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PubMed1977

Toxoplasmosis in a California sea lion (Zalophus californianus).

Disseminated toxoplasmosis was diagnosed in a female California sea lion that had been used in thermoregulation studies for about 4 years while housed in a small enclosure with a fresh-water pool at the University of Hawaii, Honolulu. Toxoplasma gondii was demonstrated in and around necrotic lesions of the heart and the stomach. Source of the infection was not established; however, studies on toxoplasmosis in cats were being conducted at the institution, and common caretakers attended both groups of animals.

Animals↗
PubMed1993

[Acquired cerebral toxoplasmosis in an non-immunosuppressed child].

BACKGROUND: Postnatally acquired toxoplasmosis is relatively common as an unapparent infection. When there are severe clinical manifestations such as encephalitis, pneumonia and myocarditis, the patient should be checked for immunocompetence deficiencies. CASE REPORT: A two-year old girl living in French Guyana suffered from acute respiratory distress due to interstitial pneumonia plus pericarditis that was treated by closed pericardial aspiration. Palsies of four limbs and chorioretinitis gradually appeared. The CSF protein content was elevated, 1 g/l, but the number of cells was normal. Serologic tests indicated a recent toxoplasma infection; she was given sulfadoxine, pyrimethamine and spiramycin. Her neurologic condition and the persistent antibodies, indicating active disease, led to her transfer to our Department 3 months after the onset of the disease. The CSF contained 47 cells/mm3 and 0.8 g/l proteins. Measurement of both IgM and IgG classes of toxoplasma antibodies showed persistent high titers in the blood and CSF. The CT scan showed numerous calcifications in the brain and hypodense areas in the frontal and parietal lobes. The MRI showed extensive changes. The severity of the disease in this girl led us to study her immune system. It was normal. The girl was given 6-week treatments with pyrimethamine-sulfadiazine for 2 years. This treatment stabilized the disease, but her titers of toxoplasma antibodies remained high. CONCLUSION: The initial clinical presentation of the disease in this patient and persistent high titers of toxoplasma antibodies, especially of the IgM class, argue against the possibility of congenital toxoplasmosis and favor the diagnosis of acquired disease in a patient who has no immune deficiency.

Child, Preschool↗
PubMed1977

Segmental retinal periarteritis as a complication of toxoplasmosis.

Segmental retinal periarteritis is a relatively rare clinical entity with varied etiologies. This report describes a case of acute toxoplasmosis with segmental periarteritis without concomitant periphlebitis. To my knowledge this has never been reported previously. The diagnosis of toxoplasmosis was proven by both clinical findings and serology.

Adult↗
PubMed1993

[Acute toxoplasmosis. Laboratory diagnosis].

BACKGROUND: The microbiological diagnosis of acute toxoplasmosis in immunosuppressed patients, cannot, usually, be done through serological techniques. The methods for isolation or direct detection of parasite are the only ones that might be helpful to determine an earlier diagnosis, on these patients. METHODS AND RESULTS: The use of urine in 3 patients with acute toxoplasmosis, allowed us to isolate the parasite after inoculation of the sample in human embryonic fibroblast cell line (MRC-5). CONCLUSION: In our opinion urine could be an adequate sample for isolation or detection of Toxoplasma gondii in immunosuppressed patients, and an alternative to serological methods, as well.

AIDS-Related Opportunistic Infections↗
PubMed1995

Genetic resistance against acute toxoplasmosis depends on the strain of Toxoplasma gondii.

The role of the strain of Toxoplasma gondii in genetic control of resistance against acute infection with T. gondii was studied with 2 strains of T. gondii, which differ in their virulence and genotype. Following peroral infection with 10 cysts of the C56 strain, C57BL/6 (H-2b) and C3H/HeN (H-2k) mice died significantly earlier than BALB/c mice (H-2d) mice, although all of the mice eventually died of acute toxoplasmosis from 10 to 23 days after infection. There was no significant difference in time to death between C57BL/6 mice and C3H/HeN mice. In peroral infection with 100 cysts of the less virulent ME49 strain, all C57BL/6 mice died of acute toxoplasmosis from 7 to 10 days after infection. C57BL/6 mice died significantly earlier following infection with the ME49 strain than with the C56 strain, whereas all C3H/HeN mice infected with the ME49 strain survived as did BALB/c mice. These results indicate that genetic control of resistance against acute infection with T. gondii differs depending on the strain of T. gondii.

