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The author describes a case of a central nervous system toxoplasmosis in a diabetic patient. A review of the literature about toxoplasmosis and its predisposing causes was made, and diabetes has not been reported up till now among them.
The diagnosis of some infectious diseases contracted during pregnancy is very important, as these diseases can be transmitted to the fetus. Four hundred and eighty-one pregnant women were studied, of an average 24.5 years of age (from 14 to 46), during their first prenatal visit to the State of S. Paulo's Health Care Centres in the subdistrict of Paz (Butantan), City of S. Paulo, Brazil, between April and October, 1988. Classified by trimester of pregnancy, 230 patients (47.8%) fell into the first, 203 (42.2%) into the second and 48 (10%) into the third trimester. Of the 474 patients that declared their income, 309 (65.2%) earned 1 MSPC (minimum salary per capita) per month, which gives some indication of the low socioeconomic status of our patients is. The serologic tests for syphilis, toxoplasmosis and Chagas' disease were analysed for each patient, more than one technique being used for each. The results were as follows: 25 patients (5.2%) had a positive test for syphilis; in 67 patients (13.9%) active toxoplasmosis was diagnosed (Presence of IgM antibodies in 6); 14 patients (2.9%) were positive for Chagas' disease, among which 10 (71.4%) came from the States of Bahia and Minas Gerais, where this disease has a high prevalence.
Toxoplasmosis is a highly prevalent zoonotic human infection caused by the Apicomplexa protozoon Toxoplasma gondii. The acute disease is usually mild or asymptomatic, except for foetal infection transmitted by acutely infected pregnant women, which courses as a devastating disease. In order to determine possible regional variations in risk factors, we studied the frequency of seronegativity in areas of the São Paulo Metropolitan Region, comparing titers and age groups. The prevalence of seronegativity was determined retrospectively in 1286 pregnant women receiving prenatal care at public health services in four selected areas of the São Paulo Metropolitan Region of similar socioeconomic background. The São Paulo City area had the higher frequency of seronegativity (41.1%), followed by the Northwest (31.5%) and Southwest (29.9%) areas, with similar intermediate levels, and by the Northeast (22.5%) area with the lowest frequency (p < 0.001). A rough estimate disclosed about 280 infected infants/year in the São Paulo Metropolitan Region. Serological titers analyzed by age group suggested a decline in antibody levels with age, as shown by a lower frequency of higher titers in older groups. Our study emphasizes the importance of determining the regional prevalence of toxoplasmosis for proper planning of public health prenatal care.
A series of already published and unpublished seroepidemiological surveys for toxoplasmosis, carried out in Chile in 1982-1994, is reviewed, expanded and analyzed. The surveys included 76,317 apparently healthy individuals of different ages (0.57% of the country's total population), from 309 urban and rural-periurban localities. Urban groups were integrated by blood donors, delivering mothers and middle grade schoolchildren, while rural-periurban individuals corresponded to unselected family groups. Blood samples were collected in filter paper. The presence of antibodies to Toxoplasma gondii was determined by the indirect hemagglutination test (IHAT), titers > or = 16 were considered positive. The test resulted positive in 28,124 (36.9%) of the surveyed people. Two hundred and six (0.3%) individuals presented IHAT titers > or = 1000, probably corresponding to acute or reactivated infections. A progressive increase of positive IHAT from northern to southern regions of the country was noted, phenomenon probably related to geographical conditions and to a higher production and consumption of different types of meat in the latter regions. It is postulated that ingestion of T gondii cysts by humans is epidemiologically as important as ingestion of oocysts. The result presented stress the epidemiological importance of toxoplasmosis in humans, and warn about eventual implications in immunocompromised patients and in transplacental transmission, organ transplants and transfusions.
The authors report the use and the outcome of claritromycin associated with pyrimethamine in the treatment of toxoplasma encephalites in two patients with AIDS. Both patients had the diagnosis stablished on clinical grounds, positive sorology (IgG) for toxoplasmosis and computed-tomographic (CT) scan of the brain showing lesions consistent with T. gondii encephalitis. The two patients were initially treated with pyrimethamine and sulfadiazine, which was changed to clindamycin due to allergic reactions. These reactions (skin rash) occurred with clindamycin as well and the patients were treated with claritromycin and pyrimethamine. The scheduled regimens were 1.5 to 2 g of clarithromycin plus 25 mg of pyrimethamine. The clinical response was very good in both cases with regression of neurologic signs and encephalitic abnormalities observed on CT scan. The authors suggest that clarithromycin associated with pyrimethamine may be an alternative treatment for toxoplasmosis in AIDS patients, who cannot receive or tolerate sulfa treatment.
