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PubMed1995

Disseminated toxoplasmosis in AIDS patients--report of 16 cases.

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.

AIDS-Related Opportunistic Infections↗
PubMed1985

Five drug regimens for treatment of acute toxoplasmosis in squirrel monkeys.

Five drug regimens for the treatment of acute toxoplasmosis were compared in a monkey model. Systemic disease that is almost always fatal in squirrel monkeys within 7-9 days was produced by oral inoculation of a brain suspension made from mice chronically infected with the Beverly strain of Toxoplasma gondii. All untreated controls died of toxoplasmosis (6/6) while treatment gave the following results: sulfamethoxazole, 0/3; spiramycin, 5/5; clindamycin/sulfadiazine (CLD/SLD), 0/4; pyrimethamine/sulfadiazine (PYR/SLD), 0/5; trimethoprim/sulfamethoxazole (TMP/SMZ), 0/4. Three of the five monkeys treated with CLD/SLD died during or shortly after the experiment from probable CLD toxicity. Sulfonamides alone or in combination with PYR or TMP were significantly more effective than spiramycin in treating toxoplasmosis in this model. The dose regimen used in this study did not allow us to determine if the addition of PYR or TMP changed the protection of sulfa alone.

Animals↗
PubMed1976

[Evaluation of some epidemiological factors in human toxoplasmosis].

The authors compared a group of 197 women with different ascertained forms of toxoplasmosis and a group of 72 women with negative serological reactions on toxoplasmosis and hereby they revealed that the consumption of insufficiently heated meats as well as the contact with animals (rearing and digestion embowelling or drawing of coat) play an eminent part. As test animals above all cats were used. The results of the two groups were compared and a significant difference between them was ascertained for the consumption of the insufficiently heated meat as well as for the contact with the animals. The women with toxoplasmosis more frequently consumed insufficiently heated meat and had more contact with cats and other animals.

Adult↗
PubMed2000

[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)].

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Toxoplasmosis serodiagnosis: comparison of Access Toxo IgM II assay compared to Axsym Toxo IgM and Vidas Toxo IgM assays].

The Access Toxo IgM II test (Beckman Coulter Inc) was evaluated on 1,190 samples from toxoplasmosis serology requests, documented seroconversions, umbilical cord blood or venous blood from healthy newborn, and from newborns with congenital toxoplasmosis. Results were compared to those obtained with Vidas (bioMérieux) and Axsym (Abbott) assays, with Isaga as confirmatory technique. Results obtained with the Access test well correlate those with the Vidas (98.3%) and the Axsym (97.6%) assays. Less "bordeline" results are also observed with the Access test (0.22% versus 0.56% and 1.24% with Vidas and Axsym assays respectively). Results obtained from seroconverted patients prove that the Access assay is more sensitive than Vidas and Axsym assays, with respectively 2 and 4 samples detected earlier for 28 cases studied (recently seroconverted patients). Results obtained using prospective samples and with sequential sera obtained from patients with seroconversion clearly demonstrate that Access Toxo IgM II assay is perfectly adapted to toxoplasmosis diagnosis.

Adult↗
PubMed2001

Histopathological features of ocular toxoplasmosis in the fetus and infant.

BACKGROUND: Ocular disease is a frequent manifestation of congenital Toxoplasma gondii infection. There are only limited data available in the literature concerning early stages of this disease in fetuses and infants. The purpose of our study was to characterize histopathological features in the eyes of 10 fetuses and 2 infants with congenital toxoplasmosis. METHODS: Fifteen eyes from 10 fetuses, 3 eyes from 2 premature infants, and both eyes from a 2-year-old child with congenital toxoplasmosis were examined by light microscopy. Immunohistochemical analysis to identify inflammatory cells and T gondii antigens was performed. The findings in infected eyes were compared with those of age-matched control eyes. RESULTS: Retinitis (10/18 eyes), retinal necrosis (4/18 eyes), disruption of the retinal pigment epithelium (12/18 eyes), and choroidal inflammation and congestion (15/18 eyes) were characteristic findings. Optic neuritis was present in 5 of 8 fetal eyes with associated optic nerve available for evaluation. An eye obtained from a 32-week-old fetus showed retinal rosettes at the edge of a scar. T cells predominated in retinal lesions and choroid. Parasites were identified by immunohistochemical analysis in 10 of 18 eyes. CONCLUSIONS: Ocular toxoplasmosis causes irreversible damage to the retina in utero. The fetus and infant mount inflammatory responses that may contribute to ocular damage. These findings have important implications for serological screening programs and in utero therapy.

