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PubMed2003

Toxoplasmosis in pregnancy is still an open subject.

OBJECTIVE: To assess the consequences of a systematic screening for toxoplasma infection in pregnant women in a potentially high risk population. METHODS: We have investigated all consecutive women with likely toxoplasma seroconversion in a referral center setting. Data were obtained from 68 women for whom an acute infection during pregnancy was considered likely or definite. They were all treated with antibiotics in the first instance and offered, if in the first or second trimester, amniocentesis for detection of vertical transmission (PCR and IFAT). Third trimester seroconversions and positive cases after amniocentesis were offered more aggressive antibiotic treatment. RESULTS: Five fetuses/neonates (7%) were found to be infected. Four of them were diagnosed prenatally at amniocentesis, two women decided for termination of pregnancy, two were treated and gave birth to seronegative, normally developing children. One case was found postnatally, after a third trimester conversion; this developed into hydrocephalus with neurologic impairment. DISCUSSION: Prenatal screening and antibiotic treatment of mothers infected with toxoplasmosis showed good feasibility in our infection-susceptible population. However, there were some weak points; for example, the high number of invasive procedures and the questionable prevention of mother to child transmission in the second to third trimester.

Amniotic Fluid↗
PubMed1995

[Hemichorea associated with cerebral toxoplasmosis and AIDS].

Only 12 AIDS cases with hemichorea were reported in the literature. We report the first case of hemichorea associated with AIDS and cerebral toxoplasmosis in our country. A 26-year-old man had 3 episodes of focal seizures on the left side with subsequent loss of consciousness. A few weeks later, he noticed progressive left-sided weakness. Examination revealed a left hemiparesis. MRI of the head showed a round mass in the right frontal lobe and a smaller lesion in the left temporo-occipital area. Laboratory showed positive serum ELISA and Western Blot analysis for HIV antibodies. Serum tests for Toxoplasma showed elevated titers. He was treated with pyrimethamine and sulfadiazine. His weakness improved and he had no further seizures. Two weeks later, choreic movements appeared in the left foot, finally involving the entire left hemibody. A second MRI showed a new small lesion in the right cerebral peduncle. The patient completed 6 weeks of treatment, with further reduction in the size of the lesions. Nevertheless, the left hemichorea persisted. We believe that the hemichorea our patient had was caused by the contralateral peduncular lesion. Lesions involving the subthalamic nucleus or its connections may cause contralateral hemiballismus or hemichorea. In spite of the favorable response to antitoxoplasmic therapy, the hemichorea persisted. The present report illustrates an uncommon neurological complication in AIDS. We believe that a combination of a focal cerebral lesion and the HIV infection caused the movement disorder presented by the patient.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Seroepidemiology of toxoplasmosis in 2 communities of Rwanda (Central Africa)].

We collected dry blood specimens from two rural areas in Rwanda, that were tested for antibodies to Toxoplasma gondii through the Direct Agglutination technique. 50% of the adults in both communities had antibodies to T. gondii. The Ngenda (NGD) population apparently acquired antibodies at a later stage of its life (only 12% were positive at 14 years of age). The Nyarutovu (NVU) population already showed a 31% positivity at the same age. We would like to point out the pathogenic role played by toxoplasmosis during pregnancy and the need of new studies about the epidemiology of the disease as well as the transmission mechanism in Rwanda.

Adolescent↗
PubMedDate not supplied

IgG recognizing 21-24 kDa and 30-33 kDa tachyzoite antigens show maximum avidity maturation during natural and accidental human toxoplasmosis.

We describe the avidity maturation of IgGs in human toxoplasmosis using sequential serum samples from accidental and natural infections. In accidental cases, avidity increased continuously throughout infection while naturally infected patients showed a different profile. Twenty-five percent of sera from chronic patients having specific IgM positive results could be appropriately classified using exclusively the avidity test data. To take advantage of the potentiality of this technique, antigens recognized by IgG showing steeper avidity maturation were identified using immunoblot with KSCN elution. Two clusters of antigens, in the ranges of 21-24 kDa and 30-33 kDa, were identified as the ones that fulfill the aforementioned avidity characteristics.

Acute Disease↗
PubMed2006

Seroprevalence of toxoplasmosis in a low-income community in the São Paulo municipality, SP, Brazil.