In order to evaluate the seroprevalence of the american trypanosomiasis, syphilis, toxoplasmosis, rubella, hepatitis B infection, hepatitis C infection and human immunodeficiency virus infection among pregnant women attended at the Hospital Universitário Regional Norte do Paraná, Londrina State University, Paraná, a retrospective study of the serologic results performed in the prenatal routine during the period of June 1996 to June 1998 was carried out. The rates of seropositivity were as follows: american trypanosomiasis = 0.9%, syphilis = 1.6%, toxoplasmosis = 67% (IgG) and 1.8% (IgM), rubella = 89% (IgG) and 1.2% (IgM), hepatitis B surface antigen = 0.8%, hepatitis C virus = 0.8% and human immunodeficiency virus infection = 0.6%. An association between the increase in the seroprevalence of Chagas' disease and patient age was detected (p=0.006). The results underscore the importance of the serological tests in perinatal care, to prevent both the congenital and perinatally transmitted forms of theses infectious diseases.
In order to asses the soroprevalence of HTLV- I/II, HIV, siphylis, and toxoplasmosis infection among pregnant women seen at Basic Health Units in the municipality of Botucatu - São Paulo - Brazil, and risk factors for HTLV- I/II infection, sorologic surveys were carried out and results of sorologic surveys carried in pregnance routine evaluation were assessed. Seroprevalence was 0.1% (1 in 913) for both HTLV-I and HTLV-II. Seroprevalence was 0.1% (1 in 913) for both HTLV-I and HTLV-II. Siphylis, toxoplasmosis and HIV were identified. None of the factors or characteristics risks was found to be useful to identify those prenant women HTLV-II infected. Infection among pregnant women and southeast brazilian blood donnors were not diferent in statistical evaluation.
Tests were performed for antibodies IgG, IgM and IgA anti-Toxoplasma gondii antibodies in serum and intraocular fluids (Aqueous and vitreous humor) from patients with ocular toxoplasmosis. By the results obtained, it was verified that intraocular IgG and IgA anti-Toxoplasma gondii antibodies can be important markers for the diagnosis of ocular toxoplasmosis.
Acute toxoplasmosis in three members of the same family was related to drinking unpasteurized goat's milk. The goats were reared, for milk production in a peri-domestic area. Based on indirect immunofluorescent reactions antibody titers greater than 1: 1024 were recorded in eight out of fifteen animals examined and were highest in the five lactating adult females. Toxoplasma was isolated, by inoculation of mice, from the milk of one of these females. Dogs reared in the same house showed no symptoms of acute toxoplasmosis and low antibody titers were detected in these animals. It was also found that the human infections could not have been due to the ingestion of food contaminated with oocysts.
An experimental model for acquired and congenital ocular toxoplasmosis as well as a model to induce experimental autoimmune uveitis (EAU) was investigated in Calomys callosus. Toxoplasma gondii, ME-49 strain, was used to infect males and pregnant- and not pregnant-females while S-antigen, a major glycoprotein of the retinal photoreceptor cell, was used to induce EAU. The ocular lesions elicited by T. gondii were characterized by the presence of cysts, free tachyzoites and inflammatory cells in the retina or related tissues. In the congenital form, 40% of the fetus presented ocular lesions, i.e., presence of cysts in the retina, vitreous, and extra-retinal tissues. In the acquired form, 75% of the females and 50% of the males presented unilateral ocular cysts both at 21 and 47 days post-infection. It was also demonstrated that S-antigen was not uveitogenic in the C. callosus model. No lesion was observed in the animals exclusively immunized with this retinal component, even when jacalin was used as additional adjuvant for polyclonal response to the retinal antigen. It can be concluded that C. callosus may constitute in a promising model for study both acquired and congenital ocular toxoplasmosis, particularly when it is important to make sure that a non autoimmune process is involved in the genesis of the ocular infection.
We studied the frequency of specific anti-Toxoplasma IgM, IgA and IgE antibodies in serum of 28 immunocompetent Colombian patients, selected by ophthalmologists and with lesions that were compatible with ocular toxoplasmosis. Patients were classified in three groups: (i) group 1 consisted of ten patients with a first episode; (ii) group 2, with seven patients with a recurrence and (iii) group 3, consisted of eleven patients with chronic chorioretinal lesion without uveitis. We found that 10/28 (35%) of Colombian patients with ocular toxoplasmosis possessed at least one serological marker for Toxoplasma infection different from IgG. In group 1 (first episode), we found simultaneous presence of specific IgM plus IgA plus IgE in 1/10 (10%). In group 2 (recurrences) in 1/7 (14%) we found IgM and IgA test positives and in 1/7 (14%) we found IgM and IgE tests positives. In group 3 (toxoplasmic chorioretinal scar) the IgA serological test was positive in 2/11 (18%). These results show that serum IgM or IgA or IgE can be present during recurrences.
