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Acquired immunodeficiency syndrome with CNS toxoplasmosis: a case report.

Central nervous system (CNS) toxoplasmosis is an important infectious complication of acquired immunodeficiency syndrome (AIDS) which appears to result from reactivation of a previously acquired infection and requires prolonged treatment. A 31-year-old male presented in a drowsy mental state and with an unstable gait. Computerized tomographic (CT) scan and magnetic resonance imaging (MRI) showed multiple nodular lesions in the cerebrum and cerebellum; the seropositivity for the human immunodeficiency virus (HIV-1) and high serum IgG toxoplasma titers were also demonstrated. A presumptive diagnosis of CNS toxoplasmosis was based on neurological signs and neuroradiological findings. This was confirmed by improvement in both clinical and neuroradiological pictures during treatment with pyrimethamine and clindamycin. Four months later, however the patient died of intracranial hemorrhage and massive upper GI bleeding.

Acquired Immunodeficiency Syndrome↗

[Toxoplasmosis in pregnancy: prevention, prenatal diagnosis and treatment].

Maternal infection with Toxoplasma gondii acquired during pregnancy occurs in more than 500 women per year in Switzerland. Systematic screening at the beginning of pregnancy allows the introduction of health education programs. The screening during pregnancy is performed to diagnose primary maternal infections and to propose prenatal diagnosis and treatment. The administration of specific antibiotherapy during pregnancy (spiramycine or the association of pyrimethamine and sulfonamides) significantly reduces the risk of fetal infection. Prenatal diagnosis of congenital toxoplasmosis is possible and reliable. It avoids unnecessary termination of pregnancy when the fetus is not infected and specific therapy in case of infection (association of pyrimethamine and sulfonamides). Prenatal treatment may be proposed without prenatal diagnosis as of the 16th week of gestation. In any case, prenatal treatment seems to reduce the incidence of severe congenital toxoplasmosis.

Coccidiostats↗

[Congenital toxoplasmosis in the Poznan region].

Among 3,734 women, hospitalized for giving birth, 58.9% had a positive Toxoplasma serological test (DA). No clinical expression of congenital toxoplasmosis was observed in 4,311 newborns; seven had a false positive ISAGA test with cord blood. Only 24% of the women were aware of congenital toxoplasmosis and only 3% were serologically examined before. Health education should be intensified and serological tests more commonly performed especially in the risk groups.

Adult↗

[Cerebral toxoplasmosis in a hospital environment in Lomé (Togo)].

The authors report the clinical, serological and neuroradiological results of a study about 23 cases of cerebral toxoplasmosis in the Teaching Hospital of Lome. Response to antitoxoplasmic treatment was rapidly favourable with all patients. Cerebral toxoplasmosis was the inaugural manifestation of AIDS in 20 of the 23 patients.

Adolescent↗

Unusual presentation of acquired toxoplasmosis in an immunocompetent adult.

We report an unusual clinical presentation of toxoplasmosis. Fever and headache were the only complaints of a 48-year-old immunocompetent man who was found to have a rash, hepatitis and a pericardial effusion. Lymphadenopathy was not present. Evolving atypical lymphocytosis was the clue to the diagnosis of toxoplasmosis. Undercooked meat was the probable source of infection.

Acute Disease↗

Congenital toxoplasmosis among premature infants with different clinical pictures in Saudi Arabia.

No doubt, toxoplasmosis is a prevalent infection in all the Arab countries. However, the incidence differs from one country to another and even within the same country. Congenital toxoplasmosis is the most important form of the infection. In the present study, some 78 premature infants with different clinical pictures were examined for Toxoplasma IgG (by IHAT and ELISA) and Toxoplasma IgM (by ELISA). The results showed Toxoplasma IgG ranging between 32.1% (IHAT) and 46.2% (ELISA) while IgM (ELISA) was 23.1%. The highest positivity rate was among those suffering jaundice and the lowest was among those suffering fever of unknown origin. Protection of women particularly pregnant ones, from Toxoplasma infection is a must.

Animals↗

[Relation between toxoplasmosis and orofacial clefts in children].

The authors performed a serological observation of toxoplasmosis by using the methods of IFT, CFT and ELISA in 118 mothers and their children with orofacial clefts. The results were compared with those gained in the control group of healthy mothers and their children. Titre means of toxoplasma antibodies in inflicted mothers and their children were higher than in the control group. The results were evaluated statistically. The authors assume that a certain proportion of orofacial clefts may be induced by toxoplasmosis. (Tab. 6, Ref. 13.).

Cleft Lip↗

Influence of chronic toxoplasmosis on some human personality factors.

An effect of parasites on host behaviour was tested on the toxoplasma-human model. Three hundred and thirty-eight (338) people were assessed with Cattell's personality questionnaire and then tested for Toxoplasma gondii infection with a delayed type hypersensitivity test for Toxoplasma. A highly significant correlation between chronic toxoplasmosis and two personality factors (G-Low Superego Strength and L-Protension) was found (p = 0.0032 and 0.0020, respectively). A correlation of the intensity of the personality factor-shifts with the duration of the infection (estimated from antibody titer) suggests that toxoplasmosis induces the shift in human personality, rather than the personality factors G and L influence an acquisition rate of Toxoplasma gondii infection.

