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PubMed1992

[Pericardial manifestations of toxoplasmosis].

A case of pericarditis due to toxoplasmosis in a 20 year old non-immune depressed man with a favourable outcome with specific antiparasitic treatment is reported. Pericarditis is rare in toxoplasmosis and does not require an associated immune deficiency. The clinical presentation is that of acute benign pericarditis, the diagnosis depending on positive toxoplasmosis serology (positive IgM or increasing IgG antibody titres) and the absence of another obvious cause. Isolation of the parasite by direct examination or animal inoculation is very rare. The spontaneous evolution is to pericardial constriction whilst specific antibiotic therapy (sulfadiazine-pyrimethamine) leads to a rapid cure in most cases. This underlines the necessity of searching for toxoplasmosis in patients with unexplained pericarditis.

Adult↗

PubMed1992

[Toxoplasmosis: new aspects, diagnosis and treatment].

The position of visceral toxoplasmosis in HIV infection has changed in the late 1980's. The strong prevalence of toxoplasmosis in the French population and the regression of pneumocystosis due to generalization of primary prophylaxis have made cerebral toxoplasmosis the initial manifestation of AIDS in about 20% of the cases. At the same time, a better management of AIDS patients has made it possible to hope for a longer survival, even in patients with very deep immunodeficiency. Altogether, these various elements are in favour of developing a primary prophylaxis in patients at high risk for visceral toxoplasmosis. During the last few years, other visceral forms of this infection have emerged, which are either localized (chorioretinitis, diffuse encephalitis) or disseminated, affecting the lung, liver, heart, muscles, bone marrow and other viscera. These forms usually imply a very severe immunodeficiency. Because of the toxicity of the reference therapy, sulfadiazine-pyrimethamine, attempts are being made at developing more effective and better tolerated treatments. At the moment, the clindamycin-pyrimethamine combination is a possible alternative. Other compounds, and in particular macrolids, are still under study.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[Real-time quantitative PCR for toxoplasmosis diagnosis].

Congenital toxoplasmosis results from foetus contamination by Toxoplasma gondii during pregnancy. It is a frequent and severe condition calling for close monitoring of mothers at risk. During the last decades, numerous advances have been made specially in the antenatal diagnosis. The congenital toxoplasmosis diagnosis relies currently on PCR test of amniotic fluid, with a sensitivity of 80%. More recently, real-time quantitative PCR has been developed to improve toxoplasmosis diagnosis. We therefore compared the diagnosis value of quantitative real-time PCR with our conventional PCR-hybridization for the diagnosis of congenital toxoplasmosis.

Amniotic Fluid↗

PubMed2004

[Seroprevalence of toxoplasmosis among women having spontaneous abortion and pregnant women following in a center of health up-town in Dakar].

A prospective survey carried on 70 women having a spontaneous abortion and 70 pregnant women was achieved in the center of health Roi Baudouin of Guediawaye (Senegal) between November 2001 to April 2002 to study the toxoplasmosis in the two groups. Anti-toxoplasmosis antibodies were searched for on all women by a technical solid-phase enzyme immunoassay. The solid-phase is a combs. The seroprevalence of the toxoplasmosis is 37.1% among women having aborted and 40% for pregnant women. The difference is not statistically significant (p = 0.729). The seroconversion is 22.8% among women having aborted and 10% for pregnant women. The difference is statistically significant (p = 0.041). The research of factors favoring the infestation, related to through food habits, pleads in favor of a contamination during childhood, essentially soil and/or eating undone meat. With regard the high percentage of not immunized women (62.9% for women having aborted and 60% for pregnant women), it is necessary to take prophylactic measures to prevent congenital toxoplasmosis.

Abortion, Spontaneous↗

PubMedDate not supplied

[Prevalence of toxoplasmosis and methods for its laboratory diagnosis].

The review presents data on the prevalence of toxoplasmosis in different countries and regions. It gives a comparative assessment of the methods of serodiagnosis of toxoplasmosis, which permit identification of specific immunoglobulins G, M, A, and E. The authors show a role of laboratory diagnostic techniques in the differentiation of the acute form of toxoplasmosis from its chronic form. They provide the currently available modifications of the basic procedure for enzyme immunoassay, molecular genetic methods, and a direct fluorescent antibody test for the detection of Toxoplasma gondii antigens. The current view of a cellular immune response and its role in monitoring the development of toxoplasmosis are considered.

Animals↗

PubMedDate not supplied

Toxoplasmosis and systemic lupus erythematosus. Comparative serological studies.

