Toxoplasmosis Research Articles

Ocular outcomes of toxoplasmosis in the Amazon-Cerrado transition zone, Brazil: a population-based study.

Eye damage represents one of the gravest outcomes of toxoplasmosis, potentially leading to varying degrees of vision impairment, up to and including blindness. Monitoring ophthalmological indicators in individuals affected by toxoplasmosis, alongside understanding its impact on visual acuity, can motivate the scientific community to advocate for strategies to prevent vision loss associated with toxoplasmosis. This is a retrospective study analysing medical records and clinical documentation from patients at an ophthalmological clinic in a city located at the intersection of the Cerrado and Amazon Forest biomes. It was noted that >20% of patients exhibited visual acuity ≤20/200, a condition medically recognized as blindness for the affected eye. Our study highlights a significant portion of individuals experiencing lasting visual impairments due to toxoplasmosis. These findings remain obscured by the existing national guidelines, which only mandate reporting for congenital and gestational toxoplasmosis cases, thereby overlooking sporadic manifestations and their consequential effects. The effort to identify ophthalmologic consequences is crucial both for personalized clinical care and for shaping national guidelines for managing toxoplasmosis.

Clinical outcomes of pediatric patients with congenital toxoplasmosis in a fourthlevel center Introduction. Congenital

Congenital toxoplasmosis is a highly prevalent parasitic disease worldwide, with a high burden of disease and neurodevelopmental involvement in pediatric patients. To describe the clinical sequelae and neurodevelopmental state of pediatric patients with congenital toxoplasmosis at the Hospital Militar Central during 2013 to 2020. We conducted an observational, descriptive, cross-sectional study with an analytical component, including pediatric patients diagnosed with congenital toxoplasmosis. Patients consulted the Hospital Militar Central from January 2013 to December 2020. The Ages and Stages Questionnaires 3 neurodevelopmental scale was applied to children under six years old. Forty-five patients with confirmed congenital toxoplasmosis were included, with a mean age of 5.9 years; 60% were male; 11.2 % were symptomatic at birth, and 33% presented chorioretinitis. During the follow-up, 73% presented ophthalmologic sequelae, 64% cerebral calcifications, 4.4% hydrocephalus, 11.2% cerebral palsy, and 13.4% focal epilepsy. In children under six years old, 58% presented neurodevelopmental compromise, and in those over six years old, 62% had cognitive deficits. In this cohort, 68% of the patients received posnatal treatment, with a statistically significant association between not receiving treatment and ophthalmological sequelae (OR = 5.2; p < 0.001). Congenital toxoplasmosis is associated with important long-term sequelae similar to those described in several Latin American series. These findings highlight the importance of early diagnosis, evaluation, treatment, and timely interdisciplinary follow-up of patients in our country to improve their prognosis.

Diseases Caused by and Behaviors Associated with Toxoplasma gondii Infection

Toxoplasma gondii is an Apicomplexan parasite that is estimated to infect at least one-third of the global human population. T. gondii infection may be transmitted horizontally or vertically. The main risk factors for transmission to humans are related to diet, especially the consumption of undercooked meat, along with soil contact. In immunocompetent persons, the acute infection may go undetected as it typically produces minor, non-specific symptoms that are self-limited. After infection is established, recurrent retinochoroiditis is the most common clinical disease. In contrast, severe systemic or cerebral toxoplasmosis may be life-threatening for immunocompromised individuals. Furthermore, congenital toxoplasmosis acquired in utero may have devastating consequences if not recognized and promptly treated. A growing body of research has identified associations between latent T. gondii infection, and personality traits and risk-taking behaviors. Other studies have documented associations between latent infection and psychiatric conditions that include schizophrenia and bipolar affective disorder. With no current treatment regimens being curative of T. gondii infection, effective prevention measures at both the public health and individual levels are vitally important.

Toxoplasma gondii Infection of BALB/c Mice Perturbs Host Neurochemistry.

