Toxoplasmosis IgG Research Articles

Seroprevalence and risk factors associated with toxoplasmosis and hydatidosis among the butchers of Tabriz city, the northwest of Iran: a case control study

IntroductionOccupation plays an important role in the spread of infectious diseases in humans. Toxoplasmosis and hydatidosis are world-wide diseases with different routes of transmission. This study aimed to investigate the prevalence of toxoplasmosis and hydatidosis and risk factors associated with these diseases among the butchers of Tabriz City, the northwest of Iran.MethodsIn this case-control study conducted in Tabriz city in 2023, 250 serum samples were collected from butchers (n = 125) and outpatients referred to Imam Reza Hospital (n = 125) and. The ELISA test was used to identify IgG and IgM antibodies against toxoplasmosis and IgG antibodies against hydatidosis. The results were analyzed by statistics tests using SPSS v. 16 software. Risk factors’ association was tested using Chi square or logistic regression analysis.ResultsThe results indicated that 66/125 (52.8%) cases and 40/125 controls (32%) were positive for toxoplasmosis IgG antibody. Also, 5/125 (4%) and 1/125 (0.8%) were positive for toxoplasmosis IgM antibody in the case and control groups, respectively. In addition, 10/125 people (8%) were positive for anti-hydatidosis IgG antibody in the case group, while no positive cases were found in the control group. The main risk factors for toxoplasmosis were age (OR: 1.014), education level (OR: 0.638), and work experience(OR: 1.695), these factors for hydatidosis included age and education level (OR: 1.765 and 0.271) respectivily.ConclusionsOur results suggest the high prevalence of toxoplasmosis and in butchers of Tabriz, which required special attention and basic measures. Moreover, the prevalence of hydatidosis IgG antibodies also requires more attention to be focused on breaking the transmission and reducing the infection.

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis.

Background and objective Rheumatoid arthritis (RA) is a chronic autoimmune disease causing synovium inflammation and functional impairment. Toxoplasmosis is an intracellular zoonotic parasitic infection anda risk factor in immunosuppressed diseases including RA. The involvement of the cholinergic mechanism is not clear when both diseases exist in combination. This study aimed to examine plasma cholinesterase (ChE) activity in patients suffering from RA with concomitant toxoplasmosis, taking into account the enzyme susceptibility to in vitro inhibitory challenge with the organophosphate dichlorvos in RA patients. Methods This was a case-control study involving 88 RA patients and 61 healthy controls of both genders.The RA patients were allocated into three groups. The first group received no therapy (n=14), the second group received conventional anti-arthritis therapy (n=49), and the third group received conventional+biologic therapy(n=25). Plasma ChE activity was determined by an electrometric method. Plasma samples were screened for Toxoplasmagondii (T. gondii)infection, using ELISAT. gondii antibodies IgG andIgM.In vitro inhibition of plasma ChE activitywas assessed by incubating the samples with dichlorvos at0.25 and 0.5 μM.The time-dependent dichlorvos (0.25 μM)-induced plasma ChE inhibition and its kinetics weredetermined. Results The RA patients comprised 76 (86.4%) females and 12 males (13.6%), whereas healthy controls included 22 (36.1%) females and 39 (63.9%) males. The rates of toxoplasmosis IgG positivity in controls and RA patients were 26.2% and 39.8%, respectively. Plasma ChE activity in patients with RA was significantly higher than that in the control group, by 16%. Plasma ChE values of RA patients with conventional therapy and conventional + biologic therapy were higher than that of the control group, by 18% and 27%, respectively. Odds and risk ratios of elevated plasma ChE activity (20%) in RA patients with therapyindicated that high plasma ChE activity among RA patients with therapyis a risk factor. The plasma ChE activity of T. gondii IgG-positive RA patients was not significantly different from that of theIgG-negative ones. Dichlorvos at 0.25 and 0.5 μM significantly inhibited in vitro plasma ChE activity incontrols and RA patients. The rates of plasma ChE inhibition by dichlorvos were lower in the RA groups with conventional therapyin comparison with those in the control group (77% vs. 91%). Examining the dichlorvos time-dependent ChE inhibition kinetics, RA groups showed increases in the half-life of inhibition by 23.6% to 32.7% and the total inhibition time by 23.5% to 32.5%, together with decreases in the inhibition rate constant by 19% to 24.5%, an indication of reduced inhibition rate of plasma ChE activity compared to that of the control group. Conclusions The autoimmune nature of RA and its chronicity might have contributed to the increase in plasma ChE activity among the patients. This increase in enzyme activity could be a risk factor in RA patients undergoing conventional therapy alone or in combination with biologic therapy; however, the clinical significance of such a condition remains obscure at present. The in vitro inhibition of plasma ChE activity in RA patients suggests reduced susceptibility of the enzyme to ChE inhibition by dichlorvos. Toxoplasmosis was not a risk factor when plasma ChE activity was taken into account among RA patients.

