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PubMed1981

Toxoplasmosis update and public health implications.

Toxoplasma gondii has a coccidian life cycle in the intestine of domestic and wild felids that includes a series of asexual and sexual stages and an oocyst stage that is shed in the feces. Oocysts complete their development outside the body, eventually becoming infective for about 350 species of vertebrates including cats and man. The effects of climate on oocyst survival and the physical and biological means of oocyst dispersal are discussed. Infectivity and pathogenicity for livestock species vary. Acute disease results from rapidly multiplying tachyzoites that may be transmitted by carnivorism, transfusion, vertical transmission and other routes. Patent infections may persist for the life of a host as bradyzoites within tissue cysts. Bradyzoites initiate acute infection in other hosts after carnivorism or organ transplantation or in the same host after immunosuppression. Also discussed are: (a) prevalence of T. gondii in livestock as determined by digestion and serological techniques, (b) identification in humans as accomplished by isolation, serological and skin test techniques and (c) identification in cats as accomplished primarily by fecal examinations for oocysts infective for mice. Source of human infections, major outbreaks, treatment, effects on mental health and methods for preventing toxoplasmosis in man and livestock are listed.

Animals↗
PubMed1995

[Occurrence of toxoplasmosis in pregnant women in Denmark. A study of 5.402 pregnant women].

Consecutive serum samples from 5402 women were analyzed for specific IgG and IgM Toxoplasma gondii antibodies by enzyme immunosorbent assay. The prevalence of IgG antibodies was 27.4%. The seroconversion rate was estimated to be 1.16% per year (SE = 0.0017) in all age groups, consistent with an incidence of acute toxoplasmosis in pregnant women of 0.65%. Based on theses figures, the estimated number of congenitally infected cases are discussed. There was no difference in the prevalence of antibodies in women from rural or urban areas, or from different parts of Denmark.

Acute Disease↗
PubMed1975

[Indirect flourescent antibody test in toxoplasmosis. Advantage of the use of fluorescent anti-IgG conjugate (author's transl)].

The indirect fluorescent antibody (IFA) test effected with anti-human conjugate gives appreciably equivalent results to those obtained with the dye (SABIN-FELDMAN) test, but weak serum dilutions may raise non specific reactions, due to the presence of substances possessing the IgM antibody properties. Those substances are not present in the serum of children during the first months of their life. The application of an anti-IgG conjugate allows to prevent those unspecific reactions. The application of the modified IFA test for detecting the toxoplasmic infection during pregnancy and the use of the REMINGTON test for the early diagnosis of the congenital toxoplasmosis are discussed.

Female↗
PubMed1995

[Cost-benefit analysis of screening for congenital toxoplasmosis].

A comprehensive cost-benefit analysis of possible screening strategies for congenital toxoplasmosis is necessary as a basis for the decision whether or not screening is efficient and socially desirable. The total costs of the disease in Switzerland were calculated for the year 1990. Direct costs (all diagnostic and therapeutic interventions, including care of handicapped children) and indirect costs (partial and total work losses in the future) were taken into account. Today, the direct costs amount to approx. SFr. 20 mio per year (i.e. approx. SFr. 2.8 mio per million population). The indirect costs were calculated at SFr. 4 mio per year. Moreover, the costs incurred with three possible screening programs (1 test with all pregnant women, with 1, 2 or 5 additional tests, depending on the strategy) were estimated, together with the concomitant cost savings. The financial resources needed for the screenings would amount to SFr. 7 mio-18 mio per year, depending on the strategy chosen. However, the possible savings would be in the range of SFr. 4 mio-12 mio only. The possible savings are, in any case, of the same order of magnitude as the costs for screening. Screening would become cost-efficient if costs for the serological tests could be lowered.

Cost-Benefit Analysis↗
PubMed1994

Analysis of aqueous humor in ocular toxoplasmosis: detection of low avidity IgG specific to Toxoplasma gondii.

Using a modified enzyme-linked immunosorbent assay that included dissociation of antigen antibody complexes with 6M urea solution, we analyzed the avidity of Toxoplasma-specific IgG in aqueous humor and serum samples from 24 patients with toxoplasmic chorioretinitis. As a control, we studied aqueous humor and serum samples from 14 cataract patients without history of uveitis and serum samples from 10 patients with recent primary systemic toxoplasmic infection without ocular lesions. IgG avidity was markedly lower in aqueous humor samples from patients with toxoplasmic chorioretinitis than in serum samples, despite those samples presenting higher levels of Toxoplasma-specific IgG than in serum samples. The detection of the low-avidity Toxoplasma-specific antibodies can offer a valuable aid to make a specific etiologic diagnosis and perhaps contribute to understand the pathogenic mechanisms of ocular toxoplasmosis.

Adolescent↗
PubMed1995

[Diagnosis and therapy of toxoplasmosis infections in pregnancy at the Rostock University Gynecologic Clinic 1986-1994].

