Cases Of Toxoplasmosis Research Articles

New Allele-Specific Oligonucleotide (ASO) amplifications for Toxoplasma gondii rop18 allele typing: Analysis of 86 human congenital infections in Brazil

This study aimed to detect and differentiate Toxoplasma gondii by the allele typing of its polymorphic rop18 gene. For this purpose, a novel genotyping system using allele-specific oligonucleotides (ASOs) was designed, consisting of three ASO pairs. The first and third pairs specifically amplify rop18 allele I and allele III, while the second pair amplify both allele I and II. Genomic DNA from 86 congenital infections was analyzed by ASO-PCRs, successfully typing 82 (95.35%) samples. The remaining 4 samples (4.65%) required sequencing and single nucleotide polymorphism (SNP) analysis of the amplification products. The distribution of samples according to rop18 alleles was: 39.5% of allele III, 38.4% of allele II, 19.8% of mixed rop18 alleles (I/III or II/III), and 2.3% of allele I. The six severely compromised infants exhibited the highest parasite load levels and were infected during the first and early second trimesters of pregnancy. Among these cases, two were associated with rop18 allele I parasites, two with mixed rop18 alleles (I/III), one with allele II, and one with allele III parasites. In conclusion, all severe cases of congenital toxoplasmosis were infected during early pregnancy, but they were not exclusively associated with rop18 allele I parasites, as observed in murine toxoplasmosis. Furthermore, nearly one-fifth of parasites were non-archetypal, exhibiting more than one rop18 allele, indicating a higher genetic diversity of Toxoplasma gondii in this South American sample. Overall, a robust T. gondii rop18 allele typing was developed and suggested that congenital toxoplasmosis in humans involves complex mechanisms beyond the parasite genotype.

The epidemiology of patients with toxoplasmosis and its associated risk factors in Taiwan during the 2007-2020 period.

Toxoplasmosis is a zoonotic parasitic disease caused by the protozoan Toxoplasma gondii (T. gondii), and may cause miscarriage and birth defects during pregnancy. This study aimed to assess the epidemiological features, epidemic trends, and correlations between the before number of confirmed toxoplasmosis cases in Taiwan from 2007 to 2020 in gender, age, season, and residential area, and hypothesized the environmental and climate factors also might affect the disease in Taiwan. This study reviewed publicly available annual summary data on reported toxoplasmosis cases in the Taiwan Centers for Diseases Control (TCDC) between 2007 and 2020. This study collected 150 confirmed domestic and nine patients with imported toxoplasmosis. There was an increasing trend in the incidence of toxoplasmosis, 0.09-0.89 cases per 1,000,000 people, peaking in 2017. The average annual toxoplasmosis incidence was 4.4, 13, and 18 during 2007-2011, 2012-2016, and 2017-2020, respectively. Comparing sex, age, season, and place of residence, the incidence rate was highest in male, 20-39 years-old patients, summer, and the eastern region, with 1.02, 1.72, 0.38, and 3.63 cases per million population, respectively. Additionally, comparing the distribution of cases by age group in Taiwan, there were significant differences between 40-59 years-old in the northern region (odds ratio (OR) = 0.343, 95% confidence interval (CI) = 0.167-0.705, p = 0.004) and 40-59 years-old in the southern region (OR = 4.488, and 95% CI = 2.149-9.374, p< 0.001), respectively. Linear regression analysis also showed that PM (particulate matter) 2.5 (μg/m3) concentration was positively associated with toxoplasmosis (β = 0.095, p = 0.037). CO concentration was negatively correlated with toxoplasmosis (β = -14.001, p = 0.021). This study is the first to report domestic and confirmed cases of imported toxoplasmosis from the surveillance data of the TCDC between 2007 and 2020. It identified that residence and age were associated with an increased risk of toxoplasmosis in Taiwan. This study confirmed that toxoplasmosis remains a prevalent infectious disease in Taiwan, its epidemic is gradually increasing and becoming more severe. These findings might be useful for policy-makers and clinical experts to direct prevention and control activities to patients with T. gondii, which causes the most severe illness and greatest burden to Taiwanese people.

Elevated interleukin-10 levels in patients with ocular toxoplasmosis.

