LIMITED VALUE OF CEREBROSPINAL-FLUID FOR DIRECT-DETECTION OF TOXOPLASMA-GONDII IN TOXOPLASMIC ENCEPHALITIS ASSOCIATED WITH AIDS

The diagnosis of acquired immunodeficiency syndrome-associated toxopla smic encephalitis (TE), a typically focal disease resulting from react ivation of tissue cysts, relies mainly on indirect diagnostic methods. In a prospective study, we investigated the value of detection of Tox oplasma gondii in cerebrospinal fluid (CSF) by using the polymerase ch ain reaction and the mouse inoculation test, Twenty-four patients with 26 episodes of TE, 2 HIV-infected patients with primary acute Toxopla sma infection, and 38 HIV-infected control patients with latent Toxopl asma infection were investigated. Detection of T. gondii in CSF by bot h methods was possible in only 3 of the TE patients (11.5%), the remai ning patients being negative with either of the methods. In contrast, T, gondii DNA was detected in both of the acutely infected patients, i ndicating that in primary acute toxoplasmosis parasites may easily be found in the CSF, whereas in the majority of TE cases in immunocomprom ised patients, T. gondii parasites do not gain access to the CSF drawn by lumbar puncture.