Toxoplasmosis Research Articles

Late presenter patient with HIV/SARS-CoV-2 coinfection

Introduction. Late presentation of a large number of HIV-infected patients remains an important public health problem. The current SARS-CoV-2 pandemic has had serious consequences for health services, especially for patients living with HIV, who had limited access to health facilities, leading to a delayed diagnosis and initiation of antiretroviral treatment (ART), as well as to an increased mortality. Case presentation. We describe the case of a 55-year-old patient, from a rural area, who was admitted to Emergency County Hospital Targu Jiu in November 2022 reporting significant weight loss (5 kg in one month), physical fatigue, dizziness, headache, loss of appetite, diarrhea, symptoms that occurred 3 months ago. Elisa test-HIV1,2 was performed, with a positive result and the patient was transferred to the HIV/AIDS Department - ”Victor Babes” Clinical Hospital ofInfectious Diseases and Pneumophtisiology Craiova. It was performed SARS-CoV-2 Rapid Antigen Test and the result was positive. Head computed tomography revealed lesions of cerebral toxoplasmosis. The patient underwent treatment with antibiotics, antifungals, cerebral depletives, corticosteroids, gastroprotective drugs, vitamins, parenteral hydro-electrolytic rebalancing therapy and symptomatic drugs. ART was initiated 2 weeks after the diagnosis, with favorable evolution. At 3 months after ART initiation, the CD4 cell count increased to 120 cells/mm3 and VL-HIV was undetectable. Conclusions. In the context of the COVID-19 pandemic, late presentation for HIV/AIDS has been more common globally. Prompt treatment of opportunistic infection and then ART initiation led to a slowly favorable evolution in a patient with confirmed SARS-CoV-2 infection.

Seroprevalence and risk factors of Toxoplasmosis among HIV infected women of child-bearing age attending care and treatment clinics in Dar es Salaam, Tanzania.

Toxoplasmosis in HIV-infected women of child-bearing age (HIV-WCB) increases the risk for congenital toxoplasmosis, leading to many complications. However, its magnitude is unknown in this population. Objectives: The study aimed to determine the prevalence and factors associated with toxoplasmosis among HIV-WCB. This was a cross-sectional study conducted from July to August 2020 among HIV- WCB attending care and treatment clinic (CTC) at Muhimbili National Hospital and Mnazi Mmoja hospital. Questionnaire and TORCH rapid test were used to obtain data and serological testing respectively. Data analysis was done using statistical package for social sciences (SPSS) version 20. Overall, 29.7% of the study participants were positive for anti-T. gondii IgG, whereas none tested positive for IgM. Multivariate analysis showed that the probability of being infected with T. gondii increased by 57.1% for participants who consumed raw vegetables (p=0.005, aOR=0.43, 95%CI = 1.24-8.77). Other common risk factors such as undercooked meat consumption, source of drinking water, and cat ownership at home showed no association. A high number of HIV-WCB have not developed immunity to T. gondii in the study area. Introduction of routine screening during antenatal visits for pregnant women and further epidemiological studies are warranted in the country.

Diagnosis and Treatment of Tuberculous Meningoencephalitis and Toxoplasma Encephalitis in Positive HIV Patient: Case Report

Background Tuberculous meningoencephalitis (TBME) and toxoplasma encephalitis (TE) are the most frequent cerebral opportunistic infections in positive HIV patients in developed countries. This study aims to determine a presumptive diagnosis of TBME and TE based only on clinical, CD4-count, and radiology features and to attend suitable early treatment for better patient outcomes. Case Description A 40-year-old presented to the emergency unit of dr. Mintohardjo Naval Hospital with decreased consciousness. History of positive HIV status, pulmonary tuberculosis for six months and anti-tubercular-treatment (ATT) drop-out. The GCS was E2M5V2, lung crackles, nuchal rigidity, positive Babinski reflex, and duplex hemiparesis. CD4-count: 4 cells/mm3. Multiple hypodense lesions, “finger-like-oedema”, featured on non-contrast head CT-scan. A lumbar puncture was not performed. Treatment of TBME included an ATT regimen, pyridoxine, cotrimoxazole, anti-oedema, and TE treatment included clindamycin and pyrimethamine. Based on the clinical and radiological diagnosis of TBME (nuchal rigidity, history of ATT drop-out, multiple hypodense lesions on CT-scan) and TE (altered mental status, duplex hemiparesis, CD4-count, “finger-like-oedema” projections on CT-scan), ATT and TE treatment were given for ten days. There were significant clinical improvements by GCS E4M6V3, negative nuchal rigidity after being treated early by ATT and TE treatment. Conclusions Presumptive Diagnosis of TBME and TE in HIV patients can be determined only based on clinical, CD4-count, and radiology examination. However, there are significant clinical improvements in giving ATT along with TE treatment immediately in positive HIV patients.

