Central-Nervous-System Toxoplasmosis in Homosexual Men and Parenteral Drug Abusers

Abstract

CNS toxoplasmosis developed in 7 of 269 patients with the acquired immunodeficiency syndrome reported to the New York City [USA] Health Department through July 1982. Focal neurologic abnormalities, mass lesions on computed-tomographic brain scans, lymphocytic cerebrospinal fluid pleocytosis and detectable IgG antibody to Toxoplasma gondii were common, but IgG titers of 1:1024 or more, IgM antibody to T. gondii, and positive open brain biopsies were uncommon. Serologic findings suggested that the disease resulted from recrudescent rather than primary infection. Of 5 patients, 4 improved when treated with sulfonamides and pyrimethamine, but 2 had relapses. An aggressive diagnostic approach and sometimes even empiric therapy are warranted when CNS toxoplasmosis is suspected in a seropositive patient with the acquired immunodeficiency syndrome.