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Introducción: El síndrome de inmunodeficiencia adquirida es el estadio final de una enfermedad crónica, transmisible y progresiva de causa viral. La neurotoxoplasmosis es la infección oportunista más frecuente en pacientes inmunodeprimidos. Objetivo: Caracterizar a los pacientes con neurotoxoplasmosis secundaria al virus de inmunodeficiencia humana/sida según variables epidemiológicas, clínicas e imagenológicas. Métodos: Se efectuó un estudio observacional, descriptivo y transversal de 18 pacientes con sida, quienes recibieron diagnóstico clínico y microbiológico de neurotoxoplasmosis, caracterizados según hallazgos en la resonancia magnética por imágenes antes y después del tratamiento, desde enero de 2017 hasta diciembre de 2019. Resultados: En la investigación primaron el sexo masculino, las edades de 34 o menos años (66,7 %) y las manifestaciones clínicas de fiebre (100,0 %) y cefalea (88,9 %). La localización más habitual de las lesiones fue en la unión cortico-subcortical (66,1 %). Resultaron más frecuentes las imágenes hipointensas en T1 y en recuperación de la inversión atenuada de fluido y las imágenes hiperintensas en T2; se destacaron las lesiones múltiples (66,7 %), de pequeño tamaño (50,0 %) y los contornos irregulares (88,9 %). Antes del tratamiento tuvieron mayor frecuencia el realce de tipo anular (72,2 %) y el edema vasogénico de grado 2 (50,0 %); después de este, 55,6 % de los afectados presentaron calcificaciones y 72,2 % hemorragia intralesional. Se evidenció que 77,8 % tuvieron mejoría con respecto al edema cerebral. Conclusiones: La resonancia magnética por imágenes permitió caracterizar a los pacientes con virus de inmunodeficiencia humana/sida y toxoplasmosis cerebral, así como evaluar la respuesta terapéutica a través de las modificaciones en los hallazgos imagenológicos.

Introduction: The acquired immunodeficiency syndrome is the final stage of a chronic, communicable and progressive disease of viral cause. The neurotoxoplasmosis is the most frequent opportunist infection in immunodepressed patients. Objective: To characterize patients with secondary neurotoxoplasmosis to human immunodeficiency virus/aids according to epidemiological, clinical and imaging variables. Methods: An observational, descriptive and cross-sectional study of 18 patients with AIDS was carried out, who received clinical and microbiological diagnosis of neurotoxoplasmosis, characterized according to findings in the magnetic resonance by images before and after the treatment, from January, 2017 to December, 2019. Results: In the investigation there was a prevalence of the male sex, the ages of 34 or less years (66.7 %) and the clinical signs of fever (100.0 %) and headache (88.9 %). The most common localization of the lesions was in the cortico-subcortical juntion (66.1 %). The hypointense images in T1 and fluid attenuated inversion recovery and hyperintense images in T2 were the most frequent; the multiple lesions (66.7 %) of small size (50.0 %) and irregular contours (88.9 %) were notable. Before the treatment the enhance of anular type had more frequency (72.2 %) and grade 2 vasogenic edema (50.0 %); after this, 55.6 % of those affected persons presented calcifications and 72.2 % intralesional hemorrhages. It was evidenced that 77.8 % had improvement respect the cerebral edema. Conclusions: The magnetic resonance by images allowed to characterize the patients with human immunodeficiency virus/aids and cerebral toxoplasmosis, as well as to evaluate the therapeutic response through the modifications in the imaging findings.

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INTRODUCCIÓN: La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun cuando existen guías plenamente divulgadas y conocidas, se observa poca implementación de ellas en algunas instituciones de salud y una inadecuada interpretación de las pruebas serológicas en las gestantes. Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. CASOS CLÍNICOS: Se reportan dos casos de toxoplasmosis congénita, uno de ellos con desenlace fatal. En ambos no se siguieron las guías de práctica clínica, lo cual conllevó un diagnóstico tardío y, en consecuencia, un manejo en condiciones inapropiadas con daños graves. CONCLUSIONES: La toxoplasmosis es una infección congénita aún prevalente en algunos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Además, existen algunas variedades de cepas de T. gondii con un comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos e incluye mayor riesgo de muerte. BACKGROUND: Congenital toxoplasmosis continues to be a public health problem. Although clinical guidelines have been divulgated and are well known, they are not implemented in some health institutions, in addition of an inappropriate interpretation of the serological tests in pregnant women. This situation can lead to lack of screening and treatment in pregnant women with primary Toxoplasma gondii infection. CASE REPORTS: We report two cases of congenital toxoplasmosis, one with a fatal outcome. In both cases, the clinical guidelines were not initially followed, leading to a delayed diagnosis and, consequently, an inappropriate management in conditions with severe damage. CONCLUSIONS: Toxoplasmosis is a congenital infection still prevalent in some countries, with severe sequelae, neurological disability, and even late risk of ocular damage. ­Additionally, some varieties of the T. gondii strains have a more aggressive pattern in Latin America, worsening the clinical presentation of cases and including a high risk of death.

