Toxoplasmosis cerebral como enfermedad oportunista en pacientes con VIH/SIDA en el Hospital Teodoro Maldonado Carbo de Guayaquil.

Abstract

Cerebral toxoplasmosis or neurotoxoplasmosis (NT) is one of the most frequent opportunistic infections in HIV-positive patients. This pathology occurs in about 10% of untreated AIDS patients. The location of the infection, caused by the parasite Toxoplasma gondii, indicates severe immunodeficiency, with CD4 + T lymphocytes less than 200 cells / mm3, and when untreated, can lead to the death of the patient. Objectives: To determine the prevalence of NT in patients with HIV who were admitted to the Teodoro Maldonado Carbo Hospital (HTMC) in Guayaquil during the years 2012 -2016. Materials and Methods: The sample consisted of 118 HIV / AIDS patients admitted to Toxoplasmosis at the Department of Infectious Diseases from January 2012 to December 2016. A review of the clinical records of the database obtained from the AS400 system of the HTMC with the CIE10 nomenclator (B20-B582). Results: 393 HIV / AIDS patients were found, of whom 118 (30%) had NT. eighty patients who met the inclusion and exclusion criteria defined in the study were admitted. The majority belonged to the masculine gender (68; 85%). The predominant age group was between 29-39 years old (43; 54%). The most prominent neurological symptom was headache (65; 81%), followed by altered level of consciousness (34; 43%). The most commonly used diagnostic imaging method was tomography (58; 73%). About 33% (26) patients had a high viral load, whereas in the CD4 + T lymphocyte count 79% (63) of the sample had values below 200 cells / mm3. The treatment of choice was the combination of the drugs Trimethoprim -sulfamethoxazole, clindamycin and macrolide (63; 79%). In relation to the patient´s discharge conditions (56; 70%) their hospitalization was terminated. Conclusion: Due to the high prevalence of neurotoxoplasmosis, it is important to bear in mind that any HIV + patient who arrives at an emergency with neurological symptoms such as headache and alterations in the level of consciousness deserves to rule out NT as an opportunistic disease.