[The sensitivity and specificity of the clinical, serological and tomographic diagnosis of Toxoplasma gondii encephalitis in the acquired immunodeficiency syndrome (AIDS)]

Toxoplasmic encephalitis (TE) is among the most common neurologic affections and it is the most prevalent cause of intracerebral mass lesions in AIDS patients. All patients with AIDS hospitalized at the Hospital de Clínicas de Porto Alegre between May/85 and December/91 (516 cases) had their files revised to determinate TE prevalence, serology, sensitivity and specificity of the computed tomography (CT) brain scan, clinical findings and serology to make its diagnosis. The prevalence on CT was 13% (presumptive diagnosis). Blood serology and cerebrospinal (CSF) serology to toxoplasma were positive respectively in 65% and 49%. Autopsies of 125 patients were also revised with a prevalence of 22% (definite diagnosis). CT scan had 65% of sensitivity and 82% of specificity. Sensitivity and specificity of serology on blood was respectively 95% and 30%, while the cerebrospinal fluid (CSF) serology had 77% of sensitivity and 56% of specificity. The following clinical findings were considered: fever (sensitivity = 92%; specificity = 56%), neurological focal signs (sensitivity = 59%; specificity = 82%) and headache (sensitivity = 41%; specificity = 69%). We conclude that, based on the high serology sensitivity and high CT scan specificity, they constitute an useful approach to make TE diagnosis.

[Hydroelectrolyte, acid-base, and renal function changes in patients with acquired immunodeficiency syndrome]

BACKGROUND

A variety of metabolic and renal disturbances have been described in patients with Acquired Immunodeficiency Syndrome (AIDS) but their influence on the clinical outcome has not been reported. The present study was undertaken in order to evaluate the prevalence of fluid and electrolyte, acid-base, and renal function disturbances in AIDS patients. The influence of these abnormalities on the clinical outcome was studied as well.

MATERIAL AND METHODS

Following to a previously established protocol, the charts of all patients hospitalized during the first semester of 1989 were reviewed.

RESULTS

The prevalence of hyponatremia was 45% and 80.7% at admission and during hospitalization respectively of 99 patients. Hypokalemia was present in 23.1% of the patients. Metabolic acidosis and renal failure were 20.1% and 28.4% prevalent. The relative risk for mortality in patients with hypokalemia was 4.4. Metabolic acidosis and acute renal failure had relative risks of 12.9 and 21.4.

CONCLUSIONS

There is an elevated prevalence of fluid and electrolyte, acid-base and renal function disturbances in these patients. The presence of hypokalemia, metabolic acidosis, and renal failure are significantly associated with mortality in AIDS.

[The neuropathological findings in the acquired immunodeficiency syndrome (AIDS): a review of 138 cases]

This is an autopsy study performed in a retrospective fashion to determine the incidence of diseases that could affect the central nervous system in AIDS. For this purpose, 138 autopsies of patients with AIDS performed at the "Hospital de Clínicas de Porto Alegre", Brazil, between January/85 and December/90 were studied. All the brains were evaluated macroscopically and microscopically mainly through hematoxylin-eosin staining and if necessary special techniques like PAS, Grocott, Giemsa and Ziehl-Nielsen were done. Results have revealed 29 (21%) cases with cerebral toxoplasmosis; cryptococcosis in 17 (12%); tuberculosis in two (1%) and one case (0.7%) of candidiasis. Besides these inflammatory lesions, 15 (10%) presented vascular lesion; 8 (6%) had gliosis and 7 (5%) cases had suggestive findings of HIV encephalopathy. We can conclude that the CNS is a important target affected by AIDS and that cerebral toxoplasmosis is the principal disease in the CNS in AIDS patients.

Phase II study of teniposide in patients with AIDS-related Kaposi's sarcoma

Antitumour activity of cytotoxic agents, evaluated in patients with AIDS-related Kaposi's sarcoma (KS), is about 30-80%. However, responses are mostly partial and short. Experience with etoposide is similar. Teniposide has a longer elimination half-life and superior antitumour activity compared with etoposide in some experimental models. Thus a phase II trial was done in 25 patients with AIDS-related KS. Teniposide was given by 60-min infusion at 360 mg/m2 every 3 weeks. 10 (40%) showed a partial response, median duration of 9 (6-20) weeks. The main side-effects were leukopenia, thrombocytopenia, nausea and vomiting, alopecia and mucositis.