Tratamento da neurotoxoplasmose com a associação sulfametoxazoil-trimetoprim relato de 10 casos

Nóbrega, José Paulo Smith

doi:10.1590/S0004-282X1991000300008

Resumos

É crescente a incidência da neurotoxoplasmose em virtude do alastramento da AIDS. Seu tratamento, em geral, mostra bons resultados com a associação sulfadiazina-pirimetamina. Neste estudo são apresentados os resultados obtidos com a associação sulfa-metoxazol-trimetoprim. Conclui-se que ambos os esquemas apresentam resultados superponíveis.

Toxoplasmosis is the most frequent parasitic infection of the CNS in the immunocompromised host. When promptly treated with the sulfadiazine-pyrimethamine combination patients with cerebral toxoplasmosis characteristically respond with clear clinical and CT improvement within 1-2 weeks. We report the results achieved with the combination sulfamethoxazole-trimethoprim, and conclude that both combinations have similar effects in the treatment of CNS toxoplasmosis.

CONTENTS CONTEÚDO

José Paulo Smith Nóbrega

Doutor em Neurologia - Centro de Investigações em Neurologia, Divisão de Clínica Neurológica, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo

RESUMO

É crescente a incidência da neurotoxoplasmose em virtude do alastramento da AIDS. Seu tratamento, em geral, mostra bons resultados com a associação sulfadiazina-pirimetamina. Neste estudo são apresentados os resultados obtidos com a associação sulfa-metoxazol-trimetoprim. Conclui-se que ambos os esquemas apresentam resultados superponíveis.

SUMMARY

Toxoplasmosis is the most frequent parasitic infection of the CNS in the immunocompromised host. When promptly treated with the sulfadiazine-pyrimethamine combination patients with cerebral toxoplasmosis characteristically respond with clear clinical and CT improvement within 1-2 weeks. We report the results achieved with the combination sulfamethoxazole-trimethoprim, and conclude that both combinations have similar effects in the treatment of CNS toxoplasmosis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Dr. José Paulo Smith Nóbrega - Alameda Casa Branca 844 - 01408 São Paulo SP - Brasil.

