Cerebral Toxoplasmosis in RSCM Hospital Jakarta

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Cerebral Toxoplasmosis in RSCM Hospital Jakarta

• Darma Imran
• Herlyani Khosama, Nurhayana Lubis, Widi Widowati,
  Alifa Dimayanti, Jofizal Jannis

Department of Neurology RSCM Hospital -
Indonesia University
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Pokdisus AIDS FKUI
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Department of Neurology RSCM Hospital -
Indonesia University
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AIDS related CNS Opportunistic Infectionin 203
Cases at RSCM Hospital Jan 2004 March 2006
Department of Neurology RSCM Hospital -
Indonesia University
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Choosing between Toxo TB Bacterial Absces

• Empiric Anti Toxoplasmic
• No history of toxo prophylaxis
• Empiric Anti TB drug
• CD4 gt 200
• Thorax photo Miliar TB
• Empiric Antibiotic for Bacterial Brain Absces
• Neuroimaging study compatible with bacterial
  brain absces

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Aim

• To review the clinical manifestations and
  treatment response of Suspected Cases of Cerebral
  Toxoplasmosis

Department of Neurology RSCM Hospital -
Indonesia University
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Methods

• Retrospective data from January 2004 to January
  2007
• 125 Suspected cases of cerebral toxoplasmosis
• Who received empiric anti-toxoplasmic treatment

Department of Neurology RSCM Hospital -
Indonesia University
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300 cases of AIDS Related Intracranial
Complications
175 other cases
125 Suspected Cases of Cerebral Toxo
Received Empiric Treatment
36 No Response (no clinical improvement)
89 Response (Clinical Improvement)
Department of Neurology RSCM Hospital -
Indonesia University
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Neuroimaging Studies
Single lesion 20 Multiple lesions
80 Subcortical lesions 61

• Contrast examination
• Without contrast 9
• Enhancement 78

Department of Neurology RSCM Hospital -
Indonesia University
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Empiric anti Toxoplasmic Treatment

• 2004
• Pyrimethamine-sulfadoxine bid po
• Drug allergy 34.2
• Clindamycin 600 mg qd po
• 2005 - present
• Pyrimethamine 200 mg load ? 75 mg/d
• Clindamycin 600 mg qd po

Department of Neurology RSCM Hospital -
Indonesia University
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Patients Characteristics
Department of Neurology RSCM Hospital -
Indonesia University
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Clinical Manifestations
GCS Glasgow Coma Scale
Department of Neurology RSCM Hospital -
Indonesia University
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Outcome

• Respon to anti-toxoplasmic treatment
• Clinical improvement 89 (71)
• No response 36 (29)
• Clinical response in 7 days 65 (73)
• Mortality rate 31

Department of Neurology RSCM Hospital -
Indonesia University
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Outcome
Department of Neurology RSCM Hospital -
Indonesia University
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Conclusion

• Clinical response to anti-toxoplasmic treatment
  71
• Glasgow coma scale below 12 on admission have
  poor outcome
• Patients with pulmonary tuberculosis tended to
  have poor outcome.

Department of Neurology RSCM Hospital -
Indonesia University
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Thank you
darma_imran_at_cbn.net.id
Department of Neurology RSCM Hospital
University of Indonesia