Antigens, CD↗
PubMedDate not supplied

[Childhood toxoplasmosis today].

The comparative study of two groups of children suffering from acquired or congenital toxoplasmosis, being in hospital during two different decades (1979-1985--39 children and 1991-1997--117 children) proved: the fact that atypical or subclinical manifestations of the acquired toxoplasmosis (54%) draws our attention to the systematic research of the infection with Toxoplasma gondii, especially at the groups with increased risk now that the frequency of the diseases generating immunodeficiency; the increased frequency of congenital toxoplasmosis (5% in the first group, 8% in the second group) and especially of the invalidating of screening tests to the pregnant women; the therapeutic arsenal limited by the rate price/toxicity/medical resistance, must be individualized for each case, taking into account the increased number of other associated diseases (chronic hepatitis B 7%, TB 17%, HIV infection 5%); Rovamicine treatment at the second group had similar results to those obtained by administrating Pirimetamine--Trimetoprim to the children from the first group.

Adult↗
PubMed1975

[Prevention of congenital toxoplasmosis. Results at the maternity department of the Hôpital Saint-Antoine in 1972].

The authors report the results of checking for toxoplasmosis in a maternity hospital in Paris in one year. 3,409 women were checked. 19 cases of toxoplasmosis were detected and treated. 4 of these were cogenital toxoplasmosis, of which 3 were obvious. We have to point out that sero-conversion did not occur during the survey after we had started to prescribe hygienic diets to patients in the survey. The difficulties accompanying this form of prophylaxis have been analysed.

Adult↗
PubMed2002

[Evaluation of prevention strategies for congenital toxoplasmosis: a critical review of medico-economic studies].

BACKGROUND: Congenital toxoplasmosis (CT) may lead to serious neurological or sensory consequences. A serological screening of women at risk of acquiring toxoplasmosis became mandatory in France, first during the visit before wedding (1978), then during the visit for pregnancy declaration (1985) and at last with a monthly follow-up during pregnancy since 1992. The efficacy and the profitability of the program was never assessed, in spite of the modification of the epidemiological context. However medico-economical studies were conducted in countries in which no prevention program for CT was available to determine the interest of an antenatal screening similar to the French one or of other prevention strategies. METHODS: Eight studies comparing at least two strategies were selected. Methodologies used in those studies were analyzed by two independent readers with the help of a standardized scale. A score was calculated for each study. RESULTS: Each study analyzed suffered from methodological limitations, in particular concerning the estimation of antenatal treatment efficacy, which could lead to invalidate their conclusion. The most reliable studies in regard to methodological guidelines, that is with the higher score, concluded that antenatal screening was not contributive. However, they could not be transposed directly in the present French situation, because of the difference of the epidemiological and economical context. CONCLUSIONS: Given the difficulty to obtain a clear conclusion, it seems necessary to perform a rigorous decision analysis to identify the more effective and acceptable program in terms of human and financial costs for preventing congenital toxoplasmosis.

Cost-Benefit Analysis↗
PubMed2002

[Toxoplasmosis in sick persons].

A screening investigation was conducted designed to identify ill persons presenting with toxoplasmosis with the aid of an intracutaneous test with toxoplasmin and complement-fixing reaction with a dry toxoplasmic antigen. Toxoplasmosis was detected in those persons having lymphadenitis, therapeutical patients, women with aggravated obstetrical history having had spontaneous abortions and having given birth to sick children, patients with sluggish meningoencephalitis presenting with epileptoid and hypothalamic syndrome, polyneuritis, and patients with myopia, chorioretinitis and uveitis. Identification and treatment of toxoplasmic invasion constitutes a valid method of control of spontaneous abortions of toxoplasmic etiology. Detection in a timely fashion of toxoplasmic invasion in pregnant women and preventive treatment with two 5-day cycles of pirimetamin (0.025) twice a day and sulfodimezin (0.5) four times daily with a 10-day interval between the cycles has been found out to prevent toxoplasmosis affliction of the fetus.

