Toxoplasmic Lymphadenitis Research Articles

Toxoplasmic Lymphadenitis of the Head and Neck Region.

We analyzed the clinical characteristics and treatment results in patients with a final diagnosis of toxoplasmic lymphadenitis after surgery. A total of 23 patients with a final diagnosis of toxoplasmic lymphadenitis of the head and neck region after surgery from January 2010 to August 2022 were enrolled. All patients with toxoplasmic lymphadenitis presented with a neck mass and a mean age of over 40. The most common location of toxoplasma lymphadenitis in the head and neck was neck level II in 9 patients, followed by level I, level V, level III, the parotid gland, and level IV. Three patients had masses in multiple regions of the neck. Preoperative diagnosis (based on imaging tests, physical examination, and fine-needle aspiration cytology results) was benign lymph node enlargement in 11 cases, malignant lymphoma in 8 cases, metastatic carcinoma in 2 cases, and parotid tumors in 2 cases. All patients underwent surgical resection and were diagnosed with toxoplasma lymphadenitis based on the final biopsy. There were no major complications after surgery. A total of 10 patients (43.5%) received additional antibiotics after surgery. There was no recurrence of toxoplasmic lymphadenitis during the follow-up period. It is challenging to assess the diagnostic accuracy of preoperative examination in toxoplasma lymphadenitis; hence, surgical resection is necessary to differentiate it from other diseases.

Toxoplasmosis lymphadenopathy-A series of 8 cases diagnosed in a 2-year timeframe: Is it a needle in a haystack?

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an obligate intracellular parasite. Clinical presentation of infection depends on the age and immune status of the patient. In immunocompetent patient, it may present as a non-specific lymphadenopathy and self- limiting illness. In contrast, in immunocompromised patients it can be a life-threatening infection. We present a series of 8 cases of toxoplasma lymphadenitis diagnosed in our institute in last two years. Lymphadenopathy raises a suspicion of malignancy; however, diagnosis of reactive lymphadenitis often marks the end of diagnostic evaluation. Careful morphological evaluation, the classic triad, often can direct at a conclusive diagnosis. We are presenting a case series to draw attention to this entity as majority of the published literature is in the form of case report and serological surveys and very occasional study showing both the histopathology and serology in tandem.

Toxoplasma Lymphadenopathy: A Comparative Diagnostic Assessment of Clinical, Serological and Histopathological Findings.

Toxoplasma Gondii (TG) is a zoonotic protozoan with extensive symptomatology. Toxoplasmic lymphadenopathy is considered an affirmative sign and is proved by a biopsy of the enlarged nodule. This study was conducted to compare the clinical, serological, and histopathological findings for the diagnosis of toxoplasmic lymphadenopathy. This study involved biopsy examinations from twelve cases with TG lymphadenopathy. ELISA serological tests were performed for TG specific IgM and IgG immunoglobulins. PCR was done to ratify the results obtained by ELISA. The ages of the patients ranged from 15 to 48 years (mean=27.8). Most of the cases are male n=8(66.7%), while female n=4(33.3%). The asthenia was not only the most frequent clinical presentation (83.3%), but it also last longer. All cases had a positive biopsy. Eight (67.7%) cases revealed seropositivity. Two of them had positive PCR in those who were positive IgM, suggesting that the infection was acute. Six (50%) cases revealed positive IgG tests, while those with negative serology were 4(33.3%). The site of lymph nodes involvement had been assessed and mostly cervical (91.6%). The histopathological results yielded 100% positive findings, thus biopsy was very important in the diagnosis and differential diagnosis of lymph nodes enlargement. The chronic phase of toxoplasmosis does not show the protozoa in the blood causing an absent DNA band for amplification of the PCR cycles, which could explain the lack of bands particular for TG. A negative serological test does not exclude toxoplasmic lymphadenitis, especially in immune-compromised patients.

