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PubMed2004

[Prevention and treatment of congenital toxoplasmosis: organization protocol].

AIM: Prevention and treatment of congenital toxoplasmosis are still a matter of debate among obstetricians, pediatricians and epidemiologists. There is no consensus about antenatal screening and diagnostic tests, nor there is about treatment for presumed infection in pregnancy. As an example of this type of organisation for health care delivery, a regional model has been promoted as a multidisciplinary approach for prenatal diagnosis of congenital toxoplasmosis. The model had been designed on the national guidelines of the National Health Institute (Istituto Superiore di Sanità, ISS). METHODS: Suspected maternal infections are referred and seen as outpatients at our centre on a specific day of the week; maternal investigation (specific IgG, IgM, IgA and IgG avidity titres) are performed at the Institute of Virology of the University of Bari, and patients are started on spiramycin. All cases of true or presumed seroconversion are counselled for amniotic fluid sampling and the sample is sent to ISS. In cases of late seroconversion and positive amniotic fluid results, patients are prescribed pyrimethamine+sulphonamide+folinic acid and alternate spiramycin until the end of pregnancy. A fetal-neonatal follow-up is performed in all cases. RESULTS: During the period 1999-2001, 180 cases of presumed toxoplasmosis infection have been referred (average 60 cases per year). We have been able to reclute, since the adoption of the national network protocol, 1/3 of presumed regional cases with a positive increasing trend. CONCLUSION: The service for prenatal diagnosis of toxoplasma gondii infection has definitely benefitted from the adoption of this protocol, which combines adherence to a national network and pays respect to regional requirements.

Clinical Protocols↗
PubMed2005

Azithromycin prophylaxis and treatment of murine toxoplasmosis.

OBJECTIVE: To evaluate the azithromycin effects alone and in combination with other agents in the prophylaxis and treatment of murine toxoplasmosis. METHODS: A total of 280 BALB/c mice were included, and 2 x 103 Toxoplasma organisms of the RH strain Toxoplasma gondii strain ATCC50174 were given intraperitoneally to each mouse. In experiment one, 40 animals were given azithromycin 200 milligram/kilogram/daily for 3 days starting the day of inoculation, 40 mice were control. In experiment 2, the treatment was started 48 hours after inoculation and given daily for 3 days: one group received azithromycin 200 milligram/kilogram/day, the second group received pyrimethamine 25 milligram/kilogram/day, and the sulfadiazine 100 milligram/kilogram/day. The third group was control. In experiment 3, 7 groups of animals received one of the following (1) none, (2) azithromycin 200 milligram/kilogram/day, (3) pyrimethamine 25 milligram/kilogram/day and sulfadiazine 100 milligram/kilogram/day, (4) azithromycin and sulfadiazine, (5) azithromycin and pyrimethamine, (6) azithromycin with sulfadiazine and pyrimethamine, (7) sulfadiazine alone. Treatment was initiated 72 hours after inoculation for 3 days. The study was conducted at the Animal Care Facility of King Saud University, Riyadh, Kingdom of Saudi Arabia. RESULTS: Animals that received azithromycin simultaneously with inoculation survived, and all control animals died. All animals died in groups receiving single drug therapy. Animals treated with azithromycin and sulfadiazine showed a survival rate of 40%, sulfadiazine and pyrimethamine 40%, or azithromycin with sulfadiazine and pyrimethamine 95% (p<0.0001). CONCLUSION: Azithromycin alone was found to be effective in the prophylaxis of murine toxoplasmosis. Combination therapy was effective in the treatment of murine toxoplasmosis.

Animals↗
PubMedDate not supplied

Primary cerebral toxoplasmosis: a rare case of ventriculitis and hydrocephalus in AIDS.