1. Antunes MC, Mussi MGD. Tratamento da toxoplasmose cerebral. Rev Bras Neurol 1991, 27:13.
2. Brumfitt W, Hamilton-Miller JMT, Kosmidis J. Trimethoprim-sulfamethoxazole: the present position. J Inf Dis 1973, 128(Suppl):778.
3. Carey RM, Kimball AC, Armstrong D, Lieberman PH. Toxoplasmosis: clinical experiences in a cancer hospital. Am J Med 1973, 54:30.
4. Carrazana EJ, Rossitch E Jr, Samuels MA. Cerebral toxoplasmosis in the acquired immune deficiency syndrome. Clin Neurol Neurosurg 1989, 91:291.
5. Cohen SN. Toxoplasmosis in patients receiving immunosuppressive therapy. J Am Med Ass 1970, 211 : 657.
6. Conti DJ, Rubin RH. Infection of the central nervous system in organ transplant recipients. In Patchell RA (ed) : Neurologic Complications of Transplants. Neurologic Clinics, Volume 6. Philadelphia: Saunders, 1988, p 241.
7. Couvreur J, Desmonts G. Acquired and congenital toxoplasmosis. In Harris AA (ed) : Microbial disease. Handbook of Clinical Neurology. Amsterdam: Elsevier, 1988, Vol 8(52), p 351.
8. Feldman HA. Effects of trimethoprim and sulfisoxazole alone and in combination on murine toxoplasmosis. J Inf Dis 1973, 128 (Suppl):774.
9. Glatt AE, Chirgwin K, Landesman SH. Treatment of infections associated with human immunodeficiency virus. N Engl J Med 1988, 318:1439.
10. Gordin FM, Simon GL, Wofsy CB, Mills J. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1984, 100:495.
11. Gossman PL, Remington JS. The effect of trimethoprim and sulfamethoxazole on Toxoplasma gondii in vitro and in vivo. Am J Trop Med Hyg 1979, 28:445.
12. Herbert V. Metabolism of folic acid in man. J Inf Dis 1973, 128(Suppl):601.
13. Hitchings GH. Mechanism of action of trimethoprim-sulfamethoxazole. J Inf Dis 1973, 128(Suppl):433.
14. Jehn U, Fink M, Gundlach P, Schwab WD, Bise K, Deckstein WD, Wilske B. Lethal cardiac and cerebral toxoplasmosis in a patient with acute myeloid leukemia after successful allogeneic bone marrow transplantation. Transplantation 1984, 38:430.
15. Kennedy PGE, Johnson RT. Infections of the Nervous System. London: Butterworths, 1987.
16. Lowenberg B, van Gijn J, Prins E, Polderman AM. Fatal cerebral toxoplasmosis in a bone marrow transplant recipient with leukemia. Transplantation 1983, 35:30.
17. Luft BJ, Naot Y, Araujo FG, Stinson EB, Remington JS. Primary and reactivated toxoplasma infection in patients with cardiac transplants: clinical spectrum and problems in diagnosis in a defined population. Ann Intern Med 1983, 99:27.
18. Luft BJ, Remington JS. Toxoplasmic encephalitis. J Inf Dis 1988, 157:1.
19. Navia BA, Petito CK, Gold JWM, Cho E, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19:224.
20. Nóbrega JPS. Tratamento da neurotoxoplasmose. In Nitrini R (ed) : Condutas em Neurologia 1991. São Paulo: Clínica Neurológica HC/FMTJSP, 1991, p 62.
21. Patchell RA (ed). Neurologic Complications of Transplants. Neurologic Clinics, Volume 6. Philadelphia : Saunders, 1988.
22. Pons VG, Jacobs RA, Hollander H. Nonviral infections of the central nervous system in patients with acquired immunodeficiency syndrome. In Rosenblum ML, Levy RM, Bredesen DE (eds) : AIDS and the Nervous System. New York: Raven Press, 1988, p 263.
23. Price RW, Navia BA. Infections in AIDS and in other immunosupressed patients. In Kennedy PGE, Johnson RT (eds) : Infections of the Nervous System. London: Butter-worths, 1987, p 248.
24. Puccioni M, Favoreto AC, Andre C, Peixoto CA, Novis SAP. Síndrome de imunodeficiência adquirida: análise das complicações neurológicas em 44 casos. Arq Neuro-Psiquiat (São Paulo) 1989, 47:385.
25. Puccioni-Sohler M, Correa RB, Perez MA, Schechter M, Ramos C Filho, Novis SAP. Complicações neurológicas da síndrome de imunodeficiência adquirida: experiência do HUCFF-UFRJ. Arq Neuro-Psiquiat (São Paulo) 1991, 49:159.
26. Remington JS, McLeod R. Toxoplasmosis. In Braunde A, Davis C, Sierer J (eds): Infectious Diseases and Medical Microbiol. Ed 2. Philadelphia : Saunders, 1986, p 1521
27. Reynolds ES, Walls KW, Pfeiffer RI. Generalized toxoplasmosis following renal transplantation : report of a case. Ann Intern Med 1966, 118:401.
28. Rosenblum ML, Levy RM, Bredesen DE (eds). AIDS and the Nervous System. New York : Raven Press, 1988.
29. Ruskin J. Remington JS. Toxoplasmosis in the compromised host. Ann Intern Med 1976, 84:193.
30. Thiermann E, Apt W, Atias A, Lorca M, Olguin J. A comparative study of some combined treatment regimens in acute toxoplasmosis in mice. Am J Trop Med Hyg 1978. 27:747.

Tratamento da neurotoxoplasmose com a associação sulfametoxazoil-trimetoprim relato de 10 casos

Treatment of toxoplasmosis of the central nervous system with the combination sulfamethoxazole-trimethoprim: report of 10 cases

Datas de Publicação

Publicação nesta coleção
22 Fev 2011
Data do Fascículo
Set 1991

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Antunes MC, Mussi MGD. Tratamento da toxoplasmose cerebral. Rev Bras Neurol 1991, 27:13.

[2] 2. Brumfitt W, Hamilton-Miller JMT, Kosmidis J. Trimethoprim-sulfamethoxazole: the present position. J Inf Dis 1973, 128(Suppl):778.

[3] 3. Carey RM, Kimball AC, Armstrong D, Lieberman PH. Toxoplasmosis: clinical experiences in a cancer hospital. Am J Med 1973, 54:30.

[4] 4. Carrazana EJ, Rossitch E Jr, Samuels MA. Cerebral toxoplasmosis in the acquired immune deficiency syndrome. Clin Neurol Neurosurg 1989, 91:291.

[5] 5. Cohen SN. Toxoplasmosis in patients receiving immunosuppressive therapy. J Am Med Ass 1970, 211 : 657.

[6] 6. Conti DJ, Rubin RH. Infection of the central nervous system in organ transplant recipients. In Patchell RA (ed) : Neurologic Complications of Transplants. Neurologic Clinics, Volume 6. Philadelphia: Saunders, 1988, p 241.

[7] 7. Couvreur J, Desmonts G. Acquired and congenital toxoplasmosis. In Harris AA (ed) : Microbial disease. Handbook of Clinical Neurology. Amsterdam: Elsevier, 1988, Vol 8(52), p 351.

