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Sassetti C, Borrelli C, Mazuy M, Turrini I, Rigante D, Esposito S. The relationship between infectious agents and juvenile dermatomyositis: a narrative update from the pediatric perspective. Front Immunol 2024; 15:1377952. [PMID: 38660309 PMCID: PMC11039888 DOI: 10.3389/fimmu.2024.1377952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy affecting children, being marked by chronic inflammation which mostly impacts on both skin and skeletal muscles; diagnostic criteria of JDM include an unforeseeable mixture of clinical features, while treatment modalities commonly require corticosteroids or immunosuppressant agents. Although the pathogenesis of JDM is not completely understood, several infectious triggers have been linked to its priming via anecdotal reports related to children. Pediatric cases of recent-onset JDM have been temporally associated to an infectious disease by the power of increased titers of circulating antibodies to a putative infectious agent, including parasites, and/or detectable viral RNA or bacterial DNA. With this narrative review we offer an update about JDM association with a host of infections, namely parvovirus B19, Epstein-Barr virus, Coxsackie virus, human immune deficiency virus, severe acute respiratory syndrome coronavirus 2, Mycoplasma pneumoniae and Toxoplasma gondii, as resulting from the medical literature. Few are the evidence-proved results addressing JDM as an unambiguous post-infectious disorder and available data specifically related to children are poor, highlighting the need of further research into the exploration between environmental cut-out factors and JDM.
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Affiliation(s)
- Chiara Sassetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudia Borrelli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martha Mazuy
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ida Turrini
- Department of Child Neurology and Psychiatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica Sacro Cuore, Rome, Italy
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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2
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Hjalmarsson C, Daniels NF, Davies I, Milner Y, Wincup C. Dermatomyositis with concurrent hepatitis B and schistosomiasis infection. Br J Hosp Med (Lond) 2023; 29:1-3. [PMID: 36989157 DOI: 10.12968/hmed.2022.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
| | - Natasha F Daniels
- Department of Medicine, Whipps Cross University Hospital, London, UK
| | - Ieuan Davies
- Department of Medicine, Whipps Cross University Hospital, London, UK
| | - Yasmin Milner
- Department of Medicine, Whipps Cross University Hospital, London, UK
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
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Abd El-Rehim El-Henawy A, Abdel-Razik A, Zakaria S, Elhammady D, Saudy N, Azab MS. Is toxoplasmosis a potential risk factor for liver cirrhosis? ASIAN PAC J TROP MED 2015; 8:784-91. [PMID: 26522292 DOI: 10.1016/j.apjtm.2015.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To document Toxoplasma gondii (T. gondii) antibody status in patients with liver disease, blood samples were taken from 180 hepatic patients and 180 healthy controls. METHODS Toxoplasma IgG antibody was detected using enzyme-linked immunosorbent assay and histopathological assessment of liver biopsy METAVIR score was applied. RESULTS Anti-T. gondii IgG antibodies were found in 32.8% of patients and in 22.2% of controls (P = 0.02). Toxoplasma seropositivity was significantly associated with lymphadenopathy, history of blood transfusion and reflex impairment in patients. Chronic hepatitis C virus (HCV) and chronic HCV-related cirrhosis groups compared to chronic HBV and chronic HBV-related cirrhosis groups expressed significantly higher prevalence of T. gondii seropositivity (odds ratio (OR) = 4; 95% confidence interval (CI): 1.3-12.6; P = 0.013, OR = 4.8; 95% CI: 1.5-14.9; P = 0.006, respectively). Within the chronic HCV group, T. gondii seropositivity significantly associated disease evolution as regards to METAVIR histopathological system for fibrosis and inflammation (OR = 19.4; 95% CI: 2.3-165.2; P = 0.0008, OR = 0.29; 95% CI: 0.1-0.8; P = 0.01, respectively). Albumin, international normalized ratio (INR) and platelets count were the laboratory parameters significantly altered in Toxoplasma-positive chronic HCV patients (P = 0.001, 0.03, 0.04, respectively). Child-Pugh scoring for cirrhosis in chronic HCV group placed the majority of seropositive patient in class C with significant statistical difference compared to Child A reference group (OR = 0.08; 95% CI: 0.01-0.5; P = 0.003). CONCLUSIONS Toxoplasma seropositivity was high in patients with cirrhosis and associated higher grades of inflammation and necrosis signifying disease evolution, suggesting that cirrhotic patients may thus form a risk group for toxoplasmosis.
