Features of the course of toxoplasmic encephalitis in hiv-infected patients

Abstract

This article presents the results of a retrospective analysis of clinical characteristics and examination outcomes in 23 patients with toxoplasmic encephalitis (TE) among HIV-infected individuals. Among the examined individuals, 11 (47.8%) were men and 12 (52.2%) were women. The patients' ages ranged from 31 to 55 years, with an average age of 37.5 ± 0.38 years. The average CD4+ lymphocyte count was 102.5 ± 21.2 cells/μl, and the HIV RNA load in plasma was 292,773.8 ± 113,180 copies/mL. All patients were confirmed to have stage 4 HIV infection (according to the CDC classification, 1993). Toxoplasmosis infection was confirmed by blood serology (presence of anti-Toxoplasma IgG antibodies via ELISA), and toxoplasmic encephalitis was diagnosed through MRI with characteristic focal brain changes. According to our analysis toxoplasmic encephalitis in HIV-infected patients develops gradually, with cognitive and psychiatric disorders as primary manifestations, followed by focal neurological impairments (hemiparesis, seizures, speech problems). All HIV patients with detected Toxoplasma antibodies at the onset of the disease can be considered at risk for developing toxoplasmic encephalitis. TE in the brain manifests when CD4+ cell levels drop below 200 cells/μL and is characterized by polysymptomatic presentation, with an average of 5.67±0.37 symptoms in our patients. The data from our correlation analysis between altered blood parameters and the presence of symptoms in TE among HIV-infected patients showed that the greater the severity, activity, and duration of toxoplasmic infection (indicated by eosinophilia), the more diverse the symptoms. This, in turn, leads to an increase in ESR, the development of leukocytopenia, and hypochromic anemia.