Tuberculosis/toxoplasmosis co-infection in Egyptian patients: A reciprocal impact

Seroepidemiological study on coinfection of toxoplasmosis and active tuberculosis in Northern Iran: a case control study

Coinfection of tuberculosis (TB) and human parasitic infections is common in developing countries. There is little information about the prevalence of Toxoplasma gondii (T. gondii) infection among TB patients in Iran. In this case-control study, anti-toxoplasma antibodies were measured by ELISA method in 100 patients with active tuberculosis and 100 healthy individuals who were matched in terms of sex, age, and place of residence. Anti-T. gondii IgG antibodies were diagnosed in 62% of TB patients (95% CI 53-71%) and 70% of control subjects (95% CI 62-78%). Anti-T. gondii IgM antibodies were found in 1% of both TB patients and control group. The seroprevalence of T. gondii infection was not significantly different between TB patients and healthy individuals (P > 0.05). None of the assessed sociodemographic and behavioral factors was recognized as a risk factor for toxoplasmosis in TB infected patients. Moreover, the level of anti-T. gondii IgG antibodies concentration in TB patients was significantly higher than in control subjects and revealed skewness towards humoral immune response in TB patients. Coinfection of toxoplasmosis and tuberculosis was prevalent but T. gondii infection was independent of active TB in this co-endemic area.

Effect of concurrent infection of Helicobacter pylori with Toxoplasma gondii infection on gastric pathology

BACKGROUND

Toxoplasma gondii (T. gondii) and Helicobacter pylori (H. pylori) are among the most prevalent foodborne parasitic and bacterial infections worldwide. However, the concurrent impact of coinfection on gastric pathology has yet to be studied in depth. The effect of coinfection generally either adds a synergetic or antagonistic impact; we aimed in the current work to assess the impact of T. gondii coinfection on the progression of H. pylori-associated gastric pathology and reporting H. pylori virulent strains. The study was conducted on 82 patients complaining of persistent gastrointestinal symptoms with failed treatment response and prone to endoscopy. They were subjected to stool examination to detect H. pylori antigen, serological screening for latent toxoplasmosis, endoscopy, histopathological examination, and molecular detection of H. pylori virulence strains in gastric biopsies. Out of the 82 patients, 62 patients were positive for H. pylori antigen in stool and 55 patients confirmed positivity by histopathology; out of them, 37 patients had isolated Vac As1 variants, 11 patients had combined Vac As1 and Cag A variants, and 7 patients had combined Vac As1, Cag A and VacAs2 variants. Patients with the combined two or three variances showed significantly deteriorated histopathological features than patients with a single Vac As1 variant (P < 0.05). Latent toxoplasmosis was positive among 35/82 patients. Combined H. pylori and Toxoplasma gondii infection had significantly marked inflammation than patients with isolated infection (P < 0.05).

CONCLUSION

Screening for toxoplasmosis among H. pylori-infected patients is recommended as it is considered a potential risk factor for gastric inflammation severity. H. pylori gastric inflammation may be heightened by Toxoplasma coinfection.

Co-exposure to pathogens in wild ungulates from Doñana National Park, South Spain

Multiple infections or co-exposure to pathogens should be considered systematically in wildlife to better understand the ecology and evolution of host-pathogen relationships, so as to better determine the potential use of multiple pathogens as indicators to guide health management. We describe the pattern of co-exposure to several pathogens (i.e. simultaneous positive diagnosis to pathogens in an individual considering Mycobacterium tuberculosis complex lesions, and the presence of antibodies against Toxoplasma gondii, bluetongue virus, and hepatitis E virus) and assessed their main drivers in the wild ungulate community from Doñana National Park (red deer, fallow deer, and wild boar) for a 13-years longitudinal study. The lower-than-expected frequency of co-exposure registered in all species was consistent with non-mutually exclusive hypotheses (e.g. antagonism or disease-related mortality), which requires further investigation. The habitat generalist species (red deer and wild boar) were exposed to a greater diversity of pathogens (frequency of co-exposure around 50%) and/or risk factors than fallow deer (25.0% ± CI95% 4.9). Positive relationships between pathogens were evidenced, which may be explained by common risk factors favouring exposure. The specific combination of pathogens in individuals was mainly driven by different groups of factors (individual, environmental, stochastic, and populational), as well as its interaction, defining a complex eco-epidemiological landscape. To deepen into the main determinants and consequences of co-infections in a complex assemblage of wild hosts, and at the interface with humans and livestock, there also is needed to expand the range of pathogens and compare diverse assemblages of hosts under different environmental and management circumstances.

