Primary Toxoplasmosis Research Articles

Neurological complication in HIV patients

Human Immunodeficiency Virus (HIV) is neurotropic and immunotropic, making themassive destruction of both systems. Although their amount has been reduced, there is still neurological presentations and complications of HIV remain common in the era of combination antiretroviral therapy (cART). Neurological opportunistic infections (OI) occur in advanced HIV diseases such as primary cerebral lymphoma, cryptococcal meningitis, cerebral toxoplasmosis, and progressive multifocal encephalopathy. Neurological problem directly related to HIV appear at any stage in the progress of HIV disease, from AIDS-associated dementia to the aseptic meningitis of primary HIV infection observed in subjects with an immune deficiency. The replication of peripheral HIV viral is able to be controlled in the era of effective antiretroviral therapy. Non-HIV-related neurological disease such as stroke increased important as the HIV population ages.

31: Congenital toxoplasmosis prevention by pyrimethamine-sulfadiazine vs spiramycin, a randomized trial

To compare the efficacy and tolerance of prenatal treatment with pyrimethamine-sulfadiazine (PS) vs spiramycin (S) following primary maternal Toxoplasma gondii infection, to reduce perinatal transmission. A randomized, open-label trial in 36 centers in France, compared pyrimethamine (50 mg qd) + sulfadiazine (1g tid), with folinic acid vs spiramycin (1g tid). Pregnant women with confirmed seroconversion were eligible for the trial, after 14 weeks gestation. There was no change in usual procedures for serological screening, prenatal diagnosis or management of infected fetuses and neonates. 143 women were randomized from 11/2010 to 01/2014, 73 to PS and 70 to S. Baseline characteristics were well balanced between the 2 groups with a median age of 30 years (IQR 26; 32), a gestational age at seroconversion of 19 weeks (14; 25). An amniocentesis was performed in 132 cases, with a positive PCR for T. gondii in 7/68 (10.3%) in the PS group vs. 13/64 (20.3%) in the S group. Two pregnancies were terminated for fetal toxoplasmosis with cerebral abnormalities. Children with undefined infection status were excluded from primary analyses (N=18). The transmission rate was 12/65 in the PS group (18.5%), vs 18/60 in the S group (30%): OR = 0.53 (95% CI 0.23-1.22, p=0.15). The prenatal treatment effect was similar (OR=0.47; CI 0.18; 1.23; p=0.12) after adjustment for gestational week at seroconversion (OR=1.18 per additional week, CI=1.08-1.28 ; p<10-3) but tended to be stronger when started within 3 weeks of seroconversion (p=0.08 for interaction). Three SAE were possibly related to the study drugs, 2 toxidermias and one liver enzyme elevation, all in the PS group. This is the first RCT to study prenatal prophylaxis to prevent congenital toxoplasmosis. There is a trend towards lower transmission with PS, but it did not reach statistical significance, possibly due to lack of power because of premature termination of enrollment. This encourages further research to determine the efficacy of chemoprophylaxis following maternal primary toxoplasmosis.

Seroprevalence of Toxoplasma gondii among pregnant women in Almadinah Almunawwarah KSA

Abstract Objectives Given its detrimental obstetric and congential sequelae, the detection of primary toxoplasmosis is most critical during pregnancy. This study aims to detect the seroprevalence of Toxoplasma gondii ( Toxoplasma gondii ) among pregnant women who either have histories suggestive of toxoplasmosis or may be at risk. Methods Serum samples of 150 pregnant women aged 18–45 years were tested by the rapid Toxoplasma test (TOXO IgM/IgG test, InTec). The results were further confirmed by the enzyme-linked immunosorbent assay (ELISA) technique for IgM and IgG. Results Serological results of toxoplasmosis seropositivity were statistically analyzed in light of the available epidemiological data. Thirty-two cases (21.3%) were IgG positive, and none was IgM positive, as shown by both tests. Conclusion Significant relations were observed between seropositivity, maternal age and history of abortion, and probability of delivering a child with a congenital anomaly. Despite the lack of evidence of recent infection in this study, the high rates of T. gondii seropositivity among pregnant women signaled a threat of primary exposure during pregnancy.

