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PubMed2000

Diagnosis of toxoplasmosis in children with malignancy.

The study aimed at the diagnosis of toxoplasmosis in 73 children with malignancy; 31 with lymphoma (22 with Hodgkin's and 9 with non-Hodgkin's lymphoma) and 42 with leukemia (34 with acute lymphoblastic leukemia and 8 with acute myelogenic leukemia). In positive cases toxoplasmosis was manifested by any of the following; fever, lymph node enlargement, neurological manifestations and/or hepatosplenomegaly. The indirect hemagglutination test (IHA) for toxoplasmosis detected 4 (5.4%) positive cases with malignancy, 2 with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and one with acute lymphoblastic leukemia. The immunoglobulin M enzyme-linked immunosorbent assay (IgM ELISA) detected only one (1.4%) case with Hodgkin's lymphoma. Immunoglobulin G (IgG) ELISA detected 6 (8.2%) positive cases, 3 with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and 2 cases with acute lymphoblastic leukemia. Polymerase chain reaction for detection of parasite DNA in blood (PCR) was the most useful in diagnosing toxoplasmosis with malignancy, as it was able to detect 9 (12.3%) positive cases; 5 (6.8%) with Hodgkin's lymphoma, one (1.4%) with non-Hodgkin's lymphoma and 3 (4.1%) with acute lymphoblastic leukemia. No positive toxoplasmosis cases were detected with acute myelogenic leukemia by any of the above methods.

Adolescent↗
PubMed2001

Seroepidemiology of toxoplasmosis in the Lublin region.

Reported are results of serologic examinations for the presence of anti-Toxoplasma antibodies by direct agglutination in 1,497 people: 1,327 forestry workers and 86 farmers occupationally exposed to T. gondii from the Lublin region (eastern Poland) and 84 inhabitants of the city of Lublin examined as the control group, including 50 blood donors and 34 workers from forestry headquarters. 58.5% positive results in forestry workers, 56.9% in farmers and 46.4% in the control group were obtained. The highest percentages of positive results were obtained in Sosnowica, Wlodawa and Sobibor, all localities in the Chelm district. This finding and the prevalence of clinical cases may suggest that the Chelm district (easternmost area of the Lublin region, bordering Ukraine) is an endemic area of toxoplasmosis. A case of toxoplasmosis in a 39 year old farmer is described in whom reinfection was identified 20 years after primary diagnosis. Rapid increase in specific serologic titres and symptoms typical for toxoplasmosis were noted. The rest of the family and household animals were also found to be positive which supports the suggestion of a family-environmental case of toxoplasmosis. Survey for anti-Toxoplasma antibodies in various domestic and wild animals comprised sera from 262 cows, 120 pigs, 34 geese, 65 chickens, 3 roe deer and 10 sheep from the Lublin region. High percentages of positive results were found in cattle (53.8%) and in pigs (15%). Fowl were positive only in 0-5.9%. The cattle and pigs from the Chelm district are most probably the main sources of toxoplasmosis threatening humans in this area.

Adult↗
PubMed2001

Characterization of Toxoplasma gondii-specific T cells recovered from vitreous fluid of patients with ocular toxoplasmosis.

