In our HIV patients we see more more cryptococcal meningitis than CNS toxoplasmosis. Crypto is typically not going to have any significant radiologic abnormality unlike toxo in which imaging plays a large role in diagnosis. So I'm guessing, being a radiologist, you've got a sampling bias that favors toxo.
PO amphotericin B would be a huge boon in treating these patients and shortening hospital stays. Outpatient Ampho B is not a good option in most cases.
Just in case it's not clear I am by no means claiming domain expertise, merely stating that what I was taught and my understanding was similar to the initial comment I replied to hence the caveats and soft language. My statement should not be read as contradicting an ID expert or claiming that the author of the article is incorrect.
> In our HIV patients we see more more cryptococcal meningitis than CNS toxoplasmosis. Crypto is typically not going to have any significant radiologic abnormality unlike toxo in which imaging plays a large role in diagnosis. So I'm guessing, being a radiologist, you've got a sampling bias that favors toxo.
Agree crypto is much more subtle on imaging than either HIV encephalitis or toxo, the most common finding we see is dilated PVS which is nonspecific (particularly without priors). I only mentioned my anecdotal experience as it corresponds with what's taught to us but I agree it's highly susceptible to bias and I don't consider it evidence.
For example on StatDx (UpToDate for radiologists):
>[Cryptococcus is the] most common fungal infection in AIDS patients
>3rd most common [CNS] infection seen in AIDS patients (HIV > toxoplasmosis > Cryptococcus)
This could very well be out of date/incorrect, they don't give in-text citations like UpToDate so I'm not sure where these specific statements are coming from.
Do you have a reference handy? If so I can submit it as feedback on the article to get it updated/reviewed.
Honestly there is conflicting information about which is more prevalent (toxo or crypto). From what I've found the sources that site toxoplasmosis as most common are older, and the ones reporting cryptococcal meningitis as more common are more recent. I suppose the incidence may have shifted since the 90s. I don't really know.
Anecdotally I see more crypto (private practice ID in southeast US).
Interesting. Probably did shift then, it would fit the pattern of epidemiological changes taking a while to percolate to radiology and as it's far more likely we miss crypto on MRI than toxo we probably wouldn't notice a change in our reporting incidence to make a radiologist question that ranking.
Thanks for taking the time to search and comment. Always appreciate learning from my clinical colleagues + now I can flex a new obscure fact to radiology trainees like a proper academic physician.
PO amphotericin B would be a huge boon in treating these patients and shortening hospital stays. Outpatient Ampho B is not a good option in most cases.