RESUMO
This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD(4): 17 cells/mm3), had a high viral load (RNA PCR:230,000 copies/ml), was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir) for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Infecções por HIV/complicações , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Toxoplasmose Cerebral/complicações , Toxoplasmose Cerebral/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Adulto , Animais , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Feminino , HIV/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/parasitologia , Doenças do Recém-Nascido/virologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/parasitologia , Complicações Infecciosas na Gravidez/virologia , Toxoplasma/isolamento & purificação , Toxoplasmose Cerebral/transmissão , Resultado do Tratamento , Carga ViralRESUMO
This study was carried out in 60 AIDS patients who presented toxoplasma encephalitis in Martinique (French West Indies). Diagnosis was based on a combination of fever, neurologic signs, and characteristic CT-scan images in patients with positive HIV serology. There were 46 males and 14 females with a mean age of 40 years. The mode of transmission was heterosexual in most cases (68.3%). The incidence of drug-related transmission was low (6.7%). Neurotoxoplasmosis was the most frequent presenting symptom of AIDS (53.3%) followed by esophageal candidosis (20%) and pneumocystosis (10%). Clinical symptoms were headache (56.5%), fever (48.3%), hemiparesia (36.6%), and confusion (36.6%). CT-scan showed most lesions to be multiple (70%), hypodense (89%), and subject to contrast uptake (93%). Mean lymphocyte level was 1128/mm3 with 88 CD4/mm3 and a CD4-to-CD8 ratio of 0.14. Conventional treatment using a combination of pyrimethamine and sulfadiazine led to skin rash and neutropenia and had to be discontinued in 30% of cases. Clinical symptoms and mean survival (327 days) were the same as comparable findings from Europe and North America.