Cases Of Toxoplasmosis Research Articles

Facts and Fictions about Toxoplasma gondii in Women of Misan Province

Background: Toxoplasma gondii (T. gondii) is one of the most common protozoa worldwide that infects human and animals. Because of lack of data about the facts and myths of T. gondii infection in human Iraq, this study was aimed to define and answered all the related questions in a scientific knowledge manner. Materials and Methods: A survey study was conducted among women to assess their knowledge about facts and myths of toxoplasmosis in the Department of Microbiology, Faculty of Medicine, University of Misan, Misan, Iraq, from November 1, 2018 to July 30, 2022. All women answered all the questions. A total of 6055 women, aged from 18 to 68 years, were enrolled, only comprising women who lived in Misan. A questionnaire was constructed upon the objectives and involved questions correlated to personal, demographic, social, economic, and educational information. The questionnaire investigated facts and myths concerning T. gondii. Results: All women completed the survey lists with a response rate of 100%. The mean age was 41.53 ± 20.74 years. Most individuals (3133, 51.74%) were grouped to 18–40 years of age. In terms of the knowledge of toxoplasmosis, women who knew a person with toxoplasmosis (23.15%), though it affects men (47.46%), thought that it is an infectious disease (86.16%), thought that it can be prevented (68.22%), thought that it can be treated or cured (82.84%), thought that it is a hereditary condition (59.64%), thought that cats are a causative agent of toxoplasmosis (74.15%) and thought that it transmits by intersexual course (34.32%). Concerning risk knowledge, women who thought the risk of toxoplasmosis transport by eating unhealthy food are 70.45%, women who thought the risk is raised when wearing tight underwear are 42.25%, women who thought the risk was raised with old age are 49.58%, women who thought the risk could be raised when they use contraceptives are 31.11%, women who thought the risk increased with pregnancy are 84.23%, and women who thought the risk could be raised with smoking and alcohol intake are 45.70%. Of 6055 women, a total of 5578 (92.12%) women said that toxoplasmosis is a zoonotic disease. About 96.10% of the sample said that it transmits by cats. Almost always, 99.45% of women thought that it is a cause of abortion, stillbirth, and congenital anomalies. In addition, only 16.99% of women in this survey know that there are over two million new cases of toxoplasmosis in the world annually. About 11.33% of women thought that toxoplasmosis cases are asymptomatic whereas others thought that they have a fever, gastro intestinal tract symptoms, genito urinary tract symptoms, and ophthalmologic symptoms. Conclusions: Many facts and myths can affect the knowledge of women about toxoplasmosis. In kinds of literature, there are no real modes for studying myths about infectious diseases in particular toxoplasmosis which may be of benefit in preventing and managing processes.

АНАЛИЗ АКТИВНОСТИ ТОКСОПЛАЗМЕННОЙ ИНВАЗИИ У ЛЮДЕЙ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА

Introduction. Persons of the older age group, due to weakened immunity, are at risk for toxoplasmosis: with age, the level of seropositivity and the risk of reactivation of infection in people with chronic infection increases. But in clinical and epidemiological terms, this group has not been sufficiently studied. Purpose of the study. Determination of the level of seropositivity and the degree of activity of toxoplasma invasion in persons of the older age category without pathology, as well as in combination with psychoneurological symptoms or transplantation of solid organs. Materials and methods. The ELISA method was used to determine various classes of antibodies to T. gondii in the blood sera of 614 people aged 60 to 93 years (conditionally healthy individuals, patients with neuropsychiatric pathology, with cognitive decline, after organ transplantation). Results. IgG antibodies to T. gondii were detected in 51,5 % of the examined people. There was a trend of increasing infection from the age of 60-64 years to 75-79 years. Very few cases of acute toxoplasmosis have been identified; more significant was the detection of IgA antibodies, a reactivation marker, in 10,1 % of the examined antibodies. The largest number of individuals with IgA was observed in patients after transplantation, with neuropsychiatric pathology and cognitive decline. Discussion. Since toxoplasmosis is a latent infection of the brain and its association with a number of mental and neurodegenerative diseases has been proven, the high T. gondii infection in elderly people and the presence of reactivation markers in them suggests systematic monitoring of invasion, especially when combined with CNS pathology and reduced immunity. People aged "60+" with a certain clinical history are at risk in the presence of a parasite in the body. Conclusion. Finding an association between toxoplasmosis and psychiatric disorders in immunocompetent individuals is the basis for further monitoring of such associations with a view to their prevention and treatment. Key words: toxoplasmosis, Toxoplasma gondii, psycho-neurological diseases, elderly people, detection of antibodies.