PURPOSE: The mechanisms involved in reactivations of latent ocular Toxoplasma gondii (Tg) infections in immunocompetent patients are poorly understood. In view of the possible role of T cells in the immunopathogenesis of the disease, ocular infiltrating T cells obtained from patients with recurrent ocular toxoplasmosis were characterized phenotypically and functionally. METHODS: Ocular infiltrating T cells were recovered from vitreous fluid (VF) samples of 10 patients with active recurrent ocular toxoplasmosis. Two patients with uveitis of other origins were included as control subjects. T-cell lines (TCLs) were generated by mitogenic stimulation and tested for reactivity to Tg and human retinal protein extracts. The TCLs of three patients were cloned by limiting dilution. Tg-reactive T-cell clones (TCCs) were characterized with respect to their phenotype, T-cell receptor variable (TCR V)-beta gene usage, HLA restriction, and cytokine secretion profile. RESULTS: Reactivity to Tg could be detected only in the TCLs of patients with ocular toxoplasmosis. None of the TCLs showed reactivity to human retinal antigens. All tested intraocular Tg-specific TCCs (n = 23) were CD3+CD4+ and displayed differential TCR Vbeta usage. Twenty-one TCCs were HLA-DR restricted and two TCCs were restricted by HLA-DP. The majority of the intraocular Tg-specific TCCs showed a bias toward a T-helper (Th)0-Th2 cytokine profile. CONCLUSIONS: The data indicate that T cells specific for the triggering microorganism infiltrate the eye of patients with recurrent ocular toxoplasmosis. The functional characteristics of the VF-derived Tg-specific T cells and their presence at the site of inflammation suggest their involvement in the local inflammatory response of ocular toxoplasmosis.

Adult↗
PubMed2001

[Toxoplasmosis, rubella, syphilis, hepatitis B and HIV infection in women being followed for pregnancy in a population on the east coast of New Caledonia ].

In view of the sparse available data concerning the main infectious illnesses screened for during pregnancy (toxoplasmosis, rubella, syphilis, hepatitis B virus and HIV) in the Northern Province and generally throughout New Caledonia, we decided to undertake a retrospective study based on the files of pregnant women having consulted between September 1996 and September 1999 in the East-Coast provincial hospital (New-Caledonia). First, we wished to estimate the prevalence of toxoplasmosis, rubella, syphilis, hepatitis B virus and HIV Second, we wished to specify the main characteristics of these pregnant women, to trace the evolution of seroprevalence over the study time period and consider the influence of various factors such as age, place of residence and professional occupation. The biological study of these pregnancies was hindered by the fact that approximately half of women consult only from the second trimester of their pregnancy. This result underlines the importance of emphasising efforts aiming to bring women to consult earlier and of improving the regularity and also the interpretation of serological tests (especially for toxoplasmosis serology). Within this population, we found the following percentages of seroprevalence: for toxoplasmosis between 83.6% and 89.6% (zone of hyperendemla), for rubella between 91.6% and 95.8%, for syphilis between 7% and 12.4%, for hepatitis B virus between 61.8% and 76% (for women immune to hepatitis B, the frequency of acquisition of immunity by viral infection was understood between 64.3% and 80.3%) and for HIV 0%. The hepatitis B surface antigen (HbsAg) carrier rate was estimated between 1.7% and 4.9%. Following and informing pregnant women of the risk of toxoplasmosis appears to be of key importance as well as screening HbsAg carriers in order to limit viral transmission to the foetus.

Female↗
PubMed1975

[Study of the outcome of pregnancy in sheep with positive serologic reactions to toxoplasmosis according to the complement fixation test].

Studied were five flocks of 240 sheep each. It was found that prior to impregnation the positive complement-fixation test (c. f. test) reagents varied from 16 to 61 per cent with titers ranging from 1:50 to 1:10. Abortions, however, were established only in two of the flocks consisting of young sheep, aged 3 and 4 years, at the first or second lambing. The abortions took place in the fourth month of pregnancy. In one of these flocks having 43 per cent positive reagents there were 40 per cent returns, and 28 of the ewes miscarried, 12 of them being positive for toxoplasmosis. In the second flock there were 61 per cent positive reagents, and 9 of the ewes miscarried, 5 of them being positive for toxoplasmosis. In the remaining three flocks consisting of 5-year-old sheep there were no abortions. The ewes that miscarried and were positive for toxoplasmosis showed a rise in their serum titers: from 1:40 on the 15th day after the abortion to 1:80 on the 30th day. It is believed that in these sheep the abortions are not due to toxoplasmosis, and in sheep flocks with a high percent of positive toxoplasmosis reagnets there may not be abortions.