Toxoplasma gondii infection has been associated with psychoneurological disease in humans and behavioural changes in rodents. However, the mechanisms accounting for this have not been fully described and in some cases could be argued to reflect the severe neuropathology that some mice suffer during infection. Herein we employ a multi-omics approach to extensively examine BALB/c mice that are resistant to toxoplasmic encephalitis. Using a combination of LCMS (liquid chromatography-mass spectrometry) and RNAseq we demonstrate that infection alters the neurochemistry and the transcriptome of the brains of BALB/c mice. Notable changes to tryptophan, purine, arginine, nicotinamide and carnitine metabolism were observed in infected mice and this was accompanied with changes to the levels of a number of transcripts associated with enzymes these metabolic pathways. In addition, changes were seen in transcripts of many immunologically important genes known to contribute to immunity to T. gondii. Changes in the levels of additional transcripts during infection have previously been associated with psychoneurological diseases. The results demonstrate that the BALB/c mouse, with its relatively mild neurological disease, is a useful model for characterising the effects of T. gondii infection on murine neurochemistry. The results also implicate specific biochemical pathways in mediating these changes and should inform further mechanistic studies and suggest therapeutic targets.

Seroprevalence of Toxoplasma gondii and Associated Risk Factors in Pregnant Women in Araçatuba, São Paulo, Brazil: A Multi-Level Analysis

This study assessed the seroprevalence of Toxoplasma gondii and risk factors among 428 pregnant women attending Basic Health Units (BHUs) in Araçatuba, São Paulo, Brazil. The seroprevalence was 55.14%, indicating high exposure to the parasite in this population. Using a multi-level logistic regression model, this study analyzed these predictors to determine their association with a higher seropositivity rate, with BHUs included as a random factor. Predictors associated with higher seropositivity included older age (36–45 years), with a 71.64% prevalence in this group, and multiparity (61.65%). Women with lower educational levels were also more likely to be infected, with 59.46% seropositivity recorded among those who had only completed elementary school. Despite identifying several risk factors, no significant correlation was found between undercooked meat consumption or contact with soil and infection. These findings highlight the need for targeted public health interventions, particularly for educating high-risk groups about toxoplasmosis prevention, such as safe food handling and avoiding raw dairy products. Additionally, BHUs play a critical role in early detection and prevention. These units are important for providing healthcare access and preventive education for vulnerable populations. Given the high seroprevalence, this study underscores the urgency of implementing prenatal screening and educational programs to reduce the risks of congenital toxoplasmosis in this region.

Toxoplasmosis Infection in an HIV-Negative Patient Presenting with Clinical and MRI Findings Similar to those of Multiple Sclerosis.

This case aids in the differential diagnosis between multiple sclerosis and cerebral toxoplasmosis. It highlights the necessity of conducting ELISA tests for parasitic infections when multiple sclerosis is suspected.

Increase in Congenital Toxoplasmosis During the COVID-19 Pandemic in the US

During the COVID-19 pandemic, prenatal care services were disrupted. We analyzed the trajectory slopes of cases of congenital toxoplasmosis (CT) and acute toxoplasmosis during pregnancy from 2019 to 2022 (to reflect the cases during the pandemic years 2020–2022) vs. 2000 to 2019, using data from the Remington Laboratory, the National Reference Center for Toxoplasmosis in the US. During the pandemic, there was a statistically significant upward trajectory in the yearly number of CT cases. Monitoring of this trend is needed.

National survey to estimate seroprevalence for toxoplasmosis among pregnant women in France, 2021

Abstract Background Toxoplasmosis during pregnancy can result in congenital malformations and fetal death. In France, universal antenatal screening and monthly re-testing of seronegative pregnant women has been established since the 1970s. However, decreasing Toxoplasma gondii seroprevalence among pregnant women and lower incidence of congenital toxoplasmosis may challenge the cost-effectiveness of such programs. The aim of this study was to estimate the current seroprevalence among pregnant women participating in the 2021 national perinatal survey (ENP). Methods All adult women giving birth in France between 15-21 March 2021 were invited to participate in the ENP. Data collected included demographic information, nationality, socio-economic status, education level and Toxoplasma gondii serology. We classified a woman as seropositive if she had IgG antibodies prior to pregnancy or seroconverted during it. Univariable and multivariable regression analyses using Poisson model were conducted to estimate prevalence ratios (PRs) and identify significant factors associated with seropositivity. Results Among the 15,605 participating women, 0.22% seroconverted during pregnancy. The overall seroprevalence was 25.95%. Seropositivity was higher with increasing age (∼5% per 5 years), among residents of French overseas territories Guadeloupe/Saint Martin (PRs:1.07; 95%-CI: 1.03-1.10), La Réunion (PRs:1.10; 95%-CI: 1.08-1.13) and Mayotte (PRs:1.27; 95%-CI: 1.23-1.31), with lower education (PRs:1.22; 95%-CI: 1.04-1.42) and African nationality (PRs:1.11; 95%-CI: 1.02-1.20). Conclusions High seroprevalence for Toxoplasma gondii was found in older women, which may reflect their higher risk of past exposure. The observed geographical differences in seroprevalence may mirror dietary and environmental diversity. Declining seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies. Key messages • Older women and residents of French overseas territories show higher toxoplasmosis seroprevalence, possibly due to past exposure risks and diverse diets/environments. • Declining toxoplasmosis seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies.