Exploring the association between precipitation and population cases of ocular toxoplasmosis in Colombia.

Previous studies suggest a relationship between precipitation and ocular toxoplasmosis (OT) reactivation and congenital toxoplasmosis infection. We aimed to investigate the relationship between precipitation and the frequency of new OT cases in Colombia from 2015 to 2019. This retrospective cohort study analyzed data obtained from a claims-based database created by the Colombian Ministry of Health and national registries of precipitation of the Institute of Hydrology, Meteorology, and Environmental Studies. We estimated the daily number of OT cases, interpolating data from the average number of annual cases from 2015 to 2019. Then, we compared exposures (mean daily precipitation) in the case period in which the events (interpolated OT new cases) occurred by a quasi-Poisson regression, combined with a distributed lag non-linear model to estimate the non-linear and lag-response curve. In the 5-year analysis, there were 1,741 new OT cases. Most of the cases occurred in 2019, followed by 2015 and 2018. New OT cases among departments were significantly different (P< 0.01). The cumulative exposure-response curve was decreasing for most departments. Nevertheless, in Chocó, Bogotá, Cesar, Cauca, and Guajira, when a certain amount of precipitation accumulates, the relative risk (RR) increases, which was contrary to the pattern observed in the other regions. The response curves to the one-day lag showed that precipitation influences the RR; however, the trends vary by department. Finally, an increasing trend in the number of cases was directly proportional to precipitation in Guajira, Atlántico, Norte de Santander, Santander, Caquetá and Quindío (r = 0.84; P< 0.05). Precipitation influenced the RR for new OT cases. However, varying trends among geographical regions (departments) lead us to hypothesize that other sociodemographic, behavioral, and environmental variables, such as wind and water contamination, could influence the RR.

P449 Semi-quantitative cryptococcal antigen rapid test (CryptoPS, Biosynex®) for cryptococcal meningitis in patients living with HIV in Sub-Saharan Africa: prospective multicenter diagnostic accuracy study (DREAMM)

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackgroundCryptococcal meningitis (CM) remains a leading cause of HIV-related meningoencephalitis in African low- and middle-income countries (LMICs), causing 15%-20% of HIV-related deaths. Rapid Diagnostic Tests (RDTs) are powerful tools and key to speeding-up the diagnosis at the bedside, allowing for rapid and targeted treatment, especially in LMICs. For the past 10 years, Cryptococcal Antigen (CrAg) RDTs have a major role in CM management.Driving Reduced AIDS Meningo-Encephalitis Mortality (DREAMM) was a multicenter implementation science study and a capacity-building project to reduce the mortality of HIV-related central nervous system infections (CNS). One of the main DREAMM approaches was to improve the diagnosis of CNS infections at the bedside and in parallel in local laboratories. Within DREAMM, HIV-infected, adult people living with HIV (>18 years old) with suspected CNS infections were recruited in five hospital sites in Cameroon, Malawi, and Tanzania.ObjectivesOur objective was to evaluate the implementation of CrAg CryptoPS (Biosynex, Illkirch Graffenstaden, France), a new semi-quantitative RDT, in routine care settings in Sub-Saharan Africa.MethodsAll CrAg CryptoPS performed were compared to the reference CrAg lateral flow assay (Immy®). The evaluation was done by the local research teams in four DREAMM laboratories sites. CrAg CryptoPS's implementation was evaluated in 301 plasma samples and 258 cerebrospinal fluid (CSF) samples from 320 participants (patients diagnosed with cerebral toxoplasmosis did not have a lumbar puncture). In this analysis, the results will be considered in a binary way (positive/negative).ResultsBetween January 2018 and March 2021, 356 participants were prospectively enrolled with suspected HIV-related CNS infections, including CM, tuberculous meningitis, cerebral toxoplasmosis, and bacterial meningitis cases. Cryptococcal meningitis was the leading cause of CNS infections in Malawi and Tanzania with 66.3% (53/80) and 59.6% (59/99) cases respectively, and the second cause in Cameroon with 40.0% (39/90) cases after cerebral toxoplasmosis.In plasma, CryptoPS's sensitivity was 99.23% (95% CI, 0.98-1.01) and specificity was 94.15% (95% CI, 0.91-0.98); positive and negative predictive values were 92.8% and 99.4%, respectively. In CSF, the sensitivity and specificity of CryptoPS were 100% (95% CI, 0.0-0.0), and 99.26% (95% CI, 0.98-1.01), respectively; positive and negative predictive values were both 100%. A low number of false-positives were observed (<4% in plasma and <0.5% in CSF).ConclusionCryptoPS was evaluated in a context of hospitalized patients within a project including all causes of HIV-related CNS infection, not only CM. The sensitivity and specificity of CryptoPS calculated in these preliminary results are promising. Semi-quantitative CryptoPS has the potential to be used to tailor antifungal therapy but further optimizations need to be done prior to large-scale implementation in African LMICs. In addition, future work to determine CrAg antigen titres is planned, in the perspective to optimize treatment of CrAg positive cases who decline lumbar puncture.

