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PubMed1980

Infants potentially at risk for congenital toxoplasmosis: a prospective study.

Fifty-two children were selected as being potentially at risk for congenital toxoplasmosis by serologic testing of 8,043 pregnant women in the Oslo area. These infants were then studied during the neonatal period and subsequently followed up for three years. Three were found to be congenitally infected with Toxoplasma gondii, and one infant was dysmature at birth. The diagnosis was confirmed by persistent dye-test antibodies and by recovery of parasites in placenta and/or amniotic fluid. The Toxoplasma indirect fluorescent IgM-antibody test remained negative, while measurements of cord IgM and IgA levels and serial estimations of specific antibody load supported an early diagnosis. The specific cell-mediated immunity, as measured by the in vitro lymphocyte stimulation test, turned positive at 1 year of age and then increased markedly during the second and third years. The lymphocyte responses of the uninfected children, however, remained negative. The infected children received pyrimethamine/sulfadiazine treatment during their first year, with no clinical signs of congenital toxoplasmosis.

Antibodies↗
PubMed1997

Prenatal diagnosis of congenital toxoplasmosis in 261 pregnancies.

Two hundred and sixty-one pregnant women underwent prenatal screening by cordocentesis and/or amniocentesis between 1987 and 1994. The following tests were used: (i) detection of anti-Toxoplasma gondii IgM, IgA, and IgE antibodies by immunocapture and the comparative immunological profile method based on enzyme-linked immunofiltration assay of fetal blood and (ii) direct detection of the parasite in cell culture and by mouse inoculation with fetal blood (FB) and/or amniotic fluid (AF). Of the 31 cases of congenital toxoplasmosis, 24 (77 per cent) were detected prenatally. Overall, the FB and AF inoculation methods were the most effective (50 per cent sensitivity with FB inoculation to mice and/or cell culture and 74 per cent with AF). However, antibody detection in FB was the only positive test in three cases. Of 18 surviving children diagnosed prenatally, only one developed chorioretinitis (9 months of age). Seven newborns (23 per cent) with negative prenatal tests were diagnosed by postnatal laboratory monitoring, but none of these children developed clinical toxoplasmosis. There may have been more false negatives, as only 48 per cent of unaffected children were followed up for at least 12 months. All the tests had a specificity of 100 per cent. Fetal blood sampling has considerable value but also carries some risks and is currently being abandoned in favour of amniocentesis alone with gene amplification and mouse inoculation.

Amniocentesis↗
PubMed1999

Congenital toxoplasmosis: prenatal diagnosis, treatment and postnatal outcome.

We report a female patient with congenital toxoplasmosis who presented with hydrops fetalis and cerebral abnormalities, detected on fetal ultrasound. Following prenatal treatment, the hydrops fetalis resolved and at four months of age she has normal growth and development. This case emphasizes the potential good prognosis in cases with congenital toxoplasmosis detected and treated prenatally.

Adult↗
PubMed1998

Congenital toxoplasmosis: diagnosis by exfoliative cytology.

Toxoplasmosis, caused by the intracellular protozoan Toxoplasma gondii, has as its major routes of acquisition either ingestion (of the cyst or oocyte) or transplacental infection (by trophozoites). Transplacental transmission occurs to the fetus in utero or to the newborn at vaginal delivery. Maternally acquired infections can infect the embryo as early as the 7th week of gestation. It has been estimated that 15-17% of maternal infections acquired between the 7th and 14th weeks of gestation are transmitted to the embryo (Lynfield R, Eaton RB., Teratology 1995;52:176-180.). We present a 7-wk-old white male, delivered at 38 wk of gestation, who shortly after birth was found to have hepatosplenomegaly and anemia; he developed liver failure and ascites with persistent anemia during the first week of life. After an extensive, but nondiagnostic, work-up, a paracentesis was performed which led to a diagnosis of congenital toxoplasmosis. This case demonstrates the utility of exfoliative cytology in determining the cause of neonatal ascites, especially of an infectious etiology. To our knowledge, this represents the first reported case of Toxoplasma gondii diagnosed by exfoliative cytology in a pediatric patient.

Anemia↗
PubMed2001

Prenatal diagnosis of congenital toxoplasmosis by duplex real-time PCR using fluorescence resonance energy transfer hybridization probes.