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Resumen Introducción: La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun cuando existen guías plenamente divulgadas y conocidas, se observa poca implementación de ellas en algunas instituciones de salud y una inadecuada interpretación de las pruebas serológicas en las gestantes. Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Casos clínicos: Se reportan dos casos de toxoplasmosis congénita, uno de ellos con desenlace fatal. En ambos no se siguieron las guías de práctica clínica, lo cual conllevó un diagnóstico tardío y, en consecuencia, un manejo en condiciones inapropiadas con daños graves. Conclusiones: La toxoplasmosis es una infección congénita aún prevalente en algunos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Además, existen algunas variedades de cepas de T. gondii con un comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos e incluye mayor riesgo de muerte.

Abstract Background: Congenital toxoplasmosis continues to be a public health problem. Although clinical guidelines have been divulgated and are well known, they are not implemented in some health institutions, in addition of an inappropriate interpretation of the serological tests in pregnant women. This situation can lead to lack of screening and treatment in pregnant women with primary Toxoplasma gondii infection. Case reports: We report two cases of congenital toxoplasmosis, one with a fatal outcome. In both cases, the clinical guidelines were not initially followed, leading to a delayed diagnosis and, consequently, an inappropriate management in conditions with severe damage. Conclusions: Toxoplasmosis is a congenital infection still prevalent in some countries, with severe sequelae, neurological disability, and even late risk of ocular damage. Additionally, some varieties of the T. gondii strains have a more aggressive pattern in Latin America, worsening the clinical presentation of cases and including a high risk of death.

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Resumen Se reporta el caso de un paciente masculino de 29 años con antecedente de diabetes mellitus tipo 1, con enfermedad renal crónica estadio 5 secundaria a enfermedad renal diabética que requirió de trasplante renal de donante vivo en el año 2000 y en tratamiento inmunosupresor con prednisolona, tacrolimus y micofenolato desde dicho procedimiento, quien ingresó al servicio de urgencias por crisis epiléptica focal con generalización secundaria. El enfoque diagnóstico de toxoplasmosis cerebral en pacientes inmunocomprometidos es un reto clínico debido a la gran variabilidad de signos y síntomas asociados en esta población y a la alta frecuencia de complicaciones, lo cual puede confundir el diagnostico.

Abstract A 29-year-old male patient with a history of type 1 diabetes mellitus, stage 5 chronic kidney disease secondary to diabetic kidney disease that required living donor kidney transplantation in 2000. During these years, he has received immunosuppressive treatment with prednisolone, tacrolimus, and mycophenolate. He was admitted to the emergency department for focal epileptic crisis with secondary generalization. The diagnostic approach of cerebral toxoplasmosis in immunocompromised patients is a clinical challenge, due to the great variability of associated signs and symptoms in this population and the high frequency of complications, which can confuse the diagnosis.

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Major neurocognitive disorder due to multiple etiologies, or dementia due to multiple etiologies (DME), is a term coined by the Diagnostic and Statistical Manual of Mental Disorders to refer to complex cases when multiple pathologies, such as Alzheimer's disease, Lewy Bodies, human immunodeficiency virus (HIV), vascular-related brain damage or frontotemporal lobar degeneration, are identified as contributing to neurocognitive impairment and/or behavioral alterations, based on patient's neuroimaging tests, laboratorial exams, associated symptomatology and medical history. In this study, we report the case of a 63-year-old male patient who presented with parkinsonism symptoms, aphasia and cognitive impairment on multiple domains after cerebral toxoplasmosis related to acquired immunodeficiency syndrome, vascular damage and a history of alcohol abuse. We discuss the neurocognitive and neurobehavioral variables that characterized this diagnosis, as well as the importance of the differential diagnosis of DME on the field of neuropsychology of aging and, especially, for individuals living with HIV infection.

Transtorno neurocognitivo maior devido a múltiplas etiologias, ou demência por múltiplas etiologias (DME), é um termo estabelecido pelo Manual Diagnóstico e Estatístico de Transtornos Mentais para se referir a casos complexos em que múltiplas patologias, como a Doença de Alzheimer, Corpos de Lewy, o vírus da imunodeficiência humana (HIV), danos de origem vascular ou a degeneração lobar frontotemporal, são identificados como contribuintes para o comprometimento neurocognitivo e/ou para alterações comportamentais, com base em testes de neuroimagem do paciente, exames laboratoriais, sintomatologia associada e histórico médico. Neste artigo, relatamos o caso de um paciente do sexo masculino de 63 anos que apresentou sintomas de parkinsonismo, afasia e comprometimento cognitivo em múltiplos domínios após neurotoxoplasmose relacionada à síndrome da imunodeficiência adquirida, dano vascular e histórico de abuso de álcool. Foram discutidas as variáveis neurocognitivas e neurocomportamentais que caracterizaram esse diagnóstico, assim como a importância do diagnóstico diferencial de DME para a neuropsicologia do envelhecimento e, especialmente, para indivíduos portadores do HIV.