There are still controversial views as to the relation between SLE and toxoplasmosis. Therefore, we looked for serological markers in both diseases. In patients with SLE (17), toxoplasmosis (28), and in normal controls (28) anti-Toxoplasma gondii antibodies, anti-nuclear antibodies of different specificities, anti-histone and anti-cardiolipine antibodies, as well as antibodies against most common public idiotypes were measured. Significant increases in antinuclear antibodies and other SLE-related antigens were observed in patients with SLE. On the contrary, low levels of these antibodies were found in toxoplasmosis patients and in controls. The same was true for 16/6 anti-DNA idiotype antibodies. The incidence of anti-Toxoplasma antibodies in SLE sera did not differ in comparison with that in the normal population. Our data suggest that subacute and chronic toxoplasmosis do not play essential roles in generating the antibodies that are important to the pathogenetic mechanism operating in SLE.

Adult↗

PubMed1991

Incidence of toxoplasmosis in patients with glandular fever and in healthy blood donors.

The differential diagnosis of the clinical syndrome of glandular fever may include Epstein-Barr virus, cytomegalovirus and Toxoplasma gondii infection. Some general practitioners and clinical laboratories choose to perform serological investigations for toxoplasmosis in all patients with glandular fever, who have negative Paul-Bunnell test results. The validity of this approach was assessed by a comparison of the incidence of toxoplasmosis in healthy blood donors and in a group of patients with clinically diagnosed glandular fever who had negative Paul-Bunnell tests. The results showed no significant difference in the frequency of acute or chronic toxoplasma infection between the two groups. In view of these findings, together with evidence of the lack of appropriate effective therapy for toxoplasmosis in immunocompetent individuals, and the dangers of failing to recognize concurrent severe disease of a separate aetiology, we recommend that Paul-Bunnell negative patients with clinically diagnosed glandular fever are not investigated for toxoplasmosis as a routine. However, these guidelines do not apply to patients at risk of severe sequelae from toxoplasma infection, notably pregnant women, who still require a full assessment.

Adult↗

PubMed1991

[Antibody titer to Toxoplasma gondii in uveitis of toxoplasmosis and other origin].

The diagnostic value of toxoplasma serology in ocular toxoplasmosis is a controversial issue. Some authors feel that a positive titer indicates nothing more than that the patient had been exposed to Toxoplasma gondii at some stage. Even if in most cases the diagnosis is based on the morphological findings on the fundus, it might sometimes be useful to have an additional serologic evaluation. In a retrospective study we compared the level of antitoxoplasmosis antibodies (measured in a complement fixation test and an immunofluorescence test) in 75 patients with clinically proven ocular toxoplasmosis and 146 patients with uveitis of other origin. In our results we showed that the incidence of positive titers and antibody levels are significantly higher in patient with ocular toxoplasmosis than in other uveitis patient (chi 2-test, Mann-Whitney Willcoxon test, p = 0.05). There was no significant difference between antibody levels in patients with anterior uveitis, posterior uveitis or panuveitis of nontoxoplasmotic origin. No correlation between the antibody levels and amount of retinochorioidal fundus lesions could be found. Based on our results, we conclude that in cases where fundus findings are compatible with ocular toxoplasmosis and a complement fixation or immunefluorescence test is positive, specific antitoxoplasmotic therapy should be started.

Animals↗

PubMed1991

[Value and limitations of toxoplasmosis serology in HIV patients].

Antibody titers to Toxoplasma gondii were studied in 62 AIDS patients with active toxoplasmosis (cerebral in 42, pulmonary in 10 and ocular in 10), confirmed by biopsy or by imaging techniques with a therapeutic test, and in 1,499 HIV-positive patients. The purpose of this study was to evaluate the value of antibody assays for the diagnosis of active infection and the prevalence of toxoplasmosis in HIV-positive individuals. IgG antibodies to Toxoplasma were found in 61 of the 62 AIDS patients, but not in one patient with pulmonary toxoplasmosis, with no significant differences in mean titers obtained by dye test, indirect immunofluorescence and sensitized agglutination. Twenty patients (31.7%) had dye test titers of 400 IU/ml or more; three patients had IgM antibodies. Thirteen (38%) of the 34 patients who had serial antibody assays exhibited a rise in IgG titers with no detectable production of IgM antibodies. Antibodies to Toxoplasma were found in 75% of the 1,499 HIV-positive subjects, a proportion which is not significantly different from that seen in HIV-negative controls; however, HIV-positive subjects were significantly more likely than controls to have high titers (greater than or equal to 500 IU in 18.7% of patients versus 9.2% of controls, p less than 0.001). A follow-up study in 177 HIV-positive patients with antibodies to Toxoplasma showed an annual reactivation rate of 12%; in five of 30 patients, the rise in antibody titers occurred concomitantly with or a few months before clinical toxoplasmosis; 25 patients remained asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗

PubMed1991

Results of a preventive program for congenital toxoplasmosis.

