| Abstract | UVOD: Toxoplasma gondii važan je uzročnik bolesti središnjeg živčanog sustava u
uznapredovaloj fazi infekcije HIV-om. U osoba zaraženih HIV-om radi se o reaktiviranoj
infekciji koja se javlja kada je broj CD4+ limfocita T niži od 100 do 150/µL krvi, a specifična
klinička prezentacija bolesti ovisi o lokaciji cista u središnjem živčanom sustavu i upalnom
odgovoru. Cerebralna toksoplazmoza tipično se očituje multiplim prstenastim lezijama s
okolnim edemom na CT snimci mozga.
METODE: Ovaj rad predstavlja prikaz slučaja bolesnika oboljelog od HIV-a koji nije
surađivao u antiretrovirusnom liječenu te je dva puta obolio od cerebralne toksoplazmoze i
HIV encefalopatije. Evaluacija HIV-bolesti učinjena je određivanjem apsolutnog broja CD4+
limfocita T u krvi i viremije HIV 1 RNA u krvi/likvoru. Dijagnoza cerebralne toksoplazmoze
i HIV encefalopatije postavljena je na temelju kliničke slike, seroloških pretraga, analize
cerebrospinalne tekućine i neuroradiološke obrade.
PRIKAZ SLUČAJA: 48-godišnji muškarac zaprima se u OB Karlovac zbog pogoršanja
neurološkog stanja u vidu slabosti lijeve noge i otežanog govora. Heteroanamnestički se
doznaje za prethodno poznatu infekciju HIV-om i prethodno liječenu cerebralnu
toksoplazmozu te se bolesnik premješta u našu Kliniku. Reevaluacija HIV-bolesti učinjena je
odmah po prijemu, apsolutni broj CD4+ limfocita T je iznosio 58/µL krvi, a broj HIV-1 RNA
117 000 kopija//mL plazme. Serološkim pretregama su dokazana IgG protutijela na
Toxoplasma gondii u serumu. U cerebrospinalnoj tekućine je detektirana Toxoplasma gondii
DNA 1000 kopija/mL i HIV-1 RNA 41 000 kopija/mL. Kompjutorizirana tomografija i
magnetna rezonancija mozga otkrivaj u obje hemisfere brojne hiperintezne lezije, različitih
dimezija i oblika koje pokazuju izraženu rubnu prstenastu postkontrastnu imbibiciju s okolnim
edemom. Na temelju rezultata dijagnostičkih pretraga postavljena je sumnja na drugu epizodu
cerebralne toksoplazmoze i HIV encefalopatije. Liječenje cerebralne toksoplazmoze započeto
je sulfadijazinom, primetaminom i leukovorinom, a antiretrovirusno liječenje kombinacijom
dolutegravir/abakavir/lamivudin. U daljnjem tijeku boravka dolazi do poboljšanja neurološkog
stanja, ali je bolesnik ovisan o tuđoj pomoći prilikom izvođenja svih aktivnosti
samozbrinjavanja.
ZAKLJUČAK: Incidencija toksoplazmoze u osoba zaraženih HIV-om ovisi o prevalenciji
toksoplazmoze u populaciji osoba zaraženih HIV-om, o stupnju imunosupresije, ali i o primjeni
antiretrovirusne terapije i profilakse bolesti. Rano otkrivanje infekcije HIV-om, zadržavanje
osobe u skrbi i suradnja u liječenju najvažniji su preduvjet za uspješno antiretrovirusno
liječenje i sprječavanje pojave oportunističkih infekcija. |
| Abstract (english) | INTRODUCTION: Toxoplasma gondii is an important cause of central nervous system disease
in the advanced stage of HIV infection. In persons infected with HIV, it is a reactivated
infection that occurs when the number of CD4+ T lymphocytes is lower than 100 to 150/µL in
the blood. The specific clinical presentation of the disease depends on the location of the cyst
in the central nervous system and the inflammatory response. Cerebral toxoplasmosis typically
manifests multiple ring-enhancing lesions with surrounding edema on a brain CT scan.
METHODS: This paper presents a case report of a patient with HIV who didn’t cooperate with
antiretroviral treatment and suffered from cerebral toxoplasmosis and HIV encephalopathy
twice. The evaluation of HIV disease was done by determining the absolute number of CD4+
T lymphocytes in the blood and HIV 1 RNA viremia in the blood/CSF. The diagnosis of
cerebral toxoplasmosis and HIV encephalopathy was established on the basis of the clinical
presentation, serological tests, CSF analysis and neuroradiological findings.
CASE REPORT: A 48-year-old man is admitted to GH Karlovac due to worsening
neurological condition in the form of left leg weakness and difficulty speaking.
Heterianamnesis revealed a previously known HIV infection and previously treated cerebral
toxoplasmosis, after that the patient was transferred to our Clinic. Re-evaluation of HIVdisease was done immediately after admission, and the absolute number of CD4+ T
lymphocytes was 58/µL in the blood, and the number of HIV-1 RNA was 117,000 copies//mL
of plasma. IgG antibodies to Toxoplasma gondii in the serum were detected by serological
tests. Toxoplasma gondii DNA 1,000 copies/mL and HIV-1 RNA 41,000 copies/mL were
detected in the cerebrospinal fluid. Computed tomography and magnetic resonance imaging of
the brain reveal numerous hyperintense lesions in both hemispheres, of different sizes and
shapes, which show marked marginal annular post-contrast imbibition with surrounding
edema. Based on the results of the diagnostic tests, a second episode of cerebral toxoplasmosis
and HIV encephalopathy was suspected. Treatment of cerebral toxoplasmosis was started with
sulfadiazine, primetamine and leucovorin, and antiretroviral treatment with the combination of
dolutegravir/abacavir/lamivudine. In the further course of the stay, the neurological condition
improved, but the patient was dependent on other people's help while performing all self-care
activities.
CONCLUSION: The incidence of toxoplasmosis in people infected with HIV depends on the
prevalence of toxoplasmosis in the population of people infected with HIV, on the degree of
immunosuppression, but also on the use of antiretroviral therapy and disease prophylaxis. Early
detection of HIV infection, retention of the person in care and cooperation in treatment are the
most important prerequisites for successful antiretroviral treatment and prevention of
opportunistic infections. |