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ABSTRACT Major neurocognitive disorder due to multiple etiologies, or dementia due to multiple etiologies (DME), is a term coined by the Diagnostic and Statistical Manual of Mental Disorders to refer to complex cases when multiple pathologies, such as Alzheimer's disease, Lewy Bodies, human immunodeficiency virus (HIV), vascular-related brain damage or frontotemporal lobar degeneration, are identified as contributing to neurocognitive impairment and/or behavioral alterations, based on patient's neuroimaging tests, laboratorial exams, associated symptomatology and medical history. In this study, we report the case of a 63-year-old male patient who presented with parkinsonism symptoms, aphasia and cognitive impairment on multiple domains after cerebral toxoplasmosis related to acquired immunodeficiency syndrome, vascular damage and a history of alcohol abuse. We discuss the neurocognitive and neurobehavioral variables that characterized this diagnosis, as well as the importance of the differential diagnosis of DME on the field of neuropsychology of aging and, especially, for individuals living with HIV infection.

RESUMO Transtorno neurocognitivo maior devido a múltiplas etiologias, ou demência por múltiplas etiologias (DME), é um termo estabelecido pelo Manual Diagnóstico e Estatístico de Transtornos Mentais para se referir a casos complexos em que múltiplas patologias, como a Doença de Alzheimer, Corpos de Lewy, o vírus da imunodeficiência humana (HIV), danos de origem vascular ou a degeneração lobar frontotemporal, são identificados como contribuintes para o comprometimento neurocognitivo e/ou para alterações comportamentais, com base em testes de neuroimagem do paciente, exames laboratoriais, sintomatologia associada e histórico médico. Neste artigo, relatamos o caso de um paciente do sexo masculino de 63 anos que apresentou sintomas de parkinsonismo, afasia e comprometimento cognitivo em múltiplos domínios após neurotoxoplasmose relacionada à síndrome da imunodeficiência adquirida, dano vascular e histórico de abuso de álcool. Foram discutidas as variáveis neurocognitivas e neurocomportamentais que caracterizaram esse diagnóstico, assim como a importância do diagnóstico diferencial de DME para a neuropsicologia do envelhecimento e, especialmente, para indivíduos portadores do HIV.

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RESUMO A neurotoxoplasmose (NTX) é uma das principais doenças oportunistas presentes em indivíduos portadores do vírus da imunodeficiência humana (HIV). A doença promove lesões cerebrais focais com efeito de massa que podem gerar uma variedade de sequelas capazes de comprometer a realização das atividades da vida diária, dentre elas, a deambulação. O objetivo deste estudo foi verificar os principais déficits motores apresentados e identificar os fatores de risco para a perda de mobilidade ao final da internação. Trata-se de um estudo observacional cuja amostra foi composta por dados de prontuários de indivíduos portadores do vírus HIV e diagnóstico de NTX. Foi realizada a revisão de prontuários eletrônicos e a classificação da mobilidade hospitalar, além da coleta de dados clínicos e epidemiológicos. Aplicou-se estatística descritiva e regressão logística binária. Foram avaliados 161 prontuários, com prevalência do sexo masculino e mediana de idade de 39 anos. Os déficits motores na admissão foram a ausência de deambulação (42,9%), hemiparesia (42,3%), paresia de membros inferiores (37,3%), déficit de equilíbrio (35,4%). Ao final da internação 32,9% não deambulavam. Os preditores para perda da mobilidade ao final da internação foram: utilização de ventilação mecânica invasiva (VMI), inclusão no programa de cuidados paliativos e não deambular na admissão. Os principais déficits motores foram a ausência de deambulação, a hemiparesia à direita e o déficit de equilíbrio.