REIV-TOXO Project: Results from a Spanish cohort of congenital toxoplasmosis (2015-2022). The beneficial effects of prenatal treatment on clinical outcomes of infected newborns.

Some regions of Spain are withdrawing their pregnancy screening program for congenital toxoplasmosis (CT). The Spanish Research Network of Congenital Toxoplasmosis (REIV-TOXO) was created to describe the current status of CT in Spain. The aims of this study were to describe the epidemiological and clinical characteristics of CT and to evaluate the effect of prenatal treatment on clinical outcomes to inform decision-making policies. Ambispective observational study including CT cases recorded in the REIV-TOXO database that includes 122 hospitals (2015-2022). Inclusion criteria were one or more of the following: positive PCR in maternal amniotic fluid; positive Toxoplasma gondii-specific IgM or IgA antibodies at birth; positive PCR in the placenta, newborn blood, urine or CSF; increase of specific IgG levels during infant follow-up; or specific IgG persistence beyond age 12 months. Fifty-six newborns (54 pregnancies) were included. Prenatal screening allowed 92.8% of cases to be identified. The time of maternal infection was well documented in 90.7% of cases, with 61.1% occurring in the third trimester. A total of 66.6% (36/54) pregnant women received antiparasitic treatment: 24/36 spiramycin, 8/36 pyrimethamine, sulfadiazine, and folinic acid, and 4/36 both treatments sequentially. Most cases were asymptomatic at birth (62.5%, 35/56), and 84% (47/56) newborns completed one year of treatment. Median follow-up was 24 months (IQR = 3-72): 14.2% children exhibited new complications, mainly ocular. Newborns born to mothers treated prenatally had four-fold lower risk of CT clinical features at birth (p = 0.03) and six-fold lower risk of further complications during follow-up (p = 0.04) with no treatment-related differences during pregnancy. While diagnosis based only on neonatal assessment misses a significant number of CT cases, prenatal screening allows treatment to be started during pregnancy, with better clinical outcomes at birth and during follow-up. REIV-TOXO provides valuable information about CT in Spain, highlighting the need for universal maternal screening.

Digital Narratives: The Impact of Instagram® on Mothers of Children with Congenital Toxoplasmosis.

Congenital toxoplasmosis leads to severe complications in childhood and presents significant global health challenges. In Brazil, the prevalence of toxoplasmosis during pregnancy and congenital cases ranges from 0.3 to 8 per 1000 live births. The clinical manifestations of congenital toxoplasmosis can include neurological and ocular damage, among other health issues, which place significant burdens on affected families. This study aims to investigate the experiences and motivations of mothers of children with congenital toxoplasmosis who share their journeys on social media, particularly Instagram. A qualitative virtual ethnography was used that explored the content shared by mothers of children diagnosed with congenital toxoplasmosis, aiming to understand how social media aids in their coping strategies and the support networks they create. Fifteen Instagram accounts were analyzed, and twelve mothers participated in in-depth interviews. Thematic analysis revealed three main themes: the initial search for information and support, the evolving role of social media in advocacy and education, and the creation of a supportive online community. This study highlights the potential of social media to provide emotional support, disseminate information, and foster communities among mothers facing similar challenges, ultimately contributing to better care strategies and professional awareness for supporting families dealing with congenital toxoplasmosis.

