A SPECTRUM IN THE PATHOLOGY OF TOXOPLASMOSIS IN PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

We describe a variety of toxoplasmic lesions in seven patients with th e acquired immunodeficiency syndrome. The first patient had multiple s mall-intestinal ulcers associated with Toxoplasma tachyzoites and high antibody titers; he died of disseminated histoplasmosis. The second p atient, who died of tuberculosis, also had an inactive chronic Toxopla sma infection, with tissue cysts in the brain that were associated wit h glial nodules. A third patient died of Toxoplasma encephalitis, mani fested by multiple foci of necrosis associated with Toxoplasma tachyzo ites, cysts, and hypertrophic arteritis. A fourth patient had been tre ated for toxoplasmic encephalitis with co-trimoxozol (trimethoprim-sul famethoxazole combination) for 3 to 4 days and showed degenerating tac hyzoites associated with necrotic areas. A fifth patient, treated for toxoplasmic encephalitis with co-trimoxazol for 14 days, had necrotic lesions associated with Toxoplasma antigen and a few cysts. A sixth pa tient with encephalitis and Toxoplasma tachyzoites and young cysts in the biopsy showed healed brain lesions after 22 days of treatment. A s eventh patient, diagnosed radiologically and serologically with Toxopl asma encephalitis, was treated for 7 months; his ring-enhancing lesion s subsided, and he died of a central nervous system lymphoma. Toxoplas ma could not be isolated from the brain, although toxoplasmic DNA was detected in the brain and heart by polymerase chain reaction. The path ogenesis of the range of these lesions, their diagnosis, and the possi bility of terminating Toxoplasma infection by prolonged chemotherapy a re discussed.