RESUMEN La neurotoxoplasmosis (NTX) es una de las principales enfermedades oportunistas presentes en individuos con el virus de la inmunodeficiencia humana (VIH). La enfermedad promueve lesiones cerebrales focales con efecto de masa que pueden generar una variedad de secuelas capaces de influir el desempeño de las actividades de la vida diaria, incluida la deambulación. El objetivo de este estudio fue verificar los principales déficits motores presentados e identificar los factores de riesgo de pérdida de movilidad al final de la hospitalización. Este es un estudio observacional cuya muestra consistió en datos de registros médicos de individuos con el virus del VIH y diagnóstico de NTX. Se revisaron los registros médicos electrónicos y se clasificó la movilidad hospitalaria, así como la recolección de datos clínicos y epidemiológicos. Se aplicaron estadísticas descriptivas y regresión logística binaria. Evaluamos 161 registros médicos, con una prevalencia masculina y mediana de 39 años. Los déficits motores al ingreso fueron ausencia de deambulación (42.9%), hemiparesia (42.3%), paresia de miembros inferiores (37.3%), déficit de equilibrio (35.4%). Al final de la hospitalización, el 32,9% no caminaba. Los predictores de pérdida de movilidad al final de la hospitalización fueron: uso de ventilación mecánica invasiva (VMI), inclusión en el programa de cuidados paliativos y no deambulación al ingreso. Los principales déficits motores fueron la ausencia de deambulación, hemiparesia derecha y déficit de equilibrio.

ABSTRACT Neurotoxoplasmosis (NTX) is one of the main opportunistic diseases present in individuals with the human immunodeficiency virus (HIV). This disease promotes focal brain lesions with mass effect that can generate a variety of sequelae capable of compromising the performance of activities of daily living, including ambulation. Our study sought to verify the main motor deficits presented and identify risk factors for mobility loss at the end of hospitalization. It is a observational study, whose sample consisted of data from medical records of individuals with HIV and diagnosed with NTX. Electronic medical records were reviewed, clinical and epidemiological data were collected and hospital mobility was classified. Descriptive statistics and binary logistic regression were applied. We evaluated 161 medical records, with male prevalence, with a median age of 39 years. Motor deficits at admission were absence of ambulation (42.9%), hemiparesis (42.3%), lower limb paresis (37.3%), balance deficit (35.4%) and 32.9 % could not walk at the end of hospitalization. Predictors of mobility loss at the end of hospitalization were: use of invasive mechanical ventilation (IMV), inclusion in the palliative care program and non-ambulation on admission. The main motor deficits were the absence of ambulation, hemiparesis on the right and the balance deficit. The predictors for inability to walk at the end of hospitalization were the need for IMV, inclusion in the palliative care program, and no ambulation at admission.

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The epidemic associated with infection by human immunodeficiency virus (HIV) is one of the main health problems in the world, about one million people died as a result of infection related to it; according to the statistical data of 2016 the number of infected persons was 36,7 million, 34,5 million were adults and 2,1 million children (under 15 years), it was calculated for 2016 that there were about 1,8 million of new HIV infections.Toxoplasma encephalitis (ET) is a zoonosis of global distribution is one of the most frequent opportunistic diseases in patients with immunosuppression by HIV. Toxoplasma gondii is a protozoan, which infects the human being through the intake of raw or undercooked meat. The following is the report of a case of a 25-year-old patient with a recent diagnosis of HIV infection, who went to the emergency room for generalized headache of moderate intensity, which did not yield to the administration of medications, was accompanied by drowsiness, paresthesia of the tongue and left hemicara.

The epidemic associated with infection by human immunodeficiency virus (HIV) is one of the main health problems in the world, about one million people died as a result of infection related to it; according to the statistical data of 2016 the number of infected persons was 36,7 million, 34,5 million were adults and 2,1 million children (under 15 years), it was calculated for 2016 that there were about 1,8 million of new HIV infections.Toxoplasma encephalitis (ET) is a zoonosis of global distribution is one of the most frequent opportunistic diseases in patients with immunosuppression by HIV. Toxoplasma gondii is a protozoan, which infects the human being through the intake of raw or undercooked meat. The following is the report of a case of a 25-year-old patient with a recent diagnosis of HIV infection, who went to the emergency room for generalized headache of moderate intensity, which did not yield to the administration of medications, was accompanied by drowsiness, paresthesia of the tongue and left hemicara

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RESUMEN La toxoplasmosis cerebral es la infección oportunista más frecuente del sistema nervioso central (SNC) del paciente infectado por el virus de la inmunodeficiencia humana (VIH). Se considera un problema de salud pública por las secuelas físicas y neurosicológicas que genera. Se presenta con una sintomatología muy variable que puede ir desde cefalea, pasar por la fiebre y emesis, hasta las convulsiones y los cambios de comportamiento. No se encontró en la literatura mundial ningún reporte de caso donde se hiciera un diagnóstico de novo de VIH por fotopsias como primera manifestación de toxoplasmosis cerebral. A continuación, se presenta el caso de un paciente masculino, de 39 años, quien consultó por cuadro clínico de dos meses de evolución, constituido por fotopsias en ambos ojos acompañado de cefalea hemicráneana izquierda, sin más síntomas acompañantes. El examen oftalmológico no tuvo hallazgos patológicos, por lo cual se solicitó una tomografía axial computarizada (TAC) simple y contrastado de órbitas y cerebro, por el resultado se realizó una impresión diagnóstica de toxoplasmosis cerebral que fue la presentación inicial de su VIH subyacente.