Efficacy of Clindamycin in Preventing Abortion and Vertical Transmission of Toxoplasma gondii (PRU Strain) Infection in Pregnant BALB/c Mice

Background: Toxoplasma gondii transmission can occur during pregnancy if the mother contracts the infection for the first time. Treatment strategies include the use of antimicrobial medications and providing supportive care. Spiramycin is commonly used to treat toxoplasmosis in pregnant women and to hinder the disease's transmission. However, its ability to treat the fetus is questionable due to its limited capacity to cross the placental barrier. Additionally, economic constraints and sanctions may impede access to this medication. Objectives: Consequently, in search of an effective treatment, for the first time in Iran, the effectiveness of clindamycin in preventing abortion and vertical transmission of the PRU strain of T. gondii infection in pregnant mice was evaluated. Methods: On the twelfth day of gestation, pregnant mice were exposed to T. gondii and subsequently received treatment with either clindamycin or spiramycin. This resulted in the establishment of four distinct groups: A normal control group, an infected group without treatment, an infected group treated with clindamycin, and another infected group treated with spiramycin. Following these interventions, a series of parasitological evaluations (including microscopic examination and real-time PCR), histopathological evaluations, and immunological assessments were conducted. Results: The findings showed a significant reduction in the number of cysts in the eye and brain (ranging from 77.32% to 90.72%) among the groups treated with clindamycin and spiramycin compared to the control group. Furthermore, treatment with clindamycin, like treatment with spiramycin, was able to suppress inflammatory changes, prevent cell death, and reduce vascular cuffs in the brain, as well as decrease bleeding, placental thrombosis, and the accumulation of inflammatory cells in the placenta. Clindamycin was also effective in diminishing retinal folds, tiny retinal bleeds, and cell vacuolation in eye tissues. Immunologically, treatment in both the spiramycin and clindamycin groups resulted in a decrease in the level of the cytokine TNF-α, indicating an increase in the cellular immune response. In addition, increased levels of IL-10 in the treated infected groups could contribute to the reduction of TNF-α production. Conclusions: Typically, spiramycin is the first choice for treating congenital toxoplasmosis, but clindamycin can be a useful substitute or additional treatment when resistance to primary medications occurs, when there is intolerance, or when access to the main drugs is restricted.

A Comprehensive Bibliometric Analysis of Research Trends About Congenital Toxoplasmosis.

Toxoplasma gondii is an obligate intracellular protozoon that infects approximately one-third of the human population. The parasite could transmit from mother to fetus in cases of acute infection during pregnancy and cause complications in the fetus. The bibliometric analysis is a popular research area that evaluates all the studies indexed in particular databases on a subject. This article puts forth bibliometric review of the literature on maternal and congenital toxoplasmosis research indexed in the Web of Science database between 1945 and 2024. VOS viewer, Web of Science and MS Office Excel 17 programs were used in the study. The results of the search showed 1476 publications. The countries that most contributed to the literature were France (n=306, 20.73%), the USA (n=229, 15.52%), and Brazil (n=146, 9.89%). The most cited country was also France (n=10271, 35.52%), followed by the USA (n=9113, 31.51%), and England (n=2611, 9.03%). The top three countries by number of citations per document were Denmark (44.88), the USA (39.79) and France (33.57). The five departments with the most publications are Pediatrics (20.26%), General Internal Medicine (18.16%), Infectious Diseases (16.8%), Obstetrics (14.57%), and Immunology (11.86%). Wallon M. (n=57), Peyron F. (n=49), Thulliez P. (n=36) and Vilena I. (n=36) were the leading authors in terms of contribution to the literature. The five most published journals were Pediatric Infectious Disease Journal (3.66%), Journal of Clinical Microbiology (2.78%), Lancet (2.3%), Presse Medicale (1.76%), and American Journal of Obstetrics and Gynecology (1.63%). France is one of the countries that pays the most attention to congenital toxoplasmosis and compatible with this, in our study, the country with the highest number of studies on congenital toxoplasmosis was France. It is thought that drawing more attention to this issue and conducting more studies in countries where the disease is common might yield successful results, as in France.

Management of Stage-4 HIV with Cerebral Toxoplasmosis Coinfection and SIADH Complication

HIV/AIDS stage 4 is the stage where the HIV/AIDS patients have low immunity protection against infections, which can led to coinfections and complications. This case report presented an evaluation of the diagnosis and treatment of an HIV/AIDS stage 4 patient with cerebral toxoplasmosis coinfection and SIADH complications. A man (47 years, 35 kg), married with two children, complaining of weakness, nausea, vomiting, weight loss, and low appetite. Sodium level were measured, showing a 117 mg/dL level that continued to decrease throughout the patient's treatment. Five days later, the patient lost his consciousness with a GCS score of 224, indicating severe brain injury, and was diagnosed with cerebral toxoplasmosis based on the result of head CT-SCAN with contrast. On day 6, the patient was tested positive for HIV and diagnosed with stage 4 with an absolute CD4 count of 4 cells/μl. Therapy was provided by giving pyrimethamine-clindamycin therapy for cerebral toxoplasmosis, followed by Tenofovir, Lamivudine, and Evafirenz as antiretroviral therapy. Treatment for hyponatremia was done by administration of 3% NaCl and tolvaptan. The patient started experiencing an improvement in consciousness after the 10th day of medication, and sodium levels fluctuated throughout the treatments. Patient was discharged after 15 days with clinical improvements.