We describe the clinical, radiological and neuropathological findings in an adult AIDS patient presenting with ventriculitis and hydrocephalus as the primary manifestations of cerebral toxoplasmosis. Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific. Cranial computed tomography showed a subtile ventricular dilatation whereas magnetic resonance imaging disclosed triventricular hydrocephalus due to stenosis of the aqueduct and a periventricular nodular rim of high signal intensity on T2- and proton density-weighted images. This rim also showed a slight enhancement on post-contrast T1-weighted images. Focal intracerebral lesions could not be delineated, neither by neuroimaging nor by pathology. Neuropathological examination showed severe ventriculitis with large ependymal and subependymal necrosis as well as dilatation of the lateral and the third ventricle. The only microorganism demonstrated at histology in the central nervous system was Toxoplasma gondii. We conclude that ventriculitis and hydrocephalus without any focal parenchymal lesion may be the only manifestations of CNS toxoplasmosis. It is important to recognize this unusual form of presentation of cerebral toxoplasmosis in order to perform specific therapy.

AIDS-Related Opportunistic Infections↗
PubMed2005

[Congenital toxoplasmosis: possibilities for laboratory diagnosis].

A case history and the steps taken in diagnosing congenital toxoplasmosis in a child whose mother experienced asymptomatic infection with the protozoon Toxoplasma gondii are presented. At pregnancy week 35, amniocentesis was performed because of fetal hydrops, ascites, hepatosplenomegaly and dilated left lateral brain ventricle on sonography. Laboratory tests showed high titers of IgM, IgE and IgA antibodies (acute infection markers) against Toxoplasma gondii in serum of the pregnant woman. Congenital toxoplasmosis in the new-born spontaneously delivered at week 41 was confirmed by detection of Toxoplasma gondii DNA in blood, acute infection markers in serum and hydrocephalus and calcifications on brain sonography. The woman received intensive treatment for toxoplasmosis during the last pregnancy trimester and her new-born child's treatment started immediately after delivery. The accurate diagnosis and early institution of therapy in both the pregnant woman and her child led to progressive normalization of laboratory tests (decreased titers of antibodies and Toxoplasma gondii DNA negativity) and significant regression of the brain lesions in the child.

Adult↗
PubMed2004

[Toxoplasmosis in patients with lymphoid hyperplasia of the head and neck].

OBJECTIVES: To investigate the incidence of toxoplasmosis in patients with lymphoid hyperplasia of the head and neck. PATIENTS AND METHODS: In this study, 53 patients (32 males, 21 females; mean age 11.2+/-4.3 years, range 5 to 22) were investigated. There were hypertrophic tonsillitis in 13 patients, hypertrophic tonsillitis and adenoid hyperplasia in 22 patients, adenoid hyperplasia in 10 patients, and lymphadenopathy of the neck in eight patients. In venous blood samples, IgM and IgG antibodies for Toxoplasma gondii were investigated with the enzyme-linked immunoabsorbent assay (Axsym, Abbott). RESULTS: Positive IgG was determined in 23 patients (48%) with hypertrophic tonsillitis (n=6), hypertrophic tonsillitis and adenoid hyperplasia (n=10), adenoid hyperplasia (n=3), and lymphadenopathy of the neck (n=4). Positive IgM was determined in 5 patients (9.4%) with hypertrophic tonsillitis (n=1), hypertrophic tonsillitis and adenoid hyperplasia (n=1), and lymphadenopathy of the neck (n=3). CONCLUSION: Toxoplasmosis, which is known to cause lymphadenopathy, may be a reason for lymphadenopathy of the neck. Toxoplasmosis should be considered in the differential diagnosis of untreated patients with tonsillitis, adenoid hyperplasia, and chronic neck lymphadenopathy.

Adenoids↗
PubMed1992

[Recall of the importance of serological monitoring of children with suspected congenital toxoplasmosis].

Emphasis is put on the need for repeating serologic tests at regular intervals until one year of age in infants with suspected congenital toxoplasmosis. In 11 of 33 cases, antibody titer changes were the only evidence of toxoplasmosis, a disease which may induce severe ocular lesions if appropriate treatment is not given. Although well-recognized as indispensable, serologic monitoring is not always performed; in one group of 326 infants with suspected congenital toxoplasmosis, 133 (41%) were not followed up for more than six weeks.

