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ELISA kits from different commercial firms were evaluated and compared with monoclonal immunosorbent agglutination test ISAGA for detection anti-T. gondii IgM antibody. The results presented in this study show that both ELISA-IgM tests, as well from Organon, as from Abbott firms promise to be of the same value for the diagnosis of acute acquired and congenital toxoplasmosis.
Role and significance of some animals in the spreading and persisting of toxoplasmosis in the biocenosis were discussed. The most important sources and ways of infection in man and prophylactic measures were also presented.
A 55-year-old Japanese male who developed acute polymyositis and chorioretinitis due to toxoplasmosis is described. The patients was well until one month prior to the present admission, when he had an onset of painful swelling of lymphnodes in the posterior cervical region, proximal muscle weakness, myalgia and a partial defect in the visual field of the right eye. He admitted that he had had a chance to eat half-cooked mutton while he had visited Saudi Arabia 40 days before. He was unable to go up and down the stairs at the peak of the illness. Serum CPK was 2050 u/l (N = 5-50) on January 11, 1989. These symptoms improved spontaneously except for the visual field defect. He was admitted to our hospital on January 31, 1989. On admission, neurological examination was unremarkable except for retinal exudate in the right eye which appeared consistent with the clinical diagnosis of toxoplasma chorioretinitis. Serum CPK was 103 u/l, and EMG showed myogenic changes. The IgM-immunofluorescent (IFA) anti-Toxoplasma gondii antibody titer was elevated to 640, and IgG-immunofluorescent antibody to 20480 after IgM-IFA. These clinical and serological findings indicate acute and recent Toxoplasma gondii infection. It appeared likely that Toxoplasma gondii directly caused acute myositis and chorioretinitis. Clinical manifestations of toxoplasma myositis may mimic those of idiopathic polymyositis, however, the clinical course of the former is usually self-limited probably because of generation of antibodies which will inhibit the growth of the organism.(ABSTRACT TRUNCATED AT 250 WORDS)
The occurrence of toxoplasmosis during pregnancy raises numerous problems. Determination of the time of the maternal infection is the first problem since we know that the frequency and gravity of fetal involvement vary according to the term of the pregnancy. Then, with information obtained from prenatal diagnostic tests (sonogram, amniocentesis, fetal blood sampling), it is important to recognize infected fetuses and advocate a management which goes beyond therapeutic abortion. Finally, the final problem is the follow-up of these children; in fact, after all these diagnostic and therapeutic measures, it is unfortunate that many children become lost to follow-up after the first year.
The authors describe the most important methods in use for the laboratory diagnosis of toxoplasmosis, with special reference to the presence of IgM and to their significance in the diagnosis of acute infection. Statistics of tests carried out on pregnant women at the "Giovanni Lelli" Centre (Rome, Italy) during the years 1981-1984 are quoted. The recommended diagnostic protocol to be followed to prevent congenital infections is given.
A chronologic description of the principal events and discoveries related to toxoplasmosis from 1908 when the causal agent was discovered up to date is performed. The main data with a parasitic interest are summarized, and the endodiogenic multiplication is explained. The cat is the definitive host for this protozoan. Its evolutive cycle in the intestinal epithelium of this domestic animal is commented. The oocyst is recognized as the main infecting form of this microorganism. The classical concepts of congenital and acquired histoplasmosis are briefly exposed. A brief comment of the ophthalmic and gyneco-obstetric complications from the disease is made. Possible relationships between toxoplasmic adenopathies and neurotic states in psychiatry are emphasized.
After observation of choroiditis of toxoplasmic nature in a member of a rural family, the authors have led a clinical and serological study on other five members of the household. Three of five had antibody titers and two of these demonstrated antibody titers consistent with recent toxoplasmic infection; one of these members manifested asymptomatic choroiditis. Therefore, it would be interesting to carry out a clinical and serological study on relatives of patient with toxoplasmosis.
Even simple lymphadenitis during pregnancy may possibly be an acquired lymphatic form of toxoplasmosis with all detrimental consequences to the foetus.
Forty four cases of toxoplasmosis seen in a 20 years span are reviewed. The largest number of cases corresponded to the neonatal group. The most important clinical findings usually involve the central nervous system, reticulum endothelium, skin and eyes. The disease is compared to an equivalent group of congenital lues (Torch complex). Clinical and radiological criteria for the differentiation are established. The most important finding is the presence of intracraneal calcifications. The different patterns and distribution are discussed. The radiologist plays an important role in the diagnosis of this condition, particularly, in the neonatal group of patients where the incidence of intravenous calcification appears to be higher.
Recent research has shown that Toxoplasma gondii, the cause of human toxoplasmosis, is a protozoan close to the genus Isospora, whose life cycle involves cats as the definitive host, and other mammals, including man, and birds as intermediate hosts. Cats shed oocysts in their faeces; these are infective to the intermediate hosts when ingested. But the non-felid intermediate hosts can also become infected by eating other intermediate hosts. Probably most human infections occur in this manner and result from eating raw or insufficiently cooked meats. Most people become infected during their life time, but most infections are benign and unnoticed. Occasionally the disease picture may simulate infectious mononucleosis. However, in intrauterine or neonatal infections the disease may be most severe and chorioretinitis, encephalomyelitis, hydrocephalus or microcephaly may result. Diagnosis depends upon demonstrating the parasite in biopsy material or through changing titres in serological tests.