SUMMARY Cerebral toxoplasmosis is the most frequent opportunistic infection of the central nervous system (CNS) in patients infected with the human immunodeficiency virus (HIV). It is considered a public health problem due to the physical and neurosychological sequels that it generates. It presents with a very variable symptomatology that can be from headache, fever and emesis until convulsions and behavior changes. No case report was found in the world literature where it was new diagnosed of HIV by photopsies as the first manifestation of cerebral toxoplasmosis. The case of a 39-year-old male patient was present. He presented with 2-month clinical course consisting of photopsies in both eyes, accompanied by left hemicranial headache. No more accompanying symptoms. The ophthalmologic examination was without pathological findings, for which simple and contrasted computed axial tomography of orbits and brain was requested where as a result a diagnostic impression of cerebral toxoplasmosis was made wich was the initial presentation of his underlying HIV.

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RESUMEN La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun existiendo guías plenamente divulgadas y conocidas, se observa poca implementación de las mismas y falta de adecuada interpretación de pruebas serológicas en gestantes Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Reportamos una serie de casos, con compromiso neurológico y sistémico (dificultad respiratoria, hepatoesplenomegalia, enterocolitis, calcificaciones cerebrales, trombocitopenia, corioretinis, ascitis, choque). Si bien el virus de Zika causó epidemia en 2015-2016 en Brasil, Colombia y otros países, toxoplasmosis es un diagnóstico diferencial aún prevalente en estos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Adicionalmente, existen algunas variedades de cepas de T. gondii con comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos, incluyendo además mayor riesgo de muerte.

ABSTRACT Congenital toxoplasmosis continues to be a public health threat. Even existing guidelines, publicly known, its implementation and lack of appropriate interpretation of serological tests in pregnancy is often observed. This leds to failure in opportunities for positive and known interventions to decrease the fetal risk due to Toxoplasma gondii infection. We reported herein a case series, with variable neurological and systemic compromise (respiratory distress, hepatosplenomegaly, enterocolitis, brain calcifications, thrombocytopenia, ascites, shock), even fatal, calling for awareness about the fact that despite the Zika epidemics in 2015-2016 in Brazil, Colombia and other countries, precisely toxoplasmosis, is a differential diagnosis still prevalent in these territories, that can leds to severe consequences, with neurological disability and risk of ocular damage, even lately. Additionally, with varieties of T. gondii with more aggressive patterns in Latin America, which make worse those cases, including also a higher risk of death.

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Introducción: El síndrome de inmunodeficiencia adquirida afecta el sistema inmune de la persona, particularmente a los linfocitos T. La toxoplasmosis cerebral constituye la infección oportunista más común en pacientes con VIH-SIDA, aparece en sujetos con menos de 100 linfocitos T CD4/mm3. Ante la sospecha clínica de neurotoxoplasmosis se deben solicitar estudios de imagen como tomografía de cráneo o resonancia magnética nuclear de encéfalo. El objetivo del presente trabajo es describir en un grupo de pacientes los hallazgos de imagen con neurotoxoplasmosis y VIH/SIDA. Materiales y métodos: Serie de casos de 27 pacientes cuyos exámenes de imagen fueron revisados conjuntamente con el contaje CD4 y las neuroimágenes (RMN), de pacientes con diagnóstico de VIH/SIDA y Toxoplasmosis, de enero 2010 a julio 2012, en el Hospital Carlos Andrade Marín. Resultados: Hubo predominio de varones (8:1) entre los pacientes con un contaje CD4 inferior a 100/mm3. El mayor porcentaje de lesiones en la RMN fueron grado 2, correspondientes a la clasificación de lesiones por imagen de toxoplasmosis cerebral, caracterizadas por ser lesiones ocupantes de espacio, que tienen realce y edema perilesional; con hipointensidad en T1 e hiperintensidad en T2. La mayor parte pertenecieron a la clase C3 de la clasificación CDC y hubo un predominio de grado 2, de la clasificación de neurotoxoplasmosis por imágenes. Discusión: Las imágenes de neurotoxoplasmosis demostradas con RMN en pacientes con VIH/SIDA son de mucha utilidad para el diagnóstico y seguimiento de esta entidad.