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Affiliation(s)
| | - Ahmed Abdel-Razik
- Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sahar Zakaria
- Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Dina Elhammady
- Department of Tropical Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Niveen Saudy
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Manar Sobh Azab
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt.
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Flegr J, Prandota J, Sovičková M, Israili ZH. Toxoplasmosis--a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries. PLoS One 2014; 9:e90203. [PMID: 24662942 PMCID: PMC3963851 DOI: 10.1371/journal.pone.0090203] [Citation(s) in RCA: 383] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 01/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Toxoplasmosis is becoming a global health hazard as it infects 30-50% of the world human population. Clinically, the life-long presence of the parasite in tissues of a majority of infected individuals is usually considered asymptomatic. However, a number of studies show that this 'asymptomatic infection' may also lead to development of other human pathologies. AIMS OF THE STUDY The purpose of the study was to collect available geoepidemiological data on seroprevalence of toxoplasmosis and search for its relationship with mortality and disability rates in different countries. METHODS AND FINDINGS Prevalence data published between 1995-2008 for women in child-bearing age were collected for 88 countries (29 European). The association between prevalence of toxoplasmosis and specific disease burden estimated with age-standardized Disability Adjusted Life Year (DALY) or with mortality, was calculated using General Linear Method with Gross Domestic Product per capita (GDP), geolatitude and humidity as covariates, and also using nonparametric partial Kendall correlation test with GDP as a covariate. The prevalence of toxoplasmosis correlated with specific disease burden in particular countries explaining 23% of variability in disease burden in Europe. The analyses revealed that for example, DALY of 23 of 128 analyzed diseases and disease categories on the WHO list showed correlations (18 positive, 5 negative) with prevalence of toxoplasmosis and another 12 diseases showed positive trends (p<0.1). For several obtained significant correlations between the seroprevalence of toxoplasmosis and specific diseases/clinical entities, possible pathophysiological, biochemical and molecular explanations are presented. CONCLUSIONS The seroprevalence of toxoplasmosis correlated with various disease burden. Statistical associations does not necessarily mean causality. The precautionary principle suggests however that possible role of toxoplasmosis as a triggering factor responsible for development of several clinical entities deserves much more attention and financial support both in everyday medical practice and future clinical research.
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Affiliation(s)
- Jaroslav Flegr
- Department of Biology, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Joseph Prandota
- Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Michaela Sovičková
- Department of Biology, Faculty of Science, Charles University in Prague, Prague, Czech Republic
| | - Zafar H. Israili
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Manlhiot C, Liang L, Tran D, Bitnun A, Tyrrell PN, Feldman BM. Assessment of an infectious disease history preceding juvenile dermatomyositis symptom onset. Rheumatology (Oxford) 2008; 47:526-9. [PMID: 18304939 DOI: 10.1093/rheumatology/ken038] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES A number of studies have looked at the role of infectious diseases in triggering juvenile dermatomyositis (JDM). Previous studies have found a moderately high frequency of infectious symptoms prior to disease onset; however, no specific pathogens could be identified. We sought to correlate preceding infectious symptoms with onset and outcomes of JDM. METHODS We studied an inception cohort of all JDM cases diagnosed at The Hospital for Sick Children (SickKids) between 1988 and 2006. Data pertaining to symptoms at onset, diagnosis and disease outcomes were abstracted. Two independent paediatric infectious disease specialists reviewed all records of patients with symptoms or tests suggestive of infection. RESULTS A total of 110 patients were reviewed; of these, 78 had sufficient information about disease onset for inclusion. Potential indications of an infectious process prior to JDM onset were found in 55/78 (71%) patients and were further evaluated for evidence of infection temporally associated with symptom onset. Features suggestive of infection prior to JDM symptom onset were found in 40/55 [probable (30/40) or possible (10/40)]. Most children with probable infections had respiratory illnesses [24/30 (80%)]. Fewer patients than expected had disease onset during summer months. The presence of an infection at onset was not found to be associated with differences in characteristics at diagnosis or disease outcomes. CONCLUSIONS A substantial number of JDM patients have a clinical history consistent with an infection prior to onset. Newly diagnosed patients should undergo a full infectious disease assessment as part of their initial work-up; specific attention should be given to respiratory infections.