In elderly patients, ocular toxoplasmosis is one of the most common etiologies of uveitis, which should be differentially diagnosed from ocular lymphoma, another common pathology of uveitis in older adults. The high level of interleukin (IL)-10 and an IL-10/IL-6 ratio higher than 1 (>1.0) are helpful parameters to diagnose ocular lymphoma. In this study, we used aqueous humor samples to detect 4 cases of ocular toxoplasmosis in patients with high levels of IL-10 and an IL-10/IL-6 ratio higher than 1. Our results show that ocular toxoplasmosis may be associated with increased cytokine levels in aqueous humor.

Suspected clinical toxoplasmosis in a 12-week-old puppy in Singapore

BackgroundToxoplasma gondii is traditionally known as a parasite of felids, with possible infection in intermediate hosts such as dogs and humans, and thus a disease of public health significance. Published data on the prevalence of toxoplasmosis in dogs and cats in Singapore is scanty, and this paper documents a suspect clinical case of toxoplasmosis in a free-roaming puppy trapped from an offshore island of Singapore.Case presentationA 12-week-old puppy presented with hindlimb weakness and sarcopenia, with rapidly progressing ascending paralysis and respiratory distress, one week after trapping. Toxoplasmosis was suspected after indirect fluorescence antibody testing (IFAT) revealed anti-T. gondii antibodies. The puppy responded quickly to clindamycin treatment and was discharged from hospital after 10 days.ConclusionWhile rare and undocumented, veterinary clinicians in Singapore are advised to also include toxoplasmosis infection as a differential diagnosis in dogs presenting with similar clinical signs. This is especially so for dogs which have access to the outdoors.

Congenital toxoplasmosis among hospitalized infants in Poland in the years 2007–2021: study based on the national hospital registry

Congenital toxoplasmosis (CT) is a rare entity and it may pose a life-threatening risk for the newborns. The aim of the study was to evaluate the incidence and other selected factors of CT in Poland. Our study is a population-based study on CT patients in 2007–2021. The study was based on 1504 hospitalization records of first-time diagnosis of CT in newborns. In the study group, we observed 763 males (50.7%) and 741 females (49.3%). The mean and median age was 31 days and 10 days, respectively. Based on the hospital registry, the mean annual CT incidence was estimated to be 2.6 per 10,000 live births (95% CI 2.0–3.2 per 10,000 live births). The incidence of CT cases fluctuated over the years 2007–2021, with the highest incidence in 2010 and the lowest one in 2014. There were no statistically significant differences between the incidence of CT in relation to sex or place of residence. The periodic fluctuations in the number of cases of congenital toxoplasmosis indicates the need to develop effective prevention programs to effectively counteract the disease and its consequences.

Acute disseminated toxoplasmosis in an immunocompetent adult patient. Case report

Abstract Introduction: Toxoplasmosis is a disease of global distribution caused by the parasite Toxoplasma gondii, which develops differently depending on the immunologic status of the patient. In immunocompetent patients, it is usually asymptomatic and complications such as pneumonitis, encephalitis, or multiple organ dysfunction are rare. The following is the case of an immunocompetent patient with acute disseminated toxoplasmosis. Case report: A 42-year-old man, with no history of immunocompromise, or relevant medical, family or personal history, was transferred to the emergency department of a tertiary care institution in the city of Bogotá D.C. (Colombia) due to a fever that had lasted for a month, headache, and progressive neurological deterioration. Studies looking for other infectious etiologies, as well as for autoimmunity, neoplasms, and metabolic disorders, were negative. Computed tomography (CT) of the skull showed findings of meningoencephalitis. He was considered as a possible case of toxoplasmosis and treatment with trimethoprim/sulfamethoxazole was initiated. During his stay in the intensive care unit (ICU), he developed multiple organ dysfunction syndrome (MODS) and ultimately died. The post-mortem histopathological study of tissues reported the presence of Toxoplasma gondii bradyzoites, which confirmed the diagnosis of acute toxoplasmosis. Conclusions: Acute disseminated toxoplasmosis is a diagnostic challenge because it can mimic other etiologies. A timely diagnosis may prevent medical complications and increase the patient's chances of recovery. Knowledge about this disease in immunocompetent patients is a subject being developed.