Acute Disease↗
PubMed1996

Contribution of nitric oxide to the host parasite equilibrium in toxoplasmosis.

We studied the effect of nitric oxide (NO) production on the evolution of toxoplasmosis in C57BL/6 mice. Infection was induced by i.p. injection of Toxoplasma gondii strain ME49. NO synthesis was inhibited by treatment with aminoguanidine, a structural analogue of L-arginine. The severity of infection was evaluated by histopathologic examination of the brain. In the infected mice treated for 2 wk with aminoguanidine, we observed an increase in the number of toxoplasma tachyzoites and intracellular cysts accompanied by an exacerbated inflammation of the brain tissue compared with that in controls. When spleen cells from infected mice were stimulated in culture with toxoplasma Ag, there was a marked cytotoxic effect on cells collected during the acute stage of infection and an inhibition of proliferation of the remaining viable lymphocytes. These effects were correlated with high levels of NO and PGE2 production. The suppression of NO synthesis prevented cell death and restored the lymphocyte proliferative response as well as lymphokine production. The neutralization of IFN-gamma or TNF-alpha had no effect on NO production in the cultures of infected mouse spleen cells. Cultures in which purified macrophages and lymphocytes from infected and naive mice were mixed indicated that the production of NO was dependent on lymphocyte activation. In the later stages of infection, when the production of NO was abating, preventing PGE2 secretion with indomethacin also increased the lymphocyte proliferative response. We conclude that the opposing effects of NO in toxoplasmosis, which protects against Toxoplasma gondii and at the same time limits the immune response, probably contribute to the establishment of the characteristic chronic state of host parasite equilibrium.

Animals↗
PubMed1996

[Decision analysis of congenital toxoplasmosis in the absence of exact knowledge of the treatment benefits and secondary effects].

Decision analysis seemed the appropriate method to bring out the interest of toxoplasmosis serology in children born from mothers who seroconverted during pregnancy. In particular it provides the possibility to choose between IgA serology, recently introduced in hospital practice, and IgM serology that is the reference test. We study a series of 96 children suspected of having congenital toxoplasmosis who were followed up until the age of one. A decision analysis is thereafter conducted by synthesizing data about clinical efficacy with the RBNCN ratio that is the net benefit of treating an affected person divided by the net cost of treating an unaffected person; these costs and benefits are clinical. The effectiveness of the treatment (sulphonamides in most cases) was not quantified. Therefore, we used the fact that the RBNCN ratio is equal to the number of healthy children likely to be treated unnecessarily in order not to leave untreated a contaminated child. Although data available in the literature and data from our study still remain insufficient to draw a final conclusion, IgA antibodies are significantly more sensitive than IgM antibodies (p < 0.01). Conversely, IgA antibodies are significantly less specific than IgM antibodies (p < 0.001). The sensitivity analysis shows that the IgA test is preferred to the IgM test if the mother is contaminated during the third trimester. On the other hand, for low prevalences, as observed in the first trimester, the IgM serology is more useful.

Anti-Infective Agents↗
PubMed1996

Tumour necrosis factor-alpha (TNF-alpha) in human toxoplasmosis.

Tumour necrosis factor alpha (TNF-alpha) is a cytokine that is secreted by activated macrophages and monocytes. This work studied TNF-alpha level in sera of patients with toxoplasmosis. Twenty eight female patients (12 of whom had obstetric troubles) and 17 healthy controls were the subjects in this work. According to IHA test and detection of IgM antibodies, three groups of patients were defined, group (I) patients with acute infection, group (II) patients with chronic infection and had high antibody titre, group (III) patients with chronic infections and had low antibody titre. Sera from patients as well as controls were tested for their level of immunologically reactive TNF-alpha using enzyme-linked immunosorbant assay (ELISA). TNF-alpha levels in the sera of patients were significantly higher as compared to healthy control group. Acute infection was associated with the highest levels of TNF-alpha indicating that it may play a role in the pathogenesis of acute toxoplasmosis. In chronic infection, the level of TNF-alpha correlated with IHA antibody titre suggesting that, antibodies against T. gondii may participate in TNF-alpha production. It could be concluded that TNF-alpha may contribute to the pathology in acute infection and may play a role in modulating the host's immune defence against T. gondii in chronic infections.

Acute Disease↗
PubMed1996

[Seroepidemiology of toxoplasmosis in Niamey, Niger].

