life, considering the patient's immunocompromised status and the potential for severe neurological complications 1. Given the potential for significant edema and the need for prompt treatment, corticosteroids may be considered in addition to antiparasitic therapy 1. Prophylaxis with trimethoprim-sulfamethoxazole is recommended for at-risk immunocompromised patients to prevent reactivation 1.
From the Research
Features of Toxoplasmosis (Toxoplasma gondii infection) Encephalopathy
The features of Toxoplasmosis (Toxoplasma gondii infection) encephalopathy include:
- High mortality and morbidity 2
- Non-specific clinical symptoms and radiological features, making diagnosis challenging 2
- Focal neurological abnormalities, such as hemiplegia, personality changes, or aphasia, in about 75% of cases 3
- Altered mental state, epilepsy, cranial nerve damage, paresthesia, cerebellar signs, meningitis, motor disorders, and neuropsychiatry 3
- Rapid progressive memory loss as an initial symptom in some cases 3
Diagnosis and Treatment
Diagnosis of Toxoplasmosis encephalopathy can be aided by:
- SPECT with 201TI, with sensitivity and specificity over 90-95% for lymphoma 2
- PCR technique to detect T. gondii, with sensitivity 50-65% and specificity 95-100% 2
- Brain biopsy, which should be considered as soon as possible in cases where diagnosis is uncertain 2 Treatment options include:
- Pyrimethamine and sulfadiazine, which is the treatment of choice 2, 4
- Trimethoprim-sulfamethoxazole (TMP-SMX), which appears to be an effective alternative therapy in resource-poor settings 5
- Desensitization to TMP-SMX, which may be necessary in cases where patients are intolerant to conventional treatments 6
Clinical Considerations
It is essential to consider Toxoplasmosis encephalopathy in the differential diagnosis of patients with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) who present with neurological symptoms 3 Early diagnosis and proper treatment are crucial to prevent life-threatening complications 3