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In the course of prenatal care, the sera from 5670 pregnant women were investigated. The average infection rate in the population was 39.22%; 60.39% were seronegative. To minimise the risk involved in toxoplasmosis infection, toxoplasma-antibodies must be definitely determined during prenatal care. This should be carried out simultaneously with the determination of antibodies to the rubella virus.
BACKGROUND: The diagnosis of ocular toxoplasmosis has remained a merely clinical one, because the low sensitivity of established methods does not allow clinical consequences. The underlying open prospective study was undertaken to analyse the sensitivity of a combination including the newly available tests for the diagnosis of the disease. METHODS: From 27 patients included until now, aqueous humor and serum samples were collected and sent to one of two reference laboratories according to their actual availability. From all samples, total IgG and anti-Toxoplasma IgG as well as specific IgM and IgA were quantified, and from the results, the antibody ratio was calculated according to the formula of Goldmann and Witmer. From the samples sent to laboratory 2, antibody avidity was determined and Toxoplasma DNA amplified using PCR. RESULTS: A confirmation of the clinical diagnosis was achieved in 5/9 cases (56%) from samples sent to laboratory 1, and from 14/18 samples (78%) sent to laboratory 2. Calculation of the antibody ratio was confirmed to be the most sensitive method with a confirmation rate of 41%, followed by PCR (28%), determination of specific IgA (22%) and finally antibody avidity (15%). A confirmation with two independent tests was achieved in 28% of cases. CONCLUSION: None of the methods analysed was sensitive enough to establish the diagnosis in a given case. The combination of all four methods, however, achieved a sensitivity, which is high enough to justify a clinical routine analysis of aqueous humor samples.
A 45-year-old man with AIDS was treated for a recurrence of cerebral toxoplasmosis with sulphadiazine, 4 g, and pyrimethamine, 75 mg, daily. Owing to a lack of appetite and dysphagia he drank rather little water during the first week of treatment. On the 13th day after starting the drugs he had bilateral renal colics and renal failure was diagnosed (serum creatinine 3.8 mg/dl). Ultrasound examination demonstrated multiple stones with bilateral urinary retention. After parenteral fluid replacement, alkalization of the urine with sodium-potassium-hydrogen citrate and N-butylcopolamine a stone, consisting of sulphadiazine and acetylsulphadiazine, was passed after two days. Three days later the creatinine concentration was within normal limits, and in further two days the ultrasound picture was normal. It is pointed out that diarrhoea, fever or dysphagia often prevent sufficient fluid intake in AIDS patients. Satisfactory oral fluid intake and alkalization of urine is thus of great importance for avoiding complications during sulphadiazine treatment.
Between 1966-1983 ten children with hydrocephalus following toxoplasmosis were shunted. Hydrocephalus was diagnosed at ages ranging from birth to one year. Except for one with stenosis of the foramen of Monro all had aqueductal obstruction. A high ventricular fluid pressure and distinct cerebral mantle reduction were always present. Intracerebral calcifications were common. Only 1 had normal eyes. All 9 survivors remained shunt dependent during a mean follow-up period of 9.6 years. One fifth of revisions were related to problems specific for toxoplasma-associated hydrocephalus. A temporary external ventricular drainage or a multiple shunt system were found useful in some cases. Two thirds of the children had a reasonable outcome. Neonatal hydrocephalus, extensive intracerebral calcification and severe ocular involvement were poor prognostic indicators.
Sera of six children, clinically suspected of having congenital toxoplasmosis, and of their mothers were examined for specific antibodies. In four, prenatal infection was established shortly after birth by significant titre differences between the neonatal and maternal sera. In three neonates, toxoplasma-specific IgM antibodies were demonstrated. In two children, aged seven and 16 months, postnatal infection could not be absolutely excluded, although both they and their mothers had high toxoplasma antibody titres.
BACKGROUND: Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune. PATIENT AND METHODS: We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection. RESULTS: Both patients responded well to treatment with systemic antibiotics and corticosteroids. Visual acuity returned to 20/60 in one patient and 20/20 in the other. CONCLUSION: Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy.
Clinical examination of the eyes of mice with congenital toxoplasmosis provided a good indication of the extent of underlying histopathological damage in the eye, but was of little value for predicting neuropathological severity. Furthermore, the dye-test titre was not related either to the degree of ocular damage or to the severity of brain damage.
