Prevalence of Toxoplasmosis among HIV/AIDS Patients and Correlation of Radiological Investigations with Laboratory Findings

Abstract

Background: Toxoplasma gondii an intracellular protozoan causes toxoplasmosis a worldwide neglected tropical disease, which also causes severe disease in immunocompromised patients. The Toxoplasmosis was known for cerebral involvement more commonly among patients with HIV/AIDS and serious than extra-cerebral toxoplasmosis. For cerebral toxoplasmosis patients the definitive diagnosis is crucial by demonstrating the presence of the tachyzoite form of Toxoplasma gondii directly in the cerebral tissues. This study was undertaken to assess the prevalence of toxoplasmosis among HIV patients and role of radiological investigation in the diagnosis. Materials and Methods: A prospective cross-sectional study was conducted at Department of Microbiology, Government Medical College and Hospital, Nagpur, Maharashtra, India. A total of 362 HIV positive patients attending ART clinic and provides informed consent were included in this study. The relevant investigations of each patient with clinical history were noted. ELISA test was carried out from blood samples to detect anti-toxoplasma IgM and IgG antibodies as per the manufacturer’s instructions. Data was analyzed using SPSS version 21. Results: Out of 362 HIV positive patients, Majority of the male patients were positive for HIV positive than females, 62.43% and 37.57% respectively.  About 99.17% of patients were married and most of them were from urban area (86.46%), Majority of the patients were labourers (39.78%) followed by house wives (20.72%). A total of 23.48% HIV positive patients were co-infected with toxoplasmosis of which 21.55% patients were married and from urban area. Most of the HIV positive patients and co-infected with toxoplasmosis were between the age groups of 25-34 and 35-44 years.  The overall correlation of serological and radiological features was seen in 68.23%. Although radiological investigations were helpful in  providing better localization of toxoplasmosis but less confirmatory than ELISA. So combination of modalities should be used in diagnosis of toxoplasmosis for appropriate management. Both the ELISA and the CT–scan were simultaneously positive in 75 (20.72%)  and negative in 172 (47.51%) cases. Among all HIV-toxoplasma co-infected patients, hyper density was seen in 15.29% patients, hypo density was present in 43.52% patients. Ring enhancement was observed among 29.41% cases. Conclusion: We conclude from this study that the prevalence of toxoplasmosis in HIV positive patients was high (23.48%) and more commonly found between the age groups of 25-34 and 35-44 years. Radiological investigations were helpful in providing better localization of toxoplasmosis but less confirmatory than ELISA.