Toxoplasmosis awareness, seroprevalence and risk behavior among pregnant women in the Gampaha district, Sri Lanka

Background: Primary gestational toxoplasmosis can be transmitted to the fetus with deleterious effects on the pregnancy. There is very little information regarding gestational toxoplasmosis in Sri Lanka. This survey was done to determine the prevalence and awareness of toxoplasmosis and to identify risk factors of infection among pregnant women in the Gampaha district, Sri Lanka.Methods: Women attending obstetric clinics at the Colombo North Teaching Hospital in 2014 were tested for Toxoplasma gondii (T. gondii) specific Immunoglobulins G (IgG) and M (IgM) subtypes using the OnSite Toxo IgG/IgM Rapid Test-Dip Strip®. Disease awareness and risk behaviors of the participants were investigated.Results: Of the 293 participants (mean age 27 years, SD ± 5.92), 38% were primigravidae with a mean gestational age of 16.2 weeks (SD 7). The prevalence of anti-T. gondii IgG and IgM antibodies was 12.3% (n = 36) and zero, respectively. Unadjusted and adjusted odds ratios were calculated to determine risk factors of infection (cat-ownership, handling cats, consumption of meat, commercial meals and unwashed raw vegetables and fruits, handling soil and not washing hands after handling soil). On bivariate analysis, eating commercially prepared meals weekly or more was associated with toxoplasma seroprevalence with marginal statistical significance. On multivariate analysis, none of the considered risk factors were significant. Toxoplasma awareness was 4.4% (n = 13); health personnel (46.2%, n = 6) and media (53.8%, n = 7) being sources of information.Conclusions: Health education programs to increase awareness of toxoplasmosis is recommended at antenatal clinics.

A cluster of probable primary toxoplasmic lymphadenitis in a Thai family: case reports and a review of the literature

Background: Primary toxoplasmosis is frequently asymptomatic in immunocompetent adults. To our knowledge, a cluster of primary toxoplasmosis in Thailand has not been previously reported. Objectives: To report a cluster of primary toxoplasmosis in a Thai family. Methods: Physical examination, complete blood count, liver function tests, blood chemistry, chest radiography, and lymph node histopathology. Results: A previously healthy 39-year-old man presented with painless bilateral cervical lymphadenopathy for one month. Simultaneously, his 6-year-old son had painless cervical lymphadenopathy. Lymph node histopathology of the man showed the classic triad of characteristics of toxoplasmic lymphadenitis. Both patients were doing well when last seen two months after symptomatic and supportive treatment. Conclusions: Patients with toxoplasmic lymphadenitis can survive without specific antiparasitic treatment. Normal hosts may have a benign clinical presentation. Keywords: Immunocompetent hosts, primary toxoplasmosis, toxoplasma, toxoplasmic lymphadenitis, toxoplasmosis

Unusual optic disc placement of toxoplasmosis in a diabetic patient

A 44-year-old woman presented to our clinic with reduced vision in the right eye for two weeks. Visual acuity was 4/10 in the right eye. A swelling optic disc, vascular attenuation in the optic nerve head, a few splinter hemorrhages around the optic disc, and moderate vitritis were detected in the right eye. The left eye was normal. She had a diabetes mellitus (DM) history for five years. Serum IgM and IgG found a high titer for toxoplasmosis. A papillitis was diagnosed that was caused by primary toxoplasmosis without any chorioretinal focus. The patient was treated with an appropriate systemic antibiotics for toxoplasmosis and per oral corticosteroid. Optic disc swelling resolved within four weeks. Visual acuity was 9/10 two months later. We aimed to emphasize that the unusual placement of toxoplasmosis should be kept in mind in the differential diagnosis of papillitis in diabetic patients.

Risk factors for Toxoplasma gondii infection in women of reproductive age in northern Kosovska Mitrovica

Introduction: Toxoplasma gondii is one of the causative agents from the groups of TORCH infections, which are commonly associated with congenital anomalies. Objective: Defining risk factors for infection by Toxoplasma gondii of women in reproductive ages in the territory of Kosovska Mitrovica, as well as determination of seroprevalence of infection by Toxoplasma gondii in prenatal screening of pregnant women and women of childbearing age. Materials and Methods: A cross sectional study that included 49, pregnant women and women of childbearing age has been conducted. The pregnant women have been monitored on regularly base, or some women have been treated in the Gynecology and Obstetrics Department of the Health Center in Kosovska Mitrovica. Ages, place of residence, education, gynecological history and exposure to the potential risk factors associated with Toxoplasma have been collected by questionnaires. Sera have been tested on the presence of IgM and IgG antibodies to Toxoplasma gondi by ELISA standard manufacturer's protocol (Euroimmun, Luebeck, Germany). Results: Our study shows that 32 (65.3%) women were seronegative, while 17 women (34.7%) were seropositive. Significant seropositivity has been recorded for the women who were in contact with the ground (42.9%), compared to the women who did not have this contact (23.8%). Uses of undercooked meat in the diet did not show any effect to the seropositive status of the respondents, i.e. greater percentage of analyzed patients (75.5%) used inadequately cooked meat. Even 93.3% of respondents deny contact with a cat. It is observed that seropositivity increased with the age. Conclusion: Seroprevalence to Toxoplasma gondii infection of women of childbearing in the territory of northern Kosovska Mitrovica is not high, which implied that there is a higher possibility for acquiring primary toxoplasmosis infection during pregnancy especially for women who come in contact with the ground.