Adolescent↗

Central nervous system toxoplasmosis in the AIDS patient.

Toxoplasmosis is a central nervous system infection commonly occurring in persons with HIV disease. The disease can manifest as encephalitis and cause neurological damage. The author presents an overview of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of toxoplasmosis. The nurse's role in the management of patients diagnosed with the disease is discussed, including doing comprehensive, on-going assessments, providing education, and addressing quality-of-life issues.

AIDS-Related Opportunistic Infections↗

[Primary prophylaxis against cerebral toxoplasmosis. Efficacy of folinic acid in the prevention of hematologic toxicity of pyrimethamine].

OBJECTIVES: Cerebral toxoplasmosis is the most frequent opportunistic infection in patients with acquired immune deficiency syndrome in France. We evaluated the effect of adding folic acid to the standard treatment (including pyrimethamine) on preventing induced cytopenia in order to determine the optimal dose. METHODS: From January to September 1990, pyrimethamine (50 mg 3 times per week) was given as primary prophylaxis against toxoplasmosis to 30 patients who were positive for human immunodeficiency virus (CDC classes II or II, CD4 counts < 200/mm3). The patients were randomly divided into three groups given 5, 25 and 0 mg folic acid 3 times per week. Associated treatments were the same in all patients (zidovudine 600 mg/d, pentamidine isethionate aerosol, 300 mg, once a month). Blood cell counts and lymphocyte subset counts were made on days 0, 30, 90 and 180. RESULTS: Two patients were lost to follow-up and between day 90 and 180, 3 were excluded due to other opportunist infection and 1 due to zidovudine induced anaemia. Between the groups, there was no difference in haemoglobin level or cell counts on day 0. No haematologic toxicity was observed at day 90. Haemoglobin was significantly reduced in the control group (0 mg folic acid) on day 180 (mean haemoglobin on day 180, 13.8, 13.1 and 12.1 g/dl in groups 1, 2 and 3 respectively). No variation in polynuclear neutrophil counts was observed. CONCLUSION: These findings suggest that folic acid has a moderate beneficial effect on preventing haematologic disease in patients treated with pyrimethamine. There was no observed dose effect.

AIDS-Related Opportunistic Infections↗

Atypical herpes simplex: a sign of toxoplasmosis activity in AIDS patients and the use of thalidomide.

Nowadays difficulties in detecting toxoplasmosis activity that usually is diagnosed in an advanced stage such as toxoplasmic encephalitis contributes to the poor prognosis of these patients. In four AIDS patients the increase of IgG, IgM and particularly IgA and atypical Herpes simplex onset were prior to the toxoplasmosis onset or recrudescence and mainly before neurologic symptoms onset. It was concluded that atypical Herpes simplex onset and immunoglobulin increase is an early sign of Toxoplasma activity.

AIDS-Related Opportunistic Infections↗

[Recurrence of cerebral toxoplasmosis in 15 AIDS patients].

Relapse of brain toxoplasmosis in AIDS patients continue to occur despite maintenance therapy. The characteristics of 15 patients who experienced a relapse were reviewed. Mean delay of relapse was 7 months (2-20). Maintenance therapy for the 2 months prior to the relapse was pyrimethamine alone (n = 4), pyrimethamine plus dapsone (n = 3), pyrimethamine plus spiramycine (n = 1), pyrimethamine plus clindamycine (n = 4), pyrimethamine plus sulfadiazine (n = 1) and no treatment (n = 2). Strict compliance was ascertained for only 5 patients. Compared with the first episode of brain toxoplasmosis, all 15 patients had new neurological signs, and new lesions of the brain were detected by CT scan in 67% patients. This study showed that poor compliance to maintenance therapy is a major factor of relapse, and the less favourable response to acute therapy could be due to progression of immunodeficiency.

AIDS-Related Opportunistic Infections↗

[Toxoplasmosis peri-myocarditis as initial manifestation of highly malignant non-Hodgkin's lymphoma].

A case report of a 28-year-old mother of two children with FUO is presented. Physical examination revealed an anemic and febrile woman, who lost 10 kg of weight during the past 3 months. Furthermore, two lymphatic nodes with diameters below 1 cm were detected at the neck and inguinal region. A search for origin of fever including evaluation of foci, malignancies and laboratory investigations was primarily unsuccessful. At day 7 after admission a pericardial murmur could be heard. Echocardiography revealed a pericardial effusion, which increased up to 4 cm during the following days, leading to hemodynamic impairment and asystole. Immediate CR was successful, pericardial effusion was aspirated. Looking for etiology of fever the presence of IgM-antibodies against toxoplasma gondii by an ELISA test was possible. Therefore, toxoplasmosis was diagnosed and a treatment-regimen comprising pyrimethamin and sulfadiazin was initiated. Because of the threat to life and very high titers of C-reactive protein, antibiotic therapy (imipenem) was given additionally. An immunologic impairment was excluded by normal ratio of CD4:CD8 of lymphocytes, normal HIV-test and a nonsuspicious Jamshidi-biopsy of the bone marrow. However, in week 9 after admission lymphatic node-tumors suddenly appeared at the neck and pulmonary hilus. After diagnostic exstirpation a malignant non-Hodgkin-lymphoma (T-cell-type) was diagnosed. It is concluded that in obscure pericardial effusion toxoplasmosis should be considered and that this manifestation may be a precursor of malignant non-Hodgkin-lymphoma.

