Seroprevalence of anti-toxoplasma IgG antibody in HIV patients with neurological manifestations

Abstract

Neurological complications of HIV disease secondary to opportunistic infections are significantly common. At least one third of patients with advanced HIV disease will present with neurological complications possibly secondary to opportunistic Infections such as Cerebral Toxoplasmosis. In patients with the acquired immunodeficiency syndrome (AIDS), toxoplasmic encephalitis (TE) is usually a presumptive diagnosis based on positive anti-toxoplasma Antibody (Ab), clinical manifestations and characteristic neuroradiological abnormalities. One hundred and nineteen patients were recruited in to this study; all of the participants were sero-positive for HIV, with a history suggestive of opportunistic infections of CNS or obvious neurological symptoms and signs such as headache and confusional state, meningeal irritation, cranial nerve deficits, adult onset seizures and hemiplegia. The aim of the study was to determine seroprevalence of anti-toxoplasma IgG Ab in HIV/AIDS patient with neurological manifestations, and to establish a rational means for the clinician facing decision making concerning empiric anti-toxoplasma therapy. The Study was conducted between November 2008 and January 2009 at the University Teaching Hospital, a major teaching hospital in Lusaka, Zambia, that still offers out-patient as well as inpatient health care to a wide spectrum of population. The study looked at male and female HIV positive adults regardless of whether or not they were on treatment with Highly Active Anti-retroviral therapy (HAART), who presented with central nervous system manifestations/ abnormalities. After obtaining informed consent from the participant or next of kin, history was obtained including demographic factors and anti-retroviral therapy state. Clinical examination was conducted for every participant with special emphasis on neurological examination. Blood samples were collected for serology test for Anti-toxoplasma IgG Ab using TOXO Direct Latex which is rapid slide agglutination procedure, developed for the direct detection of Anti-toxoplasma Ab in human serum. v The seroprevalence of toxoplasmosis was 11.8%, total number of specimen tested were 119 with frequency of 105 negative (88.2%) and 14 positive (11.8%). The majority of the patients were males 61(52.6%), the total number of female participants was 55 (47.4%). Most of the patients 94 (79.0%) were HAART naïve/pre-HAART, and 25 (21.0%) were on HAART. Common clinical manifestations of the patients enrolled were headache, neck-ache/stiffness, confusion, convulsion, fever and focal neurological lesions (hemi-plegia & cranial nerve deficit). Seroprevalence of toxoplasma was quite low as compared to other studies though this could be explained by the small sample size. Further investigations were warranted to determine the diagnostic ability of utilizing the toxoplasma Ab test