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Affiliation(s)
- C Manlhiot
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Crum-Cianflone NF. Infection and musculoskeletal conditions: Infectious myositis. Best Pract Res Clin Rheumatol 2007; 20:1083-97. [PMID: 17127198 DOI: 10.1016/j.berh.2006.08.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infectious myositis, an infection of the skeletal muscle(s), is uncommon. This clinical entity may be caused by viral, bacterial, fungal, and parasitic pathogens. Viral etiologies typically cause diffuse myalgias and/or myositis, whereas bacteria and fungi usually lead to a local myositis which may be associated with sites compromised by trauma or surgery and are more common among immunocompromised patients. Localized collections within the muscles are referred to as pyomyositis. Other pyogenic causes of myositis include gas gangrene, group A streptococcal myonecrosis, and other types of non-clostridial myonecrosis. Early recognition and treatment of these conditions are necessary as they may rapidly become life-threatening.
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Affiliation(s)
- Nancy F Crum-Cianflone
- Infectious Disease Division, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste. 5, San Diego, CA 92134-1005, USA.
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Reed AM, Ytterberg SR. Genetic and environmental risk factors for idiopathic inflammatory myopathies. Rheum Dis Clin North Am 2002; 28:891-916. [PMID: 12506777 DOI: 10.1016/s0889-857x(02)00029-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although the studies discussed are beginning to reveal a number of genetic and possible environmental risk factors for myositis, further investigations are needed to fully understand and classify these syndromes. The difficulties in this process include small numbers of subjects with varying disease phenotypes available for study, polygenic risk factors for which it remains unclear which are primary and which are secondary or linked genes, and the lack of validated environmental exposure assessment tools. New technologies and international collaborative approaches, however, may overcome some of these difficulties and allow us to identify genetic and environmental risk factors, as well as the critical gene-environment interactions in the IIM and its subgroups. Nonetheless, our understanding of these diseases is still in the early stages. Although we have learned a great deal about these disorders through detailed investigations over the last several decades, we have even further to go to understand the environmental triggers and genetic susceptibilities for the myositis syndromes.
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Affiliation(s)
- Ann M Reed
- Division of Pediatric Rheumatology, Departments of Pediatrics and Internal Medicine, Mayo Clinic Rochester, Mayo Medical School, 200 First Street SW, Rochester, MN 55905, USA.
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Abstract
OBJECTIVES To consolidate the spectrum and frequency of parasite-related rheumatic syndromes, which have largely been regarded as exceedingly rare by the general medicine, infectious disease, and rheumatology literature. METHODS A MEDLINE search was performed for articles on rheumatic syndromes related to parasitic infections published from 1966 through December 2000. Identified articles included clinical and epidemiologic studies describing cases of rheumatic syndromes associated with verified parasitic infection. RESULTS Rheumatologic syndromes, including inflammatory arthritis, inflammatory myositis, and vasculitis, have been described among multiple different parasite infections of all parasitic divisions, including Protozoa, Nematoda, and Platyhelminthes. Individual parasitic divisions are often associated with particular rheumatic syndromes, such as reactive arthritis and spondyloarthropathy, inflammatory or infectious myositis, and reactive or parainfectious vasculitis. CONCLUSIONS AND RELEVANCE Parasitic infection may underlie the clinical presentation of some rheumatic conditions. Given the continued and growing number of patients at risk for parasitosis by virtue of their country of origin, travel habits, and an immunocompromised state, potential parasitosis must be considered in patients undergoing evaluation for rheumatic complaints.
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Affiliation(s)
- Stanford L Peng
- Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA 02115, USA.
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9
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Paspalaki PK, Mihailidou EP, Bitsori M, Tsagkaraki D, Mantzouranis E. Polyomyositis and myocarditis associated with acquired toxoplasmosis in an immunocompetent girl. BMC Musculoskelet Disord 2001; 2:8. [PMID: 11818029 PMCID: PMC65052 DOI: 10.1186/1471-2474-2-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2001] [Accepted: 11/20/2001] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure. CASE PRESENTATION We report a case of polymyositis and myocarditis in a 13-year old immunocompetent girl with toxoplasmosis. The patient presented with proximal muscle weakness, dysphagia, palms and soles rash and elevated serum levels of muscle enzymes, with liver and myocardial involvement. The diagnosis of toxoplasmosis was confirmed by serology. The patient was treated with prednisolone and had an excellent outcome. During a follow-up period of four years no relapses occurred and antibody levels to the T. gondii significantly decreased. CONCLUSIONS Although several previous cases of toxoplasmosis occuring in association with polymyositis have been described in the literature such a wide spectrum of acute toxoplasmosis is rather unusual in immunocompetent adolescents. The relationship between T. gondii and polymyositis remains obscure. Appropriate investigation should be performed in every case of polymyositis not only for the appropriate treatment but also for further elucidation of this relationship.