A new perspective in the treatment follow-up of toxoplasma retinochoroiditis: Infiltrate thickness measurement

BackgroundThis study aimed to describe the spectral domain optical coherence tomography (SD-OCT) findings of active lesions in toxoplasma retinochoroiditis cases and to examine the changes in retinochoroidal infiltrate thickness after treatment. MethodsA total of 21 newly diagnosed patients with ocular toxoplasmosis were included in this prospective study. A complete ophthalmologic examination and SD-OCT were performed at the first visit. The patients were followed up weekly, and the SD-OCT images were taken over the lesion at each visit for 6 weeks. The characteristics of the active retinochoroiditis focus at the first visit were determined, and the infiltrate thicknesses at all visits were analyzed. ResultsA statistically significant BCVA difference was observed at the first visit and at the last visit 6 weeks later (p < 0.01). The first week after treatment showed a significant decrease in infiltrate thickness (113.904 ± 86.001 µm). In the following weeks, this decrease continued more softly. The thickness change at 6 weeks was significantly reduced (16.095 ± 14.784 µm) compared with the previous ones. Weekly infitrate thickness changes were compared among themselves; a statistically significant difference was found between the 1st and 2nd weeks and the 5th and 6th weeks (p = 0.035 and p = 0.007, respectively). Detached posterior vitreous in 71% (15/21) and increased posterior vitreous thickness in 76% (16/21) of active lesion were detected. All patients had 100% (21/21) increased retinal reflectivity and disorganized retinal layers, and choroidal hypo-reflectivity was observed in 86% (18/21). ConclusionSD-OCT is a useful imaging modality in the diagnosis and follow-up of ocular toxoplasmosis cases. Serial thickness measurements of toxoplasma retinochoroiditis lesions may help confirm our diagnosis and determine the need for treatment.

P.139 Cerebral toxoplasmosis in an HIV-negative patient

Background: Toxoplasma gondii is a protozoan parasite with the ability to infect any nucleated cell in humans. Most immunocompetent infected individuals are asymptomatic. Latent toxoplasma can become reactivated in immunocompromised individuals though this is exceptionally rare in HIV-negative individuals. Methods: We present the case of a 47-year-old male with chronic immunosuppression secondary to marginal zone lymphoma and steroid therapy. Results: The patient presented to hospital with a 1-week history of word-finding difficulties, intermittent right facial numbness and leg weakness, and tonic-clonic seizures. CT head showed a left temporal heterogenous mass measuring 2.8 × 2.8 × 3.5 cm. Biopsy of the lesion showed Multiple tachyzoites and rare bradyzoites with strong positivity for the toxoplasma specific immunostain. The patient was treated with trimethoprim/sulfamethoxazole which resulted in complete neurologic recovery. Conclusions: Our literature review included 32 cases of cerebral toxoplasmosis in HIV-negative patients with an overall mortality rate of 48%. Cerebral toxoplasmosis has a predilection for immunosuppressed patients with an underlying hematologic malignancy (74%, n= 23). Successful treatment requires early recognition of the disease and prompt treatment with sulfamethoxazole and trimethoprim, pyrimethamine, or sulfadiazine. Patients who recover from acute toxoplasmosis should remain on lifelong suppressive antibiotic therapy to prevent relapse.

Seroepidemiology of Toxoplasmosis in Pregnant Women Referring to the Pregnancy Care Center of Ramsar

Background Toxoplasmosis is a common parasitic infection with high prevalence and worldwide distribution. It may cause severe disease in the fetus of newly infected pregnant women. Objective This study aimed to evaluate the seroprevalence of toxoplasmosis and its related risk factors among pregnant women in Ramsar city, Mazandaran province, north of Iran, from October 2017 to March 2018. Methods In this analytical-cross sectional study, specific anti-Toxoplasma gondii IgG and IgM antibodies were measured in 191 pregnant women by ELISA method. The length of T. gondii infection was estimated by the IgG avidity test. Demographic and behavioral information about pregnant women and possible risk factors of toxoplasmosis were collected through interviews. Results Specific IgG antibody against T. gondii was detected in 46.1% and IgM in 5.8% and both IgG and IgM antibodies were detected in 4.7% of pregnant women. The IgG avidity test did not show any acute case of toxoplasmosis. None of the demographic characteristics, such as age, occupation, place of residence, education, income, trimester of pregnancy, frequency of pregnancy, and history of abortion was correlated with toxoplasmosis. Moreover, behavioral characteristics, such as the source of consumed water, contact with soil, presence of cats in the household, consumption of vegetables, type of meat consumed, and the way of cooking meat had no significant correlation with toxoplasmosis seropositivity. Conclusion More than half of the pregnant women (54%) were toxoplasmosis-free and therefore at risk of acquiring this infection. Increasing the knowledge of pregnant women about toxoplasmosis prevention may reduce the risk of this infection during pregnancy.