Abortion, Veterinary↗
PubMed2003

Clinical manifestations of ocular toxoplasmosis in Yogyakarta, Indonesia: a clinical review of 173 cases.

Toxoplasmosis was the most common cause of primary retinochoroiditis. The majority of cases of ocular toxoplasmosis were congenital. However, cases of acquired ocular toxoplasmosis have been reported. The clinical manifestations of congenital ocular toxoplasmosis were choroidal coloboma, strabismus, nystagmus, ptosis, microphthalmia, cataract and enophthalmia. The purpose of this study was to determine the clinical presentation and visual outcome of 173 patients with ocular toxoplasmosis at Dr Sardjito Hospital, Dr Yap Eye Hospital, and private practice during the last six years. A total of 173 subjects were studied--98 males and 75 females. The ages at which first diagnosis was established ranged from 3 months to 68 years, frequently in young adults and occurring mostly in students. The most-reported chief complaint was blurred vision in 70.5% and floaters in 6.1% of cases. The most frequent clinical manifestations were chorioretinitis (71.2%), macular scars (22.4%), squint (6.4%), congenital cataract (2.8%), nystagmus (6.4%) and atrophic optic papilla (2.8%). Bilateral involvement was found in 32.4% of all patients. The therapeutic outcome showed improvement, especially visual acuity in acute cases (25.6%). However, visual acuity categorized as blindness was 13.9%. The results of the study imply that suddenly blurred vision in the quiet eye in the young adult, squint, and nystagmus in children could be chorioretinal inflammation and scar caused by Toxoplasma gondii.

Adolescent↗
PubMed1992

[Heart or heart-lung transplantation and toxoplasmosis].

Among all organ transplantations, those of heart or heart-lung carry the greatest risk of toxoplasmosis. The disease is observed mainly when the donor is seropositive and the recipient seronegative. In these mismatched couples the risk may be as high as 57 percent. Cardiac tissue transplants are responsible for most contaminations. A subclinical serological reactivation can be observed in seropositive recipients. Patent forms are associated with seroconversion in seronegative subjects. Toxoplasmosis is often severe with multivisceral foci; interstitial pneumonia is possible. The serological diagnosis is easy in cases with significant antibody movements, but it may be difficult if the titre is low or stable. The parasitological diagnosis rests on the isolation of toxoplasma in blood, cerebrospinal fluid, bronchoalveolar lavage fluid and cardiac or cerebral biopsy. Immune defence against toxoplasmosis is primarily cellular, with lymphocytosis and inversion of the CD4/CD8 ratio. Macrophages play a crucial role. Interferon-gamma is the major mediator of cellular resistance. In spite of its immunosuppressive action, cyclosporin clearly has an antiparasitic action in vitro and in vivo. A cytomegalovirus infection might facilitate toxoplasma reactivation. Prevention of toxoplasmosis in transplant recipients includes systematic serology of the recipient and, if possible, the donor, detection of mismatched couples and systematic treatment with pyrimethamine of recipients at risk (in seronegative recipients, this drug has reduced the risk from 57 to 14 percent). Cyclosporin should be used as immunosuppressant in preference to other drugs of this kind. Corticosteroids administered in rejections increase the risk of toxoplasmosis.

Cyclosporine↗
PubMed2003

The significance of complement fixation test in clinical diagnosis of toxoplasmosis.