Toxoplasmosis Infection during Pregnancy.

This literature review aims to give an overview of the current knowledge concerning how a toxoplasmosis infection affects the mother and her fetus. A thorough search of PubMed and a complimentary search of Google Scholar databases were used to identify relevant studies for this review. Although a Toxoplasma gondii infection is preventable, this infection is contracted by consuming contaminated food and water and by exposure to environmental sources of infection such as contaminated soil. Maternal-to-fetal transmission of this infection can result in devastating ophthalmic and neurological consequences for the fetus. Although a toxoplasmosis infection can result in long-term effects on the fetus, chronic disease is also associated with mental illness in mothers. Effective treatment can reduce the risk of congenital toxoplasmosis and the long-term consequences of infection in the fetus. Without appropriate screening and education programs, this infection will remain largely undiagnosed.

Unilateral Papilledema as a Rare Manifestation of Cerebral Neurotoxoplasmosis in HIV Patient: Case Report

Introduction: Cerebral toxoplasmosis is one of the opportunistic diseases that present in patients with HIV/AIDS. One of the rare symptoms is unilateral papilledema due to cerebral toxoplasmosis. Case report: A 26-year-old male patient came with complaints blurred vision for 2 months. The patient had a history of pouting lips, and weakness face, arm, and legs on the left side of the body. The patient has been diagnosed with the observation of space occupying lesion Cerebri in November 2020. Patient with HIV stage IV (WHO) infection and CD4 14 cells/uL and viral load 5.43 x 105 copies /mL. Visual acuity left eye 6/18 PH 6/12, contrast sensitivity examination in both eyes 1.65, and the results of FD-15 are within normal limits, but the results of perimetry was enlargement of blind spot, relative afferent pupillary defect in the left eye, with optic nerve head swelling in the left eye. An MRI showed the presence of intracerebral neurotoxoplasmosis. Discussion: Papilledema is the manifestation of optic nerve abnormality due to an increase in intracranial pressure. Cerebral toxoplasmosis leads to asymmetric target lesion present with ring enhancement image on MRI with contrast which causes SOL and manifests as papilledema. Bilateral papilledema is a hallmark of increasing cerebrospinal fluid pressure, but unilateral papilledema is a rare case with a 2% of prevalence among papilledema cases. Two proposed mechanisms of atypical papilledema were anatomical nerve sheath anomalies and unilateral axoplasmic blockage of the lamina cribrosa. Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with cerebral toxoplasmosis.

Presynaptic Hemiparkinsonism Following Cerebral Toxoplasmosis: Case Report and Literature Review.

Cerebral toxoplasmosis (CTx) is a central nervous system opportunistic infection with variable neurological manifestations. Although tropism of Toxoplasma gondii for the basal ganglia is well known, movement disorders (MDs) represent only a small percentage of CTx-related neurological complications. CTx-associated MDs are usually hyperkinetic, whereas parkinsonism associated with evidence of presynaptic dopaminergic deficit has never been described. We report a human immunodeficiency virus-positive patient who developed a complex MD featuring unilateral tremor combined with parkinsonism and dystonia following an acute episode of disseminated CTx. Her dopamine transporter scan (DaTscan) documented contralateral presynaptic dopaminergic deficit. Levodopa initiation improved both tremor and parkinsonism after ineffective trials of several other medications over the years. A total of 64 patients presenting with CTx-related MDs have been described. The most common MD was chorea (44%), followed by ataxia (20%), parkinsonism (16%), tremor (14%), dystonia (14%), myoclonus (3%), and akathisia (2%). DaTscan was performed only in 1 case, of Holmes tremor, that demonstrated reduced presynaptic dopaminergic uptake. Positive response to dopaminergic treatment was reported in 3 cases of Holmes tremor and 2 cases of parkinsonism. Presynaptic dopaminergic deficit may occur in CTx-related tremor combined with parkinsonism. Its identification should prompt initiation of levodopa, thus avoiding unnecessary trials of other drugs.

Parasite infections, neuroinflammation, and potential contributions of gut microbiota.