Abortion, Spontaneous↗
PubMed1992

Toxoplasmosis in pregnancy: an emerging concern for family physicians.

Toxoplasmosis is usually asymptomatic in pregnant women but poses a risk of severe effects on the fetus. One to eight of every 1,000 pregnant women become infected, and the infection is transmitted to the fetus in approximately 40 percent of these cases. The risk of transmission rises with increasing gestational age at the time of initial infection. Congenital infection with toxoplasmosis may lead to serious sequelae, such as blindness, mental retardation, neurologic deficits and deafness. Prevention of morbidity from toxoplasmosis depends on prevention of the infection in pregnant women, plus early recognition and aggressive treatment of maternal infections.

Female↗
PubMed1992

Epidemiologic studies on human and feline toxoplasmosis.

Human serological profiles, and feline serological and fecal profiles were used to study the epidemiology of toxoplasmosis in Santa Clara County, California. The prevalence of human toxoplasmosis was determined to be 42.9% in a test population of 147 women. The prevalence of feline toxoplasmosis was indicated to be 34.8% based on serological analysis of 158 felines. Of 107 cats tested, 6.5% were shedding Toxoplasma gondii - like oocysts in their feces. Statistical analyses of questionnaire data indicated that the major infection sources for seropositive humans in this study were: (1) eating rare-medium cooked beef; (2) exposure to cats; and (3) working in an outside garden. Of these three sources, gardening represented the least risk. The data from questionnaires with reference to age, residence, and eating and toilet habits of owned felines were evaluated and found to show no significant statistical correlation with seropositivity. The infection sources for seropositive felines could not be determined. The plausible significance of feline-human interaction, human consumption of infected meat, and gardening habits is stressed.

Adult↗
PubMed2005

Seroprevalence of acquired toxoplasmosis in HIV-infected and apparently healthy individuals in Jos, Nigeria.

Toxoplasma gondii IgG antibody seroprevalence was studied in two different populations of 219 HIV-infected patients and 144 apparently healthy individuals (AHIs). Clinical toxoplasmosis was assessed among the HIV-infected patients. Antibodies to T. gondii were detected in 85 (38.8%, 95% CI: 32.36%-45.26%) of the HIV-infected patients and in 30 (20.8%, 95% CI: 14.20%-27.46%) of the AHIs. Among the AIHs, males represented 22.0% of infections compared to females (20.0%) and individuals within age group 21-30 years accounted for the highest prevalence of 33.3% (95% CI: 11.56%-55.10%). There was no significant difference in the trend (Chi-square, P < or = 0.05). Assessment of epidemiological factors showed higher seroprevalence of Toxoplasma antibodies among those who eat rodents (29.6%) and those who constantly have contact with the soil (21.2%). Among the HIV-infected, individuals 31-40-years-old had the highest T. gondii seroprevalence (36.5%). Evaluation of the clinical findings of patients with concomitant toxoplasmosis and HIV infection greatly implicated fever (63.5%), headache (44.7%), rashes (41.2%) and anorexia (34.1%). This study contributes to the development of guidelines for the prevention and management of toxoplasmosis in HIV-infected patients and in apparently healthy individuals in a resource scarce setting.

Adolescent↗
PubMed2001

[Use of the PCR technique for diagnosis of symptomatic congenital toxoplasmosis based on own observations].

UNLABELLED: The aim of our study was to determine the usefulness of PCR technique in postnatal diagnosis of congenital toxoplasmosis in 17 infants aged from 1 week to 10 months. In 13 cases the diagnosis was established. The diagnostic procedures involved: clinical examinations, serological tests, nested-PCR method and neuroimaging examinations. RESULTS: In almost all children (except one) a high level of toxoplasmatic IgG antibodies was found; in 1/3 we identified antibodies IgM and IgA. In 14 cases the PCR test from CSF was positive. In 4 infants the suspicion of congenital toxoplasmosis was ruled out; in 2 of them PCR from CSF was negative, in 2 - a false positive result was stated. CONCLUSIONS: PCR is a valuable technique for diagnosis of congenital toxoplasmosis. Because of the possibility of false positive and negative results - it should be combined with other laboratory methods.

Adult↗
PubMed1990

[Ocular toxoplasmosis in AIDS].