BACKGROUND: The complement fixation test (CFT) is the basic method in the diagnosis of toxoplasmosis. Despite its standard and reproducible results, it is rarely used in routine diagnosis of toxoplasmosis where the detection of IgG by means of EIA tests is widely used. OBJECTIVE: The study is focused on the verification of CFT value within the spectrum of specific classes of immunoglobulins IgG, IgM, IgA antibodies and avidity of IgG antibodies, as well as on the clinical diagnosis of toxoplasmosis. METHOD: The study analysed 1705 samples of serum from patients suspected to be infected by Toxoplasma gondii. Out of these patients 451 suffered from acute lymphadenopathic toxoplasmosis (6 with seroconversion of both CFT and IgG antibodies) and 1254 serum samples were collected from patients with latent infection, out of whom 176 were with long-term persistence of IgM, or IgA antibodies after the elimination of disease. CONCLUSION: CFT is a reliable indicator of Toxoplasma infection and as opposed to IgG antibodies its levels enable a more objective determination of its course. However from the aspect of the determination of the stage of toxoplasmosis from a single sample of serum, the combination of CFT with IgM or IgA antibodies with quantitative order or test of avidity of IgG antibodies must be performed. (Tab. 4, Fig. 4, Ref. 30.).

Animals↗
PubMed1992

[Primary cerebral lymphoma in 10 patients with AIDS. Comparative clinico-radiologic study with cerebral toxoplasmosis, cerebral tuberculoma and primary cerebral lymphoma in non-immunodepressed patients].

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is the second cause of cerebral masses in patients with the acquired immunodeficiency syndrome (AIDS). The present study evaluated the possible presence of clinical or radiologic signs permitting differentiation of AIDS patients and PCNSL from those with cerebral masses of other etiologies. METHODS: Clinical history and cranial computerized tomography (CT) of patients with PCNSL and AIDS from the Hospital Clinic i Provincial in Barcelona were reviewed. Results were compared with those of patients with PCNSL without evidence of immunosuppression and with those with AIDS and cerebral toxoplasmosis or tuberculoma diagnosed during the same period. RESULTS: Of 685 patients with AIDS, 10 were identified with PCNSL. The clinical picture was not different to that observed in patients with AIDS and cerebral toxoplasmosis or tuberculomas. In contrast to PCNSL in non immunodepressed patients, the cerebral CT in patients with PCNSL and AIDS demonstrated hyperdense lesions in only 44% and contrast enhancement was not homogeneous in any case. These characteristics were similar to those observed in the CT of patients with cerebral toxoplasmosis or tuberculoma with the exception that only 8% of the lesions by toxoplasmosis were spontaneously hyperdense. CONCLUSIONS: The clinical-radiological data of primary central nervous system lymphoma in patients with the acquired immunodeficiency syndrome are similar to those observed in other etiologies. However, the presence of a sole spontaneously hyperdense region in cranial computerized tomography is more suggestive of primary central nervous system lymphoma than cerebral toxoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Prevalence, morphology and therapy of toxoplasmosis chorioretinitis in AIDS].

Toxoplasmosis-retinochorioiditis is the second most frequent opportunistic infection of the eye among our series of AIDS patients. Between 1985 and 1990 we diagnosed 7 cases in 261 AIDS patients (Walter Reed classification 6); prevalence = 2.7%). The incidence has been increasing over the years. In four cases, toxoplasmosis was restricted to the eye, in three cases, ocular disease occurred combined with toxoplasmosis of the central nervous system. Since serological findings are not very reliable in AIDS-patients, the most important element in the differential diagnosis against retinitis of different etiology is ophthalmoscopy. There are a number of findings which allow differentiation of toxoplasmosis from other forms of retinitis, especially cytomegalovirus retinitis. Toxoplasmosis-retinitis was stopped in all cases by administering a specific therapy of pyrimethamine combined with clindamycin, a sulfonamide or spiramycin. Stable scar formation was achieved after 2-3 weeks therapy. Subsequent maintenance therapy with Fansidar (pyrimethamine + sulfadoxine) protected 4/4 patients from a relapse, while maintenance therapy with pyrimethamine alone allowed a relapse in 1/2 patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Visual impairment and blindness in ocular toxoplasmosis cases.

