Toxoplasma encephalitis and AIDS in a patient with seizure and altered mental status:A case report

INTRODUCTIONIncreasing incidences of neurological complications are being encountered with the increase in the incidence of human immunodeficiency virus （HIV）. These can be due to the direct involvement of the central nervous system （CNS） by the virus or due to other opportunistic infections.

Effectiveness of non-pyrimethamine-based regimens for toxoplasma encephalitis:A systematic and meta-synthesis study

Objective:To examine the differences in effectiveness and side effects between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis since the availability of pyrimethamine in Indonesia is currently limited due to its withdrawal from the market.Methods:A systematic review and meta-synthesis study that was carried out by following a protocol guided by the Preffered Reporting Items for Systematic Review and Meta-analysis(PRISMA).Effectiveness measures included clinical improvement,mortality,and radiological improvement.We evaluated selected articles narratively because of the limitations of homogeneity.The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool for RCT(ROB 2.0)and cohort studies were assessed using the Risk of Bias In Non-Randomized Studies of Interventions(ROBINS-1)tool.Research quality was assessed using the GradePro software.Results:We included two retrospective cohort studies and one RCT.Narrative outcome assessment in these three studies did not show significant difference in effectiveness between pyrimethamine-based and non-pyrimethamine-based regimens for toxoplasma encephalitis treatment.However,drug side effects were consistently higher in the pyrimethamine-based regimen.Conclusions:This study has a high risk of bias.The quality of the research also has a low recommendation value.However,the results may be considered for application if a standard regimen is not available.

Synergistic sulfonamides plus clindamycin as an alternative therapeutic regimen for HIV-associated Toxoplasma encephalitis: a randomized controlled trial

Background: The preferred therapeutic regimen for Toxoplasma encephalitis (TE) is a combination of pyrimethamine and sulfadiazine, and trimethoprim-sulfamethoxazole (TMP-SMX) plus azithromycin is the widespread alternative therapeutic regimen. The synergistic sulfonamides tablet contains TMP, sulfadiazine, and SMX and hypothetically could be used for TE treatment. This study aimed to compare the efficacy and safety of synergistic sulfonamides plus clindamycin (regimen B) with TMP-SMX plus azithromycin (regimen A) for the treatment of human immunodeficiency virus (HIV) associated TE.Methods: This was an open-labeled, multi-center randomized controlled trial recruited from 11 centers. Each recruited patient was randomly assigned to receive regimen A or regimen B for at least 6 weeks. The overall response was evaluated by assessment of the clinical response of TE-associated clinical features and the radiological response of TE-associated radiological findings. The overall response rate, clinical response rate, radiological response rate, and adverse events were assessed at 2, 6, and 12 weeks. Death events were compared between the two regimens at 6, 12, and 24 weeks.Results: A total of 91 acquired immunodeficiency syndrome (AIDS)/TE patients were included in the final analysis (44 in regimen Avs. 47 in regimen B). The overall response rate, which refers to the combined clinical and radiological response, was 18.2% (8/44) for regimen A and 21.3 % (10/47) for regimen B at week 6. The results of clinical response showed that, in comparison with regimen A, regimen B may perform better with regards to its effect on the relief of clinical manifestations (50.0% [22/44]vs. 70.2% [33/47],P = 0.049). However, no significant differences in radiological response, mortality events, and adverse events were found between the two regimens at week 6.Conclusions: Synergistic sulfonamides plus clindamycin, as a novel treatment regimen, showed no significantly different efficacy and comparable safety in comparison with the TMP-SMX plus azithromycin regimen. In addition, the regimen containing synergistic sulfonamides may exhibit advantages in terms of clinical symptom alleviation.Trial Registration: ChiCTR.org.cn, ChiCTR1900021195.