Aqueous humor cytokine profile of patients with primary or recurrent ocular toxoplasmosis

AbstractPurpose Toxoplasma gondii infection remains the most frequent cause of infectious posterior uveitis and a significant cause of visual impairment worldwide. Still, the immune mechanisms are largely unexplored. The aim of this study is to investigate the cytokine profiles of aqueous humor samples in patients with first or recurrent manifestation of ocular toxoplasmosis and to correlate findings with clinical characteristicsMethods Using the BioRad Multiplex immunoassay, we determined the concentrations of 27 cytokines/chemokines in aqueous humor specimens obtained from 16 patients with active (n=7) or recurrent (n=9) ocular toxoplasmosis. Results were compared to 5 matched control patients without intraocular infectionResults Using the Wilcoxon‐Mann‐Whitney‐Test significant changes could be identified in both groups affected by either initial or recurrent ocular toxoplasmosis compared to controls. Patients with initial manifestation revealed a significant increase (p &lt; 0.05) of IL‐1RA, IL‐7, MIP1a and IP‐10. In addition significant changes in individuals affected by recurrent disease also differed from controls and became significant (p&lt; 0.05) for TNF‐alpha, MIP‐1b and IP‐10. The cytokine/chemokine profiles however did not differ significantly between initial or recurrent ocular toxoplasmosis subgroups.Conclusion Our data suggests that MIP1 and IP‐10 are associated with both primary and recurrent ocular toxoplasmosis. These findings may support the important role of IP‐10 and MIP, as specific chemoattractants for activated T cells in parasitic disorders. In contrast to a recent report we were not able to correlate IL‐5 and VEGF with recurrences of the disease. A larger cohort is recruited to underline the results.

Outcome of Macular Toxoplasmosis

Objective: To assess the structural and functional outcome of macular toxoplasmosis in a cohort of immunocompetent patients following treatment with antimicrobial agents and steroids. Methods: The medical records of 12 consecutive immunocompetent patients who presented to The Eye Center, Riyadh, Saudi Arabia between 2001 and 2011 with acquired primary or recurrent macular toxoplasmosis were retrospectively reviewed. All patients filled a comprehensive uveitis questionnaire and underwent complete eyeexamination including visual acuity testing, funduscopy, OCT of macula, fundus photos and fluorescein angiography when indicated. Blood was drawn for toxoplasma antibodies and for other serologic work-up. All patients received systemic antimicrobial therapy in combination with corticosteroids. Structural (macular morphology) and functional (visual acuity) response to treatment was assessed and patients were followed up for a mean period of 6 months. Results: There were 8 male and 4 female patients with mean age of 34 years (range, 16-54 years). All patients showed clinical evidence of improvement in visual acuity and healing of toxoplasmic retinochoroiditis within the first 4 weeks of therapy and at 6 months follow-up. Nine patients (75%) had 20/40 visual acuity or better at 6 months. Ten (83%) out of the 12 patients had a residual macular scar affecting their final vision. Two patients (17%) who presented early and received treatment within 24 hours of symptoms onset had full resolution of the retinochoroiditis without macular scarring and regained normal vision. Conclusion: Prompt treatment in macular toxoplasmosis may preserve vision threatening structures and lead to good visual outcome.

Toxoplasma seroepidemiology in women who intend to marry in Jahrom, Islamic Republic of Iran

Infection with Toxoplasma gondii during pregnancy can lead to severe fetal sequelae. This cross-sectional study aimed to determine T. gondii seropositivity among a sample of young women in Jahrom, Islamic Republic of Iran. Four hundred and three young women with a mean age of 20.3 years who presented for pre-marriage laboratory testing were entered in the study. T. gondii antibodies (IgG and IgM) were measured using ELISA. Of the 403 women, 15% were seropositive for T. gondii antibodies (13% for IgG and 2% for IgM). Seropositivity for T. gondii IgG differed according to age groups but there was no significant difference (P = 0.83). IgM seropositivity showed the highest rate among women aged < 20 years. Many young women in Jahrom Province are susceptible to primary toxoplasmosis during pregnancy, therefore, appropriate educational programmes to improve knowledge in this population should be implemented to prevent toxoplasmosis-related congenital malformations.