Enhanced clindamycin delivery using chitosan-coated niosomes to prevent Toxoplasma gondii strain VEG in pregnant mice: an experimental study

BackgroundCongenital toxoplasmosis occurs when a pregnant woman becomes infected with Toxoplasma gondii (T. gondii) for the first time. Treatment typically involves antimicrobial medications, with spiramycin commonly used to prevent transmission. However, spiramycin's effectiveness is limited due to poor placental penetration. Clindamycin, another antibiotic, can cross the placenta but reaches the fetus at only half the maternal concentration. Encapsulating the drug in chitosan-coated niosomes (Cs-Nio) could enhance its effectiveness by targeting specific organs and ensuring sustained release. To address the challenges of using clindamycin, a niosome-coated chitosan system was investigated for treating congenital toxoplasmosis caused by the VEG strain of T. gondii in an animal model.MethodsPregnant mice were infected with VEG strain of T. gondii on the 12th day of pregnancy, followed by treatment with various drugs across six groups. The treatments included chitosan-coated niosomes loaded clindamycin (Cs-Nio-Cli) and other controls. Parasitological evaluations (microscopic examination and real-time PCR), along with histopathological and immunological assessments were conducted to assess treatment efficacy. Finally, statistical analysis was conducted using GraphPad Prism 8.0 and SPSS 26, comparing test and control groups with T test and Mann–Whitney test. A p ≤ 0.05 was considered statistically significant.ResultsThe study found that treatment with Cs-Nio-Cli significantly reduced the number of T. gondii cysts in the brain and eyes (97.59% and 92.68%, respectively) compared to the negative control group. It also mitigated inflammatory changes, prevented cell death, and reduced vascular cuffs in the brain. In addition, Cs-Nio-Cli treatment decreased bleeding, placental thrombosis, and inflammatory cell infiltration in the placenta while improving eye tissue health by reducing retinal folds and bleeds. Immunologically, nanoclindamycin treatment resulted in lower TNF-α cytokine levels and higher IL-10 levels, indicating an enhanced anti-inflammatory response.ConclusionsAlthough Cs-Nio-Cli demonstrates promise in reducing the transmission of congenital toxoplasmosis and mitigating the effects of congenital toxoplasmosis, additional research is necessary to determine the optimal treatment regimens for the complete eradication of the parasite in the fetus.

Severe neurological and ocular manifestations in paediatric patients with toxoplasmosis. Case-series study with review of the current literature

Toxoplasmosis, both congenital and postnatally acquired, is a parasitic disease caused by infection with the protozoan Toxoplasma gondii. The most serious manifestation of this disease is congenital toxoplasmosis, resulting from transplacental infection of the foetus during pregnancy. Retinochoroiditis, intracranial calcifications, and hydrocephalus are considered the classic triad of congenital toxoplasmosis. This article describes four cases of severe neurologic and ocular manifestations in paediatric patients diagnosed with toxoplasmosis. The main aim was to examine the nature of clinical presentation as well as to emphasise the necessity of properly administered antiparasitic therapy and underline the importance of prenatal screening to reduce the risk of congenital transmission to the foetus.

Inflammatory pathways of Toxoplasmagondii infection in pregnancy

Toxoplasma gondii (T. gondii), an obligate intracellular parasite, is considered as an opportunistic infection and causes toxoplasmosis in humans and animals. Congenital toxoplasmosis can influence pregnancy and cause mild to severe consequences for the fetal and neonatal. During early T. gondii infection, neutrophils as the most abundant white blood cells provide a front line of defense mechanism against infection. The activated dendritic cells are then responsible for initiating an inflammatory response via T-helper 1 (Th1) cells. As part of its robust immune response, the infected host cells produce interferon (IFN-γ). IFN-γ inhibits T. gondii replication and promotes its transformation from an active form to tissue cysts. Although anti- T. gondii antibodies play an important role in infection control, T-helper 2 (Th2) immune response, can facilitate the growth and proliferation of T. gondii in the host cell. In pregnant women infected with T. gondii, the expression of cytokines may vary and in response diverse outcomes are expected. Cytokine profiles serve as valuable indicators for estimating the patho-immunological effects of T. gondii infection. This demonstrates the intricate relationship between pro-inflammatory and anti-inflammatory cytokines, as well as their influence on the various pregnancy outcomes in T. gondii infection.