Cerebral Toxoplasmosis in a Previously Fit Individual – Pitfalls in Management – A Case Report.

Most people with toxoplasmosis infection are asymptomatic. Cerebral toxoplasmosis in HIV patient represents poor prognostic determinant, but treatable if early treatment is initiated. A case of delayed diagnosis of cerebral toxoplasmosis is presented. A 27-year-old man presented with one-sided facial numbness and treated as Bell’s Palsy. Later he developed slurred speech. Contrast enhanced CT brain showed left frontal temporal hypodense lesion, leptomeningeal enhancement and perilesional oedema. Steroid was started. Four days later, he presented with decreased responsiveness. Retroviral was detected and diagnosis changed to opportunistic brain infection. He died after 3 days. Toxoplasmosis IgG antibodies turned out positive. In diagnosing cerebral toxoplasmosis, clinical presentation and examination are as important as laboratory testing and radiological imaging.

IDENTIFICATION OF TORCH PATHOGENS IN CONGENITAL CATARACT PATIENTS VISITING ARMED FORCES INSTITUTE OF OPHTHALMOLOGY

Objective: To assess the rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex (TORCH) pathogens in patients suffering from congenital cataract in Pakistan.
 Study Design: Cross sectional comparative study.
 Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jun 2017 to Mar 2018.
 Methodology: Cataract group included sixty children already diagnosed with congenital cataract and control group included 60 children not suffering from congenital cataract. Serum samples of all children were collected to test against IgG and IgM antibodies of Toxoplasma gondii, Rubella, Cytomegalo, Herpes simplex pathogens using enzyme linked immune essay (ELISA) technique. Data were analyzed observe in difference between unilateral and bilateral cataract and between cataract and control group.
 Results: Out of 60 children in cataract group, 29 were tested positive for Toxoplasma gondii, Rubella, Cytomegalo (CMV), Herpes simplex infections. CMV IgG antibodies were identified in 21 (35%) children followed by Rubella IgG 13 (21.7%), Toxoplasmosis IgG 8 (13.3%), CMV IgM 7 (11.7%), HSV I IgG 5 (8.3%), HSV II IgG 2 (3.3%) and HSV I IgM 1 (1.7%) antibodies. None of the children was positive for Toxoplasmosis, Rubella and HSV II IgM antibodies. There was no statistical difference in rate of positivity of Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens between unilateral and bilateral cataract and between cataract and control group.
 Conclusion: Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex pathogens are an important cause of congenital cataract with Cytomegalovirus and Rubella virus being most common respectively. In order to prevent paediatric complications, we need........

