Toxoplasmose cerebral em pessoas que vivem com HIV/aids: perfis epidemiológico, clínico, terapêutico e de neuroimagem
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2019-07-23
Autores
Aun, Fernanda Garcia
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Universidade Estadual Paulista (Unesp)
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Introdução: A aids caracteriza-se por comprometimento do sistema nervoso central, cujas células são importantes alvos para o vírus da imunodeficiência humana (HIV). Alterações neurológicas acometem cerca de 40% a 70% das pessoas que vivem com HIV/aids, chegando a 90% ou mais em estudos de necropsia. A toxoplasmose cerebral é a infecção mais comum, acomete cerca de 3% a 40% dos pacientes com aids e é a causa mais comum de lesão expansiva focal. Alguns critérios clínicos e radiológicos são utilizados para definição de seu diagnóstico. Objetivo: avaliar os dados epidemiológicos, clínicos, terapêuticos e as alterações cerebrais tomográficas no diagnóstico presuntivo de toxoplasmose cerebral em indivíduos com aids. Casuística e métodos: foram estudados, retrospectivamente, 28 pacientes com diagnóstico presuntivo de toxoplasmose cerebral, que realizaram exames de imagem a partir da suspeita clínica, atendidos no período de junho de 2012 a dezembro de 2018 e que realizaram tratamento específico para a infecção oportunista. A coleta de dados foi realizada por meio de consulta aos prontuários médicos dos pacientes que apresentaram critérios de inclusão para o estudo. Os exames de imagem foram avaliados com auxílio de médico radiologista do Serviço. As análises foram descritivas com cálculo de médias e desvios padrão para variáveis quantitativas e frequências e percentuais para variáveis categorizadas. Os sintomas pré e pós-tratamento foram comparados pelo teste qui-quadrado. Resultados: a maioria dos pacientes era composta por homens (53,6%), com média de idade de 39,8 anos. Cefaleia foi o principal sintoma (46,4%) e a maioria apresentava lesões múltiplas (82,1%), em núcleos da base e região córtico-subcortical (69,6%). O esquema terapêutico mais utilizado foi associação de sulfametoxazol/trimetoprim (71,5%). A maioria dos pacientes permaneceu com encefalomalácia supratentorial (50,0%) e calcificações residuais (35,0%). Conclusão: a toxoplasmose cerebral ocorreu principalmente em homens brancos, heterossexuais, casados e com baixa escolaridade; as alterações tomográficas foram localizadas na sua maioria em núcleos da base e região córtico-subcortical com efeito de massa e todos que realizaram controle de imagem pós-tratamento permaneceram com alguma sequela tomográfica.
Introduction: AIDS is characterized by impairment of the central nervous system, whose cells are important targets for the human immunodeficiency virus (HIV). Neurological changes affect about 40% to 70% of people living with HIV / AIDS, reaching 90% or more in necropsy studies. Cerebral toxoplasmosis is the most common infection, affecting about 3% to 40% of AIDS patients and is the most common cause of focal expansive lesion. Some clinical and radiological criteria are used to define its diagnosis. Objective: to evaluate epidemiological, clinical, therapeutic and tomographic brain changes in the presumptive diagnosis of cerebral toxoplasmosis in individuals with AIDS. Patients and Methods: 28 patients with a presumptive diagnosis of cerebral toxoplasmosis, who underwent imaging from the clinical suspicion, were studied retrospectively from June 2012 to December 2018 and who underwent specific treatment for the opportunistic infection. The data collection was done by consulting the medical records of the patients who presented inclusion criteria for the study. The imaging exams were evaluated with the assistance of the radiologist of the Service. The analyzes were descriptive with calculation of means and standard deviations for quantitative variables and frequencies and percentages for categorized variables. Pre and post-treatment symptoms were compared by the chi-square test. Results: the majority of the patients were men (53.6%), with a mean age of 39.8 years. Headache was the main symptom (46.4%) and most had multiple lesions (82.1%) in basal and cortico-subcortical regions (69.6%). The most commonly used therapeutic regimen was sulfamethoxazole / trimethoprim (71.5%). The majority of the patients remained with supratentorial encephalomalacia (50.0%) and residual calcifications (35.0%). Conclusion: Cerebral toxoplasmosis occurred mainly in white, heterosexual, married and low education men; the tomographic changes were mostly located in basal and cortical-subcortical nuclei with mass effect, and all who underwent post-treatment imaging control remained with some tomographic sequelae.
Introduction: AIDS is characterized by impairment of the central nervous system, whose cells are important targets for the human immunodeficiency virus (HIV). Neurological changes affect about 40% to 70% of people living with HIV / AIDS, reaching 90% or more in necropsy studies. Cerebral toxoplasmosis is the most common infection, affecting about 3% to 40% of AIDS patients and is the most common cause of focal expansive lesion. Some clinical and radiological criteria are used to define its diagnosis. Objective: to evaluate epidemiological, clinical, therapeutic and tomographic brain changes in the presumptive diagnosis of cerebral toxoplasmosis in individuals with AIDS. Patients and Methods: 28 patients with a presumptive diagnosis of cerebral toxoplasmosis, who underwent imaging from the clinical suspicion, were studied retrospectively from June 2012 to December 2018 and who underwent specific treatment for the opportunistic infection. The data collection was done by consulting the medical records of the patients who presented inclusion criteria for the study. The imaging exams were evaluated with the assistance of the radiologist of the Service. The analyzes were descriptive with calculation of means and standard deviations for quantitative variables and frequencies and percentages for categorized variables. Pre and post-treatment symptoms were compared by the chi-square test. Results: the majority of the patients were men (53.6%), with a mean age of 39.8 years. Headache was the main symptom (46.4%) and most had multiple lesions (82.1%) in basal and cortico-subcortical regions (69.6%). The most commonly used therapeutic regimen was sulfamethoxazole / trimethoprim (71.5%). The majority of the patients remained with supratentorial encephalomalacia (50.0%) and residual calcifications (35.0%). Conclusion: Cerebral toxoplasmosis occurred mainly in white, heterosexual, married and low education men; the tomographic changes were mostly located in basal and cortical-subcortical nuclei with mass effect, and all who underwent post-treatment imaging control remained with some tomographic sequelae.
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aids, toxoplasmose cerebral, tomografia computadorizada, sequela pós tratamento, cerebral toxoplasmosis, computed tomography, sequela post treatment