Toxoplasmosis is one of the most common zoonoses worldwide. The seroprevalence for T. gondii in human population from Brazil might range from 40 to 80%. The aim of this paper was to study the seroprevalence of T. gondii infection in children from age one to 15 living in a low socioeconomic community, named community of Jardim São Remo in the year of 2002. The community is located in the West area of São Paulo municipality, São Paulo State, Brazil. Antibodies to T. gondii were found in 110 (32.4%, CI 95%: 27.5 - 37.7) of the 339 children tested with indirect immunofluorescent antibody test. The titration of the samples revealed 29 children with serum titer equal to 16, 14 children with 32, 18 children with 64, 21 children with 128, 20 children with 256 and eight children with serum titer > 512. The age dependence of the prevalence of T. gondii infection and the association between seroprevalence for T. gondii and seroprevalence for T. canis suggest that the infection is chiefly postnatal. Seroconversion in infant population of community Jardim São Remo occurs in children as young as two years old, earlier than in the children attended at health centers of São Paulo city. The seroprevalence of T. gondii in children from Jardim São Remo was compared to the prevalence in children from other urban centers of Brazil.

Adolescent↗
PubMedDate not supplied

[Seroepidemiology of toxoplasmosis and ocular evaluation by Amsler grid in patients from the rural area treated at the Jaguapitã county health center, Paraná State, Brazil].

In this study, we collected serum from 82 randomly selected patients from a rural area in Jaguapitã county, Paraná State. All sera were subjected to indirect immunofluorescence assay (IFA) to detect IgG antibodies against T. gondii. Serum titers >/=+ 16 were considered positive. Of the 82 evaluated sera, 68 (82.9%) were positive to toxoplasmosis and 14 (17.1%) were non-reactive. The most common titers found were 64 (23/33.8%) and 256 (16/23.5%), the highest titer being 4096 (8/11.8%). The 82 patients were also evaluated by the Amsler Grid test, with 22 (26.8%) patients presenting at least one alteration in this test. Masculinity was found to be a protection factor in the Amsler grid test (OR = 0.21 0.04 < OR < 0. 86 chi2 = 4,98 p = 0,02). There were no significant statistical differences related to the epidemiological investigation. We concluded that T. gondii has a wide distribution in the population studied.

Adolescent↗
PubMed2006

[Monitoring of pregnant women with toxoplasmosis in Public Health Services].

The monitoring of 290 pregnant women with suspicion of acute toxoplasmosis attended by Public Health Services is discussed. In 69% a single test (Elisa-IgM) led to the treatment. Of 112 treated, the system did not offer any drug to 24%. In 12.1% there was a progressive increase of IgM and IgG. In 48.2% the treatment was begun thirty days after the laboratorial diagnosis.

Acute Disease↗
PubMedDate not supplied

Epidemiological aspects of toxoplasmosis in schoolchildren residing in localities with urban or rural characteristics within the city of Rio de Janeiro, Brazil.

Immunofluorescence tests (IF) for toxoplasmosis were performed on a total of 608 schoolchildren in elementary and junior high grades. 166 being in the Bonsucesso district (an urban region of Rio de Janeiro) and 442 children from locations within the lowlands of Jacarepaguá (with rural characteristics). All the IF-IgM were nonreactive, whilst 416 schoolchildren (68.4%) were IF-IgG serum-reactive (greater than or equal to 1:16). The percentages of serum-reactives in Jacarepaguá were significantly higher than in Bonsucesso, both as regards the total number of schoolchildren (p less than 0.001), as also when subdivided according to the age-grades from six to eight years (p less than 0.001) or from twelve to fourteen (p less than 0.05). Both in Jacarepaguá and in Bonsucesso, the prevalence of reactions in the 12 to 14 year age-grade was significantly greater than in the 6 to 8 year age-grade (p less than 0.001 in both cases). Expressively larger prevalences of serum reactions were found in Jacarepaguá among schoolchildren who preferred eating raw or undercooked meat, as well as among those having cats as pets; this occurred equally in the 6 to 8 year and in the 12 to 14 year age-grades. In Bonsucesso, the only significant difference was in the 6 to 8 year age-grades that had cats as pets. Thus, it has been verified that the risk of infection is greater and more precocious in localities with rural characteristics than in urban regions.

Adolescent↗
PubMedDate not supplied

A simple and economic slide micro-immunoenzymatic (micro-SIA) test for epidemiological studies of toxoplasmosis.

