Marco V. Wainstein; Luciano Wolffenbuttel; Demetrius K. Lopes; Helena E. González; Liane Golbspan; Lisiane Ferreira; Eduardo Sprinz; Matias Kronfeld; Maria I. Edelweiss
RESUMO
A encefalite por Toxoplasma gondii (ET) é a principal causa de massa no sistema nervoso central (SNC) em pacientes com a síndrome da imunodeficiência adquirida (SIDA). Com o objetivo de determinar a prevalência dessa afecção e da presença de anticorpos específicos no soro e no líquor, bem como a sensibilidade (S) e a especificidade (E) da tomografia computadorizada (TC), dos achados clínicos e dos testes específicos foram revisados todos os prontuários de 516 pacientes com SIDA, internados no HCPA entre maio/85 e dezembro/91. A prevalência através de TC foi de 13% (diagnóstico presuntivo). A pesquisa de anticorpos específicos para toxoplasmose por imunofluorescência indireta no sangue (SS) foi positiva em 65% e no líquor (SL) em 49% dos pacientes em que foi realizada. Necrópsias de 125 pacientes foram revisadas encontrando-se uma prevalência de ET em 27 (22%) casos, em que o diagnóstico foi considerado definitivo. A sensibilidade da TC foi de 65% e a especificidade de 82%. A SS apresentou S de 95% e E de 30%, enquanto a SL apresentou uma S de 77% e E de 56%. Os seguintes achados clínicos foram pesquisados: febre (S=92%; E=56%); sinais neurológicos focais (S=59%; E=82%) e cefaléia (S=41 %; E=69%). Concluímos que é alta a prevalência da ET na SIDA e que a TC e a pesquisa de anticorpos específicos no soro e no líquor, devido à alta especificidade da primeira e a alta sensibilidade da segunda, constituem-se em métodos adequados para o diagnóstico da ET, sendo discutível a necessidade de realizar biópsia cerebral nesses casos.
Palavras-chave: SIDA. Encefalite por Toxoplasma gondii. Prevalência.
ABSTRACT
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 Clinicas de Porto Alegre between May/85 and December/91 (516 cases) had their files revised to determinate TE prevalence, serology, sensivity 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 sensivity and 82% of specificity. Sensivity and specificity of serology on blood was respectiveiy 95% and 30%, while the cerebrospinal fluid (CSF) serology had 77% of sensivity and 56% of specificity. The following clinical findings were considered: fever (sensivity = 92%; specificity = 56%), neurological focal signs (sensivity = 59% ; specificity =82%) and headache (sensivity = 41 %; specificity = 69%). We conclude that, based on the high serology sensivity and high CT scan specificity, they constitute an useful approach to make TE diagnosis.
Keywords: Toxoplasmic encephalitis. AIDS. Prevalence.
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Endereço para correspondência:
Dra. Maria I. Edelweiss.
Serviço de Anatomia Patológica/HCPA.
R. Ramiro Barcelos 2350 subsolo
93054-490
Porto Alegre, RS, Brasil.
Recebido para publicação em 30/12/92.
Trabalho realizado na Unidade de Doenças Infecciosas e Serviço de Anatomia Patológica do Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS.
Auxílio: CNPq