Isolation and characterization of Toxoplasma gondii isolates from human congenital toxoplasmosis cases reveal a new virulent genotype in São Paulo, Brazil

Toxoplasma gondii causes severe disease in congenitally infected fetuses. The severity of fetal infection is related to the gestational stage at the time of maternal infection, parasite burden, and genotypic characteristics. South America has a high incidence of congenital toxoplasmosis and has the highest genotypic diversity of the parasite. In Brazil, clinical toxoplasmosis in children is notorious, however there are very limited data regarding the strains recovered from congenital infections. In this study, T. gondii strains from two cases of severe congenital toxoplasmosis from the São Paulo metropolitan area were isolated (TgHumIMTBr2 and TgHumIMTBr3) and biologically and molecularly characterized using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and microsatellite analysis, revealing a new non-archetypal virulent genotype designated as #318. The other isolate, genotype #175, has already been described in domestic and wild animals in Brazil, but is now associated with acute toxoplasmosis in humans. These data reinforce the role of non-archetypal T. gondii genotypes in the severity of human congenital toxoplasmosis, highlighting the importance of studies focused on parasite isolation and genotyping for a better understanding of the virulence of isolates from human toxoplasmosis and contributing to the knowledge of the diversity of T. gondii in Brazil.

An Infant with Hydrocephalus and Hepatomegaly

We report a histologic and PCR-confirmed case of symptomatic congenital toxoplasmosis in a premature infant with optic nerve atrophy and severe ventriculomegaly requiring ventriculoperitoneal shunt in the absence of cerebral calcifications. A significant risk factor in acquisition of this congenital infection was mother’s consumption of raw deer meat during pregnancy.

Unexpected Case of Cerebral Toxoplasmosis with Radiological Appearance Similar to Malignancy

ABSTRACTToxoplasmosis was Toxoplasma Gondii infection. In HIV-infected patients, the prevalence of toxoplasma infectionranges was 3-97%. Diagnosis cerebral toxoplasmosis almost failed to recognized varians clinical and radiologicalfeatures on organism identifiied from brain biopsy which difficult to extract from alive patient. This case reportdiscussed cerebral toxoplasmosis of brain biopsy HIV positive patient which unknown status HIV patient, previously.A 52-year-old male patient came complained not only loss of apatit and dizzy two months ago, but also fainted.MSCT Scan with and without contrast showed right temporooccipital glioblastoma. Brain MRI showed a lesion on theright temporoparietal area with perifocal edema pressing on the right lateral ventricle. Microscopical feature showedglial tissue containing large areas of necrosis with karyorrhexis debris, PMN and mononuclear leucocyte infiltration,scaterred of tachyzoites and bradyzoites, no signs of malignancy. HIV serological examination was confirmed and thepatient's results were found to be anti-HIV reactive. Conclusion diagnosis as cerebral toxoplasmosis.

