Neurologic manifestations of toxoplasmosis in AIDS

Central nervous system (CNS) toxoplasmosis is the most common cause of cere bral mass lesions in AIDS patients. Toxoplasma gondii is commonly acquired through ingestion of contaminated meats resulting in latent infection. With the onset of immunosuppression, it may preferentially infect the CNS, resu lting in a wide range of clinical presentations. Effective antibiotic thera py is available and capable of producing rapid remission of active infectio n but must be continued throughout life to prevent recurrence. Characterist ic presentations and rapid therapeutic response permit presumptive diagnosi s and initiation of specific antibiotics in many cases; however, appropriat e clinical and radiographic monitoring to detect alternative or mixed patho logies is necessary. Unusual presentations may hinder rapid diagnosis and s hould be considered in AIDS patients with cryptic CNS symptoms. Despite inc reasing attention to primary prophylaxis, the worldwide distribution of thi s parasite, its potential to be the presenting illness in previously uniden tified human immunodeficiency virus-infected individuals, and failures of p rophylaxis are likely to make toxoplasmosis an important continuing source of neurologic morbidity in AIDS.