The diagnosis of congenital toxoplasmosis frequently relies on PCR tests of amniotic fluid (AF). A duplex real-time quantitative PCR test based on fluorescence resonance energy transfer was developed to quantify the parasite load and to decrease the risk of contamination. An internal control based on the detection of 10 pg mouse DNA added to the AF was included to check for PCR efficiency. The relationship between the parasite load and the occurrence of ultrasonographic abnormalities in 87 samples of AF was analyzed. Seven AF (8%) had a parasitic load > 10(3); 14 (16%) had > 10(2)-< or =10(3); 26 (30%) had > 10-< or = 10(2); and 40 (46%) had < or = 10 parasites/ml. Four of the six AF with cerebral ventriculomegaly had >10(3) parasites/ml. The other two had 130 and 24 parasites/ml, respectively. No parasitic loads of > 10(3) parasites/ml and no ultrasonographic abnormalities were observed in the 11 AF with maternal toxoplasmosis in the third trimester. Therefore, there is a trend to associate high parasite count with ultrasonographic abnormality, but the main concern remains early maternal infection. The importance of quantification should be better evaluated with postnatal studies. The duplex LightCycler PCR test currently provides rapid and safe results.

Amniocentesis↗
PubMed1979

Dermatomyositis and toxoplasmosis.

In a patient with childhood dermatomyositis, high toxoplasma antibodies were found at the time of diagnosis. A direct immunofluorescence technique demonstrated active toxoplasmosis in the muscle biopsy. The response to treatment and follow-up in this patient suggest that toxoplasmosis could have caused the dermatomyositis.

Child↗
PubMed1991

Focal dystonia secondary to cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome.

A variety of movement disorders have been reported in patients with acquired immune deficiency syndrome (AIDS) and cerebral toxoplasmosis. We describe a 29-year-old man with left arm and hand focal dystonia secondary to Toxoplasma abscesses in the right lenticular nucleus and thalamus. Although a few cases of dystonia have been reported in AIDS, this patient represents the first reported case of focal dystonia secondary to toxoplasmosis.

AIDS Dementia Complex↗
PubMed1993

Movement disorders with cerebral toxoplasmosis and AIDS.

Movement disorders occur in some patients with cerebral toxoplasmosis with HIV-1 infection. Such movement disorders have not been described in patients with cerebral toxoplasmosis without HIV-1 infection. This report discusses their diagnostic features, aspects of management, and possible mechanisms underlying the pathogenesis of the movement disorders.

AIDS-Related Opportunistic Infections↗
PubMed1994

Fetal diagnosis of toxoplasmosis in 190 women infected during pregnancy.

One hundred and ninety women who contracted toxoplasmosis after the seventh week of pregnancy underwent antenatal diagnosis, including ultrasound examination and biological tests. Tests included Toxoplasma isolation in fetal blood and amniotic fluid by mouse inoculation, specific IgM and IgA in fetal blood, and non-specific tests. Twenty fetuses had positive specific as well as non-specific tests for Toxoplasma infection. At birth, four of these presented with clinical congenital toxoplasmosis and 12 with subclinical forms. Antenatal diagnosis enabled the detection of 83 per cent of the infected fetuses. Under specific conditions, cordocentesis permits early diagnosis and considerably reduces the number of terminations of pregnancy.

Female↗
PubMed1995

Recurrent congenital toxoplasmosis in a woman with lupus erythematosus.

We describe the case of a patient with systemic lupus erythematosus, treated by corticosteroids, who presented during two successive pregnancies with serological reactivation of toxoplasmosis associated with fetal lesions. The first infected fetus died in utero with signs of hydrops. The second fetus was treated in utero with a combination of sulfadoxine and pyrimethamine, administered to the mother, and is now well. The increasing number of immunocompromised pregnant patients with immunity to Toxoplasma gondii may lead to a higher risk of reactivation of maternal toxoplasmosis and congenital infection.

Adult↗
PubMed1990

Ocular toxoplasmosis.

Toxoplasmosis is a common infection of man and animals. The disease is widespread in nature and has a worldwide distribution. The infection is caused by the organism Toxoplasma gondii which was first isolated by Nicolle and Manceaux in Tunis from a North African rodent. The disease can be congenital or acquired with a variety of clinical manifestations that may range from a subclinical course to a generalized infection with fatal outcome. The ocular manifestations of the disease include sudden onset of floaters with blurring of vision. Toxoplasmosis causes a localized necrotizing retinitis with inflammation of the subjacent choroid. The retina sustains the primary injury and the major damage.

Animals↗
PubMed1990

Ocular toxoplasmosis--clinical aspect.

Ocular toxoplasmosis in non immuno-deficients can take 3 major aspects: 1) Pseudo-acquired (congenital) forms in teenagers and young adults; 2) Congenital forms in the newborn; 3) Acquired toxoplasmosis.

Humans↗
PubMed1992

Disseminated toxoplasmosis with sepsis in AIDS.