Abstract Introduction: Acquired immunodeficiency syndrome impairs the immune system, particularly T lymphocytes. Cerebral toxoplasmosis is the leading cause of opportunistic infection of the central nervous system (CNS) in HIV/AIDS patients, when they have CD4+ counts fewer than 100 cells/mm3. Facing a patient with clinical suspicion of neurotoxoplasmosis, a CT scan or MRI should be asked. The aim of this paper was describing image findings of a group of HIV patients with neurotoxoplasmosis Methods: Case serie involving 27 patients whose medical records were analyzed. It includes the results of clinical exams, CD4 counts and MRI files with both diagnosis HIV/AIDS and toxoplasmosis, from January 2010 to July 2012, at Carlos Andrade Marin Hospital. Results: The study sample included more men than women (8:1). Most patients had a CD4 count fewer than 100 cells/mm3. Grade 2 lesions were frequent in the MRI, corresponding to h space-occupying lesions with enhancement and perilesional edema; showing hypointensity on T1 and hyperintensity on T2. Most of the patients were stratified as C3 class from CDC classification. Discusion: HIV/AIDS patients with a significant lower CD4 count should have a CT scan or MRI asked, in order to identify neurotoxoplasmosis.

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INTRODUÇÃO: Por comprometer as células de defesa do organismo, o Vírus da Imunodeficiência Humana torna o indivíduo vulnerável ao aparecimento de diversas doenças, entre elas a neurotoxoplasmose. OBJETIVO: Verificar a influência de um protocolo de hidroterapia no equilíbrio dinâmico e nas atividades de vida diária de pacientes com neurotoxoplasmose associada à Síndrome da Imunodeficiência Adquirida (SIDA). MÉTODOS: Participaram 15 voluntários, três (20%) do sexo feminino e 12 (80%) do masculino, com média de idade de 37,44±5,5 anos e diagnóstico de neurotoxoplasmose decorrente da SIDA, cadastrados na Unidade de Referência Especializada em Doenças Infectocontagiosas Parasitárias Especiais. Foram submetidos à avaliação do equilíbrio dinâmico pelo Índice de Marcha Dinâmico e à avaliação das atividades de vida diária pelo Índice de Barthel, pré- e pós-hidroterapia, em piscina à temperatura média de 35°C, três vezes por semana em dias alternados, durante 50 minutos, totalizando oito semanas, ou seja, 24 sessões. Foi utilizado o teste de Shapiro-Wilk para análise de variâncias do Índice de Marcha Dinâmica e do Índice de Barthel, e o teste t de Student para as comparações pré e pós-tratamento e nível de significância de α=0.05. RESULTADOS: O equilíbrio dinâmico, considerando o escore total, apresentou significância estatística (p<0,0001), quando comparado pós-teste (20,3±2,5) em relação ao pré-teste (13,2±3,2). Quanto às atividades de vida diária, foi evidenciado valor estatisticamente significante (p=0,049) no pós-teste (98,8±2.2) quando comparado ao pré-teste (95,6±3.9). CONCLUSÃO: Neste estudo, o protocolo de hidroterapia melhorou o equilíbrio dinâmico e as atividades de vida diária de pacientes com neurotoxoplasmose associada à SIDA.

INTRODUCTION: For compromising the defense cells of the body, the Human Immunodeficiency Virus makes the individual vulnerable to the emergence of various diseases, including the neurotoxoplasmosis. OBJECTIVE: To determine the effect of a hydrotherapy protocol in dynamic balance and the activities ofdaily living of patients with cerebral toxoplasmosis associated with the Acquired Immuno Deficiency Syndrome (AIDS). METHODS: 15 volunteers participated, three (20%) were female and 12 of them (80%) were male; mean age 37.44±5.5 years, diagnosed with cerebral toxoplasmosis resulting from AIDS registered in Specialized Reference Unit on Infectious Diseases Parasitic Infectious Specials. Underwent evaluation of dynamic balance by the Dynamic Gait Index and the activities of daily living by Barthel Index, pre and post hydrotherapy, in the pool at an average temperature of 35°C, 3 times per week on alternate days, lasting 50 minutes, a total of 8 weeksor 24 sessions. We used the Shapiro-Wilk test for analysis of the Dynamic Gait Index and Barthel Index variances, and T Student test for pre and post-treatment comparison and significance level of α=0.05. RESULTS: Total score of dynamic balance presented statistically significance (p<0.0001), comparison post-test (20.3±2.5) compared to pre-test (13.2±3.2). As for the activities of daily living was evidenced statistically significant value (p=0.049),and the post-test (98.8±2.2) compared to pre-test (95.6±3.9). CONCLUSION: In this study, hydrotherapy protocol improved the dynamic balance and the activities of daily living of patients with cerebral toxoplasmosis associated with AIDS.

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Nuestro propósito es describir las características clínicas e imaginológicas por resonancia magnética (RM) de las enfermedades infecciosas más comunes del sistema nervioso central (SN C) en pacientes con VIH o sida que consultaron al Hospital Pablo Tobón Uribe en el período 2008-2009. Se incluyeron cuatro pacientes adultos con VIH/sida de la base de datos del Hospital Pablo Tobón Uribe diagnosticados con infecciones del SN C por medio de RM y comprobación microbiológica del diagnóstico. Los patrones imaginológicos más comunes por RM de las infecciones del SN C en pacientes con sida en nuestro medio fueron lesiones irregulares multifocales ocupantes de espacio intraaxiales, con señales heterogéneas y variables en T1, T2 y FLAI R, con edema perilesional y realce anular poscontraste.

