RESUMO
Em mulheres grávidas com infecção pelo HIV e elegíveis para a TAR, este tratamento é um método seguro e eficaz de proporcionar supressão virológica materna, diminuição da mortalidade infantil e redução da transmissão vertical. Especificamente, zidovudina (AZT)/lamivudina (3TC)/nevirapina (NVP), AZT/3TC/lopinavir-ritonavir (LPV-r) e AZT/3TC/abacavir (ABC) têm reduzido a transmissão vertical. Mais pesquisas sobre o uso de esquemas específicos e seus efeitos adversos maternos e infantis ainda são necessárias.
Assuntos
Humanos , Feminino , Gravidez , Terapia Antirretroviral de Alta Atividade , Fármacos Anti-HIV/uso terapêutico , HIV , GestantesRESUMO
Toxoplasmic encephalitis is the most common cerebral mass lesion in patients with AIDS. The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and on response to anti-Toxoplasma therapy. Typically, patients have a subacute presentation of focal neurological signs, with multiple lesions in computed tomography (CT) or magnetic resonance imaging (MRI). However, the neurological and CT scan spectrum is broad. We report a case of toxoplasmic encephalitis in a heterosexual man without prior history of HIV infection. He was admitted with four days of headache, confusion, and new onset of seizures. His brain CT disclosed no alterations and MRI revealed multiple lesions. Empirical specific anti-Toxoplasma therapy was initiated and the patient experienced excellent clinical and radiological improvement. His HIV tests were positive and the CD4+ cell count was 74 cells/ml (8.5 %). On follow up, three months later, the general state of the patient was good, without neurological sequelae and with a normal MRI. We concluded that toxoplasmic encephalitis should be considered in the differential diagnosis of meningoencephalitis in sexually active individuals, including cases without prior history or suspicion of HIV infection, and no abnormalities on CT scan.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Meningoencefalite/diagnóstico , Toxoplasmose Cerebral/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Fármacos Anti-HIV/uso terapêutico , Antiprotozoários/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningoencefalite/tratamento farmacológico , Meningoencefalite/parasitologia , Pessoa de Meia-Idade , Convulsões/diagnóstico , Convulsões/etiologia , Tomografia Computadorizada por Raios X , Toxoplasmose Cerebral/tratamento farmacológicoRESUMO
Toxoplasmic encephalitis is the most common cerebral mass lesion in patients with AIDS. The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and on response to anti-Toxoplasma therapy. Typically, patients have a subacute presentation of focal neurological signs, with multiple lesions in computed tomography (CT) or magnetic resonance imaging (MRI). However, the neurological and CT scan spectrum is broad. We report a case of toxoplasmic encephalitis in a heterosexual man without prior history of HIV infection. He was admitted with four days of headache, confusion, and new onset of seizures. His brain CT disclosed no alterations and MRI revealed multiple lesions. Empirical specific anti-Toxoplasma therapy was initiated and the patient experienced excellent clinical and radiological improvement. His HIV tests were positive and the CD4+ cell count was 74 cells/ml (8.5 percent). On follow up, three months later, the general state of the patient was good, without neurological sequelae and with a normal MRI. We concluded that toxoplasmic encephalitis should be considered in the differential diagnosis of meningoencephalitis in sexually active individuals, including cases without prior history or suspicion of HIV infection, and no abnormalities on CT scan.