DIAGNOSIS OF NEUROTOXOPLASMOSIS: CLINICAL AND RADIOLOGICAL CORRELATION

Abstract

Neurotoxoplasmosis (NTX) is the most frequent and severe neurological manifestation of Toxoplasma gondii infection in immunocompromised individuals, especially HIV-positive patients with CD4+ T lymphocyte counts below 100 cells/mm³ and recipients of hematopoietic stem cell transplantation. This study aimed to analyze the correlation between clinical findings and radiological patterns in the diagnostic consolidation of NTX. This is a narrative literature review conducted in the PubMed database, including articles published in the last five years, in Portuguese and English, that addressed the diagnosis and management of the disease. The results show that the clinical presentation is predominantly subacute, characterized by fever, progressive headache, mental confusion, focal neurological deficits, and epileptic seizures. The diagnosis is mainly clinical-radiological, supported by the presence of positive IgG serology, exclusion of differential diagnoses, and empirical therapeutic response. Magnetic resonance imaging (MRI) demonstrates greater sensitivity compared to computed tomography (CT), with typical findings including multiple lesions with ring enhancement and perilesional vasogenic edema, in addition to the eccentric target sign. Advanced techniques, such as DWI, MRI spectroscopy, and SPECT, increase diagnostic accuracy and aid in differentiation from primary lymphoma of the central nervous system. It is concluded that the integration of clinical, laboratory, and radiological data remains the main pillar for the early and reliable diagnosis of neurotoxoplasmosis, allowing for timely therapeutic intervention and reduced morbidity and mortality.