Seroprevalence and Risk Factors of Human Brucellosis and Toxoplasmosis in Ghazni Province of Afghanistan

Brucellosis and toxoplasmosis are considered neglected zoonotic diseases with a worldwide distribution, which are endemic in Afghanistan. A cross-sectional study was carried out from May 24, 2021, to Feb 20, 2022 to determine the seroprevalence and risk factors associated with human brucellosis and toxoplasmosis in suspected patients admitted to the public and private laboratories of Ghazni province of Afghanistan. To detect Brucella IgM. a semi-quantitative agglutination test was used, while for the detection of Toxoplasma IgM and IgG, a chromatographic immunoassay was applied. Seroprevalence of brucellosis and toxoplasmosis were 32.1% (76/237) and 19.6% (18/92) in tested patients, respectively. Whereas, only in five cases dual infections were found. The majority of brucellosis positive cases were among the age group &gt;45 years old (57.1%; p&lt;0.05), in district residents (43.5%; p&gt;0.05), and among those with abortion (30.6%; p&lt;0.05) and history of positive brucellosis cases (50.0%; p&lt;0.05) in their family members. High seropositive cases of toxoplasmosis were observed in males (50.0%; p&gt;0.05), 21-45 years old people (20.8%; p&gt;0.05), those who owned dogs and cats (p&gt;0.05), among those with the history of abortion cases in their animals (41.7%; p&lt;0.05), and positive toxoplasmosis cases in their family members (66.7.0%; p≤0.05). The odds of being seropositive for brucellosis was higher in those that had history of abortion (OR: 4.3; 95%CI: 1.3-4.2) and brucellosis cases (OR: 7.1; 95%CI: 1.7-28.9) among their family members. Furthermore, the odds of being seropositive for toxoplasmosis was 13.2 times more (95%CI: 2.1, 82.2; p&lt;0.05) in those which had history of abortion cases in their animals. The high seroprevalence could be attributed to the study population being drawn from suspected cases rather than the general population. To assess the cross-connection of infections in human and animal populations, it would be more beneficial to study a large number of human and animal samples concurrently.

Clinical Profile of Optic Neuritis in Malaysian Patients Older Than 45 Years of Age.

IntroductionOptic neuritis (ON) is a blinding inflammatory disease of the optic nerve, typically affecting young adults as described in the Optic Neuritis Treatment Trial (ONTT). However, there is limited information describing ON in patients older than 45 years of age. The aim of this study was to determine the clinical profile of ON in this age group in Malaysia.MethodsA retrospective case series study was performed between January 2014 and December 2018 among patients older than 45 years old, treated as ON in Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Clinical features, visual acuity, imaging, laboratory results, aetiologies, and visual outcomes were analyzed.ResultsThis study comprised 17 patients (20 eyes) with a gender distribution of eight males and nine females. The mean age of ON onset was 55.8 ± 7.7 years (46-80 years). Most patients (94.1%) presented with reduced vision and retroorbital pain, and three patients (17.6%) had bilateral eye involvement. Papillitis was observed in 13 eyes (65%), retrobulbar ON in five eyes (25%), and optic atrophy in two eyes. Presenting visual acuity was moderately correlated with final visual outcome (rs= 0.47, n = 20, p < 0.05). Post-treatment visual improvement (good and slight) was reported in 14 eyes (70%), four (20%) had no improvement while the remaining two eyes (10%) had worsening best-corrected visual acuity (BCVA). Infective causes accounted for 23.5% of cases (one ocular syphilis, two ocular tuberculosis, and one case of toxoplasmosis). Most cases (70.6%) were idiopathic ON, and only one case was diagnosed with neuromyelitis optica spectrum disorder (NMOSD).ConclusionON in Malaysian patients older than 45 years of age has no gender predilection and is most likely to be idiopathic; however, infective ON must still be ruled out. Overall visual outcomes were satisfactory. Among the infective causes, ocular tuberculosis caused poor visual recovery as compared with syphilitic and toxoplasmosis-related ON cases.

