Cerebral Toxoplasmosis in Adult Patients with HIV Infection

Hospital Physician July 2008 17 T oxoplasma gondii is an obligatory intracellular pathogen that infects a large proportion of the world population and is a well-recognized cause of illness among persons with AIDS.1 T. gondii infection typically is latent and remains asymptomatic in both immunocompetent individuals and HIV-infected patients. However, patients with HIV are at risk for developing acute toxoplasmosis due to reactivation of the organism if their CD4+ T-cell count decreases below 100 cells/μL or if this level decreases below 200 cells/μL in the presence of concomitant opportunistic infection or malignancy.1,2 Reactivation of latent T. gondii infection in patients with AIDS typically manifests as cerebral toxoplasmosis,3 which can be lifethreatening if not diagnosed and treated expeditiously. This article discusses the epidemiology, pathogenesis, diagnosis, and management of cerebral toxoplasmosis in adult patients with HIV infection.