Study The Levels Of Cytokines (IL-12,IFN-γ) And Human Proflin-1 (PFN-1) In The Sera Of Aborted Women With Toxoplasmosis And Healthy Women (non-pregnant and pregnant women)

Abstract
 Toxoplasma gondii an intracellular parasite infected large proportion of the world population, but mostly without visible clinical signs in immunocompetent patients. The present study was performed to determined the levels of cytokines (IL-12 , IFN-γ) and human proflin-1 (PFN-1) in the sera of 125 aborted women as case group and 30 healthy women (15 non pregnant and 15 pregnant women) as control groups in Women's and children Hospital in Al-Qadisiyah province from December / 2015 till March / 2016, Five ml of venous blood sample was obtained from each woman under sterile condition. Serum samples were positive for antibodies specific toxoplasmosis IgG and IgM. It was estimated levels of cytokines and profilin1 in these serums and significant increasing showed up in concentration interleukin 12 (IL-12) and profilin-1(PFN-1) and low in the concentration of interferon gamma (IFN-γ) at probability (0.05) in compare with control group that ensure their role in immune response against the parasite.
 Keywords: Toxoplasma gondii, cytokines (IL-12 , IFN-γ) and human proflin-1 (PFN-1)

Evaluation of Risk of Zoonotic Pathogen Transmission in a University-Based Animal Assisted Intervention (AAI) Program.

Introduction: Previous studies have shown that apparently healthy animals participating in Animal-Assisted Interventions (AAI) have the potential to asymptomatically carry and even transmit zoonotic pathogens to people, which is of particular concern for therapy animal teams visiting healthcare settings. This two-part study was designed to investigate the risk of zoonotic pathogen transmission within a university-based AAI program as a combination of the prevalence of these pathogens in the animal population as well as the handlers' understanding of the risks of zoonoses in AAI and their adherence to infection control practices.Methods: In part one of the study, AAI program records were retrospectively reviewed and infectious disease screening test results were compiled from 22 dogs and 2 cats. Screening tests for dogs and cats included a zinc sulfate fecal float, fecal culture, and nasal and perianal skin swabs for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus pseudointermedius (MRSP). Additional tests for cats were blood cultures for Bartonella henselae and Toxoplasmosis IgG and IgM antibody titers. In part two, a survey was conducted of 40 registered therapy animal handlers to assess knowledge, attitudes, and perceptions regarding risk of infectious disease transmission in AAI settings, including risk to the animal, the handler, and those being visited.Results: In part one, there were 17 total positive results of the 118 infectious disease screenings performed, 14 of which were potentially zoonotic organisms. In part two of the study, a majority (70%) of respondents expressed they had no concerns regarding infectious disease transmission in AAI settings. Despite handler education and guidelines, adherence to infection control practices was lacking.Discussion: The results of this study support prior findings that animals participating in AAI can be asymptomatic carriers of zoonotic organisms. Compliance with infection control practices and hand hygiene are paramount to mitigate risk of zoonotic disease transmission, but was inconsistent among this group of handlers. Given the popularity of AAI programs in the U.S., similar studies should be performed on a larger scale to determine the level of adherence to currently recommended practices and potential need for improvement in infectious disease control education and/or policies.

Toxoplasma Serology Status and Risk of Miscarriage, A Case-Control Study among Women with A History of Spontaneous Abortion.

BackgroundToxoplasma gondii is one of the major causes of abortion in pregnant women. Most cases of abortion occur in the acute phase of infection and early pregnancy. The purpose of this study was to investigate the association between spontaneous abortion and seropositive status of toxoplasmosis in women with first-time spontaneous abor- tion.Materials and MethodsThis research is a case-control study on 240 serum samples from women experiencing spon- taneous abortion for the first time as the case group, and 240 serum samples from women who had a normal delivery with no history of abortion as the control group. The level of anti-Toxoplasma gondii IgM and IgG antibodies were assessed in serum samples using ELISA. To separate the acute and chronic infections, all IgM-positive samples in both groups and IgG-positive samples of the case group were examined using IgG avidity.ResultsThe Toxoplasma IgM antibody was detected in 3.3% (8/240) of the case group and 0.4% (1/240) of the con- trol group, which was a statistically significant difference between the two groups [P=0.019, odds ratio (OR)=10.266]. Of all samples 47.5% and 46.3% of the case and control groups were positive for Toxoplasma IgG antibody, respec- tively. Seven out of 8 (87.5%) IgM-positive serum samples from the case group had low IgG avidity, indicating acute infections, whereas all IgG-positive sera and 1 IgM-positive serum, which was related to the control group, showed a high IgG avidity, indicating chronic infections.ConclusionMaternal acute toxoplasmosis during pregnancy is raised as one of the factors that increase the chance of spontaneous abortion. The necessary health training, especially on the parasite transmission ways to women before marriage, as well as the serological test in women before and during pregnancy is recommended. Polymerase chain reaction (PCR) and IgG avidity assays should be performed in the medical diagnostic laboratories for accurate distin- guishing of the initial infection of toxoplasmosis in the pregnant women.

Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

Toxoplasmosis Molecular Testing Discrepancy in a Case of Asymptomatic Microcephaly

Introduction: Microcephaly is a congenital anomaly associated with a wide range of etiological factors such as infections, medications/substances, genetic abnormalities and radiation. Environmental factors that are teratogenic must also be included in the differential diagnosis as common etiologies. In this report we describe a neonate with microcephaly whose molecular tests showed conflicting results in regards to the etiology of the condition. Case Report: We describe a case of a term female neonate that was admitted for work up of microcephaly in a nursery in South Brazil. The maternal history was significant for HIV positivity, on irregular antiretroviral therapy, substance abuse (crack) and previous incomplete treatment for neurosyphilis. The initial investigations for the neonate were significant for toxoplasmosis IgG (45,000) and the cerebrospinal fluid analisys revealed a positive real time PCR for toxoplasmosis. Triple treatment for neurotoxoplasmosis was instituted (Sulfadiazine, Pyrimethamine and Folinic Acid). As complementary exams came all negative including cerebrospinal DNA sequencing for Toxoplasma gondii and the baby became constantly neutropenic, treatment was discontinued and the infant was sent home for follow-up with serologies and ophthalmological monitoring. Discussion: This case described a new-born with microcephaly that was initially thought to be secondary to congenital neurotoxoplasmosis with a positive PCR in the CSF. However, the diagnosis was refuted with the absence of other clinical signs and once the DNA sequencing for Toxoplasma gondii was negative in the cerebrospinal fluid. The highlight of this report lies on the fact that two very accurate molecular tests showed divergent results. Although there were multiple risk factors for microcephaly in this patient, the definitive cause cannot be determined.

The role of serological titres in the diagnosis of ocular toxoplasmosis.

The role of serological titres in the diagnosis of ocular toxoplasmosis.

Amebic Colitis in a Post Liver Transplant Patient

A 63-year-old Hispanic male, presented with two week history of blood tinged diarrhea, abdominal cramping, and decreased appetite. He had been discharged from the hospital one month prior for liver transplant for hepatocellular carcinoma. Prior to the transplant he had visited Mexico where he ate an unrestricted diet including seafood and pork. He also had contact with roosters, chicken, pigeon, cats, goats and horses. He was on immunosuppressive agents, Tacrolimus, with a normal level of 17.6 ng/mL and Prednisone with Valganciclovir, Clotrimazole and Trimethoprim Sulfamethoxazole. He was admitted and managed with intravenous fluid and electrolyte resuscitation. Stool studies were negative for Clostridium difficile, Shiga Toxin 1 and 2, Salmonella, Shigella, Campylobacter, E.coli 0157 and ova and parasites. He was referred for colonoscopy which demonstrated the presence of non-hemorrhagic ulcers throughout the colon starting from the rectum and ending in the cecum (Figure 1). There was no active bleeding and there were patchy areas of normal appearing mucosa. Multiple biopsies were taken from the bases and the edges of the ulcers and of normal mucosa.Figure 1Histological exam of biopsies (Figure 2) showed benign colonic mucosa with ulceration, and granulation tissue with accompanying necroinflammtory debris. Scattered among the mucosa, were amebic organisms consistent with Entamoeba histolytica showing foamy cytoplasm with ingested red blood cells and eccentric nucleus. Entamoeba antibody titer was found to be positive, and further work up including Toxoplasmosis IgG and IgM, Cysticercosis Trypanosoma Cruzi, Brucella and Bartonella antibody titer were negative. Patient was treated and subsequently discharged on Metronidazole, for the duration of six weeks. No changes were made to the immunosuppression therapy.Figure 2In 1875, Losch first described the trophozites of Ameba coli in the feces of a Russian woodcutter with fatal diarrhea. Acquired via the oral-fecal, oral-anal and oral-genital routes, this parasite was named E.Histolytica for its ability to lyse tissues. Though not seen in our patient, amebic liver abscess is the most common manifestation of invasive amebiasis. Other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. Intestinal amebic infections are relatively rare in the Unites States. For individuals infected with a single GI parasite, E. histolytica accounts for 1% of cases. This case confirms that prior travel to endemic areas is a significant risk factor for intestinal parasitic infections. This case also highlights the importance of a thorough dietary, travel and exposure history, prior to and after starting immunosuppression in an organ transplant recipient.