Pars plana vitrectomy and visual stimulation for treatment of vitreomacular traction secondary to toxoplasmosis retinochoroiditis in a 5-year-old child

Objective: A unusual case of ocular toxoplasmosis with significant vitreomacular traction is reported. The patient improved significantly following pars plana vitrectomy combined with visual stimulation and occlusion therapy. Methods: The case of a 5-year-old girl with significant unilateral vision loss associated with vitreous condensation and macular traction is described. Results: Pars plana vitrectomy was carried out for vitreomacular traction release. This was followed by visual stimulation and occlusion therapy. Significant improvement was observed. Conclusion: Despite structural damage, the combination [...]

Placenta to the rescue: A case of congenital toxoplasmosis

Congenital toxoplasmosis is a disease caused by Toxoplasma gondii, an obligate intracellular parasite, which is transmitted via the placenta from mother to fetus. The risk of fetal infection increases with advancing gestation, while the risk of severe fetal disease decreases with gestation. Infection may result in miscarriage, preterm labour or stillbirth. Manifestations in the fetus vary and can include serious and progressive motor, hearing, visual and cognitive issues. Here we report a case of congenital toxoplasmosis detected in the placenta of a preterm infant.

The Association of Toxoplasma gondii IgG Antibody and Chronic Kidney Disease Biomarkers.

Background: Toxoplasma gondii (T. gondii) is a parasite that infects more than 40 million Americans and causes toxoplasmosis. Most cases of toxoplasmosis are asymptomatic; however, T. gondii is capable of invading organs like the kidney, causing chronic infections and cell destruction. Methods: This study focused on evaluating the association between T. gondii exposure and chronic kidney disease (CKD) using data from the 2009–2010 National Health and Nutrition Examination Survey (NHANES). T. gondii exposure was assessed using Toxoplasma gondii IgG antibody status, and the status of CKD was assessed using the CKD biomarkers. The evaluation of risk rate and population prevalence was performed. In addition, multivariable regression models were used to further investigate this association after adjusting for sociodemographic, anthropometric, behavioral, and clinical covariates commonly associated with kidney dysfunction. Results: The positive T. gondii IgG antibody participants had significantly higher levels of CKD biomarkers, including second albumin-to-creatinine ratio (p = 0.0376), second albuminuria (p = 0.0005), and persistent albuminuria (p < 0.0001) compared to the negative participants. Furthermore, there were statistical associations between T. gondii exposure and the status of CKD (negative vs. positive) (p = 0.0001), and between T. gondii exposure and the CKD stage (negative, stage 1, …, stage 5) (p = 0.0004). Without adjusting for age, the positive T. gondii participants had a significantly higher risk (27% higher) of having CKD than the negative participants (RRcrude = 1.27, 95% CI: 1.09–1.49). The age-adjusted prevalence of CKD was higher among Toxoplasma-positive participants compared to the Toxoplasma-negative participants (10.45 vs. 8.99). T. gondii infection was significantly associated with CKD (OR = 1.40, 95% CI = 1.06–1.84, p = 0.00447) after adjusting for age, gender, race/ethnicity, and BMI. Age was positively associated with CKD (OR = 8.89, 95% CI = 6.31–12.51, p < 0.0001) with the participants 45+ years old being 8.89 times more likely to have CKD than those who are <45 years old, after adjusting for T. gondii infection, gender, race/ethnicity, and BMI. Moreover, positive T. gondii increased the odds of CKD progression (OR = 1.41, 95% CI = 1.07–1.86, p = 0.0424). Conclusions: Positive T. gondii IgG antibody is associated with CKD and the progression of CKD stages. This association is more apparent among older people. Further investigations are needed to examine these findings in different geographical locations and among differentially exposed populations.