Since 1983, we have seen 11 cases of toxoplasmic retinochoroiditis in patients with AIDS. Ocular toxoplasmosis appears to be a growing concern in AIDS: 3.3% in 1983, 6.1% in 1988 and 5.9% during the first trimester of 1989. Anti-Toxoplasma gondii antibody titers in the aqueous humour were not conclusive, therefore the diagnosis was based on ophthalmoscopic criteria and on a rapid response to specific therapy. As for brain toxoplasmosis, treatment must be continued indefinitely to prevent relapse. Seven out of 11 patients had cerebral toxoplasmosis, which was diagnosed by computerized tomography (CT) scan. This suggests that a neurological evaluation and a brain CT scan should be performed in all AIDS patients with toxoplasmic retinochoroiditis.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Toxoplasmosis in pregnancy with special emphasis on laboratory diagnosis].

On the occasion of the thirty-five years of systematic research of toxoplasmosis, a review of the present knowledge of the role of toxoplasmosis in pregnancy is presented. Diagnostic procedures and the interpretation of the results of laboratory examinations are particularly stressed. The main conclusion is that in a population exposed to the infection in the way as was in the cases studied, the prevention of congenital toxoplasmosis can be achieved through a serologic follow-up of all pregnant women starting from the moment when pregnancy is established. The purpose of such screening is to identify those pregnant women who are not immunized (who are then advised to follow certain hygienic and dietetic measures) and those who are primoinfected in pregnancy. As the latter are at risk for transmitting the infection to their fetuses, they receive specific therapy and their fetuses are carefully controlled by ultrasound and other methods for the antenatal diagnosis of intrauterine infection.

Female↗
PubMedDate not supplied

[Epidemiology of toxoplasmosis in Chile. V. Prevalence of the infection in humans and domestic and wild animals, studied by indirect hemagglutination reaction, in the Juan Fernández Archipelago. V Region].

A serological study utilizing an indirect hemagglutination test (IHAT) for toxoplasmosis was carried out in 222 humans and in 58 domestic animals (31 dogs, Canis familiaris; 27 cats, Felis catus), and in 62 wild mammals distributed into 50 rabbits, Oryctolagus cuniculus and 12 goats, Capra hircus. This survey was performed in the Juan Fernández Archipelago, formed by three islands: Robinson Crusoe, Santa Clara and Alejandro Selkirk (80 degrees 47'-78 degrees 47' west long., and 33 degrees 36'-33 degrees 47' south lat.). Blood samples were collected in filter paper and IHAT with titres greater than or equal to 1:16 were considered positive. This survey showed a prevalence of 42.3% in humans with no difference between men (43.0%) and women (41.5%). A high prevalence was found within groups of young individuals (0 to 19 years old), men and women. Regarding the domestic animal population, 44.8% resulted positive, distributed as follows: dogs 9.7% and cats 85.2%. Twenty one percent of wild animals were positive, distributed as follows: rabbits 8.0% and goats 75.0%. The global prevalence of toxoplasmosis in animals (domestic and wild) was 32.5%. All titres in humans and animals were less than or equal to 1:512. Toxoplasmosis is well extended among the human and animal population of the Juan Fernández Archipelago.

Adolescent↗
PubMed1988

Toxoplasmosis: maternal and pediatric findings in 23,000 pregnancies.

An analysis of the antibody titers to toxoplasmosis for 22,845 pregnant women in the Collaborative Perinatal Project was conducted in relation to clinical and laboratory findings in the mothers and children through 7 years of age. More than 900 observations were considered for each mother and child. The major findings were in the children and included a predicted doubling in the frequency of deafness among children born to women with antibody to toxoplasmosis, a predicted 60% increase in microcephaly, and a 30% increase in low IQ (less than 70) in association with the presence of high maternal antibody titer (256 to 512) to toxoplasma. A serologically defined high-risk group of mothers was identified on the basis of high indirect hemagglutination antibody levels or seroconversions and increased IgM toxoplasma antibody levels (indirect fluorescent antibody greater than or equal to 32, enzyme-linked immunosorbent assay greater than or equal to 0.7). Of the 15 pregnancies in this group, two children had congenital toxoplasmosis and three were stillborn.

Antibodies↗