Relationship Between Toxoplasmosis And Antiphospholipid Antibodies Igg, Igm In Aborted And Non Aborted Women

Objectives: The study was designed to an estimate the prevalence of antiphospholipid IgG and IgM antibodies with toxoplasmosis patients among aborted and non-aborted women. Methodology: A total number of 70 Iraqi patients aborted and non-aborted women were included in the present study. In addition, a total of 30 apparently healthy women and negative for antiphospholipid IgG and IgM antibodies were selected as a control group. The study was carried out during the period of October 2012 till January 2013. Blood samples and laboratory investigation was in Teaching Laboratory of the Medical city of Baghdad, using to detect antibodies type IgG and IgM for antiphospholipid and Toxoplasma gondii by utilize ELISA technique according to standard procedures describe by manufacturer. Results: The results showed that the age stratum (21-30) years was found to be highly frequent in both studiedgroups was significant (P<0.05). In addition, positive toxoplasmosis IgG antibodies testing in aborted women was higher than that observed in non - aborted women group, significant (P < 0.05). Present study illustrated that the total abortion cases was with positive in APL-IgM-Ab 12/58 (20.7%), whereas 46/58 (79.3%) was negative the statistical analysis were high significant. The results of our study demonstrate significant positive correlation between abortion toxoplasmosis IgG and IgM . Conclusion: The present study demonstrates a strong association between infectious agent Toxoplasma gondii andabortion in women with anti-phospholipids antibodies. Positive toxoplasmosis IgM and IgG antibodies testing inabortion more than non-abortion. The frequency of anti-phospholipids antibodies IgM and IgG positive in abortionmore than non- abortion. Recommendation: cannot be according to the antiphospholipid antibodies IgG and IgM in abortion cases. So thatfurther studies are needed to study the relationship between rubella virus and cytomegalovirus with anti-phospholipid antibodies.

Dépistage de la toxoplasmose materno-foetale : étude des cas suivis à l’Institut Pasteur de Tunis (2007–2010)