A slide micro-immunoenzymatic assay (micro-SIA) to detect antibodies to non-particulate Toxoplasma gondii antigens is described. This assay allows the diagnosis of toxoplasmosis infection in about 1 hr. Twenty-four determinations can be performed per slide. Five hundred ng of antigen and 5 or 10 microliters drop of each reactive are necessary per well. The clear contrast of colours obtained for negative and positive sera after the test is finished, allows direct discrimination of the results. However, it is possible to quantify the results of the reaction using a minireader. Sera dilution cutoff value, determined as the most frequent titre for the general population, is 1:100. The toxoplasma micro-SIA correlates well with indirect immunofluorescence (IIF), its sensitivity is at least three times as much as IIF. The test has an intra and inter assay variation coefficient of 5.46% and of 6.24% respectively. Sera obtained at random from argentinian people were analyzed and a 56% of infection was found. The main features of the Toxoplasma micro-SIA are its simplicity, sensitivity, reproducibility, and the virtual absence of background making it very suitable for screening tests.

Animals↗
PubMed2002

Epidemiological and serological aspects in canine toxoplasmosis in animals with nervous symptoms.

The presence of anti-Toxoplasma gondii IgM and IgG antibodies was studied in samples of blood serum taken from eighty dogs with nervous symptoms at the Serviço de Enfermidades Infecciosas dos Animais, Faculdade de Medicina Veterinária e Zootecnia, Unesp, Botucatu, São Paulo, Brazil. The frequency of IgG titers were 16 (13.7%), 64 (13.7%), and 256 (5%), and for IgM titers were 16 (7.5%), 64 (15%), and 256 (8.7%). Positive reactions were more frequent in the older animals, males, from a rural environment, in constant contact with small animals, principally birds and rodents. There was a higher frequency of a positive reaction in dogs fed with kitchen food, especially in those fed with raw ingredients. The most common neurological pictures were alterations in consciousness, in movement, and in the hand-cart test. The percentage of reagents with specific IgM antibodies was high, indicating active infections, but the possibility of co-infection with the distemper virus can not be discarded, and this may be a predisposing factor for toxoplasmosis infection, once the distemper virus has a potent immunosuppressive action.

Animals↗
PubMedDate not supplied

Behçet's syndrome/AIDS/cerebral toxoplasmosis: an unusual association.

Few cases of AIDS associated to manifestations suggesting Behçet's syndrome have been reported. This case is of a young married woman who presented, during a period of 7 years, clinical manifestations consistent with the late diagnosis of Behçet's syndrome, when she developed recurrent lymphomonocytic meningoencephalitis. At this time, she was found to be infected by HIV-1. Immunosuppressive doses of glucocorticoid produced an unsatisfactory response and she evolved to death due to CNS toxoplasmosis. The latter diagnosis was presumed on the basis of magnetic resonance imaging findings and proved by necropsy after her third hospital stay. One of the factors hindering the appropriate diagnosis was the low level of CD4 and the CD4/CD8 ratio, sometimes observed in active Behçet's syndrome and higher than those observed in patients with this severe opportunistic infection. No information about the exact period of time she had been infected with HIV-1 is available. So, we do not know whether both diseases were overlooked, if the patient, infected by HIV-1, developed an unusual clinical feature consistent with Behçet's Behçet's syndrome, and subsequently evolved to AIDS.

AIDS-Related Opportunistic Infections↗
PubMed2000

Toxoplasmosis in golden-headed lion tamarins (Leontopithecus chrysomelas) and emperor marmosets (Saguinus imperator) in captivity.

From 1991 to 1995, eight New World nonhuman primates of the family Callitrichidae belonging to the collection of Fundacão Parque Zoologico de São Paulo died of toxoplasmosis. Of the eight affected nonhuman primates, four were Leontopithecus chrysomelas (one male, three females) and four were Saguinus imperator (two males, two females). The most commonly affected organs were the lungs, liver, and lymph nodes, with hemorrhagic and necrotic lesions. Histopathologic examination revealed protozoa that were morphologically consistent with Toxoplasma gondii. Immunohistochemical assays were strongly positive for T. gondii.

Animals↗
PubMed2006

Acute fatal toxoplasmosis in squirrels (Sciurus carolensis) with bradyzoites in visceral tissues.

Acute toxoplasmosis was diagnosed in 3 gray squirrels (Sciurus carolensis) from Louisiana and Pennsylvania. The predominant lesion was multifocal necrosis in several organs, especially of the lymph nodes. Numerous Toxoplasma gondii tachyzoites were seen in lesions, and the diagnosis was confirmed immunohistochemically by reaction with polyclonal T. gondii-specific antibodies. Tissue cysts were seen in several organs, including lung alveoli. The presence of tissue cysts in alveoli of pet squirrels maybe of public health concern if tissue cysts excreted in nasal secretions are swallowed by children.