Primary toxoplasmosis with critical illness and multi-organ failure in an immunocompetent young man

An immunocompetent young man became critically ill with multi-organ failure due to primary toxoplasmosis. Although treated successfully, he relapsed after 1 y with bilateral toxoplasmic chorioretinitis. Severe disseminated toxoplasmosis rarely occurs in immunocompetent patients and may reflect an increased risk of relapse. Secondary prophylaxis must be considered.

Incidence and clinical and immunological characteristics of primary Toxoplasma gondii infection in HIV-infected patients

To determine the incidence and laboratory characteristics of primary Toxoplasma gondii infection in HIV-infected individuals. This retrospective study was conducted between 1988 and 2012 on a cohort of 1130 HIV-infected patients at the AIDS Center Prague. Toxoplasma serology, standard laboratory parameters, and health status were evaluated at 3-6-month intervals for all patients. The total person-time of follow-up of patients at risk of Toxoplasma seroconversion was 3046.3 years; there were 14 primary T. gondii infections, yielding an incidence rate of 0.0046 (95% confidence interval 0.0027-0.0078). Most of the subjects were clinically asymptomatic, but in one case seroconversion was accompanied by transient cervical lymphadenopathy. The CD4+ T-lymphocyte count geometric mean increased from 418 (95% confidence interval 303-579) cells/μl before seroconversion to 501 (95% confidence interval 363-691) cells/μl after seroconversion (p = 0.004), while other parameters (CD8+ T-lymphocytes, natural killer cells, viral load, beta2-microglobulin, total immunoglobulins) remained unchanged. As compared to the control group, patients with primary toxoplasmosis had higher initial levels of total immunoglobulins IgA and IgG and a tendency to higher CD8+ T lymphocyte counts. Neither the incidence nor the course of the primary Toxoplasma infection was influenced by the immune status of the patients. Immune parameters of patients with primary Toxoplasma infection did not differ from those of the controls.

Serological assays and PCR for detection of Toxoplasma gondii infection in an ostrich farm at Ismailia Provine, Egypt

One hundred and twenty serum samples from ostriches (Struthio camelus) in a commercial farm in Egypt were tested for anti-Toxoplasma antibodies using ELISA test (IgM and IgG ) and Modified agglutination test (MAT). Five out of 120 birds (4.2%) were found positive to IgM enzyme immunoassay and 11 birds (9.2%) were IgG enzyme immunoassay positive. Modified agglutination test detected IgG in 15 birds (12.5%). PCR amplification of Toxoplasma gondii DNA in the blood of birds was recorded in 9 birds (7.5%). The Cases were categorized into acute and chronic cases depending on the result of blood-PCR and serological test where the positive cases for IGg were the most frequent (6.7%). The tissues of five dead birds tested by PCR assay showed the amplification of DNA fragment of T. gondii from the heart and brain of two birds, from only the brain of another two birds and from the heart, brain and leg muscles of one bird. The present study concluded that, the chronic cases are the most prevalent among ostriches population and the specific serological tests as MAT alone or with ELISA can be used as a highly sensitive screening test followed by PCR as a confirmatory test for diagnosis of toxoplasmosis and for detection of primary acute and chronic toxoplasmosis in ostriches. Key word: Toxoplasma, Ostriches, ELISA, MAT, PCR, Egypt.

Sequential optical coherence tomography images of retinal necrosis in acute ocular toxoplasmosis.

To describe the features of sequential spectral-domain optical coherence tomography (OCT) images in an eye with acute primary toxoplasmosis. Case report of an individual diagnosed with acute primary toxoplasmic retinochoroiditis. Initial and follow-up spectral-domain OCT findings are described. This patient developed retinitis as a result of an acute infection consistent with Toxoplasma gondii suggested by toxoplasma-specific IgM serology and the response to therapy. The retinitis appeared initially as a hyperreflective region on spectral-domain OCT. An intraretinal cyst consistent with T. gondii parasitic infection was identified. Subsequent OCT images demonstrated progression to full-thickness retinal necrosis with the development of cystic spaces in the retina. Optical coherence tomography may be useful in characterizing the features, extent, and location of retinitis caused by T. gondii. Specific OCT features may indicate whether the infection is acute phase or becoming quiescent.