Enzyme-Linked Immunosorbent Assay↗
PubMedDate not supplied

[The colorful clinical spectrum of cerebral toxoplasmosis in five HIV positive cases: what comes out of Pandora's box?].

In patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), the most common cause of focal intracranial lesion is Toxoplasma gondii infection. T. gondii encephalitis is an easily and effectively treatable disease, with promising outcomes. T. gondii has the potential to form a focal infection niche anywhere in the central nervous system, thus allowing for a colorful clinical picture. In this report, we attempted to present five HIV/AIDS cases with central nervous system toxoplasmosis demonstrating five different neurological presentations. The ages, gender and clinical findings of the patients who were admitted to our Infectious Diseases Clinics were as follows; 35 years old male patient with delirium, 49 years old male patient with focal dystony, 32 years old female patient with facial paralysis and monoparalysis, 53 years old male patient with Wernicke syndrome, 32 years old male patient with epilepsy. Cerebral toxoplasmosis were diagnosed by clinical findings and imaging techniques. The patients were treated with trimetoprim-sulfametoxazol (TMP-SMZ) and haloperidol, only TMP-SMZ, clindamycin and daraprim, TMP-SMZ and levotiracetam, TMP-SMZ and phenytoin, respectively, with recovery in neurological and radiological symptoms. In conclusion, until proven otherwise, HIV/AIDS patients presenting with focal neurological complaints should be accepted as having central nervous system toxoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Sudden death due to cardiac toxoplasmosis.

The recognition of cardiac toxoplasmosis has increased in patients with acquired immunodeficiency syndrome. The functional consequences of toxoplasmosis of heart vary considerably depending on the intensity of inflammatory reaction, the extent of involvement of myocardial muscle fibers by necrosis and intramyocytic presence of tachyzoites of Toxoplasma gondii. This report describes a case of toxoplasma myocarditis that lead to fatal cardiac arrest. To the best of our knowledge, this is the first reported case of cardiac toxoplasmosis in the Indian literature, which has manifested as sudden death.

Adult↗
PubMed1991

Toxoplasmosis--an overview.

Increasing concern over food safety has focussed attention on food-borne parasitic diseases, particularly toxoplasmosis. Infection by the protozoan parasite Toxoplasma gondii is widely prevalent in humans and in food animals. Cats are the main reservoirs of infection because they are only hosts that excrete environmentally resistant oocysts. Toxoplasma gondii infection is transmitted by ingesting undercooked infected meat, congenitally, and via feces of infected cats. The most severe clinical infections occur in congenitally infected children. Toxoplasmosis is a major cause of abortion and neonatal mortality in sheep, goats, and pigs. Strategies to control toxoplasmosis are outlined.

Animals↗
PubMedDate not supplied

[Results of serological reactions in patients with presumptive diagnosis of toxoplasmosis].

Even though Toxoplasma gondii is an ubiquitous parasite that can effect most of human structures and organs, not all clinical manifestations suggestive of being produced by it are caused by this protozoon. For these reasons sera samples of patients suspected of having toxoplasmosis are sent to the laboratory for detecting specific antibodies which would facilitate the differential diagnosis. Thus, 716 sera from suspected patients, mainly from the Metropolitan Region of Chile, were sent to the Parasitology Laboratory of Chile University in order to carry out in them, specific serological tests for toxoplasmosis: indirect hemagglutination test (IHAT), Sabin Feldman reaction (SFT) and complement fixation test (CFT). Were considered positive: IHAT and/or SFT with titers > or = 1:16 and CFT with titer > or = 1:5. The pathologies for demanding these serological tests were obstetrical problems 210 (29.3%), congenital problems 193 (27.0%), ophthalmopathies 81 (11.3%), adenopathies 77 (10.8%), AIDS 67 (9.4%), myocardiopathies 46 (6.4%) and miscellaneous 42 (5.9%). The positivity found in these sera was higher in ophthalmopathies (61.7%), followed by obstetrical problems, miscellaneous problems, myocardiopathies and AIDS (50.7-52.4%), less frequent was the positivity in adenopathies (35.1%) and congenital problems (23.1%). In general, the 43.7% of positivity for toxoplasmosis found in these patients is higher than the 37.0% found in the general population. High titers of IHAT and SFT plus positive CFT was found in 13-fold higher proportion than in the general population.