CASE REPORT: REACTIVATION OF CONGENITAL OCULAR TOXOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT AFTER RECEIVING MEASLES

A case of recurrent ocular toxoplasmosis, presented through diagnostic imaging techniques and laboratory tests. To show the course and development of the clinical picture of ocular toxoplasmosis in a 19-year-old girl with good visual acuity in both eyes, which was accidentally detected during a routine ophthalmological examination for a driver's license. At the University Clinic for Eye Diseases in Skopje, several imaging diagnostic methods have been performed, such as: fundus photography, aurofluorescence, optical coherence tomography (OCT) and fundus fluorescence angiography (FFA). Imaging techniques, along with laboratory tests for specific anti-toxoplasmosis IgG and IgM antibodies, have helped to diagnose this not-so-common entity-ocular toxoplasmosis. The development of the disease was followed by a clinical picture, certain diagnostic methods in a period of seven years. Three recurrences of the parasitosis occurred during that period. The third attack of toxoplasmosis was associated with the occurrence of measles in an otherwise healthy young woman, a possible trigger for reactivation of the disease. Regular laboratory tests of anti-toxoplasma IgG and IgM antibody titers were performed with the help of ELISA at PHI UC for infectious diseases and febrile conditions in Skopje, during the entire process of monitoring. The lesion described by the diagnostic modalities corresponded to the data obtained from the literature and together with the elevated values ​​of anti-toxoplasma IgG and IgM antibodies confirmed the diagnosis of congenital ocular toxoplasmosis. Keywords: toxoplasmosis, ocular toxoplasmosis, therapy, laboratory tests, FFA, OCT &nbsp;

Congenital Toxoplasmosis or the Tip of an Iceberg. Report of Two Cases

Among the many parasitic diseases observed in the tropics, Toxoplasmosis is a fairly common occurrence. An infected pregnant woman can transmit it, transplacentally, to her foetus. Two cases of congenital toxoplasmosis are discussed in this study. One patient is at 7 days of life, while the other is at 9 days of life. The newborns displayed the typical symptoms of jaundice, hepatosplenomegaly, chorioretinitis, and cranioencephalic abnormalities. However, the uniqueness of these observations is the presence of umbilical haemorrhage, a symptom not described in the literature researched. The evolution of this finding, during treatment is distinguished by the symptoms persisting until six months of age, in addition to growth retardation of saturation-weight, with no retardation of psychomotor development in one patient, and with hydrocephalus accompanied by psychomotor retardation in the other one. Hence, it is recommended that pregnant women are systematically screened for toxoplasmosis, and seronegative women are monitored; in fact, the early and suitable management of congenital toxoplasmosis will significantly control this parasitosis.

Serological Assessment of Toxoplasma Infection by ELISA method in Urban People and Livestock Farmers of Tabriz, Iran

Introduction: Toxoplasmosis is a common infection between humans and animals in the world. In its congenital form, the causative agent of the disease is transmitted through the mother’s placenta to the fetus. Acquired infection is caused by eating oocysts that the cat excretes with feces or through contaminated meat. In people who have problems with the immune system, in malignant patients, in people who do organ transplants, and in patients with AIDS, the infection may be acute and fatal. This study aimed to investigate the prevalence of IgM and IgG anti-Toxoplasma gondii antibodies in the blood serum of urban residents and livestock farmers of Tabriz, Iran, in 2021. Methods: The blood of 50 urban residents and 50 livestock farmers was taken for sampling. The patient’s arm vein was used for blood sampling. Then, the blood was kept at 37 degrees Celsius for 15 minutes and centrifuged (2000 rounds for 10 minutes). After centrifugation, the sera were carefully poured into a microtube and frozen and kept for an enzyme-linked immunosorbent assay (ELISA) test. Results: The study of the frequency distribution of toxoplasmosis by ELISA method in urban residents and livestock farmers in Tabriz and suburbs showed that out of 100 studied people, 36 cases (36%) of the total had anti-toxoplasma IgG titer higher than normal (positive). In the group of positive cases of toxoplasmosis in livestock farmers, 24 (48%) out of 50 cases had a higher-than-normal titer, which is considered positive. Further, out of the 50 urban people surveyed, 12 cases (24%) had titers higher than normal, which is considered positive. In the study of the frequency distribution of anti-toxoplasma IgM antibody by ELISA method in urban people and livestock farmers, 36 positive cases and 64 negative cases were observed out of 100 people, and15 out of 50 urban people (i.e., 30% of urban people) had IgM titer higher than normal. Moreover, an examination of 21 people out of 50 livestock farmers (42%) indicated higher than normal IgM titers. Conclusion: This study indicated that IgG and IgM antibody titers are higher in livestock farmers than in urban residents, and this suggests a relationship between occupation and toxoplasma infection. Therefore, the need is raised for extensive research at the national level to reduce the disease in livestock farmers and urban residents.