Animals↗
PubMed1986

Ultrasonic diagnosis of fetal ascites and toxoplasmosis.

The ultrasonic diagnosis of fetal ascites caused by Toxoplasma Gondii is presented. When a diagnosis of fetal ascites without obvious etiological malformation is established, toxoplasmosis should be suspected. A serological test should be performed, in view of the possibility of antenatal treatment of the fetus.

Adult↗
PubMed1997

Recurrence of acute colonic pseudo-obstruction in selective adrenergic dysautonomia associated with infectious toxoplasmosis.

BACKGROUND: Acute colonic pseudo-obstruction is a life-threatening condition associated with several pathologic conditions, whose pathophysiology is still uncertain. CASE: Autonomic function in a young patient operated on for acute colonic pseudo-obstruction was carefully evaluated; none of the common clinical conditions described in the literature was found to have caused the syndrome. Selective adrenergic failure was suggested by the presence of severe orthostatic hypotension, low basal plasma catecholamine level, and absence of the expected increase on standing and by the findings of provocation tests, cardiovascular tests, and acetylcholine sweat spot test. Biopsy specimens from the colon and small-bowel wall did not show any morphologic or immunohistochemical alteration either in muscle layers or in the autonomic plexus, testifying to the possible occurrence of extrinsic denervation in the presence of an intact plexus. Infectious toxoplasmosis was proved through indirect and direct hemagglutination assays, enzyme-linked immunosorbent assay IgG, IgM, and IgA, immunosorbent agglutination IgM assay, and the protozoa were demonstrated in a biopsy specimen from the rectus abdominis muscle. CONCLUSIONS: Selective adrenergic denervation of the gut resulted in recurrent episodes of colonic pseudo-obstruction, probably by direct toxicity or a cross-reaction between the immune process and a toxoplasmic antigen, stressing the importance of sympathetic inhibitory modulation on colon motor activity.

Adult↗
PubMed1989

Incidence of toxoplasmosis in pregnant women in the city of Malmö, Sweden.

The incidences of latent and primary Toxoplasma gondii infections in pregnant women were studied using stored sera from 4,351 women delivered in the city of Malmö, Sweden in 1982 and 1983. Infants born to mothers with signs of primary infection (seroconversion or specific IgM in sera collected during pregnancy) were studied with regard to serological evidence of congenital infection (specific IgM in cord serum). Sera were tested for specific IgG antibodies by direct agglutination test and enzyme-linked immunosorbent assay, and for specific IgM by immunosorbent assay. 40% of the women were seropositive at delivery. Seroconversion (change from negative to positive serological status) was demonstrated in 12 pregnant women and specific IgM in the first postconceptional serum sample (indicating infection in the first trimester or in the last year(s) before conception) in another 17. The incidence of primary maternal infection was calculated to 4-6:1,000 deliveries. Among the 29 infants born to mothers with seroconversion or, alternatively, IgM in the first postconceptional sample, 6 had laboratory signs of congenital infection. One of the 6 had a positive toxoplasma isolation test in autopsy material and 5 had a clearly positive IgM value in cord serum. The real incidence of congenital infection in this material is unknown since IgM might be absent or sparse in cord serum in spite of congenital infection. The noticeable prevalence of maternal toxoplasmosis in Malmö calls for further incidence studies in Sweden.

Adult↗
PubMed1990

Diagnosis of cerebral toxoplasmosis in association with AIDS using the polymerase chain reaction.

Two AIDS patients were provisionally diagnosed as having cerebral toxoplasma infection on the basis of compatible clinical presentation, serological evidence of exposure to toxoplasma and the detection of multiple space occupying lesions on CT scan. Initial response to conventional antitoxoplasma therapy was poor. Brain biopsy was performed and toxoplasma nucleic acid detected in the cerebral tissues utilising the polymerase chain reaction (PCR). Specific therapy was continued and a satisfactory clinical and radiological response was achieved in each case. The PCR represents a method of potential value for the diagnosis of cerebral toxoplasmosis associated with AIDS. Further studies are required to assess the sensitivity, specificity and prognostic value of this technique in comparison with established diagnostic methods.

Acquired Immunodeficiency Syndrome↗