Many parasitic diseases (including cerebral malaria, human African trypanosomiasis, cerebral toxoplasmosis, neurocysticercosis and neuroschistosomiasis) feature acute or chronic brain inflammation processes, which are often associated with deregulation of glial cell activity and disruption of the brain blood barrier's intactness. The inflammatory responses of astrocytes and microglia during parasite infection are strongly influenced by a variety of environmental factors. Although it has recently been shown that the gut microbiota influences the physiology and immunomodulation of the central nervous system in neurodegenerative diseases like Alzheimer's disease and Parkinson's, the putative link in parasite-induced neuroinflammatory diseases has not been well characterized. Likewise, the central nervous system can influence the gut microbiota. In parasite infections, the gut microbiota is strongly perturbed and might influence the severity of the central nervous system inflammation response through changes in the production of bacterial metabolites. Here, we review the roles of astrocytes and microglial cells in the neuropathophysiological processes induced by parasite infections and their possible regulation by the gut microbiota.

Congenital and childhood toxoplasmosis

AbstractToxoplasmic retinochoroiditis is a world‐wide disease and the most frequent infectious posterior uveitis resulting in vision loss with considerable consequences for the patient. Genetic and environmental factors may influence the course of the disease but the prenatal and postnatal antibiotic treatment of the infected neonates and the follow‐up of these children may substantially influence and improve their vision prognosis.The actualized recommendations will be discussed in this presentation.

Vertical transmission and pathological findings in the mother, the placenta and the offspring, during first and last thirds of gestation in a mouse model of congenital toxoplasmosis.

We performed a study of congenital toxoplasmosis of the first and third gestation periods in mice, and determined its effects on the embryos/fetuses, the placentae and the maternal organs. We infected pregnant BALB/c mice by i.v. injection of 2.5--10.0×106 tachyzoites of the ME49 T. gondii strain and euthanized them 72h later. The tissues were analyzed by histopathology, immunohistochemistry and parasite-specific qPCR. Infections with the lowest dose induced remarkably different changes in the two thirds: a) all doses diminished the number of products/litter, the lowest dose only by 14%; but most embryos still visible were degenerated in the case of the first period, while the fetuses of the last third were perfectly preserved; b) the transmission rate in the first third was relatively high, but with a very low parasite burden; c) with the lowest dose, strong vascular changes (congestion, thrombosis and hemorrhage) predominated in the placentas of the first period, while they were absent in the last third; d) necrosis caused by T. gondii to maternal organs was much stronger during the last gestation period than in the first. Our results suggest that the vascular alterations at the placenta of the first third of pregnancy prevent embryo from large parasite burden, but provoke its death by starvation. In the last gestation period, there was poor control of parasite dissemination to the placenta and the fetus, but there was greater capacity of the product to defend itself from T. gondii.

Horizontal diplopia with right abducens palsy and gaze evoked nystagmus due to pontine lesion in human immunodeficiency virus related cerebral toxoplasmosis

AbstractPurpose: This case report will discuss about the diagnostic approach in a rare case of horizontal diplopia with Human Immunodeficiency Virus (HIV) related Cerebral Toxoplasmosis.Methods: The diagnosis was based on history taking, ophthalmologic examinations, vestibular‐ocular reflex (VOR) test, convergence test, nystagmus test, cerebellar function test, serological findings and magnetic resonance imaging (MRI) of head and orbita.Results: A 30 years old man with the main complaint binocular horizontal diplopia since 2 months ago, accompanied by headache, disorder of coordination, balance, speech and also impaired of memory and concentration. There was history of head injury and promiscuity. Visual acuity of both eyes 6/6 with best corrected visual acuity. There were abduction deficit on right eye, abducting nystagmus on left eye, no vestibular‐ocular reflex, no convergence insufficiency and no dysfunction of cerebellar. Immunoglobulin‐G antibodies Toxoplasma >650.0 IU/ml, Cluster Determinant 4 (CD4) T cell 55 cells/μl, and HIV reactive in serological findings. MRI of head and orbita revealed a lesion on pontine tegmentum. Patient was diagnosed with horizontal diplopia with right abducens palsy and gaze evoked nystagmus due to pontine lesion in HIV related cerebral toxoplasmosis.Conclusions: History taking and ophthalmologic examinations are important steps to establish the diagnosis. VOR test can determine the lesion in supranuclear, nuclear or infranuclear. Serological tests and MRI of head and orbita may be helpful in confirming the diagnosis and finding the cause of binocular horizontal diplopia.