Acute toxoplasmosis mimicking metastatic lymphadenopathy of sarcoma

Abstract Introduction: Clear cell sarcoma is a rare malignant neoplasm with the potential to metastasize to lymph nodes. We report herein a case of acute toxoplasmosis that mimicked metastatic lymphadenopathy from treated clear cell sarcoma on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Toxoplasmosis is usually asymptomatic in immunocompetent hosts. Acute acquired toxoplasmosis clinically manifests as lymphadenopathy predominantly involving the cervical nodes. Patient concerns: A 45-year-old woman underwent resection of subcutaneous clear cell sarcoma of the right knee. PET/CT performed four years after surgery revealed multiple sites of lymphadenopathy with avid FDG uptake in the right neck, left axilla, left pulmonary hilum, and right inguinal regions. The patient was afebrile and asymptomatic. Metastases were suspected and excisional biopsy of a left axillary node was performed. Diagnoses: Histopathological examination revealed reactive lymphadenitis, suggesting toxoplasmic infection without evidence of malignancy. Serum levels of toxoplasmic immunoglobulin (Ig)M antibodies were high. Serum IgG antibodies were significantly elevated in six weeks from the PET/CT examination. The patient had a cat at home, which could have represented the source of infection. Interventions: The patient was carefully monitored using regular imaging examinations. Outcomes: FDG accumulations resolved spontaneously on follow-up examination one year later. Conclusion: We report a case in which toxoplasmic lymphadenitis mimicked malignant lymphadenopathy. Lymphadenopathy at a distant site from the primary malignancy with FDG avidity may be due to infectious or inflammatory conditions, creating false-positive results.

Clinical Characteristics of Cervical Toxoplasma Lymphadenitis

Background and Objectives Toxoplasmosis is a disease caused by an intracellular parasite, Toxoplasma gondii. There has been only a few studies done on cervical toxoplasma lymphadenitis, and this study was performed to evaluate its clinical characteristics and outcomes.Subjects and Method We retrospectively reviewed the patients diagnosed with cervical toxoplasma lymphadenitis from January 2010 to December 2019. We investigated clinical pathologic findings, treatment and clinical outcomes.Results Enrolled in the study were 21 patients who were confirmed with typical pathologic findings in an excisional biopsy (16/21) and core needle biopsy (5/21). Nine patients were male and 12 patients were female, with the mean age of 46.1±13.59 (19-70). All patients complained of neck masses and 5 (23.8%) patients showed pain or tenderness. Only one (4.8%) patient had mild fever. Fine needle aspiration cytology was performed in 5 patients, with no resulting pathognomonic outcomes in any one of the patients. CT scan was performed in 15 patients, with 8 (53.3%) patients showing multiple nodal enlargements but 7 (46.6%) patients showing a single enlarged lymph node. The most frequently involved location was level I (53.3%), followed by level II (46.6%), level V (46.6%), level III (40.0%), and level IV (20.0%). The serologic test for toxoplasma revealed positive IgG (100%) and IgM (85.7%). Treatments were excision only (61.9%) and excision with pharmacologic treatment using sulfonamide or pyrimethamine (38.1%). There was no case of recurrence after treatment.Conclusion Cervical toxoplasma lymphadenitis can be diagnosed by biopsy but needle aspiration has little role. It shows favorable clinical outcomes after treatment.

Cyto-serological correlation in toxoplasma lymphadenitis: Is bypassing biopsy plausible?

To study ten cases of toxoplasmic lymphadenitis (TL) in which the diagnosis was made by fine needle aspiration cytology and confirmed by subsequent serology. Retrospective study done over a period of five years. We retrieved ten cases of Toxoplasma lymphadenitis in which fine-needle aspiration cytology (FNAC) of lymph node was done after clinical examination. Serology with electrochemiluminescense was done in all the cases. The cytological features were characterised by microgranulomas, abundance of tingible body macrophages and absence of necrosis. Serologic testing for toxoplasma in all the cases revealed elevated titres. Lymphadenitis due to Toxoplasma infection should be considered in the diagnosis of unexplained lymphadenopathy at all sites, especially the cervical region. Serologic confirmation should be recommended for all suspected cases. FNAC diagnosis can eliminate the need for hospitalization and surgery. To the best of authors’ knowledge, this is 5 case series of cytodiagnosis of TL in the English literature and 2 in the Indian literature. This is the largest case series of cytodiagnosis of TL in the Indian literature and 2 largest in the world literature next to the one done by Haque et al.

