1. 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

2. 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.

3. ......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.

4. ......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.

5. ......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.

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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%).

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

14. THANK YOU