Serological and Molecular Detection of Toxoplasma Gondii among Pregnant Women Giving Birth at the University Of Gondar Specialized Hospital in Gondar Town, Northwest Ethiopia

Objective: Congenital toxoplasmosis can be presented when immunosuppressed women are reactivating of this infection acquired before pregnancy in addition to women recently exposed to this disease during pregnancy, which causes of fetal death, neonatal death or congenital defects. Women mainly get this infection by ingested improperly cooked or raw meat consisting of viable tissue cysts or by contaminated foods and water within sporulated oocysts or through the placenta. Thus, this study aimed to detect Toxoplasma gondii in pregnant women using serologically and molecularly at study area. Methods: A cross-sectional study was conducted from September 2019 to October 2020 by collecting a total of 200 umbilical cord blood and matching discharged placental tissue samples from systematic randomly selected pregnant women giving birth at University of Gondar specialized hospital. Latex agglutination test and nested polymerase chain reaction were used for the detections of this infection. Findings: The overall serological, first polymerase chain reaction and nested polymerase chain reaction findings of this study were 46%, 24% and 10%, respectively. The univariant analysis indicated that seropositivity of Toxoplasma gondii antibodies were also significantly influenced by eating raw meat, eating raw vegetables, drinking raw milk, presence of domestic cat contacts and source of water (P  0.05). In the case of multivariate analysis drinking raw milk and source of water were also significantly associated to the seropositivity of Toxoplasma gondii. Moreover, there were also fair concordant between latex agglutination within first polymerase reaction (Kappa: 0.290) andnested polymerase chain reaction tests of this parasite (Kappa: 0.231). Novelty: This nested polymerase chain reaction and the Toxo-latex agglutination tests had also fair agreements in pregnant women. Moreover, Consumption of raw meat, vegetables and milk; domestic cat contacts and source of water were the potential statically significant associated risk factors for Toxoplasma gondii seropositivity. Conclusions: Generally, these comparative tests confirmed the existence of this infection in pregnant women that played up a pool of public health risks for their embryo and infants. Thus, thoroughly cooking raw meats and vegetables; pasteurized raw milk; avoid domestic cat contacts and boiling of water will be the best prevention and control strategies of this infection. Further works on its genotyping of this pathogen will be also convinced. Keywords: Latex agglutination; Nested polymerase chain reaction; Placental tissue; Pregnant women; Toxoplasma gondii; Umbilical cord blood

Identification and multilocus genotyping of Toxoplasma gondii isolates from congenital infection in north of Iran.

Congenital toxoplasmosis can cause severe consequences in the fetus, such as spontaneous abortion which is affected by parasite strain. Also, recent studies revealed the high genetic diversity of Toxoplasma gondii. This study aims to investigate the serological status of T. gondii in pregnant women, multilocus genotyping in aborted fetuses' tissue, and archived formalin-fixed paraffin-embedded placenta. This study was performed on 100 pregnant women with spontaneous abortion and their aborted fetuses, and 250 of the archived placentae in Iran. The blood and tissue were examined for seroprevalence and genotype determination of T. gondii using ELISA and multilocus nested-PCR-RFLP, respectively. Anti-T. gondii IgG and IgM were detected in 68 samples (68%) and 1 (1%) out of 100 serums. Toxoplasma DNA was identified in 1 (1%) aborted fetuses' tissue and 32 (12.8%) placenta samples. Overall, ten positive DNA samples were successfully genotyped, and five genotypes were recognized (ToxoDB#1, #2, #10, #27, and #48). The obtained results indicated congenital toxoplasmosis is a severe risk in this region. As type I is highly pathogen and can lead to severe complications, the prevention of the infection should be considered in seronegative pregnant women.

Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis.

Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.

Presence of Toxoplasma gondii tissue cysts in human semen: Toxoplasmosis as a potential sexually transmissible infection

Toxoplasma gondii is a widely prevalent protozoan parasite in human populations. This parasite is thought to be primarily transmitted through undercooked meat and contamination by cat feces. Here, we seek to determine if Toxoplasma gondii cysts can be found within human semen. We used a mixture of histological and immunofluorescence stains to visualize Toxoplasma gondii cysts in thin smears of human semen. Further, we probed for presence of bradyzoite-specific mRNA transcription using in-situ hybridization. We visualized Toxoplasma gondii cysts in ejaculates of immune-competent and latently infected human volunteers. We confirmed the encystment by probing transcription of a bradyzoite-specific gene in these structures. These observations extend previous observations of the parasite in semen of several non-human host species, including rats, dogs, and sheep. Toxoplasma gondii infection is a clinically significant infection, in view of its high prevalence, its purported role in neuropsychiatric disorders such as schizophrenia, as well as in the more serious form of congenital toxoplasmosis. Our demonstration of intact Toxoplasma gondii cysts in the ejaculate supports the possibility of sexual transmission of the parasite and provides an impetus for further investigations.

