Youssef AADI, Youssef SEFSAFI, Fadoua EL AMRAOUI, Yassine ELBNAISSI, Yassine AOUNI, Imane ROUFIK, Khaoula TAHANI, Oumaima ELHAJJI, Mohammed EL QOTNI, Ahamed REGGAD, Khalid ENNIBI
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 2
Issue: 12
Date of Publication: 2025/12/04
Cerebral toxoplasmosis is a frequent opportunistic infection and a not uncommon manifestation of the acquired immunodeficiency syndrome (AIDS) related to the Human Immunodeficiency Virus (HIV).
This is a retrospective study over a 6-year period (June 2016 to December 2022), including HIV-infected patients with a diagnosis of cerebral toxoplasmosis in the Infectious Diseases Department of the Military Hospital of Rabat (13 patients).
The prevalence of cerebral toxoplasmosis was estimated at 3.59% among the department's HIV cohort. Clinical manifestations on admission were dominated by motor deficit (54% of cases). Disturbed consciousness was reported in 23% of cases. Medullary toxoplasmosis was associated in three patients (23%).
The CD4 count on admission was <100/mm3 in 90% of cases. PCR for the detection of Toxoplasma gondii was not performed in any patient in our study due to unavailability.
Brain MRI was performed on 9 patients, and showed multiple lesions in 69% of cases, with lesions appearing hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images in 77% of cases. The characteristic radiological descriptions of “eccentric target sign” and “concentric target sign” were found simultaneously in one patient only (7.7% of cases).
Brain biopsy was performed in 3 patients, with diffuse granulomatous process without caseous necrosis in one sample, necro-inflammatory tissue changes with vaguely epithelioid cells in another, and a single positive result for Toxoplasma gondii.
The preferred therapeutic regimens being unavailable in Morocco, orally administred Cotimoxazole was the initial treatment in 12 patients. Short-term outcome was favorable in 77% of cases. One year mortality was estimated at 30.7%.
Improvement rates under cotrimoxazole were very close to the percentages reported in the literature under first-line therapeutic lines. This leads us to consider cotrimoxazole to be therapeutically non-inferior but further investigations are necessary. Nevertheless, we emphasize the irrevocable place of the injectable form of this drug.
Cerebral toxoplasmosis, HIV, Cotrimoxazole
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