Toxoplasmosis when occurring during pregnancy can be transmitted to the fetus and lead to congenital toxoplasmosis (CT). Therefore, pregnant women are a risk group, for which it is necessary to determine the serologic profile. The objective of this study is to determine the serologic profile of toxoplasmosis in pregnant women followed at the Parasitology Laboratory of the Pasteur Institute in Tunis, to establish the prevalence of toxoplasmic infections during pregnancy and the incidence of the CT, noting the difficulties faced in the interpretation of serological results. This is a retrospective study concerning 2833 toxoplasmic serologies practiced on 2070 pregnant women, followed at the Parasitology-Mycology Laboratory of the Pasteur Institute of Tunis, between 2007 and 2010. Serological diagnosis of toxoplasmosis was done by ELISA (Enzyme Linked Immunosorbent Assay) for the detection of Immunoglobulin (Ig) G and M and the study of toxoplasmosis IgG avidity. Prenatal diagnosis was performed for 58 women by amniotic fluid sampling. Toxoplasma gondii was detected by Polymerase Chain Reaction (PCR). At birth, the diagnosis of congenital toxoplasmosis was established based on serology. The toxoplasmic serologies carried out have shown that 45.6% of the pregnant women were formerly immunized while 49.6% had a negative serology. A toxoplasmosis primary infection acquired during pregnancy was detected in 79 cases (3.8%). Among them, 33% had a true seroconversion while 67% had a recent toxoplasmosis infection in view of the positivity of IgG and IgM on the first sample with a low index of avidity (IA). For 21 parturients whose serology showed the presence of IgG, IgM and an intermediate or high IA. Among the 58 parturients in whom prenatal diagnosis was performed, PCR was positive in four cases. After birth, six cases of congenital toxoplasmosis were detected by serology.

A Rare Cause of an Ileocecal Fistula in an AIDS Patient

A 31-year-old Hispanic man presented with 5 days of right lower quadrant (RLQ) abdominal pain. His past medical history was notable for acquired immunodeficiency syndrome (AIDS), antiretroviral medication non-compliance, multiple opportunistic infections (e.g. pulmonary tuberculosis, oral candidiasis, herpes zoster), and polysubstance abuse (methamphetamine and alcohol). The patient was an unemployed construction worker who emigrated from Veracruz, Mexico nine years ago. His physical exam was notable for mild to moderate RLQ abdominal tenderness. Laboratory results revealed a white blood cell count of 5600 cells/µL with 63% neutrophils and 4% eosinophils, but were otherwise normal. CD4 count was 38 cells/µL and HIV viral load was 175,232 copies/mL. An initial computed tomography (CT) of his abdomen showed thickening of the terminal ileum and base of the cecum (Fig 1, arrow). A colonoscopy revealed a terminal ileum that was diffusely ulcerated and inflamed for 5 cm with a fistula of the terminal ileum to the cecal base (Fig 2, arrowhead points to fistula, arrow points to appendicial orifice). Blood, urine, and stool bacterial and fungal cultures were negative. Serologic testing was negative for Aspergillus Galactomannan antigen, Coccidioidies complement fixation and immunodiffusion, Cryptococcal antigen screen, Toxoplasmosis IgG and IgM antibody, Entamoeba histolytica antigen, and rapid plasma reagin. Urine Histoplasma antigen screen, stool ova and parasite, stool stain for Cryptosporidium and Isospora, and stool and sputum acid-fast bacilli smear and mycobacterium tuberculosis direct test were negative. A cytomegalovirus shell vial culture and a general viral culture were negative. Pathological specimens showed granulomatous ileitis/colitis with budding fungus (Fig 3, Gomori's Methenamine Silver [GMS] stain under 40×, inset shows a close up of the organism). Since the fungal infection could not be identified, the patient was empirically treated with fluconazole. However a month later, patient's symptoms did not improve. Figure 1 Figure 2 Figure 3 What is the etiology of the ileocecal fistula and how would you make the diagnosis? Answer: Gastrointestinal infection by Histoplasma capsulatum infection identified with internal transcribed spacer primer sets (ITSPS). Because the patient’s symptoms did not improve with fluconazole treatment, a colonoscopy was repeated a month later with pathology samples sent for fungal DNA detection by internal transcribed spacer primer sets (ITSPS) which revealed Histoplasma capsulatum. The patient responded well to treatment with intravenous amphotericin followed by oral itraconazole. Histoplasmosis is a common opportunistic infection of immunosuppressed or immunocompromised patients and in HIV-infected patients it presents in the disseminated form in 95% of cases.1 Since the organism can spread hematogenously, the disease is manifested in many varieties, including infection of the gastrointestinal tract where it presents with fever, diarrhea, abdominal pain, bleeding, weight loss, and, rarely, bowel perforation.2 It most commonly affects the ileocecum (~30%) or colon (~60%).2 The urine Histoplasma antigen screen has a sensitivity of 91.8%, and specificity of 99%, in the setting of disseminated histoplasmosis and is the most commonly used test for diagnosis. Our case is interesting for two reasons. First, there is no evidence of disseminated disease in this patient, as evidenced by a negative urine Histoplasma screen. Second, the patient presented acutely with fistulizing disease. There have been no reported case studies of gastrointestinal histoplasmosis causing fistulizing disease and reports of gastrointestinal histoplasmosis without disseminated disease are extremely rare. Our diagnosis was made by direct microscopic examination and DNA testing with ITSPS. Staining with GMS can aid in diagnosis but errors in identification of the organism are common. ITSPS, where polymerase chain reaction with primers specific to Histoplasma is used, was needed in this case since an organism could not be identified with standard serological testing and cultures.3