TZD-Based Hybrid Molecules Act as Dual Anti-Mycobacterium tuberculosis and Anti-Toxoplasma gondii Agents

Two distinct intracellular pathogens, namely Mycobacterium tuberculosis (Mtb) and Toxoplasma gondii (Tg), cause major public health problems worldwide. In addition, serious and challenging health problems of co-infections of Tg with Mtb have been recorded, especially in developing countries. Due to this fact, as well as the frequent cases of resistance to the current drugs, novel anti-infectious therapeutics, especially those with dual (anti-Tg and anti-Mtb) modes of action, are needed. To address this issue, we explored the anti-Tg potential of thiazolidinedione-based (TZD-based) hybrid molecules with proven anti-Mtb potency. Several TZD hybrids with pyridine-4-carbohydrazone (PCH) or thiosemicarbazone (TSC) structural scaffolds were more effective and more selective than sulfadiazine (SDZ) and trimethoprim (TRI). Furthermore, all of these molecules were more selective than pyrimethamine (PYR). Further studies for the most potent TZD-TSC hybrids 7, 8 and 10 and TZD-PCH hybrid molecule 2 proved that these compounds are non-cytotoxic, non-genotoxic and non-hemolytic. Moreover, they could cross the blood-brain barrier (BBB), which is a critical factor linked with ideal anti-Tg drug development. Finally, since a possible link between Tg infection and the risk of glioblastoma has recently been reported, the cytotoxic potential of TZD hybrids against human glioblastoma cells was also evaluated. TZD-PCH hybrid molecule 2 was found to be the most effective, with an IC₅₀ of 19.36 ± 1.13 µg/mL against T98G cells.

Treatments of Mycobacterium tuberculosis and Toxoplasma gondii with Selenium Nanoparticles

Toxoplasma gondii and Mycobacterium tuberculosis are pathogens that are harmful to humans. When these diseases interact in humans, the result is typically fatal to the public health. Several investigations on the relationship between M. tuberculosis and T. gondii infections have found that there is a strong correlation between them with each infection having a reciprocal effect on the other. TB may contribute to the reactivation of innate toxoplasmosis or enhance susceptibility to a new infection, and toxoplasma co-infection may worsen the severity of pulmonary tuberculosis. As a consequence, there is an earnest and urgent necessity to generate novel therapeutics that can subdue these challenges. Selenium nanostructures' compelling properties have been shown to be a successful treatment for Mycobacterium TB and Toxoplasma gondii. Despite the fact that selenium (Se) offers many health advantages for people, it also has a narrow therapeutic window; therefore, consuming too much of either inorganic or organic compounds based on selenium can be hazardous. Compared to both inorganic and organic Se, Se nanoparticles (SeNPs) are less hazardous. They are biocompatible and excellent in selectively targeting specific cells. As a consequence, this review conducted a summary of the efficacy of biogenic Se NPs in the treatment of tuberculosis (TB) and toxoplasmosis. Mycobacterium tuberculosis, Toxoplasma gondii, and their co-infection were all briefly described.

Infectious Sclerouveitis in an Immunocompetent Patient: A Probable Case of Simultaneous Ocular Tuberculosis and Toxoplasmosis

Simultaneous infections of tuberculosis and toxoplasmosis are uncommon in immunocompetent patients. We report a case of a 30-year-old male who presented with right eye redness and blurring of vision for one month. The visual acuities were hand movement and Snellen 20/30 in the right and left eyes, respectively. Panuveitis and scleritis were found in the right eye, together with dense vitritis and a large choroidal lesion that extended from the inferonasal to the superotemporal quadrants. B-scan ultrasonography of the right eye showed a choroidal detachment with scleral thickening and subtenon fluid. His IgM anti-Toxoplasma antibody was detected, and his QuantiFERON Gold testing was positive. Magnetic resonance imaging (MRI) of the orbit revealed an enhancing intraocular mass at the lateral and inferior aspects of the right globe. The diagnosis of right eye sclerouveitis with presumed tuberculosis and toxoplasmosis co-infections was made. He was treated with a course of oral azithromycin and anti-tubercular therapy along with systemic prednisolone and a topical steroid. The treatment reduced the inflammation; however, the patient suffered from a sequela of chronic uveitis with prolonged hypotony. Medical treatment alone may be insufficient in treating severe infective sclerouveitis, hence surgical intervention might be warranted to provide favorable clinical outcomes.

