Encephalitis toxoplasmic

Of 42 adult HIV-positive patients with confirmed or presumed acute toxoplasmic encephalitis who received azithromycin 900, 1200, or 1500 mg/day plus pyrimethamine, 28 responded to therapy during the induction period (5). Six patients withdrew during the induction period because of reversible toxic effects (three with raised liver... 

Jacobson JM, Hafner R, Remington J, Farthing C, Holden-Wiltse J, Bosler EM, Harris C, Jayaweera DT, Roque C, Luft BJ ACTG 156 Study Team. Dose-escalation, phase I/II study of azithromycin and pyrimethamine for the treatment of toxoplasmic encephalitis in AIDS. AIDS 2001 15(5) 583-9. 

Caumes E, Boequet H, Guermonprez G, Rogeaux O, Bricaire F, Katlama C, Gentilini M. Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimetha-mine/clindamycin in patients with AIDS and toxoplasmic encephalitis. Clin Infect Dis 1995 21(3) 656-8. 

Azithromycin is efficacious in animal models of toxoplasmic encephalitis. In a Phase I/II dose-escalation stndy of pyrimethamine (50 mg/day) plus azithromycin (900,1200, or 1500 mg/day) for induction and maintenance treatment in 30 patients with AIDS and definite or snspected Toxoplasma encephalitis, the overall response rate was 67% after 6 weeks of induction therapy (1). However, maintenance therapy for 24 weeks with this combination was associated with a high relapse rate (47%) only six patients snccessfully completed induction and maintenance therapy. Adverse events were common (particn-larly in those taking azithromycin 1500 mg) and inclnded hepatotoxicity, bone marrow suppression, ototoxicity, and gastrointestinal disturbances, which led 20% of patients to withdraw. All adverse events resolved on withdrawal. 

Schurmann D, Bergmann F, Albrecht H, Padberg J, Grunewald T, Behnsch M, Grobusch M, Vallee M, Wunsche T, Ruf B, Suttorp N. Twice-weekly pyrimeth-amine-sulfadoxine effectively prevents Pneumocystis carinii pneumonia relapse and toxoplasmic encephalitis in patients with AIDS. J Infect 2001 42(1) 8-15. 

Ribera E, Fernandez-Sola A, Juste C, Rovira A, Romero FJ, Armadans-Gil L, Ruiz I, Ocana I, Pahissa A. Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients. Clin Infect Dis 1999 29(6) 1461-6. 

Increased activities of alanine transaminase and aspartate transaminase to over five times the upper limit of the reference range were reported in a randomized trial of sulfadiazine in toxoplasmic encephalitis (99). 

OsterS, Hutchison F, McCabe R. Resolution ofacute renal failure in toxoplasmic encephalitis despite continuance of sulfadiazine. Reviews of infectious diseases. 1990 Jul-Aug 12(4) 618-20. 

Katlama C, Wit S, O Doherty E, et al. Pyrimethamine-cUndamycin vs pyrimethamine-sulfadiazine as acute and long-term therapy for toxoplasmic encephalitis in patients with AIDS. Clin Infect Dis 1996 22 268-275. 

FIGURE 3.20 HIV-infected patient with toxoplasmic encephalitis. Immunoperoxidase staining highlights cyst forms and scattered tachyzoites. (DAB substrate with hematoxylin counterstain x400.)... 

Suzuki Y, Yang Q, Yang S, Nguuyen N, Lim S, Leisenfeld O, Kojima T, Remington J IL-4 is protective against development of toxoplasmic encephalitis. J Immunol 1996 157 2564-2569. 

Opravil M, Joos B, Liithy R. Levels of dapsone and pyrimethamine in serum during once-weekly dosing for prophyl s of Pneumocystis carinii pneumonia and toxoplasmic encephalitis. Antimicrob Agents Chemother ( 994) 38,1197-9. 

Drug-drug interactions Dapsone Relapse of toxoplasmic encephalitis in an HIV-infected patient was attributed to a possible interaction between dapsone and minocycline [149 ]. 

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