Abstract

PANTOJA-RUIZ, Camila et al. Toxoplasmosis in the central nervous system: Review of the pathology, diagnostic approach and treatment. Acta Neurol Colomb. [online]. 2021, vol.37, n.1, suppl.1, pp.141-147.  Epub May 25, 2021. ISSN 0120-8748.  https://doi.org/10.22379/24224022346.

Toxoplasmosis is one of the most common infections in humans. Due to the prevalence of coinfection with HIV, it carries a high impact on health systems. Humans can become infected with toxoplasma by consuming undercooked lamb or pork meat that contains tissue cysts, or by consuming water or food contaminated with cat feces. Once present in humans, T. gondii multiplies in enterocytes and spreads through the blood or lymphatic stream, parasitizing muscle cells, the retina, and frequently the Central Nervous System. The most used technique for the detection of IgG or IgM against toxoplasma is the ELISA technique. IgG antibodies can be elevated without having an active infection, so diagnosis with IgM and later with avidity test is essential. Cerebrospinal fluid shows mild pleocytosis and hyperprotein spinal cord. Neuroimaging is highly useful, since lumbar puncture can usually be contraindicated due to lesions that produce a mass effect. Ideally, patients should be evaluated with magnetic resonance imaging, which typically shows eccentric lesions in the basal ganglia with ring enhancement after the application of contrast. Central Nervous System lymphoma should be considered as a differential diagnosis. Treatment is usually started empirically with pyrimethamine, sulfadiazine, and folinic acid, with evaluation of imaging improvement at 10-14 days. If not available, treatment with trimethoprine-sulfamethoxazole is possible. The early initiation of antibiotic treatment is essential for a good prognosis, in 4 months complete neurological recovery is observed in less than 20 % of cases and after 3 years of follow-up in approximately 30 % of patients.

Keywords : toxoplasmosis; toxoplasma gondii; opportunistic infections; HIV; AID (MeSH).

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