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

Hearing loss, uveomeningitis, and stroke in a 55‐year‐old man

976 Seroprevalence of Toxoplasmosis in Morocco

Introduction: The infection by Toxoplasma gondii is frequent and usually asymptomatic, but can have serious consequences in pregnant women. The purpose of this work was to analyze on a group of pregnant women the seroprevalence of toxoplasmosis IgG antibodies. Materials and Methods: It was a prospective study carried out over one year period at Souissi Maternity of Rabat. It has included pregnant women, in the last term of their pregnancies, hospitalized for childbirth. Maternal and neonatal parameters were collected then analyzed. The results were expressed as a percentage or on average +/-; standard deviation. Groups of women with positive serology and women with negative serology were compared. Results: 368 pregnant women were included. The average age was of 27,8+/-;6,17 years. 48,1% were primigests. 83,4% of the pregnancies were followed. The average weight of birth was of 3257,1+/-; 484,7 grams. The toxoplasmosis serology was negative at 55,7%. The analytical study showed that the seroprevalence increased with the age of the pregnant women to a significant degree, and no significant differences have been found in the prevalence of antibodies in women from rural areas compared with urban areas. Conclusion: This study included young women in age of procreating. The fact of living in rural area does not constitute a risk factor of toxoplasmic infection. In this study, the percentage of the notimmunized pregnant women is high. Thus the introduction of serological screening among the premarital and antenatal assessments is essential.

Seroprevalence of Toxoplasma gondii antibodies amongst pregnant women at Lagos State University Teaching Hospital

Background: Toxoplasma gondii (T.gondii), an obligate intracellular parasite found in many species throughout the world, causes a variety of clinical syndromes in humans and animals. It is also associated with morbidity and mortality in pregnancy. Hence the need to determine the seroprevalence of antibody to toxoplasmosis gondii amongst pregnant women. Methods: A cross-sectional study was carried out using patients attending the ante-natal clinic of Lagos State University Teaching Hospital Ikeja. All consenting newly registered antenatal patients were recruited consecutively into the study within a time frame of six weeks during which a total of 179 pregnant participants were obtained. Participants filled self administered questionnaires. Five milliliters of blood was collected from each participant after obtaining patient's consent. Sera were assayed for antitoxoplasmosis IgG antibody by enzyme linked immunosorbent assay. (ELISA.) Results: A total of 179 pregnant women were studied. An assessment of patients’ status to anti-toxoplasmosis IgG showed 40.8% were positive while 59.2% were negative. Conclusion: It appears that seroprevalence of toxoplasmosis IgG antibody amongst the pregnant women in this study population is high. Therefore, it is valuable to follow up the IgM–antibody status of their off springs which indicates recent exposure. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Use of Enzygnost Anti-human IgA conjugate in combination with the kit Enzygnost toxoplasmosis IgG (Siemens Healthcare Diagnostics) for the detection of IgA anti-Toxoplasma gondii