Our purpose is to describe the clinical and magnetic resonance imaging (MRI) features of the central nervous system (CNS ) most common infectious diseases in patients with human immunodeficiency virus (HIV) and / or acquired immudeficiency syndrome (AIDS ) that consulted to the Hospital Pablo Tobón Uribe in the period 2008-2009. We included four adult patients with HIV and / or AIDS from Hospital Pablo Tobón Uribe database, who were diagnosed having central nervous system infections by MRI and diagnostic microbiological tests. The most common MRI patterns of CNS infections in AIDS patients in our institution were irregular multifocal intra-axial space-occupying lesions with heterogeneous and variable signals on T1, T2 and FLAI R, with perilesional edema and rim postcontrast enhancement.

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Aims: To review the significance of toxoplasmosis as a public health issue in Serbia, and analyze the current strategies to alleviate the burden of the disease. Source of data: Relevant clinical and epidemiological reports from Serbia published since 1975. Summary of findings: Despite 50 years of continuous work on Toxoplasma gondii and toxoplasmosis in Serbia, exact data on the frequency of acute clinical disease, acute infections in pregnancy and congenital infection in the offspring are still lacking, due to the vague legal provision that toxoplasmosis is subject to reporting ?in case of epidemiological indications?. What, however, is clear is that the major Toxoplasma-induced public health issue in Serbia, like elsewhere in Europe, is congenital toxoplasmosis. Continuous monitoring of particular patient groups showed a dramatic decrease in the prevalence of infection over the past two decades, and a consequently increased proportion of women susceptible to infection in pregnancy, suggesting a potential increase in the incidence of congenital toxoplasmosis. Studies of risk factors for infection transmission have provided data to guide national health education campaigns. Conclusions: It is expected that the recent appointment of the National Reference Laboratory for Toxoplasmosis as the focal point for the collection of data from the primary level, will provide the means for accurate assessment of the measure of the problem, which is a prerequisite of an evidence-based nation-wide prevention program. In the mean time, health education of all pregnant women, focused at risk factors of major local significance, is advocated as a sound and financially sustainable option to reduce congenital toxoplasmosis.

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Objetivo: Describir las alteraciones macro y microscópicas observadas en el sistema nervioso central (SNC) de pacientes que fallecieron por la infección con VIH-SIDA. Metodología: Estudio retrospectivo de autopsias del 1 de enero de 2004 al 31 de diciembre de 2007 en un hospital público de tercer nivel en la ciudad de Bucaramanga, Santander. Resultados: El hallazgo neuropatológico más común en pacientes que fallecieron por la infección VIH-SIDA fue toxoplasmosis cerebral, 17 casos (28.3%) luego criptococosis cerebral, 7 casos (11.6%), tuberculosis del SNC, 3 casos (5%), encefalopatía por HIV, 2 casos (3.3%), meningitis piógena, un caso (1.6%) y hallazgos inespecíficos,2 casos (3.3%).  No hubo lesiones neoplásicas, infecciones por citomegalovirus, herpes, histoplasmosis ni leucoencefalopatía multifocal progresiva (LMP) en ninguno de los casos. En el presente estudio se encontraron cambios en el SNC en 32 casos (53.1%), que, después del respiratorio (39-65%), fue el sistema más afectado por las complicaciones relacionadas con la enfermedad por VIH. La presencia de lesión directa (encefalitis por HIV) y al mismo tiempo infección oportunista se encontró sólo en un caso (1.6%). Conclusiones: En Bucaramanga las infecciones oportunistas fueron las complicaciones más frecuentes y graves a nivel del SNC en los enfermos con VIH-SIDA, de ellas la toxoplasmosis cerebral fue la que más comprometió el SNC de los pacientes con infección con VIH-SIDA, y se expresó morfológicamente como una meningoencefalitis necrosante, ubicada de manera preferencial en la región de los ganglios basales.

