Category: Clinical Science
At the end of the session, participants will be able to:
- Characterize the clinical and pathological findings of patients with cerebral toxoplasmosis
COI Disclosure:
I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.
Presenter
Maggie Hou is a neuropathology resident from the University of British Columbia. She has a Bachelor of Health Sciences from McMaster University and completed medical school at the University of British Columbia.
1Maggie Hou, 2Kenneth Ong, 2Mostafa Fatehi, 1John Maguire
1Division of Neuropathology, University of British Columbia, Vancouver, BC, Canada
2Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
Target Audience:
Residents
Medical Students
CanMEDS:
Health Advocate
Scholar
Cerebral toxoplasmosis: 25-year retrospective institutional clinical-pathological analysis of neurosurgical biopsies
Abstract
Central nervous system (CNS) toxoplasmosis is a rare opportunistic infection classically associated with advanced HIV/AIDS but increasingly recognized in other immunocompromised populations. Atypical presentations and clinical uncertainty require neurosurgical biopsy. This retrospective case series and clinicopathological analysis included all patients with positive neurosurgical biopsies for Toxoplasma gondii within the Vancouver Coastal Health Authority between January 2000 and September 2025. Twelve patients (mean age 46.7 years; M:F 10:2) were identified. Detailed clinical documentation on eleven out of twelve patients showed that all were immunocompromised with either HIV (n=8) or medication (n=3). Many HIV patients had CD4 depletion (<200 cells/uL n=6, including <50cells/uL n=3), of which three were receiving HAART. Biopsy was primarily indicated for diagnosis (n = 7, including patients without suspicion n=4) or non-response to toxoplasmosis treatment (n = 3). Serum toxoplasmosis testing was negative in three patients (n/N: 3/7, 43%). Concurrent disease was found in six HIV patients (n/N: 6/8, 75%) including lymphoma (n=3), CMV, PML, and cryptococcus infection. Six recovered and survived over two years, four died within two months (HIV-negative n=1, HAART-treated n=1). Toxoplasmosis remains a serious condition with significant morbidity and mortality in immunocompromised patients, despite HAART and empiric toxoplasmosis treatment. In patients with HIV, biopsy was instrumental in identifying concurrent diseases including toxoplasmosis. Toxoplasmosis was also diagnosed in patients with no documented clinical suspicion and negative serology highlighting the key role of biopsy and neuropathologic analysis.