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Affiliation(s)
- Penelope K Paspalaki
- Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece
| | - Eleni P Mihailidou
- Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece
| | - Maria Bitsori
- Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece
| | - Daria Tsagkaraki
- Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece
| | - Eva Mantzouranis
- Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece
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Cuturic M, Hayat GR, Vogler CA, Velasques A. Toxoplasmic polymyositis revisited: case report and review of literature. Neuromuscul Disord 1997; 7:390-6. [PMID: 9327404 DOI: 10.1016/s0960-8966(97)00098-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Toxoplasmosis can cause polymyositis either by reactivation or by recent infection. Inconsistent response to antiprotozoal therapy has been the strongest argument against toxoplasmic polymyositis as a separate entity. We report a biopsy-proven case of toxoplasmic polymyositis in a cardiac transplant patient presenting with a severe proximal weakness, myopathic, electromyographic changes and ten-fold increase of anti-Toxoplasma antibodies. An early antiprotozoal therapy and plasmapheresis led to recovery. A review of previously reported cases of toxoplasmic polymyositis suggests that an early antiprotozoal therapy is the most important variable affecting the outcome of this disease. We propose that toxoplasmic polymyositis has two phases: acute, responsive to antiprotozoal therapy, and chronic, manifested by altered immune response requiring steroids. We suggest that all patients presenting with polymyositis should have serological tests for toxoplasmosis as a part of their initial evaluation and an early trial of antiprotozoal therapy in case of positive findings.
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Affiliation(s)
- M Cuturic
- Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA, USA
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Abstract
A variety of musculoskeletal syndromes has been described in association with numerous parasitic infestations. Arthritis, enthesitis, myositis and vasculitis have been described in infected individuals resident in, or visitors to, endemic areas. The diagnosis of parasitic rheumatism is supported by poor response to anti-inflammatory drugs and improvement following antiparasitic treatment.
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Affiliation(s)
- P E McGill
- Stobhill Hospital NHS Trust, Glasgow, UK
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13
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Bretagne S, Costa JM, Cosnes A, Authier FJ, Vidaud M, Gherardi RK. Lack of Toxoplasma gondii DNA in muscles of patients with inflammatory myopathy and increased anti-Toxoplasma antibodies. Muscle Nerve 1994; 17:822-4. [PMID: 8008014 DOI: 10.1002/mus.880170721] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Bretagne
- Laboratoire de Parasitologie, Hôpital Henri Mondor, Créteil, France
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Gherardi R, Baudrimont M, Lionnet F, Salord JM, Duvivier C, Michon C, Wolff M, Marche C. Skeletal muscle toxoplasmosis in patients with acquired immunodeficiency syndrome: a clinical and pathological study. Ann Neurol 1992; 32:535-42. [PMID: 1456737 DOI: 10.1002/ana.410320409] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The present article describes the clinical and pathological findings in 5 human immunodeficiency virus (HIV)-infected patients with muscle toxoplasmosis. The patients had marked lymphopenia (5/5), with less than five CD4+ cells/mm3 (3/3), when they developed fever (5/5), and multiorgan failure (5/5), including diffuse encephalitis, pneumonia, pancytopenia, and myopathy. Muscle involvement included weakness and wasting (4/5), myalgias (3/5), and high serum creatine kinase levels (3/3). Serology for toxoplasmosis showed high IgG titers in 3 patients (3/4). Anti-Toxoplasma therapy resulted in complete recovery in 2 patients. Muscle toxoplasmosis was detected by biopsy (3/5) or postmortem evaluation (2/5), and was identified using immunocytochemistry and electron microscopy. Toxoplasma cysts were detected in 0.5 to 4% of muscle fibers close to or remote from necrotic fibers and inflammatory infiltrates. Muscle fibers strongly expressed the major histocompatibility complex class I antigen (2/2) as in polymyositis. We suggest that Toxoplasma gondii should be sought by muscle biopsy in patients who have acquired immunodeficiency syndrome with fever, encephalitis, multiorgan dysfunction, and elevated serum creatine kinase levels of obscure origin.
