HIV: HEAD AND NERVE PROBLEMS-HEADACHES: TOXOPLASMIC ENCEPHALITIS

The symptoms of toxoplasmic encephalitis are what physicians call focal neurologic symptoms: paralysis or weakness on one side of the body, loss of speech, loss of coordination, and certain kinds of seizures. Such symptoms occur generally when there is a problem in a specific part of the brain.     Toxoplasmic encephalitis is caused by a parasite called Toxoplasma gondii that is usually acquired by eating undercooked meat or by contact with cat excrement; the parasite is not transmitted from one person to another. About 30 percent of American adults are infected with Toxoplasma gondii, and most of them are, and will remain, unaware of it. The parasite causes severe disease primarily in people with severe immunosuppression. It seems to be most common in people with AIDS when the CD4 count is less than 100.     Toxoplasmic encephalitis can be diagnosed with a blood test that detects antibodies to Toxoplasma gondii, but the test is unreliable in people with AIDS. The alternative test is one of the methods—CAT scans or MRI scans—for imaging the brain. Either of these will show a characteristic pattern of inflammation in the brain. Some people might require a brain biopsy.     The standard treatment for toxoplasmic encephalitis is an antibiotic, pyrimethamine, given in combination with other antibiotics, either sulfonamides or clindamycin. These drugs are given initially by vein and then by mouth in relatively high doses. Most people improve within two weeks; brain scans three to four weeks after treatment begins generally show reduction in the size of the area of inflammation.     Toxoplasmic encephalitis is one of the many infections in people with AIDS that responds well to treatment but recurs when antibiotics are discontinued. For this reason, in the majority of cases, antibiotics are continued indefinitely.*132\191\2*

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