Etiologies and Associated Factors Death Among People Living with the Human Immunodeficiency Virus (PLHIV) Hospitalized for Febrile Consciousness Disorders in the Infectious and Tropical Diseases Departmentof the Donka National Hospital, Guinea

Introduction: Central nervous system (CNS) damage is common duringhuman immunodeficiency virus (HIV) infectionand occur in cases of immunosuppression, which leads to altered consciousness. The objective of this work was to identify the etiologies and factors associated with the death ofPLHIVhospitalized for febrile consciousness disorders in the infectious and tropical diseases departmentfrom Donka National Hospital. Methodology: This was a retrospective study of descriptive and analytical type over five (5) years in the infectious and tropical diseases department of the Donka National Hospital. Included in this study werePLHIV under treatment antiretroviraL(ART)or not, aged over 15, hospitalized in the infectious diseases department of Donka National Hospital. for febrile consciousness disorders or those who developed it during the study period. The parameters studied were sociodemographic characteristics, clinical picture, clinical staging of HIV/Acquired Immuno-Deficiency Syndrome(AIDS) according tothe World Health Organization(WHO). Factors associated with deaths were searched from logistic regression in multivariate analysis and all variables with a value of P˂0.05 were considered statistically significant. Results: Two hundred and five out of five hundred and thirty-four (205/534) files ofPLHIV, hospitalized for febrile consciousness disorderswere sampled and enrolled for this studyi.e. a prevalence of 38.39%. The average age of the patients was 42.28 ± 12.54 years with a sex ratio of 0.97. Cerebral toxoplasmosis was the most common etiology.Severe immunosuppression was one of the factors statistically associated with death. Conclusion: Febrile consciousness disorders remain very common, with multiple etiologies inPLHIV. The CD4 count ≤ 200 cells/mm3, the depth of the coma and the absence of antiretroviral treatment were the factors associated with death.

Features of the clinical course of the new coronavirus infection in HIV-infected patients

The aim. To study the features of the clinical course of a new coronavirus infection in patients infected with HIV.Materials and methods. The study included patients with HIV infection who received inpatient care for a new coronavirus infection (n=118). The diagnosis of U07.1 was made by detecting SARS-CoV-2 RNA. The diagnosis of U07.2 was made on the basis of epidemiological and clinical data in the presence of antibodies to SARS-CoV-2 in the blood.Results and discussion. The overall cohort of patients was dominated by women (55,9%), the average age of all co-infected patients was 37,5±2,78 years. The study was dominated by patients with a long history of HIV infection (66,1%), 43,2% received antiretroviral therapy (ART). The new coronavirus infection had a moderate course in 75,4% of patients. Severe form was recorded in 16,9% of patients. The mortality rate was 12,7%. The clinical picture of the new coronavirus infection upon admission was very variable due to comorbid pathology. The most frequently recorded symptoms upon admission were: increased body temperature (100%); weakness and increased fatigue (94,8%); cough (83,9%); shortness of breath (75,4%). Less frequently recorded: rhinorrhea (54,2%); sore throat (44,1%); gastrointestinal syndrome (21,2%); cerebral syndrome (17,8%); edematous-ascitic syndrome (13,5%); hepatolienal syndrome (13,5%); exanthema syndrome (10,2%). In 28,7% of patients, the number of CD4 lymphocytes was less than 200 cells/ml. The average level of CD4 lymphocytes was 321,3±43,6 cells/ml. The work revealed that as the degree of immunosuppression increased, there was a sharp increase in cases of severe forms of the new coronavirus infection, as well as an increase in deaths. The average HIV RNA level was 578 161,9±103 457,4 copecks/ml. A high HIV viral load (more than 100 000 cop/ml) was observed in 41,5% of cases, and only in this group of patients were severe forms of the new coronavirus infection recorded and, as a consequence, death. All observed patients had comorbid pathology in the form of opportunistic infections and/or concomitant diseases. The most frequently recorded opportunistic infections were: candidiasis (77,9%), cerebral toxoplasmosis (17,8%), Pneumocystis pneumonia (16,1%), tuberculosis (14,4%), central nervous system damage caused by the Epstein-Barr virus (10,2%), cytomegalovirus infection (6,78%), HIV-associated anemia (3,39%), cervical cancer (1,69%). Often opportunistic infections had a polyetiological cause. Of the concomitant diseases, bacterial pneumonia (66,9%), chronic viral hepatitis (40,7%), cardiovascular diseases (26,3%), diseases of the gastrointestinal tract (21,2%), and nervous system were most often recorded (5,93%), urinary system (5,08%) and cancer (5,03%). In 89,8% of coinfected patients, prolonged release of SARS-CoV-2 was observed, which affected the duration of antiviral therapy and the length of hospitalization.Conclusion. The new coronavirus infection and HIV infection are the intersection of two epidemics with the subsequent mutually aggravating effect of pathogens on each other. Among the co-infected patients, young people of working age, reproductive age (30–49 years) with a long history of HIV infection (66,1%) and not taking ART (56,3%) predominated. The new coronavirus infection in HIV-infected patients more often occurred in a moderate form (75,4%), pneumonia was recorded in 83,1%. A severe form of the new coronavirus infection was recorded in 16,9% of patients. The work shows that as the degree of immunosuppression increased, there was a sharp increase in the frequency of severe forms of the new coronavirus infection. In the general cohort of patients, comorbid pathology was recorded in the form of opportunistic infections and/or concomitant diseases. Often opportunistic infections had a polyetiological cause. Multimorbidity aggravated the condition of patients and largely increased the risk of an unfavorable outcome. Mortality in the group of coinfected patients was 12,7%.