All pregnant women followed during the period 1982-87 were screened for toxoplasmosis, and 35 patients had documented seroconversion or doubtful toxoplasmosis titers. One patient opted for pregnancy termination. The remaining were followed with a protocol that included serial ultrasound examinations and prophylactic antibiotic treatment of the mother and neonate. No fetal abnormalities related to congenital toxoplasmosis were found. All the infants had negative toxoplasmosis test titers at birth; at follow-up only one was found to have developed a subclinical infection, at 2 months of age. Our data suggest that antiparasitic treatment during pregnancy for those at risk for Toxoplasma infection may reduce the transmission rate.

Adult↗

PubMed1990

[Chorioretinitis in congenital toxoplasmosis].

The goal of this study was to establish the incidence of chorioretinitis in 100 infants whose mothers presented a seroconversion during the pregnancy. It is a retrospective study over 6.5 years. There were 17 cases of latent congenital toxoplasmosis (56.7%) and 13 cases of clinical congenital toxoplasmosis (43.3%). Three infants presented with chorioretinitis: one at birth in a context of general stroke, the two others at 2 and 17 months after birth, despite treatment. The risk of retinochorioditis was the same in the case of latent or clinical congenital toxoplasmosis. The fall in the antibody titre was not a good criterion of cure; the percentage of lymphocytes in the cerebrospinal fluid could constitute a better criterion. This study confirmed the efficacy of systemic treatment of congenital toxoplasmosis.

Antibodies, Protozoan↗

PubMed1990

Ocular toxoplasmosis in AIDS patients.

We describe 16 cases of ocular and, in some patients, associated CNS toxoplasmosis in AIDS patients. T gondii is commonly associated with infection in the immunocompromised host. The lesions are most often seen in the CNS and eyes; involvement in the brain, heart, lung, liver, spleen, and lymph nodes may be observed. CNS involvement by toxoplasmosis may be an initial manifestation of AIDS and may be associated with discrete or diffuse lesions. CT scan and MR imaging may demonstrate a multitude of lesions often displaying the characteristic ring-shaped enhancement after contrast injection. Ocular involvement by toxoplasmosis, though less common than CNS involvement, is characterized by several features. These may be manifested as single or multifocal retinal lesions in one or both eyes or massive areas of retinal necrosis. Invariably these lesions are unassociated with a pre-existing retinochoroidal scar suggesting that the lesions are a manifestation of acquired rather than congenital disease. Presence of IgM antibodies may support this observation although antibody levels in AIDS patients may not reflect the magnitude of disease. Vitreous reaction is often minimal. Anterior uveitis has been reported in one case. Treatment of the ocular infection with pyrimethamine, clindamycin and sulfadiazine is effective in over 75% of patients. Once resolution of the ocular infection is observed, maintenance therapy is continued as relapses occur in the absence of treatment. Corticosteroid treatment is unnecessary and its use has been associated with the development of CMV retinitis. Other retinal infections in AIDS patients which should be considered in the differential diagnosis include CMV, herpetic-associated ARN and syphilis. Concomitant CMV and toxoplasmosis in the same eye have been seen.

Acquired Immunodeficiency Syndrome↗

PubMed1989

Toxoplasmosis of the brain and heart: autopsy report of a patient with AIDS.

Central nervous system (CNS) infection by Toxoplasma gondii is not uncommon in patients with acquired immunodeficiency syndrome (AIDS). Extraneural toxoplasmosis has been reported in the heart, lungs, testes, and skin of AIDS patients with concurrent CNS toxoplasmosis. Toxoplasma myocarditis is rare even in AIDS patients, except in Haitians. We report the case of a homosexual white man with positive HIV serology who presented with neurological complaints. A diagnosis of toxoplasmosis was not established before death, but at autopsy the patient had cerebral toxoplasmosis and Toxoplasma myocarditis.

Acquired Immunodeficiency Syndrome↗

PubMed1987

Immune response to Toxoplasma gondii--analysis of suppressor T cells in a patient with symptomatic acute toxoplasmosis.

Unresponsiveness of antigen-dependent (Toxoplasma-specific and purified protein derivative of tuberculin [PPD]-specific) T-cell proliferative responses of peripheral blood leukocytes (PBL) was observed in a patient with symptomatic acute toxoplasmosis. The immunosuppression of T-cell responses was mediated by Leu 1+, Leu 2a+, and Leu 3a- suppressor T cells that were induced by Toxoplasma gondii antigen and suppressed both Toxoplasma-specific and PPD-specific PBL T-cell responses from a patient with chronic toxoplasmosis when PBL of these patients were mixed and cocultured in vitro. Participation of class II molecules of HLA in Toxoplasma-specific proliferative T-cell responses and activation of suppressor T cells was examined by using monoclonal antibodies specific for HLA-DR and HLA-DQ molecules. Anti-HLA-DQ monoclonal antibody released the suppressive activity, while anti-HLA-DR monoclonal antibody inhibited Toxoplasma-specific T-cell responses. Thus, the suppressive effect of PBL from a patient with acute toxoplasmosis on antigen-dependent PBL T-cell responses from a patient with chronic toxoplasmosis was mediated by HLA-DQ molecules. By contrast, Toxoplasma-specific T-cell responses were activated by HLA-DR molecules (presumably present on antigen-presenting cells).