Nya:NYLAR albino mice infected with Toxoplasma gondii gradually developed a chronic and progressive wasting syndrome characterized by facial and body alopecia, corneal opacities, necrotic lesions of ears and tail, signs of neurologic disease and death within six to eight months after infection. Haematologic changes included a transient normochromic, normocytic anaemia, and persistent lymphopenia and neutrophilia. Changes in serum proteins were manifested by hypoalbuminaemia and pronounced hypergammaglobulinaemia. Serum thyroxine concentrations fell sharply during the first month of infection, then gradually returned to control concentrations. Gross changes included loss of body weight, hepatosplenomegaly, ovarian and uterine atrophy, and a marked involution of the thymus. The predominant histopathologic change in the brain was a mononuclear cell vasculitis, particularly affecting the hippocampus and the choroid plexus, ependyma, and periventricular areas of the lateral and third ventricles. These preliminary observations indicate that mice can serve as a practical animal model of great potential for study of the pathogenesis of chronic toxoplasmosis.
Electron immunocytochemistry, using rabbit polyclonal anti-Toxoplasma IgG as the primary layer in immunogold staining, was used to assess the distribution of Toxoplasma antigen within, and in relation to, intact tissue cysts in brain tissue from mice with congenital toxoplasmosis. Toxoplasma antigen was widely distributed in the matrix of the cyst, being most concentrated in the proximity of the inner surface of the parasitophorous vacuole membrane (PVM). Relatively little Toxoplasma antigen was detected directly associated with cystozoites. Small amounts of antigen were detected within the host cell components exterior to the PVM and in the host neuropil immediately adjacent to the tissue cyst.
We set out to determine the role of toxoplasmosis, detected by serological tests, in habitual abortion. A total of 280 pregnant women aged 15-46 years with parity ranged from 0-9 were studied prospectively between January 2000 and May 2001 at King Hussein Medical Center. Analyses for IgG and IgM anti-toxoplasma were carried out using indirect fluorescent antibody assay (IFAT) and enzyme-linked immunosorbent assay (ELISA). Titres of the order of 1:16-1:2048 were considered positive. According to the results, women were divided into two groups; seropositive (n=132) and seronegative (n=148). One hundred and thirty-two (47.1%) pregnant women showed seropositivity to IgG anti-toxoplasma; of them, two (1.5%) developed IgM anti-toxoplasma during the second trimester. A statistically significant increase in the rate of seropositivity to toxoplasma with increasing age and parity was found (P<0.05). There was no significant difference in the rate of habitual abortion between seropositive and seronegative women. The seropositivity was higher among women living in rural areas (P<0.02), who are using rainwater to drink (P<0.02), ingesting undercooked meat (P<0.001) and who have contact with soil (P<0.02). Toxoplasma antibodies detected by positive serological tests tend to be higher with increased age and parity. It seems that they have no role in habitual abortion.
OBJECTIVE: The study was to evaluate the diagnostic efficacy of nested polymerase chain reaction (nPCR) using primers targeting B1 gene of Toxoplasma gondii (T. gondii) with Witmer Desmonts coefficient (WDC) technique in intraocular fluids of clinically suspected toxoplasma retino choroiditis (TRC) patients. MATERIALS AND METHODS: Two hundred and seventy eight specimens from 189 patients (25 TRC patients and 164 controls) consisting of 189 serum samples and 89 intraocular fluids were included in the study. The clinical specimens were categorized into TRC patients (typical TRC lesion-group I & atypical TRC lesion-group II) and controls (voluntary blood donors-group III, patients undergoing uncomplicated cataract surgery-group IV, ocular inflammation of non-toxoplasma origin-group V). Detection of anti T. gondii IgG and IgM antibodies in serum samples and intraocular fluids were performed and WDC was calculated by the standard method. The standardized nPCR was applied on the 89 intraocular fluids. RESULTS: Clinical diagnosis of TRC based on fundus examination was considered to be the "gold standard." Anti T. gondii IgG/IgM antibodies were detected in serum by ELISA in 95.6% of 25 clinically suspected TRC patients (gp I and II), 28% of gp III, 40.4% of gp IV, and in 58.3% of gpV. Witmer Desmont's coefficient was positive in 72.7% (16/22) and nPCR in 59.1% (13/22) of TRC patients (gp I and II). Both WDC and nPCR were negative in all the controls. The difference in sensitivity of WDC and nPCR was not statistically significant (p=0.5247). CONCLUSIONS: Though both WDC and nPCR were reliable diagnostic techniques for ocular toxoplasmosis, nPCR is more acceptable because of the amount of specimen(s) required, rapidity, cost effectiveness, and direct evidence of T. gondii DNA in the intraocular fluids.