CHALLENGES OF OCULAR TOXOPLASMOSIS TREATMENT IN MULTIPLE DRUG INTOLERANCE SYNDROME: A CASE REPORT AND LITERATURE REVIEW

We report a literature review and a case of ocular toxoplasmosis in a patient with multiple drug allergies, who was successfully treated with regular intravitreal clindamycin and subconjunctival dexamethasone. A Malay lady in her twenties presented to us with right eye blurring of vision of 2 weeks duration, which she described as a central scotoma. Visual acuity at presentation was hand movements. Examination revealed intense ocular inflammation. The right eye had anterior segment inflammation of 3+ cells with fine keratic precipitates, whilst the posterior segment revealed papillitis, vitritis, retinitis, choroiditis, vasculitis and hyperpigmented chorioretinal scar inferotemporal to fovea. Ocular coherence tomography showed intraretinal fluid and retinal thickening. Fluorescein angiography showed early hypofluorescence of the lesion with progressive hyperfluorescence and leakage from the optic disc. Immunoglobulin G serology of Toxoplasma gondii was raised and immunoglobulin M levels were normal. The patient developed an allergic reaction with classical antibiotic and antifolate therapy. She was successfully treated with regular two-weekly intravitreal clindamycin and subconjunctival dexamethasone and her best corrected visual acuity was 6/18 at the end of her treatment. Intravitreal injection of clindamycin and subconjunctival dexamethasone is a good option in patients of ocular toxoplasmosis who are allergic to oral medications.

ABORTION AND NEONATAL MORTALITY DUE TO TOXOPLASMA GONDII IN BIGHORN SHEEP (OVIS CANADENSIS).

Low lamb recruitment can be an obstacle to bighorn sheep (Ovis canadensis) conservation and restoration. Causes of abortion and neonate loss in bighorn sheep, which may affect recruitment, are poorly understood. Toxoplasma gondii is a major cause of abortion and stillbirth in domestic small ruminants worldwide, but no reports exist documenting abortion or neonatal death in bighorn sheep attributable to toxoplasmosis. Between March 2019 and May 2021, eight fetal and neonatal bighorn lamb cadavers from four western US states (Idaho, Montana, Nebraska, and Washington) were submitted to the Washington Animal Disease Diagnostic Laboratory for postmortem examination, histologic examination, and ancillary testing to determine the cause of abortion or neonatal death. Necrotizing encephalitis characteristic of toxoplasmosis was identified histologically in six of eight cases, and T. gondii infection was confirmed by PCR in five cases with characteristic lesions. Other lesions attributable to toxoplasmosis were pneumonia (3/5 cases) and myocarditis (2/5 cases). Protozoal cysts were identified histologically within brain, lung, heart, skeletal muscle, adipose tissue, or a combination of samples in all five sheep with PCR-confirmed T. gondii infections. Seroprevalence of T. gondii ranged from 40-81% of adult females sampled in the Washington population in October and November 2018-2021, confirming high rates of exposure before detection of Toxoplasma abortions in this study. Of 1,149 bighorn sheep postmortem samples submitted to Washington Animal Disease Diagnostic Laboratory between January 2000 and May 2021, 21 of which were from fetuses or neonates, a single case of chronic toxoplasmosis was diagnosed in one adult ewe. Recent identification of Toxoplasma abortions in bighorn sheep suggests that toxoplasmosis is an underappreciated cause of reproductive loss. Abortions and neonatal mortalities should be investigated through postmortem and histologic examination, particularly in herds that are chronically small, demographically stagnant, or exhibit reproductive rates lower than expected.

TERRESTRIAL PATHOGEN POLLUTANT, TOXOPLASMA GONDII, THREATENS HAWAIIAN MONK SEALS (NEOMONACHUS SCHAUINSLANDI) FOLLOWING HEAVY RUNOFF EVENTS.