Spatial pattern of congenital toxoplasmosis incidence and its relationship with vulnerability and national health indicators in Brazil

There is a gap in evidence regarding spatial clusters of the congenital toxoplasmosis (CT) and its association with social and health indicators in the Brazilian territory. Thus, we aimed herein to identify CT risk areas in Brazil and its association with social vulnerability and health indicators. An ecological and population-based study was conducted. The CT incidence coefficient was calculated and smoothed using the Local Empirical Bayesian method. Global regression models and local spatial regression model were applied. High-incidence clusters of the disease were identified throughout the country. Additionally, a positive association was observed between the incidence of congenital toxoplasmosis and the Social Vulnerability Index, coverage of community health agents, and the percentage of prenatal consultations. This association was stronger the further south in the country. Herewith, the implementation and strengthening of public strategies, with focus on priority intersectoral actions for prevention, early diagnosis, and prompt treatment, is urgently required for the effective control of CT in Brazilian municipalities.

Comparative GRA6 and GRA7 for their Utility as Genetic Markers in the Genotyping of Cerebral Toxoplasmosis in Cerebrospinal Fluid.

Cerebral toxoplasmosis is a severe symptom of Toxoplasma gondii (T. gondii) infection that often affects individuals with Human Immunodeficiency Virus (HIV) infection and can be fatal. T. gondii exhibits diverse strains with varied virulence, such as cerebral toxoplasmosis, which is connected with a specific strain. Molecular methods were used to investigate the genotype of the parasite. Some researchers have used genetic markers, such as the dense granule proteins GRA6 and GRA7, in order to identify T. gondii genotype. This study aimed to evaluate the applicability of GRA6 and GRA7 as genetic markers for determining T. gondii strain from cerebrospinal fluid of AIDS patients with toxoplasmic encephalitis. 160 serum and cerebrospinal fluid (CSF) samples were collected from 2013 to 2022. The serum samples were initially tested using ELISA anti Toxoplasma IgG, and the CSF was subsequently PCR of 5'SAG2 gene for those positive IgG. A total of 69 CSF successfully positive on PCR of 5'SAG2 were included for analysis of GRA6 and GRA7 by performing PCR, sequencing and phylogenetic analysis for determination of T. gondii type. The findings of this study indicate that the use of GRA7 is better than GRA6 when using direct clinical samples. Out of the 69 samples analyzed, total of 36 samples (52.17%) were positive for GRA7. The cases can be classified as type I: 86,1% (31/36), type III: 2,7% (1/36) and atypical: 11,1% (4/36). Comparison results between GRA6 and GRA7 for genotype determination shows good results on GRA7. GRA7 can be used as a genetic marker to find out the genotype of T. gondii in direct clinical samples where GRA6 cannot be used.