Demographic, Clinical, and Laboratory Characteristics of HIV Patients with Cerebral Toxoplasmosis at Haji Adam Malik General Hospital Medan

Cerebral toxoplasmosis is one of the frequent opportunistic infections of the central nervous system of Human Immunodeficiency Virus (HIV) patients in the presence of Toxoplasma Gondii infection. In Indonesia, the incidence of HIV patients with cerebral toxoplasmosis is 45%. This study was done to determine the demographic, clinical, and laboratory characteristics of HIV patients with cerebral toxoplasmosis at Haji Adam Malik Hospital, Medan, based on medical record data in 2022. The total sample was 23 patients with time periods from January to March 2022. Demographically, the data showed that most of the HIV patients with cerebral toxoplasmosis were male (91.3%), a mean age of 36.48 ± 5.74 years, married (87%), high school graduates (69.6%), and working (91.3%). The most common clinical characteristics were headache (69.6%) and cognitive impairment (56.5%). Laboratory characteristics found were (56.5%) non-reactive (<0.8 COI) and (43.5%) reactive (≥1 COI) anti toxoplasma IgM, while reactive anti-toxoplasma IgG (≥3 IU/ml) was obtained in all research samples (100%).

Prevention of congenital toxoplasmosis in France using prenatal screening: A decision-analytic economic model.

Toxoplasma gondii is one of the world's most common parasites. Primary infection of the mother during pregnancy can lead to transmission to the fetus with risks of brain and eye lesions, which may cause lifelong disabilities. France instituted a national program based on monthly retesting of susceptible pregnant women to reduce the number of severe cases through prompt antenatal and postnatal treatment and follow-up. To evaluate the ability of the French prenatal retesting program to reduce the lifetime costs of congenital toxoplasmosis. We measured and then compared the costs and benefits of screening vs. not screening using decision-tree modelling. It included direct and indirect costs to society of treatment and care, and the lifetime lost earnings of children and caregivers. A probabilistic sensitivity analysis was carried out. Total lifetime costs per live born child identified as congenitally infected were estimated to be €444 for those identified through prenatal screening vs €656 for those who were not screened. Estimates were robust to changes in all costs of diagnosis, treatment, and sequelae. Screening for the prevention of the congenital T. gondii infection in France is cost saving at €212 per birth. Compared with no screening, screening every pregnant woman in France for toxoplasmosis in 2020 would have saved the country €148 million in addition to reducing or eliminating the devastating physical and emotional suffering caused by T. gondii. Our findings reinforce the conclusions of other decision-analytic modelling of prenatal toxoplasmosis screening.

Toxoplasma encephalitis – A presenting feature of HIV disease

Central nervous system (CNS) toxoplasmosis is one of the leading causes of secondary CNS infection and seizures in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients along with cryptococcosis and tuberculosis. Encephalitis can be a primary presentation in undiagnosed HIV patients. We are reporting a rare case of HIV/AIDS that presented to us with encephalitis and was later diagnosed as toxoplasma encephalitis. A 32-year-old male truck driver presented with altered behaviour for about 1 month and vomiting for 4 days. On clinical examination, papilloedema was present. Further investigations revealed serologically proven HIV with CD4 T lymphocyte count of 56 cells/microL. Brain imaging showed multiple ring-enhancing lesions in the bilateral cerebral hemispheres and right cerebellar hemisphere. Serum toxoplasma antibodies were found to be positive and a diagnosis of CNS toxoplasmosis encephalitis was made. Treatment with trimethoprim–sulphamethoxazole and highly active antiretroviral therapy was initiated following which there was a significant improvement in the patient's clinical condition. The patient is on regular follow-up now.