The Role of Retinol-Binding Protein 4 in Women Infected with Toxoplasma gondii

Background: Ocular toxoplasmosis mainly affected people in the second to fifth decades, as a result of acute or reactivate congenital or postnatally acquired infection. Retinol binding protein 4 (RBP4) is a protein transporter for retinol (Vitamin A) from the liver to peripheral tissue. Because of its function in vision RBP4 has become a target for ophthalmology research. Objectives: Identification of the role of RBP4 parameter in women infected with acute toxoplasmosis. Methodology: One hundred and fifteen blood samples were collected from aborted women, who were suspected of having toxoplasmosis for the period October 2020 to March 2021; in addition, 25 samples were collected from apparently healthy women to use as a healthy control group. All sera were investigated for the presence of anti-Toxoplasma IgM, IgA and IgG antibodies, all IgG-positive samples (50 samples) were neglected. IgM and IgA-positive samples (40 serum samples) out of 115 samples were used as toxoplasmosis case group (acute toxoplasmosis), while the negative IgM, IgA, and IgG aborted women samples were used as aborted nontoxoplasmic control group (25 serum samples). The samples from healthy women that gave negative results for the three antibodies were used as the healthy control group. Results: The RBP4 serum level was reflected a significant decrease 1.84 ± 0.44 ng/ml in aborted toxoplasmic cases when compared with aborted nontoxoplasmic and healthy control groups; 2.85 ± 0.60, 3.90 ± 0.62 ng/ml, respectively. Conclusion: There was a highly significant decrease in RBP4 serum levels in acute toxoplasmosis-infected women. This decreasing may be one of the indirect effects of Toxoplasma gondii infection on their hosts. Furthermore, this level can be used as aid test for the detection for toxoplasmosis.

Diagnostic Dilemma and Therapeutic Challenges in Managing an Atypical Presentation of an Ocular Toxoplasmosis Patient With Myasthenia Gravis: Literature Review

Purpose The aim of the study was to report a case of ocular toxoplasmosis (OT) in an immunocompromised patient with myasthenia gravis, the diagnostic dilemma, and therapeutic challenges in managing the patient. Method This is a case report with literature review. Articles reviewed were limited to publications in English, and there were no restrictions on date, age, ethnicity, or geographic locations of patients. In addition, a brief literature review of similar reported cases was conducted to discuss about the diagnostic dilemma and therapeutic challenges in managing our patient. Observation We report a case of an immunocompromised, 53-year-old man who presented with rapid deterioration of left eye vision for 2 weeks. The ophthalmological examination showed nongranulomatous panuveitis with dense vitritis and retinitis with the absence of adjacent pigmented scar. Diagnostic dilemma arose as the clinical picture mimicked several possible etiologies. He was initially treated clinically as viral retinitis but failed to show improvement with antiviral treatment. Because of recent history of left empyema, he was then treated as presumed endophthalmitis and received broad-spectrum antimicrobial and antifungal therapies. He was also given oral sulfamethoxazole and trimethoprim (Bactrim) because of suspicion on OT. Despite multiple drug therapy, he still did not improve clinically. A diagnostic pars plana vitrectomy was performed and the toxoplasma polymerase chain reaction was positive. Therapeutic challenges were apparent due to limited choice of antibiotics which can be used in patients with myasthenia gravis and possible resistance to Bactrim in this case. After 6 weeks of pyrimethamine and sulfadiazine, he was clinically stable with vision of 6/60 due to macular scarring. Conclusions The diagnosis of atypical OT is challenging and frequently misdiagnosed as viral retinitis or endophthalmitis, leading to delayed diagnosis and treatment. Clinicians should have a high index of suspicion whenever seeing an atypical manifestation of OT in immunocompromised patients. In addition, there is very limited published data looking into the clinical presentations, diagnostic methods, treatment modalities and outcomes, specifically in reported atypical OT case reports or series. Therefore, it warrants an in-depth review to help clinician have a better understanding about this disease.