A review of the various studies on toxoplasmosis in peninsular Malaysia is presented. The period of review spanned between 1973 and 1980 during which a number of serological surveys were carried out for the presence of Toxoplasma gondii antibody in Malaysians, using either the indirect hemagglutination (I.H.A.) or the indirect fluorescent antibody (I.F.A.) tests. The prevalence rates of Toxoplasma antibody were consistently foundhighest among Malays, followed by Indians, Orang Aslis (Aborigines) and lowest among Malays, followed by Indians, Orang Aslia (Aborigines) and lowest among Chinese, the 4 major ethnic groups living in Malaysia. Positive titres, present in all age groups, showed an increase with age but no difference due to sex. However, higher prevalence of positive cases was recorded among rural dwellers and the lower socioeconomic group than from urban dwellers. The possible routes of infection among the ethnic groups were discussed. Among animal populations, the presence of Toxoplasma antibody was detected in buffaloes, swine, goats, cattle, cats and dogs. The epidemiological importance of the findings are discussed and suggestions made for future studies.
The specificity and sensibility of IgM-IFAT for diagnosis of acute acquired and congenital toxoplasmosis may increase after separation of IgM fractions by simple gel filtration method. In the presence of IFA-IgG titers greater than 250 IU/ml with Remington test less than 1/50, specific IgM antibodies to Toxoplasma gondii should be detected by separation. The separation of IgM seems a necessary step for detecting IgM antibodies by IgM-IFA in the newborn sera.
The general characteristic of the main indices, or epidemic values (epidemetrons) is presented and the possibility of their use for characterizing the epidemiological state of the population in the foci of toxoplasmosis is evaluated.
Analysis of serological data from 63 experimentally infected sheep showed an inverse relationship between rise in toxoplasma indirect haemagglutination (IHA) titre after infection and titre at the time of infection. It was observed that, on average, sheep with a preinfection IHA titre of 1:200 or higher did not exhibit a significant rise in titre after infection. The ratio of toxoplasma antibody titres measured by the IHA and dye tests and the ratio of IHA titres in the IgM and IgG antibody fractions were shown to vary according to the duration of infection indicating that serological techniques could be developed to distinguish between latent and acute ovine toxoplasmosis.
The indirect immunofluorescence test was carried out in 500 pregnant women in urban and rural areas, with a view to following conversion to seronegative values. The evolution of the immune background in infection with T. gondii was followed up by comparative analysis of the seroepidemiological data obtained in 1976 and 1977. It was found that:--Variations in the intensity of endogenous and exogenous factors bring about changes in the frequency and intensity of the immune response in toxoplasmosis.--Postnatal evolution of the child can be correlated with the age of pregnancy when seroconversion accurred and with the intensity of the latter.--The predominance of seroconversion in the 6th and 7th month of pregnancy and negativation of some of the responses during pregnancy suggest the need of an additional serological control during these months.--The effect of optimal conditions during springtime resulted in seasonal appearance of seroconversions, offering an additional orientation.--In the neonates of seropositive mothers no cases of manifest disease were observed; the presence of infection has to be subsequently confirmed or invalidated.
An investigation carried out according to a predetermined serologic screening sought to evaluate the prevalence, level, and quality of fluorescent anti-Toxoplasma antibodies in a population sample of a certain district. The most important issues concern the risk of congenital toxoplasmosis for the above-mentioned subjects, the level of serotiter for expected risk, and the features of our screening protocol as regards thoroughness and the possibility of early diagnosis.
Visceral toxoplasmosis was diagnosed in 23 mynahs (Acridotheres) imported from Mexico, which resulted in the death of all birds in the shipment. The affected birds were inappetent and depressed and had ruffled feathers before death. Gross alterations included mottled, enlarged livers with multiple diffuse subcapsular white foci, congested lungs, mottled spleens, and thickened air sacs. Microscopic alterations were multifocal granulomatous hepatitis, pneumonitis, diffuse splenitis, focal mononuclear myocarditis, and airsacculitis. Foamy macrophages in affected areas of the livers contained 8-10 protozoan organisms 1-3 nm in diameter. Similar organisms were present in affected spleens. The organisms were identified with special stains and electron microscopy as Toxoplasma gondii. Human infection was diagnosed in the caretaker by an attending physician. He was treated with pyrimethamine and apparently recovered.
During an outbreak of human toxoplasmosis attempts were made to isolate Toxoplasma from soil near Além Paraíba, Brazil. Five soil samples were collected from the gardens and also from humid shady areas near the houses. After several washings, these soil samples were centrifuged in a glucose solution, and the supernate removed to be centrifuged in water. The sediments obtained from each of the five soil samples were then inoculated orally in groups of mice. Only one soil sample, obtained from a vegetable garden, gave rise to infection in mice. Toxoplasma-like cysts were found in the brains of two mice and also a few mice from all the four subsequent passages. Cyst-positive mice presented antibodies against T. gondii. Two young cats, seronegative by the Sabin-Feldman dye test, subsequently ingested the cyst-positive mouse brain. One cat eliminated Toxoplasma-like oocysts between the 5th and 11th days after the infection and the other cat between the 6th and 16th days. Seroconversion was observed in both cats, 15 days after the inoculation. These results further emphasize sanitary precautions essential to the control of Toxoplasma.