Toxoplasmosis is a major threat to Hawaiian monk seals (Neomonachus schauinslandi) in the main Hawaiian Islands where seal habitat overlaps with substantial human and domestic cat populations. As the definitive hosts, members of the Felidae are the sole sources contaminating the environment with infectious oocysts; these oocysts can be transported into the marine environment, thereby threatening marine mammals. To understand environmental factors influencing Hawaiian monk seal exposure to Toxoplasma gondii, we examined monk seal strandings from toxoplasmosis in relationship to location and rainfall patterns throughout the main Hawaiian Islands. Using a case-control study design, we compared mortalities due to toxoplasmosis (cases) with those from other causes (controls). We found that cases were up to 25 times more likely than controls to occur after heavy runoff events. The greatest odds ratio was observed when rainfall occurred 3 wk before strandings, potentially indicating important timelines in the disease process. Our results suggest that heavy rainfall frequently delivers sufficient numbers of oocysts to infect Hawaiian monk seals. With infectious doses of as low as a single oocyst, any contaminated runoff constitutes a risk to Hawaii's endangered monk seal.

First description of congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2: a case report

BackgroundCongenital toxoplasmosis can be associated with serious clinical consequences from fetus to adulthood. Hence, early detection is required to minimize severe sequelae through appropriate therapy. We describe the first case of a congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2 and the challenging serological diagnosis of the disease in this context.Case presentationA Caucasian boy was born at 27 weeks 2 days of gestation by cesarean section due to maternal COVID-19-related respiratory failure. Postpartum serological screening of the mother revealed a previously unrecognized active Toxoplasma gondii infection. The premature child initially tested negative for anti- Toxoplasma gondii immunoglobulin A and M antibodies 1, 2 and 4 weeks after birth, whereas immunoglobulin G antibodies were only weakly positive with no evidence of child-specific production. Neither neurological nor ophthalmological abnormalities were detected. Approximately 3 months after birth, serological testing indicated a congenital toxoplasmosis by presence of immunoglobulin A and M, in combination with a child-specific immunoglobulin G synthesis. Additionally, cerebrospinal fluid was tested positive for Toxoplasma gondii DNA. Although no clinical manifestations of congenital toxoplasmosis were detected, an antiparasitic therapy was initiated to minimize the risk of late sequelae. There were no hints for a transplacental transmission of severe acute respiratory syndrome coronavirus 2.ConclusionThis case raises the awareness of possible coinfections with the risk of transplacental transmission in cases of maternal coronavirus disease 2019. The report emphasizes the need for screening vulnerable patients for toxoplasmosis in general and especially in the context of pregnancy. It becomes evident that prematurity can complicate the serological diagnosis of congenital toxoplasmosis due to a delayed antibody response. Repeated testing is recommended to carefully monitor children at risk and especially those with a history of preterm birth.

Spectrum of parasitic infections on fine-needle aspiration cytology presenting as superficial nodules: A retrospective study of 5 years in a tertiary care hospital

Background: Parasitic infestations are very common in a developing nation like India. They may present as superficial nodules and are often either missed or misdiagnosed as other soft-tissue lesions. Fine-needle aspiration cytology (FNAC) is an easy, minimally invasive technique to detect, and diagnose these lesions. Parasitic infections are present in every age group with cysticercosis being the most common parasitic infestation. The present study highlights the role of cytology in diagnosing parasitic lesions and also analyzes the spectrum of these lesions in a tertiary care hospital. Aims and Objectives: This study was carried out to assess the spectrum of parasitic infestations in a tertiary care hospital of North West Delhi over 5 years (2015–2019). This was a retrospective and descriptive study done in the Department of Pathology, Dr. BSA Hospital, Delhi. Materials and Methods: Sixty-six cases out of a total of 15094 FNACs performed over 5 years (2015–2019) that were diagnosed as parasitic lesions on FNAC were included in our study. The records were retrieved, analyzed, and recorded. Clinical details were obtained from the FNAC requisition slips. Results: A total of 66/15094 FNACs conducted over 5 years were diagnosed as parasitic lesions. Fifty-seven cases of cysticercosis, six cases of filariasis, two cases of echinococcosis, and one case of toxoplasmosis were identified. Conclusion: As parasitic infections pose a problem in a developing country like ours; hence, early detection is always helpful and reduces the morbidity associated with it. Careful assessment of cytological material aspirated from superficial nodules can be very helpful in detecting parasites.

Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review.

Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening. We performed a systematic review of severe toxoplasmosis cases in immunocompetent patients to gain insight into the epidemiology, clinical characteristics, radiological findings, and outcomes of these cases. We classified severe toxoplasmosis as cases with the symptomatic involvement of target organs (the lungs, central nervous system (CNS), and heart), disseminated disease, prolonged disease (>3 months), or a fatal outcome. Our primary analysis focused on cases published from 1985-2022 to avoid confounding with cases in AIDS patients. We identified 82 pertinent articles (1985-2022) with a total of 117 eligible cases; the top five countries for these cases were French Guiana (20%), France (15%), Colombia (9%), India (9%), and Brazil (7%). Overall, 44% (51/117) of cases had pulmonary involvement, 39% (46/117) CNS, 31% (36/117) cardiac, 24% (28/117) disseminated disease, 2% (2/117) had prolonged disease, and 8% (9/117) of patients died. More than one organ was involved in 26% (31/117) of cases. Eighty-four percent (98/117) of cases occurred in the context of a recent acute primary Toxoplasma infection; for the remaining, the exact timing of infection was unclear. Genotyping data were very sparse. Among those reporting genotyping data, 96% (22/23) were caused by atypical non-type II strains; one case was caused by a type-II strain. Only half of the cases reported risk factors. The most common risk factors were eating raw/undercooked meat or eating game meat (47% (28/60)), drinking untreated water (37% (22/60)), or living in a toxoplasmosis high-prevalence area (38% (23/60)). For the 51 pulmonary cases, the main clinical presentation was pneumonia or pleural effusions in 94% (48/51) and respiratory failure in 47% (24/51). For the 46 CNS cases, the main clinical presentation was encephalitis in 54% (25/46), meningitis in 13% (6/46), focal neurologic findings in 24% (11/46), cranial nerve palsies in 17% (8/46), Guillain-Barre syndrome or Miller Fisher syndrome in 7% (3/46), and Brown-Sequard syndrome in 2% (1/46) of cases; more than one clinical manifestation could also be present. Among the 41 CNS cases reporting the CNS imaging findings, 68% (28/41) had focal supratentorial lesions and 7% (3/41) had focal infratentorial lesions. Brain abscess-like/mass-like lesions were seen in 51% (21/41) of cases. For the 36 cardiac cases, the main clinical presentation was myocarditis in 75% (27/36), pericarditis in 50% (18/36), heart failure and/or cardiogenic shock in 19% (7/36), and cardiac arrhythmias in 22% (8/36); more than one manifestation could also be present. Illness was critical in 49% (44/90) of cases intensive care unit care was needed in 54% (29/54) of cases among those reporting this information, and 9 patients died. The diagnosis of severe toxoplasmosis in immunocompetent hosts can be challenging. Toxoplasmosis should be considered in the differential diagnosis of immunocompetent patients presenting with severe illness of unclear etiology with pulmonary, cardiac, CNS, or multiorgan involvement/failure, or prolonged febrile illness, even in the absence of common exposure risk factors or common manifestations of toxoplasmosis (e.g., fever, mononucleosis-like illness, lymphadenopathy, and chorioretinitis). Fatal outcomes can also rarely occur in immunocompetent patients. Prompt initiation of anti-Toxoplasma treatment can be lifesaving.

Клинический случай сочетания врожденного токсоплазмоза с ВИЧ- и цитомегаловирусной инфекциями

Toxoplasmosis is one of the problems of medicine, which has serious socio-economic significance. Congenital toxoplasmosis is manifested by severe fetal damage, its chronic course with lifelong preservation of the parasite in various organs and tissues, as well as the possibility of adverse perinatal outcomes. Purpose. To present a clinical case of congenital toxoplasmosis in a child: intrauterine chorioretinitis, meningoencephalitis in combination with HIV infection and current cytomegalovirus infection. Material and methods. A patient transferred from the Ust-Ilimsky maternity hospital to the city of Ivano-Matreninsky Children's Clinical Hospital in Irkutsk. Clinical data: in an HIV-infected mother, from 4 pregnancies, 4 births, a child was born at 39–40 weeks, 2930 gr. Results. Based on the conducted studies and examinations, the child was diagnosed with: Basic: Congenital toxoplasmosis: transferred intrauterine chorioretinitis, meningoencephalitis with the formation of calcifications of cerebral vessels, ventriculomegaly. Related: 1) HIV infection, stage 2 B, progression phase on ART, IC+2, moderate immunodeficiency; 2) Congenital cytomegalovirus infection; 3) UPU. Muscular DMZHP. Ltd. CH0; 4) Normochromic anemia of moderate severity. Conclusions. Congenital toxoplasmosis remains one of the serious problems and requires in-depth study. As a prevention of the development of congenital toxoplasmosis, it is necessary to diagnose infection with toxoplasmosis in women of fertile age during family planning. Keywords: congenital toxoplasmosis, chorioretinitis, meningoencephalitis, HIV infection, CMV infection

Maternal and congenital toxoplasmosis in Mayotte: Prevalence, incidence and management.

Toxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte. We collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022-0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005-0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants. The seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring.

Case Report: Lesson Learned from Delayed Definitive Treatment of Stage 4 HIV Patient with Cerebral Toxoplasmosis – A Case Report

Background: Cases of cerebral toxoplasmosis continue to burden people living with HIV/AIDS (PLWHA). This surge in cases is primarily due to patients’ delayed definitive treatment, missed follow-up, and insufficient diagnostic equipment in some regions, particularly in developing countries such as Indonesia.Case Presentation: We report on a 35-year-old male referred to the emergency department with impairment in four extremities from a secondary healthcare facility. Specific atypical symptoms that mimicked subacute meningitis were identified during the physical examination. Internists, neurologists, and rehabilitation medicine professionals were associated with the management.Conclusion: We suggest that improved early diagnosis and treatment of HIV patients to prevent opportunistic infections, including cerebral toxoplasmosis, is needed, particularly in primary healthcare facilities in developing countries.

Neuropsychiatric Symptoms in Cerebral Toxoplasmosis with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Case Report

Cerebral toxoplasmosis is often caused by the reactivation of pre-existing infections. The increasing number of HIV/AIDS increased cases of cerebral toxoplasmosis. Cerebral toxoplasmosis can show clinical symptoms of neurological and psychiatric. Psychiatric symptoms such as psychosis are often associated with cerebral toxoplasmosis infection. Hemichorea and hemiballism are movement disorders often found in cerebral toxoplasmosis, although movement disorders are less common than other neurological symptoms. We report that a 53-year-old man with complaints of whole-body weakness three days before admitted to the hospital. Patient's appetite decreased. While being treated, he saw an oriental figure walking back and forth as if watching him. Patient also heard voices and complained involuntary movements in the right hand and leg. Neurological examination revealed right hemichorea with characteristics; arrhythmic, irregular, high amplitude, and improved at rest. Psychiatric examination revealed visual and auditory hallucinations. Laboratory examination showed anemia and leukopenia. Chest X-ray revealed a left pleural effusion. Magnetic Resonance Imaging (MRI) of the head with contrast showed multiple lesions with perifocal edema, suspected cerebral toxoplasmosis. Patient received anti-toxoplasmosis and antipsychotic. Patient improved on the sixth day of treatment. Cerebral toxoplasmosis can cause serious complications in patients with HIV/AIDS. Psychotic symptoms such as hallucinations and delusions are often associated with cerebral toxoplasmosis infection. Hemichorea is the most common type of movement disorder in toxoplasmosis cerebral patients related to HIV/AIDS. The main treatment is anti-toxoplasmosis medication. Combination with antipsychotics is effective in treating the symptoms of psychosis and hemichorea, while also inhibiting the replication of Toxoplasma gondii. Keywords: Cerebral Toxoplasmosis, HIV/AIDS, Neuropsychiatric

Risk of occupational infection in forensic workers: a review.

The occupational risk of infection in forensic workers is a cause for concern, furthermore in the current context of the coronavirus disease-19 (COVID-19) pandemic. In order to characterize this risk, we performed an extended review of the literature on occupational infections occurring in forensic workers. Seventeen articles were included. Direct contamination by aerosolization was the main mode of transmission reported, with 17 cases of tuberculosis. Indirect contamination was described as the mode of transmission in 10 cases (five cases of blastomycosis, two cases of tuberculosis, two Streptococcus pyogenes, and one case of human immunodeficiency virus). In all the other included cases, the mode of transmission was unknown. For two of them, the information provided was sufficient to link them to occupational exposure (one case of toxoplasmosis, one case of tuberculosis). For the remaining 10 cases, the link was uncertain (six cases of tuberculosis, three of hepatitis B, and one of COVID-19). Even if there is probably significant under-declaration, the number of infections linked to an occupational risk in forensic workers is not alarming, thanks to effective preventive measures.