HIV-related toxoplasma encephalitis: a tertiary care experience

Introduction: Toxoplasma encephalitis (TE) is the most commonly found in HIV patients who have no cotrimoxazole prophylaxis, especially when the CD count is <100 / µL. Therapy is often based on a presumptive diagnosis because definitive diagnosis is difficult, and TE can be life threatening. Aim of this study is to provide a characteristic description of TE in HIV patients who admitted at Sanglah Hospital. Methods: This is a retrospective descriptive study of 43 adult patients admitted with diagnosis TE at the Sanglah Hospital, Indonesia between January 1st 2018 to December 31th 2018.  Results: Most patients were male (69.8%), with the predominant age ranged 31-40 years old (39.5%).  Among all patients; 14% on cotrimoxazole prophylaxis, and 23.3% on antiretroviral therapy. The most common clinical manifestation was headache (58.1%). Oral candidiasis was found in 67.4% of patients. CD4 levels <100 cells / µL were found in 62.8% of patients, absolute lymphocytes <500 / µL in 32.6% of patients. Anemia was found in 37.2% of patients. Multiple ring enhancement was the most common feature found on head CT scan, with the profound location was parietal lobe (46.5%). Pyrimethamine + clindamycin is used in 72.1% of cases. The TE mortality rate in HIV patients in this study was 11.6%. Conclusion: TE in HIV patients was more common on male, younger age and who are not receiving appropriate prophylaxis and/or without antiretroviral therapy. Laboratory study predominantly showed severe immunodeficiency. The most patients making a full recovery with pyrimethamine and clindamycin treatment.