Disseminated toxoplasmosis after allogeneic stem cell transplantation in a seronegative recipient

Toxoplasmosis is increasingly diagnosed after hematopoietic stem cell transplantation (HSCT) and is associated with considerable morbidity and mortality. In the majority of cases, reactivation of latent disease secondary to impaired cellular and humoral immunity after HSCT is believed to be the main pathogenetic mechanism. Hence, primary toxoplasmosis is rarely considered in the differential diagnosis of infections after HSCT in a recipient who is seronegative for Toxoplasma gondii pre-transplant. We herein report a seronegative patient with acute T-cell lymphoblastic leukemia, who developed primary disseminated toxoplasmosis 5 months after HSCT from a seronegative unrelated donor. A review of all reported cases of primary toxoplasmosis after HSCT revealed significantly increased morbidity and mortality. Patients with negative pre-transplant Toxoplasma serology should therefore be considered at risk for toxoplasmosis after allogeneic HSCT. Possible prevention and monitoring strategies for seronegative recipients are reviewed and discussed in detail.

Seroprevalence of Toxoplasma gondiiand associated risk factors among pregnant women in Jimma town, Southwestern Ethiopia

BackgroundToxoplasmosis is a common parasitic infection caused by an obligate intracellular protozoan, Toxoplasma gondii. If primary toxoplasmosis occurs during pregnancy about one third of the cases could lead to congenital toxoplasmosis, with subsequent pathological effects. This study aimed at determining the seroprevalence of T. gondii among pregnant women in Jimma town, Southwest Ethiopia.MethodsA community based cross-sectional study was conducted to assess the seroprevalence and associated factors in pregnant women from August to September, 2011. A total of 201 study participants were included in this study. Data on socio-demographic and predisposing factors were collected from each study participant. Moreover, venous blood specimens were collected following Standard Operating Procedures. All the collected specimens were tested for IgM and IgG anti-T. gondii antibodies by enzyme-linked immunosorbent assay (ELISA).ResultsThe overall seroprevalence of T. gondii in the study area was 83.6%. One hundred and sixty three (81.1%) of the pregnant women were IgG seropositive, five (2.5%) were IgM seropositive. Three of the 5 pregnant women were positive for both IgG and IgM. Presence of domestic cat at home showed significant association with anti-T. gondii seropositivity (OR = 5.82, 95% CI: 1.61- 20.99; p < 0.05).ConclusionThe seroprevalence of T. gondii antibodies was high among the pregnant women. Pregnant women having domestic cat at their home were at higher risk of T. gondii infection. Hence, health education and awareness on the disease and its transmission to women of reproductive age group in general and pregnant women in particular should be created during antenatal follow up to reduce the risk of T. gondii infection in pregnant women.

Macrophage activation syndrome triggered by primary disseminated toxoplasmosis

We report the case of a patient with disseminated toxoplasmosis who presented with cervical lymphadenopathies and pneumonia. Although the infection was successfully treated with co-trimoxazole, the patient developed reactive macrophage activation syndrome (rMAS). To our knowledge, this is the first reported case of rMAS triggered by toxoplasmosis in the medical literature.

Primary Toxoplasmosis in pregnancy – results from an interdisciplinary approach

Primary Toxoplasmosis in pregnancy – results from an interdisciplinary approach

Primary central nervous system lymphoma in acquired immunodeficiency syndrome patient

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkins lymphoma of the central nervous system and eye. It is over 1000 times greater in HIV positive than in non-HIV populations. The decline in its incidence since the introduction of the highly active anti-retroviral therapy (HAART) suggests an association of this tumor with severe and prolonged immunosuppression. Clinical presentation results from neurological deficits related to the site of the tumor. Systemic B symptoms are also common. The detection of EBV DNA from the CSF, by nested PCR, is a highly sensitive and specific for HIV-related PCNSL. We present the case of a 31-yearold African American man with medical history significant for AIDS who presented with one-month history of lack of energy and somnolence. CSF appearance was normal. MRI suggested primary CNS lymphomas or toxoplasmosis. CSF EBV DNA by PCR was found to be positive. The clinical presentation of PCNSL is similar to that of toxoplasmosis encephalitis in patients diagnosed with HIV. The initial differentiation between the two pathologies on presentation is important since treatment differs and early treatment has been shown to reduce mortality.

Acute Primary Toxoplasmosis in Travelers Returning From Endemic Countries

Fourteen cases of toxoplasmosis in immunocompetent travelers who visited high prevalence countries are described. This represents the first series of toxoplasmosis in returned travelers from North America, substantiating the need to consider toxoplasmosis in returned travelers who present with non-specific symptoms, especially fever, lymphadenopathy, and fatigue.