[8] 8. Feldman HA. Effects of trimethoprim and sulfisoxazole alone and in combination on murine toxoplasmosis. J Inf Dis 1973, 128 (Suppl):774.

[9] 9. Glatt AE, Chirgwin K, Landesman SH. Treatment of infections associated with human immunodeficiency virus. N Engl J Med 1988, 318:1439.

[10] 10. Gordin FM, Simon GL, Wofsy CB, Mills J. Adverse reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome. Ann Intern Med 1984, 100:495.

[11] 11. Gossman PL, Remington JS. The effect of trimethoprim and sulfamethoxazole on Toxoplasma gondii in vitro and in vivo. Am J Trop Med Hyg 1979, 28:445.

[12] 12. Herbert V. Metabolism of folic acid in man. J Inf Dis 1973, 128(Suppl):601.

[13] 13. Hitchings GH. Mechanism of action of trimethoprim-sulfamethoxazole. J Inf Dis 1973, 128(Suppl):433.

[14] 14. Jehn U, Fink M, Gundlach P, Schwab WD, Bise K, Deckstein WD, Wilske B. Lethal cardiac and cerebral toxoplasmosis in a patient with acute myeloid leukemia after successful allogeneic bone marrow transplantation. Transplantation 1984, 38:430.

[15] 15. Kennedy PGE, Johnson RT. Infections of the Nervous System. London: Butterworths, 1987.

[16] 16. Lowenberg B, van Gijn J, Prins E, Polderman AM. Fatal cerebral toxoplasmosis in a bone marrow transplant recipient with leukemia. Transplantation 1983, 35:30.

[17] 17. Luft BJ, Naot Y, Araujo FG, Stinson EB, Remington JS. Primary and reactivated toxoplasma infection in patients with cardiac transplants: clinical spectrum and problems in diagnosis in a defined population. Ann Intern Med 1983, 99:27.

[18] 18. Luft BJ, Remington JS. Toxoplasmic encephalitis. J Inf Dis 1988, 157:1.

[19] 19. Navia BA, Petito CK, Gold JWM, Cho E, Jordan BD, Price RW. Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome: clinical and neuropathological findings in 27 patients. Ann Neurol 1986, 19:224.

[20] 20. Nóbrega JPS. Tratamento da neurotoxoplasmose. In Nitrini R (ed) : Condutas em Neurologia 1991. São Paulo: Clínica Neurológica HC/FMTJSP, 1991, p 62.

[21] 21. Patchell RA (ed). Neurologic Complications of Transplants. Neurologic Clinics, Volume 6. Philadelphia : Saunders, 1988.

[22] 22. Pons VG, Jacobs RA, Hollander H. Nonviral infections of the central nervous system in patients with acquired immunodeficiency syndrome. In Rosenblum ML, Levy RM, Bredesen DE (eds) : AIDS and the Nervous System. New York: Raven Press, 1988, p 263.

[23] 23. Price RW, Navia BA. Infections in AIDS and in other immunosupressed patients. In Kennedy PGE, Johnson RT (eds) : Infections of the Nervous System. London: Butter-worths, 1987, p 248.

[24] 24. Puccioni M, Favoreto AC, Andre C, Peixoto CA, Novis SAP. Síndrome de imunodeficiência adquirida: análise das complicações neurológicas em 44 casos. Arq Neuro-Psiquiat (São Paulo) 1989, 47:385.

[25] 25. Puccioni-Sohler M, Correa RB, Perez MA, Schechter M, Ramos C Filho, Novis SAP. Complicações neurológicas da síndrome de imunodeficiência adquirida: experiência do HUCFF-UFRJ. Arq Neuro-Psiquiat (São Paulo) 1991, 49:159.

[26] 26. Remington JS, McLeod R. Toxoplasmosis. In Braunde A, Davis C, Sierer J (eds): Infectious Diseases and Medical Microbiol. Ed 2. Philadelphia : Saunders, 1986, p 1521

[27] 27. Reynolds ES, Walls KW, Pfeiffer RI. Generalized toxoplasmosis following renal transplantation : report of a case. Ann Intern Med 1966, 118:401.

[28] 28. Rosenblum ML, Levy RM, Bredesen DE (eds). AIDS and the Nervous System. New York : Raven Press, 1988.

[29] 29. Ruskin J. Remington JS. Toxoplasmosis in the compromised host. Ann Intern Med 1976, 84:193.

[30] 30. Thiermann E, Apt W, Atias A, Lorca M, Olguin J. A comparative study of some combined treatment regimens in acute toxoplasmosis in mice. Am J Trop Med Hyg 1978. 27:747.