Abstract
Pulmonary toxoplasmosis is rare, particularly in the era of highly active antiretroviral therapy (HAART). Here, we describe two severe cases in patients not known to be HIV-infected. In both patients, early diagnosis and therapy led to a favourable outcome. Pulmonary toxoplasmosis should be considered in the differential diagnosis in potentially HIV-infected patients with respiratory symptoms.
Keywords: Toxoplasmosis, Pneumocystis Pneumonia, Pyrimethamine, Atovaquone, Pneumocystis Jirovecii
References
- 1.Antiretroviral Therapy Cohort Collaboration Life expectancy of individuals on combination antiretroviral therapy in highincome countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–299. doi: 10.1016/S0140-6736(08)61113-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Egger M., Hirschel B., Francioli P., Sudre P., Wirz M., Flepp M., Rickenbach M., Malinverni R., Vernazza P., Battegay M. Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. Swiss HIV Cohort Study. BMJ. 1997;315:1194–1199. doi: 10.1136/bmj.315.7117.1194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Palella F.J., Jr, Delaney K.M., Moorman A.C., Loveless M.O., Fuhrer J., Satten G.A., Aschman D.J., Holmberg S.D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853–860. doi: 10.1056/NEJM199803263381301. [DOI] [PubMed] [Google Scholar]
- 4.Sabin C.A., Smith C.J., Gumley H., Murphy G., Lampe F.C., Phillips A.N., Prinz B., Youle M., Johnson M.A. Late presenters in the era of highly active antiretroviral therapy: uptake of and responses to antiretroviral therapy. AIDS. 2004;18:2145–2151. doi: 10.1097/00002030-200411050-00006. [DOI] [PubMed] [Google Scholar]
- 5.Battegay M., Fluckiger U., Hirschel B., Furrer H. Late presentation of HIV-infected individuals. Antivir Ther. 2007;12:841–851. [PubMed] [Google Scholar]
- 6.Girardi E., Sabin C.A., Monforte A.D. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46(Suppl1):S3–S8. doi: 10.1097/01.qai.0000286597.57066.2b. [DOI] [PubMed] [Google Scholar]
- 7.Porter S.B., Sande M.A. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med. 1992;327:1643–1648. doi: 10.1056/NEJM199212033272306. [DOI] [PubMed] [Google Scholar]
- 8.Oksenhendler E., Cadranel J., Sarfati C., Katlama C., Datry A., Marche C., Wolf M., Roux P., Derouin F., Clauvel J.P. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome. Am J Med. 1990;88:18N–21N. [PubMed] [Google Scholar]
- 9.Rabaud C., May T., Amiel C., Katlama C., Leport C., Ambroise-Thomas P., Canton P. Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey. Medicine (Baltimore) 1994;73:306–314. doi: 10.1097/00005792-199411000-00004. [DOI] [PubMed] [Google Scholar]
- 10.Eza D.E., Lucas S.B. Fulminant toxoplasmosis causing fatal pneumonitis and myocarditis. HIV Med. 2006;7:415–420. doi: 10.1111/j.1468-1293.2006.00393.x. [DOI] [PubMed] [Google Scholar]
- 11.Signorini L., Gulletta M., Coppini D., Donzelli C., Stellini R., Manca N., Carosi G., Matteelli A. Fatal disseminated toxoplasmosis during primary HIV infection. Curr HIV Res. 2007;5:273–274. doi: 10.2174/157016207780077011. [DOI] [PubMed] [Google Scholar]
- 12.Murray J.F., Felton C.P., Garay S.M., Gottlieb M.S., Hopewell P.C., Stover D.E., Teirstein A.S. Pulmonary complications of the acquired immunodeficiency syndrome. Report of a National Heart, Lung, and Blood Institute workshop. N Engl J Med. 1984;310:1682–1688. doi: 10.1056/NEJM198406213102529. [DOI] [PubMed] [Google Scholar]
- 13.Gandhi S., Lyubsky S., Jimenez-Lucho V. Adult respiratory distress syndrome associated with disseminated toxoplasmosis. Clin Infect Dis. 1994;19:169–171. doi: 10.1093/clinids/19.1.169. [DOI] [PubMed] [Google Scholar]
- 14.Rabaud C., May T., Lucet J.C., Leport C., Ambroise-Thomas P., Canton P. Pulmonary toxoplasmosis in patients infected with human immunodeficiency virus: a French National Survey. Clin Infect Dis. 1996;23:1249–1254. doi: 10.1093/clinids/23.6.1249. [DOI] [PubMed] [Google Scholar]
- 15.Sterne J.A., Hernán M.A., Ledergerber B., Tilling K., Weber R., Sendi P., Rickenbach M., Robins J.M., Egger M., Swiss HIV Cohort Study Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet. 2005;366:378–384. doi: 10.1016/S0140-6736(05)67022-5. [DOI] [PubMed] [Google Scholar]
- 16.Pomeroy C., Filice G.A. Pulmonary toxoplasmosis: a review. Clin Infect Dis. 1992;14:863–870. doi: 10.1093/clinids/14.4.863. [DOI] [PubMed] [Google Scholar]
- 17.Pugin J., Vanhems P., Hirschel B., Chave J.P., Flepp M. Extreme elevations of serum lactic dehydrogenase differentiating pulmonary toxoplasmosis from pneumocystis pneumonia. N Engl J Med. 1992;326:1226. doi: 10.1056/NEJM199204303261816. [DOI] [PubMed] [Google Scholar]
- 18.Belanger F., Derouin F., Grangeot-Keros L., Meyer L. Incidence and risk factors of toxoplasmosis in a cohort of human immunodeficiency virus-infected patients: 1988–1995. HEMOCO and SEROCO Study Groups. Clin Infect Dis. 1999;28:575–581. doi: 10.1086/515147. [DOI] [PubMed] [Google Scholar]
- 19.Lucas S.B., Hounnou A., Peacock C., Beaumel A., Djomand G., N’Gbichi J.M., Yeboue K., Hondé M., Diomande M., Giordano C., Doorly R., Brattegaard K., Kestens L., Smithwick R., Kadio A., Ezani N., Yapi A., De Cock K.M. The mortality and pathology of HIV infection in a west African city. AIDS. 1993;7:1569–1579. doi: 10.1097/00002030-199312000-00005. [DOI] [PubMed] [Google Scholar]
