Clinical courses and outcomes of cerebral toxoplasmosis in HIV-positive patients in Shiraz, Southern Iran: a retrospective study

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Abstract
Cerebral toxoplasmosis (CTX) occurs as a latent form of Toxoplasma gondii infection, commonly found in human immunodeficiency virus (HIV)-infected individuals. A proper and timely diagnosis of CTX enables effective treatment, reducing complications and mortality. We aimed to investigate the prevalence, clinical course, and in-hospital mortality rate of CTX in HIV-positive patients admitted to the hospitals of Shiraz University of Medical Sciences (SUMS). This retrospective study included 876 HIV-positive patients admitted to Namazi and Shahid Faghihi hospitals of SUMS from 2013 to 2022. After reviewing the medical records, the clinical data of CTX patients were extracted and analyzed. Overall, 4.00% of HIV-positive patients were diagnosed with toxoplasmosis, with CTX occurring in 2.17%. The mean age of CTX patients was 37.95 ± 9.32 years, with 57.89% males and 42.11% females. The prevalence of CTX in HIV-positive women (4.32%) was significantly higher than in HIV-positive men (1.59%) (p = 0.04). In 57.89% of CTX patients, the disease was the first manifestation of HIV infection. Focal neurological deficit (52.63%), decreased level of consciousness (52.63%), headache (47.37%), and fever (42.11%) were the most common clinical manifestations of CTX. Age was inversely correlated with CTX diagnosis in logistic regression analysis (p < 0.001). CTX had a 21.05% in-hospital mortality rate. Physicians should be aware of the clinical course and high mortality rate of CTX in HIV-positive patients. Our findings also highlight the importance of implementing HIV screening programs, particularly for at-risk young adults. Future studies should address the limitations of this study by employing larger and more diverse samples.

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