Objective: To describe the macroscopic and microscopic alterations observed in the central nervous system (CNS) in patients who died through HIV-AIDS infection. Method used: Retrospective study of autopsies from January 1st 2004 to December 31st 2007 in a third-level public hospital at Bucaramanga, Santander.Results: The most common neuro-pathological findings in patients who died through HIV-AIDS infection were cerebral toxoplasmosis, 17 cases (28.3%); followed by cerebral cryptococcosis, 7 cases (11.6%); CNS tuberculosis, 3 cases (5%); HIV encephalitis, 2 cases (3.3%); and bacterial meningitis, 1 case (1.6%). Neoplasm lesions, CMV infection, herpes infection, histoplasmosis, and progressive multifocal leucoencephalopathy (PML) were not found in any case. In this study, changes were seen in the CNS in 32 cases (53.1%), which after the respiratory system (39-65%) was the most affected system for complications related to HIV infection. HIV-induced encephalopathy simultaneously with an opportunistic infection was only found in 1 case (1.6 %). Conclusion: In Bucaramanga, opportunistic infections are the most frequent and serious complications in the CNS of individuals with HIV-AIDS; among them cerebral toxoplasmosis was the most frequently observed complication in the CNS of patients with HIV-AIDS, appearing morphologically as a meningoencephalitis with necrosis and large lesions localized in the gangliobasal region.

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A síndrome oculoauriculovertebral, mais comumente conhecida como síndrome de Goldenhar, pode ser diagnosticada pelo dermatologista. Achados como hipoplasia/aplasia de pavilhão auricular e alterações vertebrais, e a presença de trago acessório encontrados no paciente são elementos-chave para a suspeita da síndrome. Sua identificação é de suma importância dada a possibilidade de outras alterações sistêmicas, com impacto até no prognóstico do paciente. Após a confirmação diagnóstica, é interessante a abordagem multidisciplinar e integral em função da potencial pluralidade de manifestações que podem ocorrer na síndrome.

The Oculoauriculovertebral Syndrome, more commonly known as the Goldenhar Syndrome, can be diagnosed by the dermatologist. Findings such as hypoplasia/aplasia of the auricular pavilion, vertebral alterations and accessory tragi are the key elements for the suspicion of the syndrome. Its identification is of utmost importance, given the possibility of other systemic alterations, with impact also on the patient's prognosis. After confirmation of the diagnosis, an integral and multidisciplinary attention is important, because of the plurality of manifestations that can occur in the syndrome.

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Objetivo: estandarización y validación clínica de la prueba de reacción en cadena de la polimerasa (PCR) para el diagnóstico de toxoplasmosis cerebral en pacientes infectados por VIH. Diseño: prueba de una prueba. Prueba de oro: constructo diagnóstico (criterios clínicos y radiológicos y respuesta al tratamiento específico). Lugar: centros hospitalarios de referencia (tercer nivel) de Bogotá y Armenia. Población: 15 casos de toxoplasmosis cerebral y 75 controles, todos fueron pacientes con infección por VIH. Mediciones: la amplificación del gen B1 se realizó con una PCR anidada y la de SAG2 con una PCR simple. Resultados: con los iniciadores para el gen B1 se detectaron hasta 10 fg de ADN de la cepa de T. gondii diluída en agua, la sensibilidad disminuyó a 1 pg sí se diluía en sangre. Con los iniciadores para el gen SAG2 se detectó 1 pg de ADN del parásito purificado. Dentro del grupo de casos dos muestras de sangre amplificaron con los iniciadores del gen B1, para una sensibilidad de 13,3 por ciento y ninguna muestra con los iniciadores para el gen SAG2. La especificidad fue del 100 por ciento. Conclusiones: los resultados presentados aquí, muestran que la prueba de PCR en sangre de pacientes infectados por el VIH tiene un valor limitado para el diagnóstico de la toxoplasmosis cerebral pero confirma un diagnóstico clínico cuando es positivo

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Objetivo: determinar el valor diagnóstico de las pruebas serológicas y IgG, y IgM e IgA anti - toxoplasma en suero de pacientes con o sin toxoplasmosis cerebral. Población: trece pacientes infectados por hiv con toxoplasmosis cerebral (TC) y 17 pacientes infectados por vih sin TC (8 asintomáticos y 9 con otras enfermedades). Metología: se utilizó la prueba de inmunofluorescencia indirecta para IgG anti - toxoplasma (IFI - IgG) y la prueba de ISAgA para estudiar el IgM e IgA anti - toxoplasma. Resultados: la prueba IFI - IgG fue positiva en el 100 por ciento de los casos con TC a nivel de los títulos fue mayor en los pacientes con TC quye aquellos sin TC (mediana 2048 vs 64; p 0,01). La prueba ISAgA IgM fue positiva en 7 de 13 casos de TC y en 2 de 17 sin TC. La medica del puntaje de IgM en pacientes con TC fue de 6 y de 0 en pacientes sin TC (p 0,011). la IgA fue positiva en 11 de 13 casos con TC y en 4 de 17 casos sin TC. La medida de puntaje de IgA en pacientes con TC fue de 9 0 en pacientes sin TC (p 0,011). Conclusiones: estos datos sugieren que los niveles de IgG y la presencia de IgM e IgA anti - toxoplasma son marcadores valiosos para el diangóstico de una TC

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