CLINICAL-SIGNIFICANCE OF THE TOXOPLASMA-GONDII CULTURE IN BLOOD AND IN OTHER ORGANIC MEDIA

BACKGROUND: The aim of this study was to determine the value of the To xoplasma gondii culture in blood and in other organic fluids in HIV po sitive and negative patients. METHODS: Retrospective analysis (October 1990-May 1992) was carried out including all patients with positive c ultures for T. gondii admitted to the Hospital Central of Asturias. Th e parasite was identified by monoclonal antibodies against the tachyzo ite membrane. All patients with positive cultures were treated with py rimethamine and sulphadiazine. RESULTS: Three hundred two samples from 256 patients, seropositive and seronegative for HIV, were analyzed. O f the seropositive group 8/45 (18 %) had positive cultures for T. gond ii versus 9/211 (4.3 %) of the seronegative group (p = 0.002). Of the 19 positive samples, 15 were from blood, 3 from bronchoalveolar lavage and one from the vitreous fluid. Four out of 9 patients (44 %) with A IDS and encephalic toxoplasmosis (ET) had blood cultures positive for T. gondii. Another 4 patients with AIDS presented toxoplasmenia withou t visceral involvement. Of the 9 HIV seronegative patients (3 immunode pressed patients), 4 had pulmonary toxoplasmosis, one ocular toxoplasm osis, and other clinical forms of toxoplasmosis were seen in the remai ning 4. All the patients evolved to cure except 2 cases coinfected by cytomegalovirus who died. CONCLUSIONS: The identification of Toxoplasm a gondii may be performed by blood cultures in half of the patients wi th AIDS and encephalic toxoplasmosis and in an undetermined percentage of the other clinical forms both in immunocompetent and immunodepress ed subjects. In addition, toxoplasmemia has been registered in AIDS pa tients preceeding any other organic seating of the parasite. Early ant itoxoplasma therapy may, therefore, be effective.