DISSEMINATED TOXOPLASMOSIS IN AIDS PATIENTS - REPORT OF 16 CASES

Between June 1986 and October 1992, disseminated toxoplasmosis was dia gnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where m ultiple organ involvement was documented in all 13. Three patients wer e diagnosed intra vitam. All 3 survived with appropriate treatment. Cl inical features indicative of disseminated toxoplasmosis were: fever o f unknown origin between 39 degrees and 40 degrees C in 16 cases, clin ical signs suggestive of sepsis or septic shock in 15, with progressio n to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, desorientation or apathy in 13 and lack of a systemi c pneumocystis carinii prophylaxis in all 16. Typical laboratory marke rs were: CD4 cell counts below 100 x 10(6)/1 in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positi ve Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodi es in all 16. Lesions indicative of cerebral toxoplasmosis were visual ized on cranial computerized tomography in only 3/10 evaluated patient s. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described abov e, systemic Toxoplasma gondii infection must be included in the differ ential diagnosis. In these patients, specific and if warranted, invasi ve diagnostic procedures followed by early vigorous therapeutic interv ention should be considered.