艾滋病合并弓形虫脑病11例临床分析

Clinical analysis of toxoplasma encephalitis in 11 HIV-infected patients

目的:总结艾滋病合并弓形虫脑病的临床特点,为临床诊治提供帮助。方法:对南京市第二医院感染科自2010年7月至2015年6月收治的11例艾滋病合并弓形虫脑病患者进行回顾性临床分析。结果:11例患者起病症状多样,CD4T淋巴细胞均低于100μl-1,血弓形虫Ig G抗体阳性4例(36.4%),脑脊液检测无特异性改变,头颅MRI平扫及增强提示单发或多发团块状病灶,伴周围水肿,增强后可见不规则环状强化。复方磺胺甲基异噁唑联合阿奇霉素治疗效果较好,急性期治疗结束后加强维持治疗的监测,以防止复发。结论:弓形虫脑病好发于CD4T淋巴细胞低于100μl-1的人群,血弓形虫Ig G抗体阳性率在这个人群中不高,诊断更多依赖于影像学检查;其治疗多首选复方磺胺甲基异噁唑联合阿奇霉素。

Objective： To summarize the clinical characteristics of toxoplasma encephalitis in HIV-infected patients in order to provide reference for clinical diagnosis and treatment. Methods： Clinical data of 11 HIVinfected patients with toxoplasma encephalitis were analyzed from July 2010 to June 2015 in the Second Hospital Affiliated to Southeast University. Results： Symptoms of 11 cases were different. CD4 T lymphocytes levels were lower than 100 μl-1. There were 4 cases（ 4 /11,36. 4%）. No specific changes were found in cerebrospinal fluid.Head MRI scan and the enhanced one showed there were single or multiple mass lesions with surrounding edema,and irregular annule after enhancement. Treatment with sulfamethoxazole complex and azithromycin is effective. After the acute treatment,maintenance treatment should be performed to prevent relapse. Conclusion： Toxoplasmic encephalitis frequently occurs in HIV-infected patients with CD4 T lymphocytes levels below 100 μl-1. Blood toxoplasma Ig G antibody positive rate is not high in these patients. Diagnosis of this disease depends on imaging examination. Treatment with sulfamethoxazole complex and azithromycin is the first choice for these these patients.