Abstract
Toxoplasma gondii is known to infect a considerable number of mammalian and avian species and a substantial proportion of the world's human population. The parasite has an impressive ability to disseminate within the host's body and employs various tactics to overcome the highly regulatory blood-brain barrier and reside in the brain. In healthy individuals, T. gondii infection is largely tolerated without any obvious ill effects. However, primary infection in immunosuppressed patients can result in acute cerebral or systemic disease, and reactivation of latent tissue cysts can lead to a deadly outcome. It is imperative that treatment of life-threatening toxoplasmic encephalitis is timely and effective. Several therapeutic and prophylactic regimens have been used in clinical practice. Current approaches can control infection caused by the invasive and highly proliferative tachyzoites but cannot eliminate the dormant tissue cysts. Adverse events and other limitations are associated with the standard pyrimethamine-based therapy, and effective vaccines are unavailable. In this review, the epidemiology, economic impact, pathophysiology, diagnosis, and management of cerebral toxoplasmosis are discussed, and critical areas for future research are highlighted.
Highlights
The opportunistic organism Toxoplasma gondii has reached a global interest due to its public health and socioeconomic impacts
In stark contrast to tachyzoites, bradyzoites divide slowly and remain dormant, protected within a stage-specific cyst, mainly located in the brain and muscle, presumably due to less rapid parasite elimination caused by reduced cellular turnover in these tissues compared to other organs
toxoplasmic encephalitis (TE) is often reported in immunosuppressed people, such as persons living with HIV (PLWH) [23]
Summary
The opportunistic organism Toxoplasma gondii has reached a global interest due to its public health and socioeconomic impacts This apicomplexan parasite can infect a large number of domestic and wild animals, and has infected a significant number of people throughout the world [1]. Recurrence of toxoplasmosis from latency is a frequent cause of toxoplasmic encephalitis (TE) in people with immunosuppressive conditions - such as advanced HIV infection, organ transplantation, neoplastic disease, or those receiving immunosuppressive therapies (e.g. rituximab). These patients are vulnerable to recrudescence of latent infection, wherein slowly-dividing bradyzoites transform into rapidly-replicating tachyzoites, which can result in fatal consequences [3]. We shed light on new targets for future research that may accelerate the discovery of improved methods for managing this condition
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