Maternal Serological Screening for Congenital Toxoplasmosis During Pregnancy and Evaluating the Pregnant Women’s Knowledge on Toxoplasmosis in Qazvin, Iran

Background: The present study was designed to determine the prevalence of Toxoplasma gondii seronegative pregnant women, estimate the frequency of fetuses at risk of congenital toxoplasmosis in the study area, and also to investigate the awareness of the studied mothers about T. gondii disease.Methods: A total of 740 pregnant women referred to two health centers in Qazvin province were surveyed voluntarily for anti-T. gondii IgG and IgM antibodies by enzyme-linked immunosorbent assay (ELISA). IgG avidity test was used as a confirmatory test for samples showing positive or borderline results for IgM antibodies. Data on socioeconomic, demographic, and knowledge of participants about toxoplasmosis were collected using questionnaires and through face-to-face interviews. Multivariable logistic regression modeling was used to identify the potential predictor variables for T. gondii infection. Results: Overall, 21.2% (157/740) and 0.27% (2/740) of pregnant women were positive for T. gondii IgG and IgM antibodies, respectively. Only 1.7% (13/740) of expectant mothers had prior information on toxoplasmosis. Among socioeconomic and demographic variables, contact with soil was the merely cause of a significant association with T. gondii infection. Other variables including age, occupation, education level, residential area, source of drinking water, abortion history, number of childbirth, consumption of raw/undercooked meat, having home cat and and consumption of raw vegetables failed to establish significant associations. Conclusion: Our results clarified that the prevalence of T. gondii has remarkably reduced in the study area. This finding indicates a low risk of congenital toxoplasmosis in this region.

Curcumin modulates neurogliogenesis and purinergic receptor expression in neural precursor cells infected with Toxoplasma gondii.

Toxoplasma gondii is an obligate intracellular parasite that causes toxoplasmosis, and its congenital transmission is of paramount concern. During embryonic development, infection with the parasite causes irreversible damage to the still-forming fetus's central nervous system (CNS). In the pathogenesis of neurotoxoplasmosis, purinergic receptors prejudice neuroprotection, neuroinflammation, and activation of microbicide mechanisms against the parasitic vacuole. This study used curcumin as a treatment for neural precursor cells (NPCs) infected with T. gondii. The congenital toxoplasmosis induction consisted of maternal infection with the VEG strain, and NPCs were obtained from the telencephalon of mouse embryos. Curcumin at increasing concentrations was administered in vitro to analyze NPC metabolic activity, cell number, and size, as well as neurogliogenesis, proving to be effective in recovering the size of infected NPCs. Curcumin partially re-established impaired neurogenesis. Purinergic A1, A2A, and P2X7 receptors may be related to neuroprotection, neuroinflammatory control, and activation of mechanisms for inducing the parasite's death. ERK 1/2 was highly expressed in infected cells, while its expression rates decreased after the addition of the treatment, highlighting the possible anti-inflammatory action of curcumin. These findings suggest that curcumin treats neurological perturbations induced by toxoplasmosis.

Diagnostic accuracy of adjusted low IgG avidity index to predict acute Toxoplasma gondii infection in the first trimester of pregnancy.

Congenital toxoplasmosis is reportable disease in Europe. To prevent it antibody serological tests were introduced in several European countries as a part of screening programmes. Immunoglobulin G (IgG) avidity index testing is one of these tests for diagnosing acute infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pregnant women. However, a low or moderate IgG avidity index can give inconclusive results for predicting woman's status. From June 2012 until the end of 2014, 17,990 women were included in the national screening program to prevent congenital toxoplasmosis. One hundred and twenty-six women were consecutively included in the study because they had low or moderate IgG avidity. Every woman with possible acute toxoplasmosis was followed up every month till delivery. Fifty-eight of 126 (46%) women got infected in months before current pregnancy, 39 women (31%) were infected early in pregnancy. Twenty-nine pregnant women of 126 (23%) got infected in the second/third trimester of pregnancy. New cut off for IgG avidity index was 0.11. With this cut off, we were able to exclude T. gondii acute infection in the first trimester with very good diagnostic accuracy (area under the curve (AUC) = 0.95, 95% confidence Interval (CI) 0.91-0.99, sensitivity 0.95, specificity 0.86). If an IgG avidity index above 0.11 is measured in a woman's serum and she is in the first trimester of pregnancy, then a odds ratio (OR) for acute infection with T. gondii is below 1 (OR 0.11, 95% CI 0.05-0.25, P < 0.0001). If we measure IgG avidity index that is ≥ 0.11 in the first trimester of pregnancy, we can exclude infection with T. gondii with good diagnostic accuracy in our cohort of women. With a new cut off we could reduce number of invasive procedures such as amniocentesis and put less pregnant women in distress.