Abstract | OBJECTIVES: METHODS: We carried out a retrospective cohort study (2000-2011) on consecutive patients with cerebral toxoplasmosis admitted to the medical intensive care unit (ICU) of 5 hospitals. Functional prognosis was graded at 3 months using the modified Rankin Scale (mRS). RESULTS: We studied 100 patients with a CD4 cell count of 25 (8-62) cells/μL and a Glasgow Coma Scale (GCS) score of 11 (6-14). At follow-up, 51 patients had an mRS score of 0-2 (functional independence), 30 had an mRS score of 3-5 (severe disability), and 19 had an mRS score of 6 (death). Compared with other specific treatments, the use of pyrimethamine- sulfadiazine was associated with improved survival (p = 0.03). Two factors present at ICU admission were independently associated with a poor outcome (mRS score >2) at 3 months: a CD4 cell count <25 cells/μL (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.1-6.7) and a GCS score ≤8 (OR 3.1, 95% CI 1.2-7.7). In patients treated with pyrimethamine- sulfadiazine, the use of adjunctive steroids to treat cerebral edema associated with focal lesions appeared safe but was not associated with better neurologic outcomes. CONCLUSION: Severe forms of cerebral toxoplasmosis in patients with HIV infection are characterized by a good prognosis in approximately 50% of cases. Profound immunodepression and impaired consciousness represent major determinants of outcome. In our study, the benefit of adjunctive steroids to treat cerebral edema could not be demonstrated.
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Authors | Romain Sonneville, Matthieu Schmidt, Jonathan Messika, Ali Ait Hssain, Daniel da Silva, Isabelle F Klein, Lila Bouadma, Michel Wolff, Bruno Mourvillier |
Journal | Neurology
(Neurology)
Vol. 79
Issue 17
Pg. 1762-6
(Oct 23 2012)
ISSN: 1526-632X [Electronic] United States |
PMID | 23054235
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Antiprotozoal Agents
- Steroids
- Sulfadiazine
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Topics |
- Adult
- Antiprotozoal Agents
(administration & dosage)
- Comorbidity
- Disease Progression
- Drug Therapy, Combination
- Female
- Glasgow Coma Scale
- HIV Infections
(drug therapy, epidemiology)
- Humans
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
- Severity of Illness Index
- Steroids
(adverse effects, therapeutic use)
- Sulfadiazine
(administration & dosage)
- Toxoplasmosis, Cerebral
(drug therapy, epidemiology, mortality)
- Treatment Outcome
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