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The detection of IgA in serum by immunocapture agglutination assay is easy to perform in routine. It represents a valuable element for the diagnosis of toxoplasmosis. The presence of IgA, even more than that of IgM, evokes a recent infection. However, caution must be taken in using the results to date back the infection since kinetics of IgA production, like other immunoglobulins, may depend on individual variations.
A retrospective study was made of the cases of cerebral toxoplasmosis (CT) diagnosed since 1985 in patients with AIDS. In the period studied, out of a total of 70 patients with AIDS, 13 (18.5%) were diagnosed with CT. In eight cases (11%) CT was the first illness indicating AIDS. The clinical, neuro-radiological and serological findings were analyzed. Also the response to treatment with pyrimethamine and sulfadiazine. Although the rate of mortality from CT has been very low among our patients, relapses have been frequent, even in patients who were on maintenance treatment with pyrimethamine, and in the medium term the prognosis is made more gloomy by the appearance of other opportunistic infections.
Several methods for serological diagnosis of toxoplasmosis were introduced in the practice during the few last years. These methods improved the detection of specific IgM antibodies and circulating toxoplasma antigens. This article presents the following methods: ELISA, SUDS, ELIFA, WESTERN-IMMUNOBLOTTING, IgM ISAGA and CIA.
Specific cellular and humoral response to Toxoplasma were evaluated during a 2 yr follow up in a patient with acquired infection. Antibodies were titrated using conventional serological tests and analyzed by western blot technique. Analysis of the patterns obtained with IgA, IgG and IgM antibodies allowed a clear differentiation between acute and chronic stages of infection. Determination of lymphocyte subsets showed an important increase in the number of CD8 suppressive cells at the acute phase whereas CD4 cells remained within the normal range. Lymphocyte proliferation to Toxoplasma antigen was detectable one month after the onset of clinical symptoms and remained constantly positive. These results indicate that western blot analysis of antigens recognized by antibodies and determination of lymphocyte subsets may be helpful in the characterization of the infectious stage of acquired toxoplasmosis.
The latex agglutination test (Toxolatex) was compared with the indirect immunofluorescent antibody test (IFAT) in investigating one hundred and fifty human sera. Both techniques showed 90.7% agreement. The mean titre of each test was significantly higher in cases with fever or lymphadenopathy than cases without these manifestations. It was concluded that the latex test provides a rapid and simple test in toxoplasmosis that can be used to exclude negative cases as nearly no false negative results were obtained. However, positive cases by latex agglutination should be confirmed and quantitated by another standardized technique.
Congenital ocular toxoplasmosis with recurrences must be treated by Spiramycin destroys trophozoites when they escape from the true cysts. Fansidar (Pyrimethamine + Sulfadoxine) seems to have less efficacity than Pyrimethamine with Sulfadiazine.
A protocol of monitoring and treatment in toxoplasmosis is suggested by the authors. During pregnancy, the administration of spiramycine at a 9 m UI daily dose remains the basic preventive treatment when a seroconversion occurs after a 4 week post-conception period. In the fetus, the antenatal diagnosis is made by ultrasound started on the 18th week after conception and repeated every 4 weeks, amniocentesis and eventually umbilical cord puncture associated with a pyrimethamine-sulfamide drug treatment in case of positive diagnosis. A therapeutic pregnancy termination is considered when lesions have been detected by ultrasound. In the newborn (neonatal or post-natal period), the diagnosis is made by transfontanel ultrasonography, ocular fundi and spinal fluid examination, detection of specific IgM antibodies in cord blood and the evolution and importance of serum antibodies response requiring a drug treatment during 15-18 months with spiramycine and pyrimethamine + sulfadoxine (Fansidar).
In the action of prevention of congenital toxoplasmosis prospective studies were carried out of women at reproductive age for detection of antibodies to Toxoplasma gondii. Women seronegative before pregnancy were subjected during pregnancy to three tests for the presence of these antibodies in the 1st, 2nd and 3rd trimester. After development of seroconversion in pregnancy further observation was conducted which made possible the diagnosis of active primary infection in pregnancy in 12 cases. Prophylactic treatment of the mothers was administered and the newborns were observed for the consequences of intrauterine infection.
Toxoplasmosis, one of the most common central nervous system lesions in patients with the acquired immunodeficiency syndrome (AIDS), has not been reported as a solitary lesion in the brainstem. This report describes a patient with AIDS that presented with third cranial nerve palsy and contralateral cerebellar signs, who at autopsy had a necrotic midbrain lesion due to toxoplasma. Inferior olivary hypertrophy, due to interruption of olivary afferent fibers by the lesion, in addition to subacute encephalitis and vacuolar myelopathy were other CNS findings.
Primary Toxoplasmosis is devoid of any consequences in the mother in most cases, while the fetus can suffer serious damages following transplacental passage of the parasite. This is probably due to its limited immunocompetence. 440 women have been seen for suspected primary infection during pregnancy: clinical and serological parameters excluded infection in 62% of the cases. In 168 cases primary infection was likely and they underwent therapy with Spiramycin 3 grams per day to prevent placental and fetal colonization: 53 cases were elected for invasive prenatal diagnosis. Amniotic fluid was obtained by amniocentesis and fetal blood by ultrasound guided cordocentesis and by fetoscopy: the samples were analyzed for specific anti Toxoplasma IgM and sent for isolation of the parasite. Diagnosis of fetal infection was made in 4 cases: 3 cases had specific IgM in cord blood, 1 case showed intracranial calcifications by ultrasound screening. Fetal infection rate is thus below 10% and prenatal diagnosis avoids unjustified interruption of pregnancies complicated by maternal toxoplasmic infection.