Acute Disease↗

PubMed1987

Depletion of T-4+ lymphocytes with monoclonal antibody reactivates toxoplasmosis in the central nervous system: a model of superinfection in AIDS.

Central nervous system toxoplasmosis causes disability and death in up to 30% of patients with acquired immune deficiency syndrome (AIDS). The source of the toxoplasma infection in these patients and the specific immune deficit that allows for this virulent form of the infection are unknown. By using a mouse model of toxoplasmosis, we found that selective depletion of T-4+ lymphocytes (CD4+ T cells) produces overwhelming infection and death in both acute and chronic toxoplasmosis. However, the pattern of infection is remarkably different in chronically infected mice as compared with acutely infected mice when the mice are depleted of CD4+ T cells. During acute infection loss of the CD4+ T cell population leads to severe systemic infection with only mild disease in the brain. In chronically infected mice depleted of CD4+ T cells, death follows severe CNS damage due to toxoplasma infection with only minor systemic involvement. In chronically infected mice treated with anti-CD4 monoclonal antibody, reactivation of the toxoplasma infection occurs despite high titers of circulating antitoxoplasma antibody. In parallel with these results in mice, CNS toxoplasmosis in AIDS patients may be due to reactivation of infection acquired much earlier in life.

Animals↗

PubMed1988

[Diagnosis and prevention of feline toxoplasmosis].

At the "Small Animal Clinic of the University of Veterinary Science" in Brno during four years 442 sick and 178 clinically normal cats were examined in regard to incidence and diagnosis of toxoplasmosis. Using the Sabin-Feldman reaction, antibodies against T.gondii were found in 40.3% of the cats (titer 4-128), whereas by means of complement fixation reaction and microprecipitation in agar gel, antibodies were found in 23.2% (titer 5-80) and 17.1% of the cats, respectively. Eight cats (1.3%) excreted T.gondii oocysts. The number of animals having specific antibodies increased statistically significant with age (P less than 0.01) and with particular hunting habits: it was higher in cats which were usually catching small rodents (P less than 0.01). A lower toxoplasmosis incidence was observed in indoor-cats (P less than 0.005) and in cats fed with boiled food only (P less than 0.005). In 35% of the cats showing no clinical symptoms of toxoplasmosis, there were found antibodies against T.gondii. Comparison of clinically normal and sick cats revealed that antibodies against T.gondii occurred significantly more often in cats with enlarged lymph nodes (P less than 0.01), with a disease of the digestive tract (P less than 0.01), of the liver (P less than 0.01), and of the nervous system (P less than 0.01). Several recommendations for diagnosis and prophylaxis of toxoplasmosis in cats are given.

Animals↗

PubMed1986

Congenital toxoplasmosis in premature twins.

In the course of the study "Toxoplasmosis and Prematurity" 330 blood samples from twins were examined. Our findings in a series of 21 premature twins (maternal sera were also examined) are reported in this paper. Toxoplasma antibodies were detected by the Sabin-Feldman test and specific IgM antibodies by the Remington test. The classical form of congenital toxoplasmosis was present in five pairs of twins, while toxoplasmosis was subclinical at birth in both twins of three pairs. The pattern of disease varied very much in seven pairs of twins. In one twin of two pairs signs of disease were present, while his cotwin appeared unaffected but with strongly positive result of SFT. The most interesting observation, however, is that in three pairs, one twin was infected and had evident congenital toxoplasmosis, while his cotwin was not, as proven by the disappearance of the Toxoplasma antibodies. This finding undoubtedly indicates the importance of whether the placenta is intact or not for the transmission of the infection.

Antibodies↗

PubMed1977

Contribution to the early diagnosis of congenital toxoplasmosis.

A method based on a single serological test enabling the diagnosis of congenital toxoplasmosis immediately after birth is described. The concentration of anti-toxoplasmosis antibody from the CSF is compared to that of rubeola used as reference. It is thus possible to distinguish between the passive passage of antibodies in the CSF and their in situ synthesis. When concentration of antibody in the CSF is higher for toxoplasmosis than for rubeola, the existence of a congenital infection of toxoplasmosis can be suggested.

Antibodies↗