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Affiliation(s)
- R Gherardi
- Département de Pathologie, Hôpital Henri Mondor, Créteil, France
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15
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Lyngberg KK, Vennervald BJ, Bygbjerg IC, Hansen TM, Thomsen OO. Toxoplasma pericarditis mimicking systemic lupus erythematosus. Diagnostic and treatment difficulties in one patient. Ann Med 1992; 24:337-40. [PMID: 1418915 DOI: 10.3109/07853899209147833] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A life-threatening T. gondii pericarditis developed in a patient with symptoms corresponding to systemic lupus erythematosus (SLE) with high concentrations of antinuclear antibodies and lymphadenopathy. The diagnosis would have been SLE-associated serositis, had not pericardial fluid been inoculated into mice, because pericarditis is frequently seen in SLE and false positive toxoplasma seroreactions may occur in ANA positive patients. High IgG T. gondii antibodies without increased IgM antibodies indicated reactivation rather than primary infection. Prolonged high-dose treatment with pyrimethamine-sulphadiazine was needed. Interestingly, the patient's SLE symptoms, including high ANA antibodies, declined to an unexpected remission after treatment for toxoplasmosis. This may not be mere coincidence, but may point to a causative role of toxoplasmosis in some cases of SLE.
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Affiliation(s)
- K K Lyngberg
- Department of Clinical Chemistry, Herlev Hospital, University of Copenhagen, Denmark
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Harland CC, Marsden JR, Vernon SA, Allen BR. Dermatomyositis responding to treatment of associated toxoplasmosis. Br J Dermatol 1991; 125:76-8. [PMID: 1873210 DOI: 10.1111/j.1365-2133.1991.tb06046.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report a 59-year-old woman with severe dermatomyositis in association with high serum toxoplasma antibody titres who was successfully treated with pyrimethamine and sulphadiazine. This case supports an aetiological role for toxoplasmosis in the pathogenesis of some cases of dermatomyositis.
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Affiliation(s)
- C C Harland
- Department of Dermatology, University Hospital, Queen's Medical Centre, Nottingham, U.K
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17
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Matsubara S, Takamori M, Adachi H, Kida H. Acute toxoplasma myositis: an immunohistochemical and ultrastructural study. Acta Neuropathol 1990; 81:223-7. [PMID: 2082660 DOI: 10.1007/bf00334513] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The occurrence is reported of acute myositis in a man with meningoencephalitis due to toxoplasmosis. The ultrastructure and immunohistochemistry of a muscle biopsy of the patient were investigated. Toxoplasma organisms were not found in the muscle biopsy. The perivascular inflammatory cells in the muscle were mainly CD4+ T cells and the inflammatory cells in and around the muscle fibres were chiefly macrophages. Expression of major histocompatibility complex class I and II antigens was observed in the infiltrating cells and endothelial cells of the blood vessels. A small proportion of the infiltrating cells expressed interferon-gamma. A possible role of the immune mechanism in the evolution of myositis is discussed.
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Affiliation(s)
- S Matsubara
- Department of Neurology, Kanazawa University School of Medicine, Ishikawa, Japan
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Hay J, Parmar O, Sims TA. Myositis in mice with congenital toxoplasmosis. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1988; 82:631-3. [PMID: 3256280 DOI: 10.1080/00034983.1988.11812301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J Hay
- School of Pharmacy, Leicester Polytechnic
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Sontheimer RD, Ziff M. Questions pertaining to the etiology and pathophysiology of polymyositis/dermatomyositis. Clin Dermatol 1988; 6:105-19. [PMID: 3293738 DOI: 10.1016/0738-081x(88)90053-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- R D Sontheimer
- Department of Medicine, University of Texas Health Science Center at Dallas, Southwestern Medical School
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Abstract
A 10-year-old girl from southern Alberta, Canada, who had close contact with cats, developed typical features of dermatomyositis. The diagnosis was confirmed by muscle biopsy. A toxoplasmosis titer was 1:16,384 by indirect fluorescent antibody technique, and the IgM response to toxoplasma was positive. Only minimal improvement followed prednisone and azathioprine administration, but she rapidly improved after 4 weeks of treatment for toxoplasmosis with pyrimethamine and sulfadiazine. A year after the onset of dermatomyositis, she showed no weakness or cutaneous lesions, and a repeat muscle biopsy no longer showed inflammation, perifascicular atrophy, or regeneration of myofibers. She remains asymptomatic more than 2 years after discontinuation of all medications. Investigation for immune deficiency disease 1 year after therapy revealed that lymphocytic response to T-cell and B-cell mitogens was normal, as were immunoglobulin and complement levels. She had mild impairment of natural killer cell activity and a positive antinuclear factor. Her rapid improvement on specific therapy and lack of significant long-term immune deficiency is consistent with acute toxoplasmosis infection in an immunologically competent child.
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21
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Behan WM, Behan PO. Immunological features of polymyositis/dermatomyositis. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1985; 8:267-93. [PMID: 3901370 DOI: 10.1007/bf00197300] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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