The effect of excess heat and cold on chronic toxoplasmosis was studied on rats. That was evident from the average increase in body weight, the effect on blood picture, deleterious effect of the pathology recorded in various organs, increased Toxoplasma brain cyst count, long persistence of parasites in the viscera, high antibody titre by I.H.A.T. in infected animals exposed to excess heat and its decrease in animals exposed to excess cold.
A very rare case of severe calcification in brain is reported. A 49-year-old man was hit and run by a motorcar in acrossing a road on foot, and he died 1 hour later in an emergency hospital. Medico-legal autopsy was done at 5 hours after his death. The cause of death was cerebral contusion caused by a struck on partieto-occipital region. Unusually severe calcification was observed in the right and left cerebral hemispheres, especially basal ganglia, in the border areas between grey and white matters of frontal, parietal and occipital lobes, as well as in the cerebellar nucleus, cortex and medulla. Histological examination showed severe multiple calcification in the brain tissue. Dispersed deposit of pseudocalcium-Ca and edema were observed around the calcifications. Proliferation of glia cells and decrease of nerve cells were also noted. In his past history, he began to speak distinctly and to stagger since 8 years ago. Three years ago, he collided with guardrail while driving his motorcycle, and he was hospitalized. Calcification in the brain was already revealed in the roentogenographic examination. In the laboratory findings, the data of serum calcium, serum phosphorus and Ellsworth-Haward test were normal. The antibody of toxoplasma, however, showed high level more than X 1,024. After he was discharged, dementia, instability of trunk and dysarthria still continued, and he used to across a crowded road unconcernedly. The cause of the calcification might be suspected to be toxoplasmosis, although neither trophozoites, cysts nor oocysts were found in the brain tissue.
Of 1,564 serum samples from adult ewes from 33 farms in Iowa, Minnesota, South Dakota, Kansas, and Nebraska where toxoplasmosis-induced ovine abortions had been diagnosed, 65.5% were found positive for Toxoplasma gondii antibodies using the modified agglutination test. Toxoplasma gondii antibody titers of ewes were: less than 64 (34.5%), 64 (14.9%), 256 (22.0%), 1,024 (14.5%), and greater than 4,096 (13.8%). Thus, 28.3% of sheep had high titers (greater than 1,024) indicating recently acquired T. gondii infection. On certain farms, up to 95% of ewes were seropositive. Prevalence of T. gondii antibodies increased with age of the ewe. Of 665 ewes, 53.6% of 1-yr-old ewes were seropositive (titers greater than 64) versus 75% of 5-yr-old ewes. Results indicate that T. gondii infection in sheep in the United States is widespread.
Screening for anti-toxoplasma antibodies by a hemagglutination test associated with direct agglutination tests, IF and ELISA, was carried out on 229 women (pregnant or not) attending the outpatient maternity clinic at Akokan (Niger). The global percent of premunition is 3.9 p.c. No evolutive toxoplasmosis was detected.
The authors examined 56 pigs by an isolation experiment for Toxoplasma gondii and simultaneously by the Sabin-Feldman reaction, microprecipitation reaction in agar (MPA), quantitative microprecipitation reaction in agar (MPAK), reaction with complement-fixing and indirect haemagglutination reaction with toxoplasma antigen. In nine pigs with positive isolation finding, the Sabin-Feldman reaction and quantitative microprecipitation reaction in agar was positive in eight cases. In cases of negative Sabin-Feldman reaction, the quantitative microprecipitation reaction was always negative. The quantitative microprecipitation reaction in agar is therefore a suitable indicator of the success of isolation experiments. For a simplicity of the test it is suitable for immunological diagnostics of toxoplasmosis in pigs in common practice.
The diagnosis of acute toxoplasmosis is based exclusively on the detection of IgM anti-Toxoplasma antibodies. The principal of the immunoenzymatic test reported here is the capture of serum IgM antibodies which are detected indirectly by the sequential addition of antigen and a monoclonal antibody directed against the immunodominant epitope at the surface of the tachyzoite. This test combines the sensitivity of enzyme-based assays and the specificity of monoclonal reagents and represents an important contribution to the diagnosis of Toxoplasma gondii infection.
Robenidine as an anticoccidial agent alone (in doses of 50 and 100 mg/kg) or in association with two other antiprotozoal compounds--pyrimethamine and sulfadoxine (in doses of 2.5 and 250 mg/kg, respectively) were tested in the treatment of chronically infected mice with an avirulent cyst-forming HF strain of Toxoplasma gondii. The efficacy of the used drugs was evaluated by the cysts number in the brains of treated mice versus control group, antibody level and viability of survived cysts by the consecutive infection of mice. According to these criteria none of the tested drugs alone or combined exhibited to be able to produce an effective cure of cyst-stage of toxoplasmosis in experimental mice.
A toxoplasmosis serological study using an indirect immunofluorescence method was made in 400 subjects in the Republic of Niger because the epidemiologic findings of this disease were very poor. Serum antitoxoplasmic antibodies were present in 18.2%. In sahelian areas prevalence of such toxoplasmic antibodies is low in the majority of studies. Analysis of seropositivity and age pointed out a late seroconversion.
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