Toxoplasmic Lymphadenitis Presenting as a Tiny Neck Tumor

(1) Background: Toxoplasmic lymphadenitis (TL), caused by the protozoan Toxoplasma gondii, is a worldwide zoonosis. We report a case of TL in the head and neck region diagnosed using ultrasound (US)-guided fine needle aspiration cytology (FNAC), serological tests, and pathological findings. (2) Case Presentation: A 51-year-old female with a chief complaint of a left posterior neck mass that had been growing for approximately 2 weeks. TL was confirmed by histopathological examinations and serological tests. US-guided FNAC and en bloc resection of the lymph node were performed. The diagnosis was confirmed as TL in the neck. (3) Conclusions: We suggest that US-guided FNAC should be considered as the first-line test for assessing a tiny mass before a definitive treatment is chosen.

Clinicopathological Study of Toxoplasma Lymphadenitis in a Girl from Baghdad Province

Clinicopathological Study of Toxoplasma Lymphadenitis in a Girl from Baghdad Province

Toxoplasma lymphadenitis caused by ingestion of raw blood and meat of deer in a 10-year-old boy

Toxoplasma lymphadenitis caused by ingestion of raw blood and meat of deer in a 10-year-old boy

FNAC of Lymph Node - A Valuable Clue to Diagnosis of Toxoplasma Lymphadenitis

Background: Fine needle aspiration cytology (FNAC) is now a days the initial investigation in most cases of superficial lymphadenopathy. In clinical practice both clinicians and cytopathologists are not commonly suspecting of Toxoplasma lymphadenitis (TL), though it may constitute a significant proportion of unexplained lymphadenitis. Careful cognizance of cytological findings can give valuable clue to the diagnosis of toxoplasmosis which can be confirmed by serological evidence.Methods: This cross-sectional study was conducted in Department of Histopathology of Armed Forces Institute of Pathology (AFIP), Bangladesh from 01 July 2017 to 31 March 2018. FNAC smears of the patients with lymphadenopathy who reported for FNAC were examined and suspicion of toxoplasmosis was made on coexistence of abundance of ‘tingible body macrophages’ (TBM) and follicular center cells (FCC), small collections of epithelioid histiocytes and absence of necrosis and/or more than occasional giant cells. Serum enzyme linked immunosorbent sorbent assay (ELISA) for Toxoplasma IgM and IgG antibody was then performed in all cases that deemed suspicious for toxoplasmosis for confirmation of the diagnosis.Results: Total 925 patients were examined by FNAC of lymph node. Among them 574 were categorized as reactive hyperplasia (RH). Thirty two patients (5.74%) of RH were suspected as TL and included in the study. Serum ELISA confirmed toxoplasmosis in 22 (68.75%, twelve male and ten female) of these 32 cases. One among the positive cases revealed bradyzoites of Toxoplasma in the smear. The age of the patients diagnosed finally as TL spanned between 5 to 47 years (mean 28.59±11.51 years) though most frequent age group was 26 Yr to 35 Yr (7 cases- 31.8%).Conclusion: A high index of suspicion of TL can be made on careful study of smears of FNAC of enlarged lymph node, diagnosis of which can then be confirmed by ELISA.Birdem Med J 2018; 8(2): 103-107

Polymerase chain reaction (PCR) in ocular and ganglionar toxoplasmosis and the effect of therapeutics for prevention of ocular involvement in South American setting

IntroductionCases of toxoplasmosis present in South America tend to be more severe than that found in other continents. Here, we present our clinical experience of ocular and ganglionar toxoplasmosis in the use of PCR, and of the treatment to prevent ocular involvement. MethodologyRetrospective analysis of clinical charts of patients with ocular and lymphadenitic toxoplasmosis at the parasitology and tropical medicine consultation in the “Universidad del Quindio” in Colombia. In total, 91 records of cases with ocular toxoplasmosis and 17 with lymphadenitis that underwent PCR analysis for B1 repeated sequence in blood, were compared to the results of 104 people with chronic asymptomatic toxoplasmosis. In addition, 41 clinical records were included from patients with confirmed toxoplasmic lymphadenitis: 10 untreated, 6 that begun treatment after four months of symptoms, and 25 that were treated during the first four months of symptoms and had a follow-up during at least one year. ResultsPatients with ocular toxoplasmosis or lymphadenitis had a higher probability of PCR positivity in peripheral blood than chronic asymptomatic people. There were no cases of retinochoroiditis in 25 patients with toxoplasmic lymphadenitis treated before 4 months of symptoms and followed during at least 12 months. In four out of ten untreated cases, new lesions of retinochoroiditis presented after the symptoms of lymphadenitis. ConclusionsToxoplasmosisin South America exhibits different clinical behavior and this influences the laboratory results as well as the need for treatment in the case of lymphadenitis. Clinicians should be aware of the geographical origin of the infection in order to adopt different therapeutic and diagnostic approaches.