Ocular toxoplasmosis is a common vision-threatening disease in Indonesia. Diagnosis of this disease is based on characteristic ophthalmoscopic appearances and laboratory findings. Between 1985 and 1989, the authors retrospectively evaluated 41 children under 12 years of age. Thirteen cases had retinal lesions suspected to be toxoplasmosis but the laboratory findings were negative. The remaining 28 children had a total of 41 eyes diagnosed as ocular toxoplasmosis. Of the 41 affected eyes, vision had decreased to finger counting or less in 23 (56%) eyes and to less than 6/15 in 9 (22%) eyes. In five (12.2%) eyes vision was greater than 6/15, and in four (9.8%) eyes the status of vision was unknown. In addition to the usual signs of toxoplasmosis, signs of strabismus and nystagmus were evident in the cases reviewed. Thus, ocular toxoplasmosis should be suspected in patients, particularly children, with those clinical signs.

Blindness↗
PubMed1991

Toxoplasmosis in two cats with inflammatory intestinal disease.

Lymphocytic-plasmacytic enteritis, a chronic inflammatory intestinal disease, was diagnosed in 2 cats. In 1 cat, recurrence of clinical signs after initiating treatment was attributed to relapse of the inflammatory intestinal disease, but was found to be attributable to relapsing toxoplasmosis secondary to immunosuppressive drug therapy. Treatment with clindamycin resolved the recurrent toxoplasmosis. In the second cat, clinical signs of toxoplasmosis did not develop, but serologic testing yielded evidence of active toxoplasmosis. Treatment with clindamycin caused the titers to decrease. Relapsing toxoplasmosis may be responsible for apparent resistance to treatment in cats for inflammatory intestinal disease being treated with immunosuppressive drugs.

Animals↗
PubMed1990

[Congenital toxoplasmosis. 5 cases of mother-to-child transmission of pre-pregnancy infection].

Five cases of congenital toxoplasmosis consecutive to a maternal toxoplasma infection that had preceded pregnancy were observed. One woman with normal immune system had developed a well-documented lymph node toxoplasmosis 2 months before conceiving. Four women had chronic toxoplasmosis diagnosed in the course of an immunosuppressive disease: Hodgkin's disease in 1 case, systemic lupus erythematosus in 2 cases and pancytopenia in 1 case. Toxoplasmosis had been recognized 3, 5 and 10 years respectively before conception in 3 women, and at an uncertain date in 1 woman. Three women had received corticosteroids during pregnancy, and 2 had undergone splenectomy. Among the 6 children (2 were twins), 1 presented with severe foetal disease at birth, 1 developed lethal systemic toxoplasmosis after birth, 1 showed hydrocephalus with therapeutically well-controlled chorioretinitis, 1 had isolated eye lesion and 2 had asymptomatic infection. The parasite seems to have been transmitted after the 20th week of pregnancy in all cases. The physiopathology of mother-to child toxoplasma transmission, the role played by maternal immunodeficiency and the practical implications of these exceptional cases are discussed.

Female↗
PubMed1990

[Ocular toxoplasmosis in patients with acquired immunodeficiency syndrome].

Ocular toxoplasmosis is an uncommonly reported complication in patients with acquired immunodeficiency syndrome. Three patients with human immunodeficiency virus (HIV) infection and ocular toxoplasmosis are reported. In two of them, cerebral toxoplasmosis was associated. Ocular involvement presented as exudative chorioretinitis, bilateral in 2 cases and unilateral in 1. The diagnosis was made on the basis of ocular disease associated with lesions consistent with toxoplasmosis of central nervous system (CNS) and response to antitoxoplasma treatment in one case, and ocular disease with rising antitoxoplasma serologic titers in the remaining two. Initial therapy included pyrimethamine plus sulfadiazine in 2 cases and pyrimethamine plus clindamycin in 1. The 2 patients treated with sulfadiazine showed hypersensitivity features, and clindamycin had to be substituted. The response to therapy was favorable, although one patient died few days after the development of CNS lesions. When chorioretinitis develops in a patient with HIV infection, ocular toxoplasmosis should be considered. As CNS involvement is commonly associated and relapse after the withdrawal of therapy is likely, these patients should be treated as those with isolated toxoplasma encephalitis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Differential diagnosis of parotid tumors: toxoplasmosis lymphadenitis of the parotid gland].