Adolescent↗
PubMed1991

Acquired immunodeficiency syndrome with disseminated toxoplasmosis presenting as an acute pulmonary and gastrointestinal illness.

Encephalitis due to the protozoan Toxoplasma gondii has emerged as a common cause of central nervous system disease in patients with acquired immunodeficiency syndrome. Extraneural disease is less common and more difficult to diagnose. We report a case of widely disseminated toxoplasmosis that presented as acute gastrointestinal and pulmonary disease in a patient without a prior diagnosis of acquired immunodeficiency syndrome. The diagnosis of toxoplasmosis was made only at autopsy. Antemortem diagnosis of disseminated T gondii infection requires a high degree of clinical suspicion and the prompt utilization of appropriate diagnostic testing. Since toxoplasmosis is a potentially treatable opportunistic infection, diagnosis allows the swift institution of anti-Toxoplasma therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Ocular toxoplasmosis and AIDS. A case report].

Ocular toxoplasmosis is uncommon in the natural course of AIDS. We report here in a case of a 27 year old man with cerebral toxoplasmosis involvement with neurological signs and coma. After an initial improvement with a sulfadiazine and pyriméthamine treatment, we noticed a foveal chorioretinitis with hyalitis in the right eye which deeply decreased the visual acuity (less than 20/400) strongly suggesting a toxoplasmic etiology. Then specific aspects such as serology, acquired or congenital toxoplasmosis, treatment are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Cerebral toxoplasmosis in a patients with the acquired immunodeficiency syndrome. Discussion of the criteria of computerized axial tomography].

Computed tomography (CT) is a sensitive noninvasive study used for the diagnosis of cerebral lesions in patients with AIDS. Toxoplasmosis is, by far, the most common opportunistic central nervous system disease (CNS) in this population; accordingly, most groups start empirical antitoxoplasma therapy if the radiological features of the lesion suggest the diagnosis. It is common, however, when CT images do not suggest toxoplasmosis, not to start empirical therapy until the investigation of the lesion with other studies has not been completed. We report a case of cerebral toxoplasmosis in a patient with AIDS which, in our opinion, illustrates that empirical antitoxoplasma therapy should be started in all CNS lesions in patients with HIV infection while etiological investigation is undertaken, independently from the appearance of the lesion in the CT.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Acute toxoplasmosis: evaluation of a thin-layer immunoassay technic for detection of IgM antibodies, anti-Toxoplasma gondii].

A solid phase method, thin-layer immunoassay (IgM-TIA) was standardized and evaluated for the immunodiagnosis of acute toxoplasmosis, through the detection of IgM antibodies to Toxoplasma gondii. A total of 300 serum samples from serologically defined acute toxoplasmosis and, from non-related infections, was investigated by IgM-TIA. Statistical analysis were carried out in comparison with conventional tests, the immunofluorescence test for the detection of IgM antibodies (IgM-IFI) and hemagglutination test which uses 2-mercaptoethanol serum treatment (2ME-HA). Also the correlation coefficients were calculated for various Toxoplasma gondii antigen concentrations, as well as, the influence of the antigenic concentration on the relative indices of sensitivity and specificity were verified. The intra and inter test reproducibilities were demonstrated statistically, as well as, the reutilization of T. gondii antigen was proven to be possible for at least 10 times. The data indicated that antigenic concentrations, from 70 to 100 Cmg/ml, were able to provide maximum sensitivity and specificity. IgM-TIA displayed similar diagnostic efficiency to those two conventional tests here utilized, and may be employed to make diagnosis of acute toxoplasmosis, mainly if laboratory animals are available.

Acute Disease↗
PubMed1990

[Computed tomography aspects of cerebral toxoplasmosis in AIDS].