Laboratory diagnosis of toxoplasmosis is mainly based on serological methods, particularly important in the most challenging situations, as the diagnosis of primary infection during pregnancy and diagnosis of congenital infection. Tests for the detection of IgA antibodies are especially important in the newborns, because they are more sensitive than IgM conventional methods. The purpose of this study was to evaluate diagnostic performances of Enzygnost system for IgA detection, achieved by using Enzygnost Anti-human IgA/POD conjugate in combination with Enzygnost toxoplasmosis IgG (Siemens Healthcare Diagnostics Products GmbH, Marburg, Germany). A retrospective study was performed with 591 serum samples submitted to the Microbiology Laboratory of S. Orsola Hospital in Bologna for toxoplasmosis screening.All the sera were tested by Enzygnost toxoplasmosis IgG, Enzygnost toxoplasmosis IgM and Enzygnost system for IgA (Siemens Healthcare Diagnostics). Border-Line or positive IgM results were confirmed by Vidas Toxo IgM (bioMerieux, Marcy l’Etoile, France). Finally, IgG Avidity was performed by Vidas Toxo IgG Avidity (bioMerieux) and LDBio Toxoplasma WB IgG/IgM (LDBio Diagnostics, Lyon, France). During the study period, 453 sera were IgA negative, 53 were Border-Line and 85 were positive when tested by Enzygnost system for IgA. No significative correlation was found between IgA positive results and low Avidity results.Three babies were correctly diagnosed as congenital toxoplasmosis infected infants because of the presence of IgA antibodies at birth. Enzygnost system for IgA anti-Toxoplasma showed good diagnostic performances.We conclude that the high sensitivity and specificity of and its suitability for automation make it an ideal screening test.

P553 Evaluation of the new Vidia® toxoplasmosis IgG and IgM assays in women of childbearing age

P553 Evaluation of the new Vidia® toxoplasmosis IgG and IgM assays in women of childbearing age

Isoniazid plus Sulphadoxine-Pyrimethamine Can Reduce Morbidity of HIV-Positive Patients Treated for Tuberculosis in Africa: A Controlled Clinical Trial

An annual 20% excess mortality rate is observed in HIV-seropositive patients after treatment for tuberculosis. An affordable secondary prophylaxis against main opportunistic diseases is needed, i.e. against tuberculosis, toxoplasmosis, pneumocystosis and other infections occurring in this target population. This open prospective randomized study assessed morbidity and mortality in 2 cohorts of HIV-seropositive patients having recently recovered from pulmonary tuberculosis: 134 patients assigned to prophylactic treatment with isoniazid (INH, 300 mg once daily) plus sulphadoxine-pyrimethamine (S, 500 mg/P, 25 mg once weekly), and 129 were controls, comparable for sex, age, weight and HIV-serology. Patients were followed-up for up to 2 years: 192 person-years (PY) in the prophylaxis group and 142 PY in the control group. Four patients developed tuberculosis and 20 patients died in the prophylaxis group, compared to 10 and 23 controls, respectively. Sick days were reported by 22 patients in the prophylaxis group and by 77 patients in the control group. This prophylaxis was associated with a moderate decrease of mortality (log rank test: p = 0.1736), a significant decrease of tuberculosis incidence (log rank test: p = 0.0234), a highly significant reduction of adverse events and sick days, and a prevention of wasting (p = 0.008) and anaemia (p = 0.045). No death from toxoplasmosis occurred in the prophylaxis group as compared to 2 possible cases among controls; toxoplasmosis IgG levels declined in treated patients, but increased in controls (p = 0.01). There was no adverse drug reaction due to SP (10,006 doses) or to INH. Compliance with SP intake was good, but moderate as with INH intake. We conclude that a secondary prophylaxis with INH+SP represents a cost-effective measure to improve health conditions of HIV-infected adults in Côte d’Ivoire, following a full treatment course against tuberculosis.