Toxoplasmic Cervical Lymphadenopathy Precedes Lymphoma

A 35 years old male presented to the outpatient clinic in Alexandria University Hospital with right neck swelling appeared 1 year ago and finally diagnosed, 9 months ago, by histopathologists in the same institute via ultrasound guided FNAC, as Toxoplasmic lymphadenitis. However, the patient represented by sudden increase in the size of this mass 3 months before this re-attendance associated with malaise and low grade fever but there was neither night sweat nor weight loss. The patient had a clear evidence of contact with cats because he was a veterinarian. There was no other positive family, surgical or medical history. On examination, large, firm, mobile right sided lymphadenopathy without signs of active inflammation in the overlying skin at levels III, IV and V. No evident lymph nodes on the other side of the neck or other sites of his body and no hepatoslenomegaly. Temperature and vital signs were normal. ENT examination did not warrant any additional abnormality Erythrocyte Sedimentation Rate (ESR) was 95mm/hr and LDH was 300 U/l these were the first red flag signs that directed the team to further evaluations for Lymphoma. Open surgical biopsy finally diagnosed it as grade III follicular non-Hodgkin’s Lymphoma through the Light microscopy which revealed grade III follicular NHL (>15 large centroblasts/high-power field) and DNA analysis which showed t (14; 18) chromosomal translocation characterized by fusion of the bcl-2 gene at 18q21 with the immunoglobulin heavy chain locus at 14q32

Ultrasound-guided core needle biopsy of cervical lymph nodes in the diagnosis of toxoplasmosis.

Our study investigates whether the histopathological features of toxoplasmic lymphadenitis (TL), specifically noncaseating microgranuloma and follicular hyperplasia, can be obtained by sonographic-guided core needle biopsy (CNB) of cervical lymph nodes. Thirty-two patients seen from June 2014 to March 2015 were positive for toxoplasma immunoglobulin M antibody. Among those patients, 21 underwent CNB of a cervical lymph node and were enrolled in this study. The pathologic findings were reviewed. Twenty-nine lymph nodes in 21 patients were sampled. Eighteen of the 21 (86%) patients had a microgranuloma without caseating necrosis or giant cells, and all 21 (100%) patients had follicular hyperplasia. The histologic findings of TL were detected by sonographic-guided CNB, which can be used as part of the first line of investigation in patients with unexplained cervical adenopathy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:192-196, 2017.

Cytokine profiles in patients with toxoplasmic lymphadenitis in the setting of pregnancy

IntroductionMajority of Toxoplasma gondii infections are benign and asymptomatic; however, some patients experience toxoplasmic lymphadenitis (TL). Factors associated as to whether infection will be symptomatic or not are unknown. MethodsDye test titers of patients with acute toxoplasmosis (pregnant and not pregnant) with TL (TL+) were compared with those in patients with asymptomatic acute infection (TL−). Additionally, mean levels of 62 serum cytokines were compared between TL+ and TL− pregnant women and between TL+ pregnant and non-pregnant women. ResultsDuring acute infection, mean dye test titer was higher in TL+ than in TL− patients (p=0.021). In addition, out of 62 cytokines, CXCL9andCXCL10 levels were higher (p<0.05) and resistin mean levels were lower (p<0.05) in pregnant women with TL+ compared to TL−. Among patients with TL+, levels of VCAM1andCCL2 were lower (p<0.05) in pregnant women than in non-pregnant women. ConclusionHere we report differences in dye test titers in patients with acute infection. Cytokine responses vary according to the presence of TL+ and to the pregnancy status. Factors underlying these differences are presently unknown and require further studies to define individual and combined roles of cytokines in TL+.

Broadening the Morphologic Spectrum of Bartonella henselae Lymphadenitis: Analysis of 100 Molecularly Characterized Cases.