A seroepidemiological survey of toxoplasmosis was carried out in Niamey, Niger, in 1992. Three hundred and seventy-one sera from 200 females and 171 males were tested by indirect immunofluorescence assay for IgG. Using a cut-off value of 12 UI, 67 sera (18%) were positive. In this group detection of specific IgM by ELISA with immunocapture revealed 8 positive sera (11.9%). Seroprevalence of specific IgG was not correlated with ethnic origin or sex but did increase with age from 6.9% in subjects under 5 years to 34.9% in subjects 50 years and over. These findings are comparable with those from previous studies in similar climates and confirm that the prevalence of toxoplasmosis is higher in humid coastal regions than dry desert areas.

Adolescent↗
PubMed1996

[Fansidar in the treatment of toxoplasmosis].

Toxoplasmosis chorioretinitis is the most frequent posterior uveitis. Different treatment modes are used for its therapy. Classical is the combination of 50 mg of pyrimethamine with 4 g of sulphadiazine and corticosteroids. In this study the results of treatment with lower doses of pyrimethamine together with long-acting sulphonamide are reported. Twelve patients were treated with Fansidar, combination of 25 mg of pyrimethamine and 500 mg sulphadoxine. The treatment consisted of a loading dose of two tablets of Fansidar, followed by one tablet a day. Prednisone 0.5 mg/kg/day was added and gradually tapered off. Patients were treated for 28 days on average (range 21-50 days). In 83% of patients the scar was considerably smaller than original lesion (on average the scar represented 25% of original lesion). Three months after the treatment the visual acuity was 6/9 or better in 83% of patients. No side-effects of the treatment were observed. Lower doses of pyrimethamine with suphadoxine in an easy once a day treatment regime could be an alternative and cost-effective therapy for ocular toxoplasmosis.

Adolescent↗
PubMed1996

Duodenal and hepatic toxoplasmosis in a patient with HIV infection: review of the literature.

We report a case of watery diarrhea due to duodenal toxoplasmosis in a patient with the acquired immunodeficiency syndrome. Treatment with pyrimethamine, clindamycin, and folinic acid decreased the diarrhea as well as the duodenal toxoplasma cyst load. Hepatic toxoplasmosis was also present, associated with an elevated serum alkaline phosphatase activity and a minimally elevated lactate dehydrogenase level.

AIDS-Related Opportunistic Infections↗
PubMed1977

[Toxoplasmosis studies in cattle by serological methods].

2037 cattle sera from seven breeding farms were analysed by SF and KBR methods. 27.29 % positive results were obtained by SF method and 8.94 % by KBR methods. The distribution of titres is shown in table VI. Race and age have no effect on toxoplasmosis infection. Positive findings varying from 1828-43-48 % were obtained in different regions which meant the effect of geografical factor. It is concluted that these differences were due to the cats, found in the government farms which spread the disease. It was observed that toxoplasmosis caused abortions, complicated still birth deliveries, post natal mortality. The SF and KBR methods were applied separately on cattle with or without clinical syndroms. It was found that the more acute cases showed higher titres.

Animals↗
PubMed1977

[Subdural hygroma in infants with congenital toxoplasmosis (author's transl)].

Cytological examination of the fluid from subdural hygromas revealed congenital Toxoplasmosis in 14 of 43 infants (32,5%). Conversely, subdural hygroma was a significant clinical symptom in 42 cases of congenital Toxoplasmosis. In 9 cases trophozoites or cystes of Toxoplasma Gondii were found in the subdural fluid, and in 4 of these in the cerebrospinal fluid as well. Since serological investigations in young infants and particularly severe infections often remain inconclusive the cytological examination of cerebrospinal fluid is emphasized importance of.

Cysts↗
PubMed1996

[Serodiagnosis of toxoplasmosis: a comparative multicenter study of a standard scale through various actual tests and expression of the results in international units. Groupe de travail toxoplasmose du Contrôle national de qualité en parasotologie. Syndicat des fabricants de réactifs de laboratoire. Groupe de travail standardisation des tests sérologiques du Réseau européen de lutte contre la toxoplasmose congénitale].