A 24-year-old woman with acquired immunodeficiency syndrome was admitted with septic fever of unknown origin and a 2-week history of diarrhea. Clinical diagnostic procedures did not reveal the cause of sepsis. Broad-spectrum antibiotics and intensive symptomatic therapy could not prevent progressive deterioration. The patient developed septic shock and consumptive coagulopathy and died 6 days after admission. Autopsy revealed disseminated infection with toxoplasma gondii and multiple organ manifestations. We conclude that disseminated toxoplasmosis should be considered in AIDS patients with septic disease of unknown origin. Extremely elevated lactate dehydrogenase may suggest disseminated toxoplasma gondii infection. New procedures such as polymerase chain reaction for detection of toxoplasmosis may be helpful diagnostic tools.

AIDS-Related Opportunistic Infections↗
PubMed1982

[Late death in congenital toxoplasmosis].

In spite of a known toxoplasmosis infection rate of up to 90% of the population of the Federal Republic of Germany published T-cases decrease steadily. T-infection during gravidity may cause more pathologic alterations in the infant cerebrum than is commonly assumed. Medico-legal aspects are very rare. A case of connatal toxoplasmosis in a 19 months old infant was found at exhumation (16 days p.m.). In the cerebrum T-parasites, terminal colonies and calcified spots were observed. Specific morphological and immunohistological findings lead to the diagnosis. The medico-legal problems of this case are discussed.

Brain↗
PubMed1978

[Cerebral toxoplasmosis complicating Hodgkin's disease in the adult. Light and electron-microscopic findings (author's transl)].

A male patient with a history of Hodgkin's disease of 11 years duration died at age 41 with signs of progressive cerebral involvement. The blastomatous process had been treated with X-rays, cytostatic agents, and corticosteroids. Autopsy revealed isolated lymphogranulomatous lesions in the chest walls and multiple foci of necrosis in the brain. In the latter, Toxoplasma could be detected by light and electron microscopy. The inflammatory response elicited by the protozoan parasite was strikingly slight. This indicated that the patient had had some immunologic impairment. Pathomorphologic and clinical aspects of cerebral toxoplasmosis in the adult are discussed. It is emphasized that patients suffering from chronic malignant disorders, particularly Hodgkin's disease, are preferentially affected by toxoplasmosis of the brain.

Adult↗
PubMed1989

Toxoplasmosis in sheep, goats and cattle in central Ethiopia.

In a seroepidemiological survey using an indirect haemagglutination assay, the prevalence rate of toxoplasmosis in central Ethiopia was 22.9% of 899 sheep, 11.6% of 753 goats and 6.6% of 785 cattle. There were high titres of 1:256 or more which suggest current infections. These results indicate that toxoplasmosis may be an important cause of reproductive wastage in small ruminants. The public health significance of this disease is discussed. Improved hygiene and management could reduce the prevalence of the disease.

Abattoirs↗
PubMed1986

Evaluation of laboratory diagnosis of toxoplasmosis by means of an ELISA-triple test. Detection of class specific IgG, IgM and circulating antigen.

The combination of three parameters (IgG, IgM and circulating antigen) in a so-called 'ELISA triple test' was suggested for advantageous diagnosing of human toxoplasmosis. A qualitative assay was used with the following arbitrary assumptions: IgG antibodies reflect an infection, IgM antibodies reflect a recent (primary) infection and circulating antigens reflect an active infection. The three assays were performed simultaneously in one microtiter plate. This approach was tested with 1091 patient sera submitted for routine diagnosis. In comparison with conventional indirect immunofluorescence and complement fixation test it was observed that combinations indicating a recently acquired infection (combinations with IgM and/or circulating antigen) mainly paralleled low or negligible conventional antibody titers. No strict association was seen between particular combinations and certain clinical symptoms suggestive for toxoplasmosis. In conclusion it was stated that the triple test for support of clinical diagnosis has some advantages but that a strong need exists to be able to demonstrate exacerbation or reinfections which are generally not characterised by IgM antibody formation of free circulating antigens but may be the reason for elevated conventional antibody titers.

Antigens, Protozoan↗
PubMed1980

Unusual presentation of acute ocular toxoplasmosis.

Two unusual cases of ocular toxoplasmosis are presented. A 24 year old woman developed retinal and optic nerve neovascularization in conjunction with acute ocular toxoplasmosis. The neovascularization regressed with resolution of the inflammation. The possibility of retinal ischemia or inflammation alone as an etiology are discussed. A 19 year old woman developed optic nerve edema and a marked decrease in vision associated with a nasal toxoplasma lesion and a macular star. With resolution of the process, optic atrophy developed but visual acuity returned to normal. Optic nerve edema and atrophy were felt to result from diffuse inflammation, but not from focal involvement in the nerve itself with the organism.

Adult↗