Bartonella henselae lymphadenitis, or cat-scratch lymphadenitis (CSL), is classically associated with stellate microabscesses, occasional giant cells, and extension of the inflammatory infiltrate into perinodal soft tissue. Availability of B. henselae molecular testing on tissue specimens has broadened our understanding of the morphologic variation in this disease. Here we sought to describe the histopathologic features of the largest series to date of molecularly proven CSL. B. henselae polymerase chain reaction-positive tissue specimens from 2010 to 2012 were identified, and hematoxylin and eosin slides were reviewed. A single-step 16S-23S rRNA-based polymerase chain reaction testing was used to identify B. henselae on formalin-fixed, paraffin-embedded tissues. A total of 100 B. henselae-positive cases were identified. The median age of the patients was 26.5 years (range, 1 to 69 y). Ninety-two percent of cases presented in lymph nodes, with 66% of these occurring above the diaphragm, most commonly in the cervical chain. Of 100 cases, 57 had classical CSL features of necrotizing granulomas with microabscesses, with or without surrounding palisading histiocytes. In contrast, 43/100 cases lacked the prototypical microabscesses of CSL including: 23 cases (53.5%) with features of fungal/mycobacterial lymphadenitis, 6 (14%) cases with features of Kikuchi lymphadenitis, and 4 cases (9.3%) with the classic histologic triad of toxoplasma lymphadenitis. In summary, B. henselae lymphadenitis may lack the typical microabscesses in almost half of cases and may closely mimic other reactive, especially infectious, lymphadenopathies. Given the lack of specificity of many of these features, a low threshold for B. henselae molecular testing on tissue is warranted in the appropriate clinical context.

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

Toxoplasmic Lymphadenitis of the Head and Neck Region

Toxoplasmosis is a worldwide parasitic disease. Toxoplasma gondii, a protozoan, causes the infection in humans. The clinical manifestations associated with Toxoplasmosis infections are non specific and frequently asymptomatic; they may include low-grade fever, fatigue, and lymphadenopathy. The histopathology and serology are helpful for confirming the diagnosis. Because fewer than 10% of infected persons are symptomatic, otolaryngologists rarely suspect and diagnose Toxoplasmic lymphadenitis when evaluating patients presenting with mass lesions in the head and neck regions. Several cases of Toxoplasmic lymphadenitis have been reported in the English literature; reports of intraglandular Toxoplasmic lymphadenitis of the parotid gland are extremely rare. We report Toxoplasmic lymphadenitis of the cervical lymph nodes and the intraglandular lymph nodes of the parotid gland that have been diagnosed retrospectively subsequent to obtaining the results of the postoperative pathology.

Striking Divergence in Toxoplasma ROP16 Nucleotide Sequences From Human and Meat Samples.

ROP16 is a protein kinase of Toxoplasma gondii identified in the mouse model as a virulent marker, but it is unknown whether this finding is relevant in human toxoplasmosis. We obtained the Toxoplasma ROP16 locus DNA sequence in samples from 12 patients with ocular toxoplasmosis, 1 sample from a patient with congenital toxoplasmosis, 22 samples from soldiers operating in the jungle, 2 samples from urban soldiers, and 10 samples from meat for human consumption. An enzyme-linked immunosorbent assay specific for antibodies against the ROP16 mouse-virulent peptide was performed in 46 serum specimens from patients with ocular toxoplasmosis and in 28 serum specimens from patients with chronic asymptomatic infection, of whom 19 had congenital infection and 11 had toxoplasmic lymphadenitis. We found a striking divergence of the ROP16 nucleotide sequences. Ten of 12 sequences (83.3%) from patients with ocular toxoplasmosis clustered with those of mouse-virulent strains, whereas 7 of 7 ROP16 sequences (100%) from meat were clustered with those of mouse-avirulent strains. Only 11 of 104 serum specimens (10.5%) had specific antibodies against the mouse-virulent peptide, and there was no association between clinical forms and positive results of serological assays. The majority of ROP16 nucleotide sequences from Colombian patients with ocular toxoplasmosis belonged to the group of mouse-virulent strains.

Molecular characterization T. gondii atypical strains isolated from pregnant women and their neonates in Southern Brazil

Molecular characterization T. gondii atypical strains isolated from pregnant women and their neonates in Southern Brazil

English

Toxoplasma lymphadenitis is a rare disease entity, microfilaria also rarely found in lymph node aspirate but coincidence of toxoplasma gondii and microfilaria in lymph node is very rare. We report here one such case of a four year old child presented with cervical lymphadenopathy, fine needle aspiration cytology showed microfilaria and bradyzoides of toxoplasma gondii, granuloma in a background of reactive lymphoid cells. On serology, serum IgM anti toxoplasma antibody was positive and IgG was negative.