Over a period of eight years, 61 patients with toxoplasmosis infection in pregnancy were examined retrospectively at women's hospital. Diagnosis of maternal infection was based on seroconversion, positive IgM, raising IgG--titers above twofold, and very high primary titers in SFT. In 20 patients (32.8%) diagnosis was found with seroconversion. In 15 patients (24.6%) the first examination revealed very high titers (SFT > or = 1:2000, KBR > or + 1:40)> Using a score, time of infection was grouped into: periconceptional (24.59%), 1st Trimester (34.43%) 2nd Trimester (31.14%), 3rd Trimester (4.92%), not specified (4.92%). The latency phase between first suspect titer and treatment did vary markedly. Duration of latency phase was longer than 6 weeks only in 10% and 20% of cases identified via seroconversion or very high titers respectively. Of all cases with different diagnostic attempts 73.9% were treated later than 6 weeks after the first suspect titer. Therapy was performed with either a combination of pyrimethamine-sulfadiacine or spiramycin monotherapy. In 18/53 newborns (33.9%) fetal infections were proven with IgM-detection post partum. Clinical evaluation was normal in 48 children (77.5%). 6 newborns (9.7%) had dilated cerebral ventricles; 3 (4.8%) had irregularly dense intracerebral structures, one newborn (1.6%) had intracerebral calcifications. Primary neurological check-up of the newborn was normal in 91.9%. 2 children (3.2%) had facial paralysis or reduced muscle tonus. In 2 newborns (3.2%) opthalmological examination of the fundus revealed signs of retino-chorioditis.

Adult↗
PubMed1995

[Ultrasonic signs of fetal toxoplasmosis. Review of the literature].

OBJECTIVE: Evaluate the frequency and discuss the mechanisms and the prognostic value of sonographic anomalies observed during the surveillance of seroconversion for toxoplasmosis during pregnancy. METHODS: Cases of seroconversion during pregnancy were collected from 6 teams working with similar protocols. There were 2,168 seroconversions. We focused on ultrasound anomalies reported. RESULTS: Ultrasound anomalies were reported in 48 cases including the 168 fetuses with proven contamination (fetal blood or amniotic fluid sample), i.e. 2.2% (48 cases out of 2,168) of the seroconversions and 28% (48 cases out of 168) of the contaminated fetuses. There were multiple lesions in 44% of the cases. Brain calcifications had been found in utero in 44% of the newborns with such anomalies. No case of microcephalia was reported. Isolated hepatomegalia (4 cases) was not an indication for medical abortion. Isolated ascitis can regress after antiparasite treatment (2 cases). Medical abortions were performed in 51% of the cases (34 cases out of 66) on the basis of ultrasound findings. CONCLUSION: Ultrasound examination is reliable but can only detect late, constituted and often irreversible lesions. Nevertheless, this examination can help in deciding on medical abortion.

Abortion, Therapeutic↗
PubMed1997

Recognition and management of toxoplasmosis.

Toxoplasma gondii is a frequent cause of subclinical latent human infection and an important opportunistic pathogen that may cause severe disease in immunocompromised patients. Patients with AIDS who have antibodies to T. gondii should be considered at high risk for development of clinical disease (toxoplasmosis). Reactivation of latent infection in the central nervous system is a common HIV/AIDS-related complication in these patients. Typical presenting symptoms are headache, confusion, fever, and focal neurologic deficits. Routine serologic tests cannot distinguish active from latent infection. Neuroradiologic studies may be highly suggestive of toxoplasmic encephalitis, but the definitive diagnosis can be made only by demonstration of toxoplasma in brain tissue. The unique pathogenesis of toxoplasmic encephalitis in patients with AIDS necessitates intensive primary therapy followed by life long suppressive therapy. Clinical and radiographic improvement is usually rapid with appropriate treatment.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Clinical view of toxoplasmosis in children--personal observations].

In this work we presented our own experience with recognized and treated toxoplasmosis among children. Treated cases were observed over several years afterwards. We analyzed the frequency and character of clinical changes, evaluated the validity of serological screening and the effectiveness of treatment. The largest age group treated were children 13 months to 5 years old. 13 children had the congenital and 12 the acquired form. The most cases occurred in the nodal, ocular and ocular-cranial forms. Thus, the most common symptoms were enlarged lymphatic nodes, strabismus, febrile seizures, intracranial calcifications. In the acquired forms of the illness a distinct correlation between treatment and the decrease antibody levels, the clinical pictures showed stagnation. The fall in antibody levels occurred earlier with intermediate immunofluorescence than with ELISA method. Among 20 children associated 30-day treatment was implemented (Daraprim, Rovamycine, Biseptol), among 4 with Fansidar and Rovamycine for 2-3 weeks. Few complications occurred at the end of or after treatment and did not require treatment/intervention. Usually it was leukopenia and thrombocytopenia. Long time observation allows to state that both therapeutic models prevent renewal of illness and can be recommended for further use.