A systematic review of maternal TORCH serology as a screen for suspected fetal infection.

The acronym 'TORCH' refers to well-recognised causes of perinatal infections: toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV). A TORCH serology panel is often used to test for maternal primary infection following detection of ultrasound abnormalities in pregnancy. This review aims to estimate the diagnostic yield of maternal TORCH serology in pregnancy following fetal ultrasound abnormalities. Primary studies published since 2000 that assessed maternal TORCH serology for suspected fetal infection and included information on indications for testing, definition of positive TORCH serology results, and perinatal outcomes were included. Eight studies with a total of 2538 pregnancies were included. The main indications for testing were polyhydramnios, fetal growth restriction and hyperechogenic bowel. There were 26 confirmed cases of congenital CMV, of which 15 had multiple ultrasound abnormalities. There were no cases of congenital toxoplasmosis, rubella or HSV confirmed in any of the eight studies. The clinical utility of TORCH serology for non-specific ultrasound abnormalities such as isolated fetal growth restriction or isolated polyhydramnios is low. It is time to retire the TORCH acronym and the reflex ordering of 'TORCH' panels, as their continued use obscures, rather than illuminates, appropriate investigation for fetal ultrasound abnormalities.

The Seroprevalence of Toxoplasma Gondii in Cats at the House of Maternal Women with Toxoplasmosis in Badung, Indonesia

Toxoplasmosis is a zoonotic disease caused by infection with the parasite called Toxoplasma gondii (T. gondii). The health and social impacts of the infection are enormous, including miscarriage, hydrocephalus, blindness, and mental retardation. The occurrence of toxoplasmosis in maternal women cannot be separated from cats around their houses. This study aimed to determine the seroprevalence of the parasite in cats found in the human carriers residences and identified the risk factors of toxoplasmosis in maternal women in Badung District, Bali Province, Indonesia. A total of 80 cat serum samples were obtained from two residential groups, 40 from the housing where the maternal women were infected and another 40 from where there were no identified sufferers of the disease. All the samples were examined using the enzyme-linked immunosorbent assay (ELISA) method to detect the presence of antibodies T. gondii in feral cat serum. The results showed that 47.5% of the examined subjects had the said antibodies. As much as 65% came from housing with cases of toxoplasmosis in maternal mothers, and 30% came from residences with none. The presence of feral cats is a major risk factor for the transmission of T. gondii to humans.

Trends of seropositivity and clinical spectra of Toxoplasmosis- A two-year observational study from a tertiary care centre in North India

Background: Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is highly prevalent in man and other warm-blooded animals. Most of the affected adults do not manifest any serious illness, but it can cause mental retardation and blindness in congenitally infected children and serious illness in immunocompromised individuals. We aimed to study the disease burden and clinical manifestations of Toxoplasma seropositive patients in the hilly region of North India. Methods: This is a hospital based retrospective cross-sectional study conducted between January-2018 and December-2019.Sera of suspected cases of toxoplasmosis were examined for presence of anti-Toxoplasma antibodies (IgG and IgM) by enzyme-linked immunosorbent assay. Antibody index of &gt;1.1 was interpreted as positive. Clinical data were retrieved from medical records maintained in the department. Result: Out of 174 included cases, 70 (40.22%) cases showed positivity to both IgG and IgM antibodies. Most of the suspected cases were sent from the Pediatrics department followed by Departments of Obstetrics and Gynecology, Ophthalmology and General Medicine. Majority of the patients (45.7%) presented with mild non-specific symptoms like fever, malaise and generalized weakness and lymphadenopathy in 25.7%. Ocular and neurological manifestations were observed in 21.4% and 20% respectively. Other rare presentations were hepatic, cutaneous, pulmonary and endocrine diseases. More than one clinical feature could be found in one patient. Co-infection with HIV and Tuberculosis was found in 8.6% and 5.7% respectively. 20% cases were associated with congenital anomalies; while 18.6% cases were detected in routine anti-natal screening. Conclusion: Toxoplasmosis is highly prevalent in this hilly region showing wide variety of clinical manifestations. Therefore, prevention and control policies mainly targeting the anti-natal cases are the need of the hour.