The most common clinical symptom of toxoplasmosis in adults is a cervicofacial lymphadenopathy. The cat is very important in the epidemiology of toxoplasmosis, but contact with cat excreta is most uncommon. The cause of oral transmission in adults is more likely to be eating undercooked contaminated meat containing tissue cysts, particularly raw pork. Toxoplasmosis as a cause of lymphadenopathy is an unusual, and normally postoperative, finding after parotidectomy for a "tumour". In the last 8 years we have seen ten patients with an acute toxoplasmosis infection. We report two patients showing clinical signs of a parotid gland tumour in whom we demonstrated an intraglandular toxoplasmosis lymphadenopathy before operation. We treated these patients successfully using pyrimethamine and sulphonamide, so that surgery was unnecessary.

Adult↗
PubMed1977

Toxoplasmosis after renal transplantation.

Infection is the main cause of death following renal transplantation. In the literature 7 fatal cases of toxoplasmosis following renal transplantation have been described. In the present papers a case of reactivated toxoplasmosis is presented where the patient survived. Fortuitous withdrawal of therapy and transplant nephrectomy may have been responsible for the patient's survival. The problems of diagnosis of toxoplasmosis following renal transplantation are discussed. Early diagnosis is vitally important as successful treatment of toxoplasmosis with pyrimethamine and sulfonamides in patients receiving immunosuppressive therapy has been reported. It is emphasised that reaction of toxoplasmosis should always be considered in patients with fever of unknown origin and cerebral symptoms.

Adult↗
PubMed1972

The posterior cervical lymph node in toxoplasmosis.

Posterior cervical node enlargement is characteristic of clinical toxoplasmosis in adults. Lymph node biopsies from 37 patients, who were tested for toxoplasmosis by serologic and isolation studies, were examined. A characteristic pattern of sinus histiocytosis was seen in 17 of 18 posterior cervical nodes and in only 1 of 4 lymph nodes from other sites from patients with toxoplasmosis. The characteristic pattern was not seen in posterior cervical nodes or in lymph nodes from other sites from patients with other diseases. Lymphoma obscured the characteristic changes of toxoplasmosis in the posterior cervical nodes and other nodes of 5 patients with these coexisting diseases. Organisms were seen in tissue sections in only 2 instances. T gondii was isolated from mice in 14 of 17 attempts using nodes from patients with toxoplasmosis, but from none of 8 attempts using nodes from patients with other diseases.

Biopsy↗
PubMed1980

An outbreak of toxoplasmosis linked to cats.

Clinical, serologic, and epidermiologic evidence documents an outbreak of toxoplasmosis involving ten of 30 members of an extended family. The index patient had unusual clinical manifestations including brain abscesses, progressive chorioretinitis, seizures, neurologic deficits, hepatosplenomegaly, pneumonitis, and eosinophilia. Toxoplasmosis was confirmed by demonstrating the organism in brain tissue and cerebrospinal fluids; clinical and serologic evidence also indicated infection with Toxocara (viscd children. Of the 11 such children, seven (68%) were seropositive, six of whom had high acute-phase titers (greater than or equal to 1024) to Toxoplasma and a disease consistent with acute toxoplasmosis. All six of the latter group required specific chemotherapy. Geophagia was associated statistically with acute toxoplasmosis among the children; it also increased the risk of infection with Toxocara and enteroparasites. Two school-aged children and two adults had serologic evidence of acute toxoplasmosis, but only one of the group was symptomatic. Epidemiologic evidence indicates that this outbreak was probably caused by ingesting oocysts from cat feces. We suggest that the severe and unusual clinical manifestations of the index patient resulted from simultaneous infection with Toxoplasma and Toxocara.

Adult↗