Adolescent↗
PubMed1997

[Toxoplasmosis infection in pregnant women in Lanzhou].

OBJECTIVE: To investigate toxoplasmosis (TOX) infection in pregnant women. METHODS: The blood samples from 1,250 pregnant women were tested by indirect hemaglutination (IHA) for TOX. 1,327 normal cases were included in control group. RESULTS: The infection rate of TOX was 7.28% and 8.14% in the study and control group respectivity. There was no significant difference between the study group and control group (P > 0.05). There was no marked relationship between various age groups. (P > 0.05). No significant difference was noted in three gestational periods. Most pregnant women with of TOX infection were active and recent. CONCLUSION: Pregnancy did not increase the chance of TOX infection.

Adult↗
PubMed1998

Active control of congenital toxoplasmosis in the population.

Repeated serological investigations (CFT, IFT, ELISA) of 50,000 pregnant women revealed that 5.1/1000 pregnancies in the Karviná district, Czech Republic are threatened by toxoplasmosis. In 2.8/1000 pregnancies the infection was contracted shortly before pregnancy, one third of them ended by spontaneous abortion. In this group the birth of a congenitally infected infant is rare. Primary infections of women who are already pregnant (2.3/1000 of pregnancies) are much more serious. This number comprises 1.2/1000 pregnancies with a spontaneous abortion and 1.2/1000 pregnancies leading to the delivery of a congenitally infected infant. By early detection, i.e. repeated serological examinations in all pregnancies, and by treatment of patients with Toxoplasma infections this hazard can be reduced substantially, i.e. to one eighth.

Animals↗
PubMed1977

Brain stem toxoplasmosis complicating Hodgkin's disease.

We describe a unique case of CNS toxoplasmosis in a patient with stage IV B Hodgkin's disease. The initial neurological manifestation was Weber's syndrome. The only laboratory abnormality was moderate elevation of CSF protein level. Postmortem examination showed parenchymal toxoplasma infiltration throughout the intramedullary course of the right oculomotor nerve in the midbrain, without meningeal involvement.

Aged↗
PubMed1983

CNS toxoplasmosis in acquired immunodeficiency syndrome.

Several distinct patterns of neurological involvement occur in epidemic acquired immune deficiency syndrome (AIDS). Two patients with this disorder had Toxoplasma gondii encephalitis, one suspected and one proved. Computed tomographic (CT) scanning showed focal lesions in both patients. Spinal fluids were remarkable for elevated protein, hypoglycorrhachia, and absence of pleocytosis. In patients with AIDS, focal CT scan findings and serum indication of past T gondii infection should prompt strong consideration of the diagnosis of CNS toxoplasmosis. The absence of specific IgM antibody or rise in IgG antibody titer to T gondii does not exclude this condition in the immune compromised host. In the patient with AIDS, CNS lesions mimicking brain abscess warrant biopsy or empiric therapy for T gondii. Early recognition and initiation of a prolonged or indefinite course of pyrimethamine plus sulfonamide therapy could reduce the mortality associated with this infection in AIDS. Computed tomographic scans, repeated frequently, appear, at present, to be the best guide to monitor the status of CNS involvement.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Cerebral toxoplasmosis in acquired immune deficiency syndrome.

The clinical course of and pathologic findings in a patient with cerebral toxoplasmosis and acquired immune deficiency syndrome were evaluated. The nonspecificity of CNS signs, symptoms, and laboratory features were noted. Appropriate serologic tests and a biopsy of suspicious cerebral lesions were mandatory for confirmation of the diagnosis and administration of appropriate therapy. The importance of recognizing the nature of this infectious process and of instituting vigorous therapy as promptly as possible was emphasized.

Acquired Immunodeficiency Syndrome↗
PubMed1976

Ocular toxoplasmosis in an adult receiving long-term corticosteroid therapy.

Sudden death of a 58-year-old woman who developed ocular toxoplasmosis while receiving long-term systemic corticosteroid therapy permitted correlation of early histopathologic lesions with their clinical counterpart recorded on fundus photographs. A wide-spread, paravascular, whitish, retinal opacification dominated the initial clinical picture. These lesions were represented histologically by focal zones of inner retinal necrosis located adjacent to arteries and veins. No associated inflammatory cell infiltrate was present, and numerous viable free Toxoplasma organisms were consistently present at the interface between necrotic and healthy retina. Electron microscopy of formaldehyde-fixed tissue provided a useful technique for confirming the identity of the infecting organism in the absence of serologic or culture data.

Adrenal Cortex Hormones↗
PubMed1978

Ocular toxoplasmosis and Hodgkin's disease: report of two cases.

Isolated ocular toxoplasmosis developed in two patients with Hodgkin's disease. The diagnosis was made by ophthalmoscopy of the fundus, serologic tests, and evolution. This raises the possibility that Toxoplasma infection and the localization of retinochoroiditic lesions on the macula could be the results of the immunosuppression associated with Hodgkin's disease.

Adolescent↗