The reversed enzyme-labelled antigen immunoassay (R-EIA), based on the capture of serum immunoglobulin M antibodies (IgM) and subsequent addition of Toxoplasma gondii soluble antigen tagged with peroxidase and substrate, was evaluated comparatively with the IgM-indirect immunofluorescence test (IgM-IIF) for the detection of anti-toxoplasma IgM antibodies in sera from individuals with diagnosed acute acquired toxoplasmosis. Additional serum groups from normal healthy individuals and sera presenting possible nonspecific reactivities were also evaluated. Complete specificity of R-EIA was shown. There was no correlation between the magnitude of R-EIA results and IgM-IIF titers, but a positive (although not linear) correlation was found between R-EIA and the IgM-IIF titers obtained after adsorption of sera with Staphylococcus aureus protein A. Direct labelling of the antigen by a simple coupling technique facilitated the assay standardization and improved its signal-to-noise ratio.
A 4-week-old female newborn developed ascending flaccid paralysis and radiologic evidence of myelitis; the diagnosis of congenital toxoplasmosis was confirmed by the presence of Toxoplasma gondii-specific immunoglobulins in both mother and infant, and detection of Toxoplasma sequences in the infant's cerebrospinal fluid by polymerase chain reaction analysis. Treatment with pyrimethamine, sulfadiazine, and methylprednisolone resulted in improvement.
The protozoan parasite Toxoplasma gondii is an important cause of ocular disease. Ocular toxoplasmosis (OT) can be a progressive and recurring disease that can threaten visual function. We present 2 cases of recurrent OT in immunocompetent patients for whom prophylaxis prevented recurrence of disease.
A new serologic method, diffusion in gel-enzyme-linked immunoassay (DIG-ELISA) is described and compared with the indirect fluorescent antibody (IFA) and indirect hemagglutination assay (IHA) for the serologic diagnosis of toxoplasmosis. The results demonstrate that DIG-ELISA is a viable alternative to IFA and IHA because of its simplicity, economy, versatility, and potential for standardization.
Extraneural manifestations of toxoplasmosis often are not recognized antemortem in patients with AIDS. We describe a patient who was seropositive for human immunodeficiency virus and presented with lethargy, abdominal tenderness, rapidly progressive ventilatory failure, rhabdomyolysis, myoglobinuria, and disseminated intravascular coagulation. Although the diagnosis of pancreatitis was not considered while the patient was alive, an autopsy demonstrated pancreatic necrosis associated with toxoplasmal cysts. No other infection was evident. This case suggests that Toxoplasma gondii can cause severe pancreatitis in patients with AIDS.
We report two cases of prolonged fever in deeply immunocompromised patients with AIDS who had been receiving trimethoprim-sulfamethoxazole (TMP-SMZ) as primary prophylaxis for several months. Investigations of the cause of fever yielded normal or negative findings except that the polymerase chain reaction (PCR) for Toxoplasma gondii in the blood was positive in both cases, and PCR of the bronchoalveolar lavage fluid was positive in one case. After a few days of treatment with pyrimethamine plus clindamycin, the two patients became afebrile and the T. gondii PCR became negative. The patients probably had disseminated toxoplasmosis attenuated by TMP-SMZ. PCR examination of blood for evidence of T. gondii genome may be useful in screening for causes of unexplained fever in patients with AIDS, even those who receive prophylaxis with TMP-SMZ.
BACKGROUND: A pilot neonatal screening programme revealed a high (approximately 1 per 4800 live births) prevalence of congenital toxoplasmosis (CT) in the State of Rio Grande do Sul, Brazil. The purpose of this paper was to estimate in a larger prospective study the prevalence of CT in the country. METHODS: At the beginning of the study, an in-house indirect enzyme immunoassay (EIA) was used, to be later replaced with a commercial capture IgM fluorometric enzyme immunoassay (FEIA). Both methods detect specific anti-Toxoplasma gondii IgM-class antibodies eluted from dried blood spots. RESULTS: Of the total of 140,914 samples received from all over the country, 47 cases were identified and confirmed as CT. This finding suggests a prevalence of 1 per 3000 live births. Of the 47 patients, only eight (17%) had clinical manifestations: two had intracranial calcifications, four had retinal scars, one had an intracranial calcification and retinal scars, and one had hepatosplenomegaly with lymphoadenopathy. The testing was paid for by the patients' families who volunteered for the study and gave their informed consent. CONCLUSION: The 3-year prospective study using sensitive detection methods, reliable confirmation, and feedback from clinicians showed that CT has an extraordinarily high prevalence in Brazil, in fact the highest ever reported in the world. Although the long-term efficacy of treatment of CT has not been well documented, in view of the availability of reliable diagnostics, confirmation and monitoring, functional logistics, and networking for screening, the insidious nature of the sequelae and the very high prevalence of the disease, neonatal screening for CT should be considered an alternative to no screening at all.