Reported are the results of a multicentre study involving 40 laboratories that was carried out in France to assess all the currently available methods used for the serodiagnosis of toxoplasmosis. For this purpose 10 batches of control sera were prepared with titres in the range 0-260 IU per ml. These sera were tested in nine laboratories using immunofluorescence methods; in three laboratories using dye tests; in forty laboratories using enzyme-linked immunosorbent assay; in four laboratories using direct agglutination and haemagglutination; in seven laboratories using the high-sensitivity IgG agglutination test; and in three laboratories using the latex agglutination test. In this way, 70 series of titrations were carried out using seven procedures and the results were compared with those obtained using the WHO reference serum in 15 cases, with the French national E6 serum in 16 other cases, and in 39 cases using 15 reference sera supplied by the reagent manufacturers. Rigorous comparison of the tests was not possible in all cases because one aim of the study was to ensure that the tests were carried out under the usual working conditions that prevailed in the participating laboratories. The results obtained indicate that the serological tests currently available for toxoplasmosis are acceptable for its serodiagnosis. Presentation of the titres in IU has advantages; however, caution is required since the definition of IU varies according to the test and reagents used. It is therefore essential that the conditions and limits for a positive reaction be carefully defined in each case, especially for commercially available kits.

Agglutination Tests↗
PubMed1995

[Toxoplasmosis in patients with AIDS].

Toxoplasmosis in patients with AIDS has specific traits, differentiating it from cases occurring in immuno-competent persons. Some features of the parasite, which are important for the clinical outcome of the disease, and the epidemiology, histopathology and clinical picture of toxoplasmosis in conditions of immuno-deficiency are discussed in the paper.

AIDS-Related Opportunistic Infections↗
PubMed1996

Gastric toxoplasmosis: case report and review of the literature.

We report a case of a 22-yr-old man with AIDS who presented with abdominal pain, vomiting, and anorexia. Diagnosis of gastric toxoplasmosis was made on biopsy and immunohistochemistry. The patient's symptoms resolved after treatment of toxoplasmosis. We present a case of an unusual manifestation of a common infection in patients with AIDS.

AIDS-Related Opportunistic Infections↗
PubMed1996

Rapid differential diagnosis of cerebral toxoplasmosis and primary central nervous system lymphoma by thallium-201 SPECT.

UNLABELLED: This study sought to assess whether 201Tl brain SPECT can significantly reduce the time required for the differential diagnosis of primary central nervous system (CNS) lymphoma and cerebral toxoplasmosis in patients with AIDS. METHODS: Eighteen patients who presented with focal lesions on CT or MRI, or both, underwent 201Tl brain SPECT shortly after admission and before a CT-guided stereotactic brain biopsy. Early and delayed 201Tl uptake ratios were obtained for patients with positive 201Tl study results, and the retention index of 201Tl was calculated. RESULTS: Ten patients had 11 foci of significantly increased 201Tl uptake in regions of corresponding CT/MRI lesions. Five of these patients had biopsy-proven lymphomas, one of them in two separate foci. Another patient was found to have metastatic adenocarcinoma. Three patients had a clinical course and response to radiation therapy consistent with lymphoma, and study results in another patient were considered falsely positive. Of nine patients with no 201Tl uptake in regions of CT/MRI lesions, two had biopsy findings consistent with a benign etiology, and the other seven improved clinically on antitoxoplasmosis medications alone. The overall sensitivity of 201Tl brain SPECT was 100%, and specificity was 90%. The 201Tl retention index in patients with lymphomas was significantly higher than that in patients with adenocarcinomas and nonmalignant lesions (1.35 +/- 0.16 versus 0.24 and 0.56, respectively). CONCLUSION: Thallium-201 brain SPECT is a sensitive and specific method for rapid differential diagnosis of CNS lymphoma and toxoplasmosis in patients with AIDS. The 201Tl retention index is useful in differentiating CNS lymphomas from other malignant and nonmalignant pathologies.

AIDS-Related Opportunistic Infections↗
PubMed1997

Anergic disseminated toxoplasmosis in a patient with AIDS. Case report.

In recent years, Toxoplasma gondii has emerged as an important life-threatening opportunistic pathogen in compromised hosts. Toxoplasma gondii is considered the opportunistic agent most frequently causing severe encephalitis in AIDS. Less common manifestations of active toxoplasma infection include extracerebral and disseminated disease. The diagnosis of extraneural or disseminated toxoplasmosis requires a high index of suspicion because the clinical and laboratory manifestations are nonspecific and may be confused with those of other opportunistic diseases. The authors report an unusual case of anergic disseminated toxoplasmosis in AIDS, with a brief comment on the clinical and diagnostic aspects of this rare, dangerous, but treatable complication.

AIDS-Related Opportunistic Infections↗