GAMBARAN PERUBAHAN KLINIS DAN RADIOLOGI PASIEN AIDS DENGAN ENSEFALITIS TOKSOPLASMA PASCA TERAPI EMPIRIS

Introduction: In patients with the acquired immunodeficiency syndrome(AIDS), toxoplasmic encephalitis (TE) is usually a presumptive diagnosisbased on the clinical manifestations, and a focal lesion on neuroradiologic imaging. A responseto specific therapy helps to confirm the diagnosis, but it isunclear how rapid the response in Indonesia. We prospectively studied the courseof patients treated for acute TE and evaluatedclinical and radiologic criteria for this empirical diagnosis. Methods: A clinical neurological assessment and brain MRI with contrast agent were used prospectivelyto evaluate the clinical and radiological outcome of AIDS patients with TE who were treated with oral clindamycin (600mgfour times a day) and pyrimethamine (75mg every day) for twoweeks. Results: Eight-teen of 27 patients (66.7%) responded clinically totherapy, the response include improvement of headache as measured by visual analog scale, mental status, and extremity weakness. Seven-teen of 27 patients (63%) responded radiologically to therapy, the improvement include decreasing in the number and diameter of lesion and also thinning of the lesion wall. The corellation between clinical and radiological response was showed by the kappa value of 0,43. Conclusions: Oral clindamycin and pyrimethamine are effectivetreatment for TE. The improvement of headache, altered mental status and extremity weakness can be used clinically to evaluate the result of therapy. The decrease in the number and diameter of lesion and also thinning of the lesion wall can be used radiologically to evaluate the result of therapy. There was a moderate agrement between clinical and radiological improvement by two weeks of evaluation.