We followed by CT 19 AIDS patients with cerebral toxoplasmosis. Diagnosis of cerebral toxoplasmosis was assessed on radiological and clinical basis, including the therapeutic response. CT allowed to confirm brain lesions (40 lesions in 19 patients) and to follow the evolution with treatment. Analysis of the CT features of these brain lesions permits to define some characteristic findings, though not pathognomonic. These lesions share common characteristics with other granulomatous diseases or with brain abscesses. The most frequently observed features are: target lesions (74%) with contrast enhancement (95%), frequently multiple (53%), associated with a hypodense area of oedema (100%), and responsible for a mass effect (79%). Under treatment, we observed improvement in 89%, resulting either in complete disappearance of the lesions (16%), disappearance of one or more contrast enhancing (46%) or hypodense (6%) areas, or volumetric regression of the hypodensities (50%). We conclude that CT is a good first-step examination for the detection and follow-up of cerebral toxoplasmosis in AIDS patients. MRI, a method with a higher sensitivity but still less accessible, may be considered at the present time as a second-step examination for those patients with solitary lesions on CT, or for symptomatic patients with normal CT.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Toxoplasma gondii serology in HIV-infected patients: the development of central nervous system toxoplasmosis in AIDS.

Central nervous system (CNS) toxoplasmosis is an important infectious complication of AIDS which requires prolonged treatment. Most cases occur in patients with serologic evidence of prior exposure and therefore appear to result from reactivation of a previously acquired infection. Antibody to Toxoplasma gondii was found in 130 out of 411 patients with AIDS (32%). Of these, CNS toxoplasmosis developed in 31 (24%). By survival analysis, the estimated probability of ever developing CNS infection in antibody-positive individuals was 28%, occurring in 26% of patients within 2 years of the onset of AIDS. All patients with HIV infection should be tested for antibody to T. gondii and monitored for any neurologic change. Methods of prophylaxis for CNS toxoplasmosis in these high-risk patients need to be developed.

Acquired Immunodeficiency Syndrome↗
PubMed1978

[Symptomatology, diagnosis, and treatment of nervous tissue affecting toxoplasmosis in adult (author's transl)].

The neurological manifestations of three adult cases with acquired toxoplasmosis appearing like a focal lesion, multiple sclerosis and with symptoms indicating a cerebellar lesion are reported. The discussion with respect to the literature shows the following results: 1. The diagnosis of mono- and oligosymptomatic toxoplasmosis with neurological symptoms is only approximate after the introduction of the indirect immunofluorescence test too. 2. The toxoplasmosis of the nervous system in the adult is not characterized by a special syndrome like the connatale form. In contrary, it often is mimicking many well known neurological or psychiatric syndromes. 3. There may be an exacerbation of a latent infection in cause of immunosuppressive therapy or radiation of malignancy or after transplantations. 4. Treatment with the combination of pyrimethamine and sulfonamids today is handled less in spite of the possible complications and of doubtful serological results, because an early diagnosis and onset of treatment is important for a good restitution.

Adult↗
PubMed1989

[Ocular toxoplasmosis in 1989].

The clinical aspect of congenital toxoplasmosis is sometimes typical, sometimes atypical. The advantage of the serological study of the aqueous is an early diagnosis and an early treatment for less expense. The classical treatment relies on the therapeutic association Pyrimethamine + Adiazine + corticosteroids which will be used during acute phases, at ordinary doses, but may be prolonged further over many months in difficult cases. Severe forms are those that are spontaneously severe or increased with the exclusive use of corticosteroids in previous attacks, noticeably when injected by local route, and in bilateral forms. Prevention of ocular toxoplasmosis is represented by the detection of sero-conversion in mother and treatment in the newborn. Due to the legal aspect of this procedure in France, the incidence of congenital toxoplasmosis has already decreased during the past years and will continue to diminish in the next future. However the possibility of acquired forms cannot be excluded, even in non immuno-depressed patients.

Adrenal Cortex Hormones↗