Adult↗

[Multicenter study of toxoplasma serology using various commercial ELISA reagents. Work Group Toxoplasmosis of the National Agency for Quality Control in Parasitology].

A collaborative study conducted by the French National Agency for Quality Control in Parasitology (CNQP) and various manufacturers of ELISA kits, represented by the Association of Laboratory Reagent Manufacturers (SFRL) compared the toxoplasmosis IgG antibody titres obtained with different ELISA-IgG kits and determined the relationships between the titres obtained by these techniques and the titre defined in international units (IU). Fifty-one serum samples with toxoplasmosis antibody titres ranging from 0 to 900 IU were tested in two successive studies with 16 ELISA-IgG kits. For the negative sera, false-positive reactions were observed with one kit. For the positive sera, the titres observed in ELISA were generally higher than those expressed in IU. Above 250 IU, the very wide variability of the titres found with the different ELISA kits renders any comparative analysis impossible. For titres below 250 IU, the results are sufficiently homogeneous to permit the use of regression analysis to study how the results for each ELISA kit compare with the mean results for the other kits. The slope of the line of regression shows a tendency to over-titration or under-titration compared with the results of the other manufacturers; the ordinate at the origin reflects the positivity threshold of the reaction and can be used to assess the risk of a lack of sensitivity (high threshold) or of specificity (threshold too low). On the whole, the trends revealed for a given manufacturer are constant from one study to the other. Within this range of titres, regression analysis also reveals the general tendency of ELISA kits to overestimate the titres by comparison with immunofluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Screening for toxoplasmosis in pregnancy: more harm than good].

Using data from international literature makes it possible to calculate for Germany benefit and harm of a screening for toxoplasmosis in pregnancy. On the basis of these data harm of such a screening is much greater than benefit. Taking the reported number of congenital toxoplasmosis in Germany as the base for such a calculation of harm and benefit makes the ratio of benefit and harm even worse.

Abortion, Induced↗

[Medullary aplasia during treatment for congenital toxoplasmosis in a twin pregnancy].

The authors report a case of a patient who in the 24th week of a twin pregnancy became sero-positive for toxoplasmosis. This was diagnosed by cordocentesis as being infected, and the treatment was therefore started with pyrimethamine and sulfadiazine and folic acid at the 28th week of pregnancy. At 35 weeks, the patient had an acute medullary aplasia due to the absence of the folates. The mother's state was improved rapidly by giving her folinic acid and the twins were normal haematologically. In this case, the authors point out how important the folates are in a pregnancy, especially in twin pregnancies, and point out the precautions that have to be taken when treatment with pyrimethamine and sulfadiazine is started for congenital toxoplasmosis.

Adult↗

Isolated homonymous lateral hemianopsia revealing central nervous system toxoplasmosis as the initial manifestation of AIDS.

A 25-year-old-healthy man, with previous history of parenteral drug abuse, developed a left homonymous hemianopsia. Computed tomographic scanning showed a single ring enhancing lesion in the right parieto-occipital area. After the demonstration of seropositivity for human immunodeficiency virus and high serum immunoglobulin G antibody titer against Toxoplasma gondii, a diagnosis of cerebral toxoplasmosis in an AIDS patient was made. An isolated visual field defect revealing cerebral toxoplasmosis may be the first presentation of AIDS. Opportunistic cerebral lesions should be always considered in subjects at risk for AIDS who present focal neurological signs.

AIDS-Related Opportunistic Infections↗

[Immunoepizootological study of ovine toxoplasmosis].

The authors examined for toxoplasmosis (by means of an indirect hemagglutination reaction) 698 sheep kept in different places in Bulgaria. Out of this total number, 217 (= 31.1%) responded positively to the tests. In sheep delivering stillborn foetuses the positive response was much more frequent (43.3%) than in sheep with normal parturitions (21.0%). Sheep from montane regions showed a significantly higher positivity (40.3%) than sheep from lowland regions (18.3%). Three cystogenic strains of Toxoplasma gondii were isolated from six stillborn lambs. Out of the 493 sheep examined in Czechoslovakia, 33.3% gave a positive response in an indirect hemagglutination reaction, 29.7% responded in an indirect fluorescence reaction, and 11.6% in a microprecipitation reaction in agar gel. Attention is drawn to the epizootological and economic importance of the study of ovine toxoplasmosis.

Animals↗