In a study of congenital transmission during acute infection of Toxoplasma gondii, 23 pregnant Balb/c mice were inoculated orally with two cysts each of the P strain. Eight mice were inoculated 6-11 days after becoming pregnant (Group 1). Eight mice inoculated on the 10th-15th day of pregnancy (Group 2) were treated with 100 mg/kg/day of minocycline 48 h after inoculation. Seven mice inoculated on the 10th-15th day of pregnancy were not treated and served as a control (Group 3). Congenital transmission was evaluated through direct examination of the brains of the pups or by bioassay and serologic tests. Congenital transmission was observed in 20 (60.6%) of the 33 pups of Group 1, in one (3.6%) of the 28 pups of Group 2, and in 13 (54.2%) of the 24 pups of Group 3. Forty-nine Balb/c mice were examined in the study of congenital transmission of T. gondii during chronic infection. The females showed reproductive problems during this phase of infection. It was observed accentuated hypertrophy of the endometrium and myometrium. Only two of the females gave birth. Our results demonstrate that Balb/c mice with acute toxoplasmosis can be used as a model for studies of congenital T. gondii infection. Our observations indicate the potential of this model for testing new chemotherapeutic agents against congenital toxoplasmosis.
We evaluated the clinical presentation and determined the ocular and neurologic sequelae in children with congenital toxoplasmosis in Brazil, taking into consideration the shortage of national publications on this disease. Follow-up evaluations were made of 43 children with congenital toxoplasmosis referred to Santa Casa de São Paulo, during a period of at least five years. Selection of the cases was based in clinical and laboratory criteria. A clear predominance of children with subclinical presentation of the disease at birth (88%) was found. Of the 43 children, 22 (51%) developed neurological manifestations. Using skull radiography, we detected neuroradiologic alterations in seven children (16%) and with tomography in 33 children (77%). Neurological sequelae were identified in 15 children (54%) in the group with cerebral calcifications and in 7 (47%) in the group without cerebral calcifications. We observed chorioretinitis in 95% of the cases. Reactivation of cicatricial lesions and the emergence of new ocular lesions were observed in five cases. The most frequent neurological manifestation was a delay in neuropsychomotor development. Most remarkable was the finding that cerebral calcifications were not associated with a higher incidence of neurological sequelae among the children. Chorioretinitis was the main ocular sequel of the infection, found in nearly all children; it can manifest years from birth, even in children submitted to specific therapy druing the first year of life, highlighting the importance of a follow-up of these children.
Three captive female nilgais (Boselaphus tragocamelus) either showed late-term abortion or their newborn calves died within 2 days of birth. Toxoplasma gondii DNA was demonstrated in the brain and liver of each fetus and in one of the two neonates by single-stage polymerase chain reaction (PCR) with TGR1E and by seminested PCR with B1 gene. Retrospectively, antibodies titers > or =640 to T. gondii by indirect fluorescence were found in the sera of all three female and one male nilgais. No other cause of abortion was detected. Fatal toxoplasmosis was also diagnosed in one captive, adult female saiga antelope (Saiga tatarica), which died suddenly. Toxoplasma gondii was detected in the liver, lung, spleen, kidney, and intestine. An unusual finding was the presence of numerous tissue cysts in the liver of this animal. Toxoplasmosis was confirmed by PCR with TGR1E and immunohistochemically. Toxoplasmic hepatitis and pneumonia were considered to be the primary causes of death.
The susceptibility of budgerigars (Melopsittacus undulatus) to graded doses of Toxoplasma gondii oocysts was studied. Sixteen budgerigars were divided into 4 groups (A-D) of 4 each. Birds in groups A-C were fed 100,000, 1,000, or 100 infective oocysts of the VEG strain of T. gondii, respectively. Budgerigars in group D were not fed oocysts and served as controls. All 4 birds in group A died (or were killed) because of acute severe enteritis 5 or 6 days after feeding oocysts (DAFO). Three of the 4 birds in group B were killed (or died) because of toxoplasmosis 9 or 14 DAFO. One budgerigar in group C and the 4 budgerigars in group D remained healthy and were killed 35 or 39 DAFO. Toxoplasma gondii was demonstrated in tissues of all budgerigars fed oocysts. The control budgerigars remained clinically normal and showed no evidence of T. gondii exposure. These results indicate that, compared to other passerines, budgerigars are relatively resistant to clinical toxoplasmosis.
Acute toxoplasmosis was diagnosed in 2 captive dik-dik (Madoqua guentheri smithi) in the Houston Zoo. Both animals became ill suddenly and died in spite of supportive therapy. Toxoplasma gondii was identified in tissues of both animals immunohistochemically, and antibodies to T. gondii were found in titers of 1:800 or more in both animals upon examination by the modified agglutination rest. The cause of death was considered to be toxoplasmic pneumonia. This is the first report of toxoplasmosis in M. g. smithi.
Toxoplasma gondii was found in endemic Hawaiian birds, including 2 nene geese (Nesochen sandvicensis), 1 red-footed booby (Sula sula), and an introduced bird, the Erckels francolin (Francolinus erckelii). All 4 birds died of disseminated toxoplasmosis; the parasite was found in sections of many organs, and the diagnosis was confirmed by immunohistochemical staining with anti-T. gondii-specific polyclonal antibodies. This is the first report of toxoplasmosis in these species of birds.
In contrast to toxoplasmosis in non-AIDS immunocompromised hosts, AIDS patients rarely have been reported to be infected at extra-CNS sites. We report the case of a 45-year-old homosexual male with AIDS who presented with pneumonitis caused by Toxoplasma gondii following a previous illness consistent with CNS toxoplasmosis.