Toxoplasma Lymphadenopathy in an Immunocompetent Host

Toxoplasma infection can be congenital or acquired. Infection with <i>Toxoplasma gondii</i> can result in multi-organ involvement in immunocompromised patients; whereas in immunocompetent patients, it usually remains asymptomatic. <i>Toxoplasma</i> is a rare cause of isolated lymphadenopathy especially in immunocompetent individuals, though it is a common manifestation of this protozoal infection. We present a 27-year-old male who presented to us with isolated cervical lymphadenopathy. Histopathology and serological studies confirmed the diagnosis of toxoplasma lymphadenopathy. It usually affects the posterior cervical group of lymph nodes, but in our case, it had also affected anterior group and presented without any constitutional symptom. The patient was treated with cotrimoxazole double strength tablet once daily for 1 month and responded well.

Prevalence of toxoplasmosis in patients infected with tuberculosis; a sero-molecular case-control study in northwest Iran

In this study, we investigated the possible association between TB and Toxoplasma gondii infection. One hundred confirmed TB individuals living in northwest Iran were classified into three subgroups; newly diagnosed patients (NTB), old diagnosed patients (OTB) and multidrug resistance patients (MDR-TB). One hundred healthy subjects in the same age and sex distribution were ethnically matched. Sera samples were screened for anti-Toxoplasma antibodies. Nested-PCR was performed by targeting the B1 and GRA6 genes. The frequency of Toxoplasma infection based on IgG titer was 71.1% in the OTB subgroup and 33% in the control group, indicating significant association between Toxoplasma seropositivity and OTB (P = 0.001). According to phylogenetic network, the type I strain of Toxoplasma was identified in the OTB subgroup (10.1%). We concluded that patients with OTB subgroup are at high risk for acquisition of Toxoplasma infection which could reactivate the latent toxoplasmosis.

Toxoplasma gondii seroprevalence among tuberculosis patients: A systematic review and meta-analysis

Toxoplasma gondii and Mycobacterium tuberculosis are intracellular pathogens, both infecting a substantial proportion of human population. We conducted a systematic review and meta-analysis to estimate the pooled T. gondii seroprevalence in tuberculosis patients. Three international databases were systematically searched for literature on prevalence of T. gondii in tuberculosis patients. A total of 1389 documents were identified, and eight papers were eligible to be included in the systematic review and meta-analysis. Geographical data gaps were evident, as no studies were identified from many countries where both infections are important. The pooled seroprevalence of IgG, IgM, and both IgG and IgM antibodies against T. gondii in tuberculosis patients were estimated to be 35.9% (95% confidence interval [CI], 19.3-56.7%), 35.0% (95% CI, 3.0-90.3%), and 13.4% (95% CI, 2.4-49.0%), respectively. In the included case-control studies, the pooled T. gondii seroprevalence (proportion anti- T. gondii IgG antibody positive) was higher in tuberculosis patients than in their controls, with an odds ratio by random effects model of 1.63 (95% CI, 1.28-2.08). The results of our work suggest an association between T. gondii seropositivity and being a tuberculosis patient, which should however be interpreted with caution because the timeline of the infections and the disease process are not accounted for. Our work showed that T. gondii seropositivity, indicating chronic infection with the zoonotic parasite, was relatively common among tuberculosis patients.

Ocular Co-infection with Mycobacterium Tuberculosis and Toxoplasma Gondii in an Immunocompetent Patient - A Case Report

Purpose: To report a case of ocular co-infection with Mycobacterium tuberculosis and Toxoplasma gondii in an immunocompetent woman.Method: Retrospective observational case report.Result: A 61-year-old woman presented with decreased vision and floaters in the right eye of 1-month duration. Ocular examination revealed panuveitis with a large yellowish-white retinochoroiditis lesion adjacent to a chorioretinal scar. Investigations showed positive Mantoux test, QuantiFERON TB test, and HRCT chest suggestive of active pulmonary tuberculosis. Serology revealed raised IgG anti T. gondii antibody. Vitreous aspirate was positive for M. tuberculosis and T. gondii genome by polymerase chain reaction and showed high IgG and IgM T. gondii antibodies. She was treated with anti toxoplasmic and antitubercular therapy along with oral corticosteroid and therapeutic vitrectomy.Conclusion: Ocular tuberculosis and toxoplasmosis can not only mimic each other but also present as co-infection in rare cases.

