Toxoplasma Encephalitis in Patients Infected with HIV & AIDS Yunilda Andriyani1, Agnes Kurniawan 2, Ika Puspa Sari 2, Retno Wahyuningsih 2, Ryan Halleyantoro3 1 Department of Parasitology, Faculty of Medicine, University of Sumatera Utara, 2 Department of Parasitology, Faculty of Medicine, University of Indonesia 3 Department of Parasitology, Faculty Medicine, University Diponegoro

INTRODUCTION Toxoplasma gondii : obligate intracellular protozoa. One third of world’s population is infected by T.gondii. Seropositive in Jakarta 70%. Asymptomatic in immunocompetent, life-threatening in immunocompromised.

......Introduction TE is an inflammation in the CNS that occurs due to the reactivation of the latent infection T. gondii. Estimated 10-50% of AIDS who suffer toxoplasmosis will continue on to be TE depends on number cases.

......Introduction Diagnosis based only on the assumptions of clinical symptoms, radiology images & response to treatment. Often, images are very similar to abnormalities in the brain, making it difficult to diagnose. Lumbar puncture rarely carried out with TE  assumed the infection occurs in the brain and not related to CSF.

......Introduction Because of the scarcity of studies using CSF for the diagnosis of TE and to determine whether anti-Toxoplasma IgG levels in the CSF are significant in the diagnosis of TE, then research was conducted on HIV and AIDS patients with suspected meningitis.

84 CSF from AIDS patients with meningitis Methods 84 CSF from AIDS patients with meningitis Adequate volume Required data from medical record 50 CSF PCR IgG Anti-Toxoplasma

CHARACTERISTIC OF RESEARCH SUBJECTS Results   n (%) Median CD4 (cells / mm 3) CD4 (cells / mm 3) min-max Gender Male Female 45 (90) 5 (10) 40 8 1-198 3-153 Age 20-30 31-45 > 45 10 (20) 38 (76) 2 (4) 24.5 43 100.5 5-197 7-194 TABLE I CHARACTERISTIC OF RESEARCH SUBJECTS

RISK FACTORS FOR HIV AND AIDS ......Results Risk Factor n (%) Sexual (Heterosexual / Homosexual) 11 (22%) IDU 16 (32%) Blood transfusion Perinatal transmission Other 8 (16%) Not known 14 (28%) TABLE II RISK FACTORS FOR HIV AND AIDS

ANTI-TOXOPLASMA IgG ON RADIOLOGICAL INSPECTION RESULTS   Anti-Toxoplasma IgG Total Positive Negative High (> 150 IU) Low (≥11-150 IU) <11 IU Radiology TE 2 7 16 Non-TE 3 10 17 30 TABLE III ANTI-TOXOPLASMA IgG ON RADIOLOGICAL INSPECTION RESULTS

Toxoplasmosis Radiology ......Results   Toxoplasmosis Radiology Total Positive Negative IgG ≥11 IU 9 13 22 7 17 24 16 30 46 Sensitivity : 56% Specificity : 57% PPV : 41% NPV : 71% TABLE IV TABLE 2X2 ANTI-TOXOPLASMA IgG DIAGNOSTIC TEST AGAINTS RADIOLOGY RESULTS

TABLE 2X2 DIAGNOSTIC TEST OF ANTI-TOXOPLASMA IgG AGAINTS PCR ......Results   PCR Total Positive Negative IgG ≥11 IU 6 18 24 4 22 26 10 40 50 Sensitivity : 60% Specificity : 55% PPV : 25% NPV : 84% TABLE V TABLE 2X2 DIAGNOSTIC TEST OF ANTI-TOXOPLASMA IgG AGAINTS PCR

Conclusions The NPV was quite good (>70%), this test can tell clinicians that >70% accuracy if a person is not suffering from TE. Clinicians should consider the possibility of TE in AIDS patients with meningitis  worsens with appropriate therapy. This study showed that AIDS patients that have been suspected as meningitis, positive for TE (20%).

......Conclusions Therefore, we need accurate diagnostic tools for TE, not only based on assumption of clinical signs and radiology results.

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