Severe acute disseminated toxoplasmosis

Abstract

In their Seminar (June 12, p 1965),1Montoya JG Liesenfeld O Toxoplasmosis.Lancet. 2004; 363: 1965-1976Summary Full Text Full Text PDF PubMed Scopus (2516) Google Scholar J G Montoya and O Liesenfeld describe the different clinical presentations usually seen in patients infected with Toxoplasma gondii. However, they do not mention the cases of severe acute disseminated toxoplasmosis acquired by immunocompetent adults in French Guiana due to new virulent strains of T gondii. 19 well documented cases have been reported in this area.2Bossi P Paris L Caumes E Katlama C Danis M Bricaire F Severe acute disseminated toxoplasmosis acquired by an immunocompetent patient in French Guiana.Scand J Infect Dis. 2002; 34: 311-314Crossref PubMed Scopus (20) Google Scholar, 3Bossi P Caumes E Paris L Darde ML Bricaire F Toxoplasma gondii-associated Guillain-Barre syndrome in an immunocompetent patient.J Clin Microbiol. 1998; 36: 3724-3725PubMed Google Scholar, 4Darde ML Villena I Pinon JM Beguinot I Severe toxoplasmosis caused by a Toxoplasma gondii strain with a new isoenzyme type acquired in French Guyana.J Clin Microbiol. 1998; 36: 324PubMed Google Scholar, 5Carme B Bissuel F Ajzenberg D et al.Severe acquired toxoplasmosis in immunocompetent adult patients in French Guiana.J Clin Microbiol. 2002; 40: 4037-4044Crossref PubMed Scopus (230) Google Scholar After consuming raw or undercooked meat from wild animals, or drinking oocyst-contaminated water from the deep forest of French Guiana, most patients developed severe symptoms, including high fever (39–40°C), myalgias, arthralgias, fatigue, dry cough, dyspnoea, generalised lymphadenopathy, hepatosplenomegaly, and a maculopapular rash. Thereafter, some developed bilateral interstitial pneumonia with acute respiratory distress syndrome, bilateral pleural and pericardial effusions, myositis, myocarditis, and neurological disorders (chorioretinitis, Guillain-Barré syndrome, confusion). Biological findings showed raised concentrations of liver enzymes, pancreatic enzymes, and serum creatine kinase, and a transiently low CD4/CD8-cell ratio. Haematological laboratory values and other blood chemical results were usually within the normal limits. Serological tests for T gondii confirmed acute infection by the presence of high titres of IgG and IgM in all cases. Isolation of virulent strains of T gondii with new atypical genotypes from clinical specimens was possible in nine cases.3Bossi P Caumes E Paris L Darde ML Bricaire F Toxoplasma gondii-associated Guillain-Barre syndrome in an immunocompetent patient.J Clin Microbiol. 1998; 36: 3724-3725PubMed Google Scholar, 4Darde ML Villena I Pinon JM Beguinot I Severe toxoplasmosis caused by a Toxoplasma gondii strain with a new isoenzyme type acquired in French Guyana.J Clin Microbiol. 1998; 36: 324PubMed Google Scholar, 5Carme B Bissuel F Ajzenberg D et al.Severe acquired toxoplasmosis in immunocompetent adult patients in French Guiana.J Clin Microbiol. 2002; 40: 4037-4044Crossref PubMed Scopus (230) Google Scholar These strains are probably well adapted to wild animals from the deep forest of French Guiana. Most of the patients were successfully treated with a combination of pyrimethamine and sulfadiazine for 6 weeks. However, cases of relapse of chorioretinitis were seen in several patients and were treated successfully. Severe acute disseminated toxoplasmosis acquired by immunocompetent patients in this area could be explained by poor host adaptation to these new virulent strains of T gondii. These strains might preferentially induce a Th2-type immune reaction rather than a Th1-type reaction.4Darde ML Villena I Pinon JM Beguinot I Severe toxoplasmosis caused by a Toxoplasma gondii strain with a new isoenzyme type acquired in French Guyana.J Clin Microbiol. 1998; 36: 324PubMed Google Scholar