Cerebellar toxoplasmosis in HIV/AIDS infant: case report and review of the literature

Anti-Toxoplasmic Immunoglobulin G Quantitation Correlates with Immunovirological Parameters of HIV-Infected Cameroonians

BACKGROUND

Toxoplasmosis is still a neglected common opportunistic infection in immunocompromised individuals, who are mainly people living with HIV (PLHIV) in whom reactivation of toxoplasmosis may occur with advanced HIV conditions in resource-limited settings (RLS).

OBJECTIVE

The objective was to assess the correlation between anti-toxoplasmic immunoglobulin G (anti-Toxo IgG) concentration and the immuno-virological status of PLHIV.

METHODS

A cross-sectional study was conducted in the year 2018 among 100 PLHIV aged ≥18 years in Yaounde-Cameroon. For each participant, anti-Toxo IgG, CD4-T lymphocytes, and plasma viral load (PVL) were measured using ELISA, flow cytometry, and real-time PCR, respectively.

RESULTS

Overall, 56% of the participants were seropositive for anti-Toxo IgG, while 33% were negative and 11% were equivocal. All (n=19) those with PVL>1000 copies/mL were seropositive to anti-Toxo IgG versus 52.85% (37/70) with PVL<1000 copies/mL; p<0.0001. Interestingly, all (n=11) those with severe immunodeficiency (T-CD4<200 cells/μL) were positive to anti-Toxo IgG versus 57.69% (45/78) with T-CD4>200 cells/μL; p<0.0001. Most importantly, PVL and anti- Toxo IgG concentration were positively correlated (r = 0.54; p<0.0001), while T-CD4 and anti- Toxo IgG concentration were negatively correlated (r = - 0.70; p<0.0001). Adjusting age, gender, immune status, and virological profile in logistic regression shows that only immune status was independently associated with the serological status of toxoplasmosis (p=0.0004).

CONCLUSION

In Cameroon, about half of PLHIV might be seropositive to anti-Toxo IgG, with decreasing immunity appearing as a risk of toxoplasmosis relapse. Thus, in the context of immunodeficiency, routine quantification of anti-Toxo IgG would alleviate the programmatic burden of this opportunistic infection in RLS with the generalized HIV epidemic.

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

Patient: Male, 9-year-old

Final Diagnosis: Fulminant and diffuse cerebral toxoplasmosis

Symptoms: Decreased level of consciousness • fever • generalized tonic-clonic seizures • hemiplegia

Medication: —

Clinical Procedure: Decompressive hemicraniectomy

Specialty: Neurosurgery

Seroprevalence and Molecular Evaluation of Toxoplasmosis in Patients Undergoing Chemotherapy for Malignancies in the Bushehr Province, Southwest Iran

Background

Toxoplasmosis is a life-threatening infection in organ transplant recipients, people receiving corticosteroid or radiation therapy, people with malignancies, and AIDS patients.

Objectives

The current study aimed to determine the prevalence of toxoplasmosis in patients receiving chemotherapy for malignancies in the Bushehr province of southwest Iran.

Methods

Blood samples were taken from 86 patients who were continuously referred to the chemotherapy center in Bushehr province and evaluated by ELISA to determine anti-Toxoplasma IgG and IgM antibodies. Moreover, a blood buffy coat of each sample was assessed by polymerase chain reaction (PCR), targeting a 529 bp gene of T. gondii. PCR products of the positive samples were sequenced to determine the genotype of the parasite.

Results

Anti-Toxoplasma IgG antibodies were detected in the sera of 21 (24.4%) cases. All of the patients were negative for anti-Toxoplasma IgM antibodies. No statistically significant correlation was found between seropositivity to Toxoplasma and duration of chemotherapy or having contact with cats. PCR detected a 529 bp band of T. gondii in the buffy coats of two out of 86 (2.3%) cases. The sequence analysis demonstrated that both cases were 95% identical to type III (VEG strain) of T. gondii.

Conclusions

Findings of this study demonstrated the presence of type III T. gondii in the buffy coats of patients undergoing chemotherapy. Given that toxoplasmosis is a life-threatening infection in immunocompromised patients, these patients should be screened for toxoplasmosis before and during chemotherapy to prevent acute toxoplasmosis.

Neurosurgery and human immunodeficiency virus in the era of combination antiretroviral therapy: a review

Human immunodeficiency virus (HIV) is a global health problem. It renders the central nervous system susceptible to infectious and noninfectious diseases. HIV-positive individuals may present to neurosurgical services with brain lesions of unknown etiology. The differential diagnosis in these cases is broad, including opportunistic infections and malignancies, and investigation should be tailored accordingly. Opportunistic infections of the central nervous system can be complicated by hydrocephalus, and the management is pathogen dependent. Patients may also present to a neurosurgical service with conditions unrelated to their HIV status. This review outlines important conditions that cause brain lesions and hydrocephalus. It addresses the issues of diagnosis and intervention in HIV-positive patients in the era of combination antiretroviral therapy, while not ignoring the potential for opportunistic central nervous system infection in undiagnosed patients. The care of HIV-positive patients presenting to neurosurgical services requires a multidisciplinary approach, which is reflected in the authorship of this review, as well as in the guidance given.

Pro-inflammatory cytokines predominate in the brains of dogs with visceral leishmaniasis: a natural model of neuroinflammation during systemic parasitic infection

Visceral leishmaniasis is a multisystemic zoonotic disease that can manifest with several symptoms, including neurological disorders. To investigate the pathogenesis of brain alterations occurring during visceral leishmaniasis infection, the expression of the cytokines IL-1β, IL-6, IL-10, IL-12p40, IFN-γ, TGF-β and TNF-α and their correlations with peripheral parasite load were evaluated in the brains of dogs naturally infected with Leishmania infantum. IL-1β, IFN-γ and TNF-α were noticeably up-regulated, and IL-10, TGF-β and IL-12p40 were down-regulated in the brains of infected dogs. Expression levels did not correlate with parasite load suggestive that the brain alterations are due to the host's immune response regardless of the phase of the disease. These data indicate the presence of a pro-inflammatory status in the nervous milieu of dogs with visceral leishmaniasis especially because IL-1β and TNF-α are considered key factors for the initiation, maintenance and persistence of inflammation.