Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey

A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcom...

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Bibliographic Details
Published in:Medicine (Baltimore) 1994-11, Vol.73 (6), p.306-314
Main Authors: Rabaud, C, May, T, Amiel, C, Katlama, C, Leport, C, Ambroise-Thomas, P, Canton, P
Format: Article
Language:English
Subjects:
Adult
Aged
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - epidemiology
AIDS-Related Opportunistic Infections - microbiology
Animals
Clindamycin - administration & dosage
Clindamycin - therapeutic use
Drug Therapy, Combination
Female
France - epidemiology
Health Surveys
HIV Seropositivity - epidemiology
Humans
Male
Middle Aged
Pyrimethamine - administration & dosage
Pyrimethamine - therapeutic use
Recurrence
Retrospective Studies
Sulfadiazine - administration & dosage
Sulfadiazine - therapeutic use
Survival Rate
Toxoplasma - isolation & purification
Toxoplasmosis - drug therapy
Toxoplasmosis - epidemiology
Toxoplasmosis - parasitology
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Summary:A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcome. During the 33-month survey, 199 cases were collected. The prevalence of ECT in patients with AIDS can be estimated at 1.5%-2%. Age, sex, and HIV risk factors were similar to those of the general AIDS population in France. Extracerebral toxoplasmosis appeared mainly in HIV-infected patients with advanced immunosuppression: the mean CD4+ lymphocyte count was 57/mm3(+/- 99). The localizations observed were: eyes (50% of patients); lung (26%); disseminated (at least 2 extracerebral visceral localizations) (11.5%); peripheral blood (acute febrile syndrome with isolated positive parasitemia) (3%); heart (3%); bone marrow (3%); bladder (1%); and isolated cases of rhinopharynx, skin, liver, lymph nodes, conus medullaris, and pericardium. In this survey, muscular and pancreatic localizations were always associated with other extracerebral localizations. A cerebral localization was diagnosed in 41% of cases. Serologic data provided little information. Ocular fundus examination, bronchoalveolar lavage, tissue biopsy, and search for parasitemia were the main diagnostic procedures. Treatment was the same as for cerebral toxoplasmosis. A clinical response was observed in 64% of cases; 19% relapsed. Death occurred in 106 (53%) cases and was related to ECT in 34% of cases.
ISSN:0025-7974
1536-5964
DOI:10.1097/00005792-199411000-00004