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Toxoplasma gondii & Human Phenotype

Compendium of Known Effects and Ongoing Research

meningitis

Central nervous system infections in immunocompromised patients

May 9, 2017
Sonneville, R., Magalhaes, E., Meyfroidt, G.
Current Opinion in Critical Care 2017; 23: 128-133
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Purpose of review Although rare, central nervous system (CNS) infections are increasingly being recognized in immunocompromised patients. The goal of the present review is to provide a practical diagnostic approach for the intensivist, and to briefly discuss some of the most prevalent conditions Recent findings Immunocompromised patients presenting with new neurological symptoms should always be suspected of a CNS infection. These infections carry a poor prognosis, especially if intracranial hypertension, severely altered mental status or seizures are present. Clinical examination and serum blood tests should be followed by brain imaging, and when no contra-indications are present, a lumbar puncture including cerebrospinal fluid PCR to identify causative organisms. Empirical therapy depends on the type of immunodeficiency. In HIV-infected patients, the most common CNS infection is cerebral toxoplasmosis, whereas in other immunocompromised patients, aspergillosis, cryptococcal meningitis and tuberculous meningitis are more prevalent. Multiple pathogens can be detected in up to 15% of patients. The diagnostic value of fast multiplex PCR has yet to be evaluated in this setting. Summary CNS infections represent a rare but severe complication in immunocompromised patients. A systematic approach including early diagnosis, appropriate antimicrobial treatment, early ICU admission and aggressive measures to reduce intracranial pressure may improve outcome.

Tagged: abscess, coma, encephalitis, hiv, meningitis, outcome, transplant recipient

Mental healthPhysical health

Toxoplasma infection in systemic lupus erythematosus mimicking lupus cerebritis

January 4, 1999
Zamir, D., Amar, M., Groisman, G., Weiner, P.
Mayo Clinic Proceedings 1999; 74:575-578
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An opportunistic infection is a known, although underdiagnosed, complication of systemic lupus erythematosus (SLE). A 48-year-old woman with a recent diagnosis of SLE was admitted to the hospital because of a fever, confused state, and convulsive episode. Her symptoms were interpreted as being compatible with lupus cerebritis. Treatment with methylprednisolone resulted in a temporary improvement in the patient's condition. Nevertheless, during the next few weeks, her physical and mental condition deteriorated, and she died of massive pulmonary emboli, An autopsy revealed no signs of lupus cerebritis; however, disseminated cerebral toxoplasmosis was found. Cerebral toxoplasmosis is a rare complication of SLE that may be misdiagnosed as lupus cerebritis.

Tagged: adults, c-reactive protein, central-nervous-system, diagnosis, meningitis

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