Long-Term Determinants of the Seroprevalence of Toxoplasma gondii in a Wild Ungulate Community

Toxoplasma gondii is an obligate intracellular protozoan which infects warm-blooded vertebrates, including humans, worldwide. In the present study, the epidemiology of T. gondii was studied in the wild ungulate host community (wild boar, red deer, and fallow deer) of Doñana National Park (DNP, south-western Spain) for 13 years (2005-2018). We assessed several variables which potentially operate in the medium and long-term (environmental features, population, and stochastic factors). Overall, the wild ungulate host community of DNP had high seroprevalence values of T. gondii (STG; % ± confidence interval (CI) 95%; wild boar (Sus scrofa) 39 ± 3.3, n = 698; red deer (Cervus elaphus) 30.7 ± 4.4, n = 423; fallow deer (Dama dama) 29.7 ± 4.2, n = 452). The complex interplay of hosts and ecological/epidemiological niches, together with the optimal climatic conditions for the survival of oocysts that converge in this area may favor the spread of the parasite in its host community. The temporal evolution of STG oscillated considerably, mostly in deer species. The relationships shown by statistical models indicated that several factors determined species patterns. Concomitance of effects among species, indicated that relevant drivers of risk operated at the community level. Our focus, addressing factors operating at broad temporal scale, allows showing their impacts on the epidemiology of T. gondii and its trends. This approach is key to understanding the epidemiology and ecology to T. gondii infection in wild host communities in a context where the decline in seroprevalence leads to loss of immunity in humans.

New-Onset Cervical Lymphadenopathy in a Patient Undergoing Treatment of Pulmonary Mycobacterium avium Complex Infection: Toxoplasmosis Lymphadenitis

Immunocompetent hosts with toxoplasmosis are usually asymptomatic. However, T. gondii can present as an acute systemic infection. Symptomatic patients usually have a benign, self-limited course that typically lasts from a few weeks to months. Herein, we present a 66-year-old immunocompetent female who developed dysphagia and new-onset cervical lymphadenopathy during pulmonary Mycobacterium avium complex treatment.

Codetection of pulmonary tuberculosis and toxoplasmosis in a pediatric bronchoalveolar lavage specimen: A cytologist's assistance to clinical management

BACKGROUND

Toxoplasmosis causes serious and sometimes life-threatening disease in immunocompromised patients like organ transplant recipients, immunodeficiency disorders or HIV-infected individuals. The co-occurrence of toxoplasmosis in a respiratory sample harboring tuberculosis (TB) may be missed especially in an area endemic for the latter infection.

CASE REPORT

A 10-year-old child presented with complaints of fever with loss of appetite and weight. Based on radiological and clinical features, a presumptive diagnosis of pulmonary TB was made and bronchoalveolar lavage (BAL) performed for cytological and microbiological confirmation. Smears from BAL showed numerous lymphocytes along with few ciliated columnar epithelial cells. Ziehl-Neelsen stain for acid-fast bacilli was positive. The Giemsa-stained cytosmears also showed clusters of crescent-shaped tachyzoites of toxoplasma gondii in a background of lymphocytes. The patient was initiated on anti-tubercular therapy with marked clinical improvement.

CONCLUSION

A diligent screening of cytosmears for a possible coinfection in a TB-positive sample is essential for the cytopathologists to detect coexisting toxoplasmosis, which is a rare but treatable disease.

Microbial biodiversity in the throats of pulmonary tuberculosis patients and tuberculin skin test (TST) positive and negative healthy individuals in Malaysia

The purpose of this study was to investigate the composition of throat microbiota in pulmonary tuberculosis patients (PTB) in comparison to healthy tuberculin skin test positive (TSTp) and negative (TSTn) individuals. Throat swabs samples were collected, and the microbiota was characterized. Richer operational taxonomic units (OTUs) were present in PTB group, compared to TSTp and TSTn. Regarding alpha diversity analysis there was a higher community diversity in TSTn compared to TSTp. Beta diversity analysis showed different species composition in TSTp compared to TSTn and PTB. There was higher presence of Firmicutes in PTB and TSTn compared to TSTp group at phylum level. At the genus level, Leuconostoc and Enterococcus were higher in TSTn compared to TSTp and Pediococcus, Chryseobacterium, Bifidobacterium, Butyrivibrio, and Bulleidia were higher in PTB compared to TSTn. Streptococcus was higher in TSTn compared to PTB and Lactobacillus in PTB compared to TSTp. At species level, Streptococcus sobrinus and Bulleidia moorei were higher in PTB compared to TSTn individuals, while Lactobacillus salivarius was higher in PTB compared to TSTp. The differences in the microbiome composition could influence the resistance/susceptibility to Mtb infection.

Parasitic infections in Malaysian aborigines with pulmonary tuberculosis: a comparative cross-sectional study

The geographical distribution of tuberculosis (TB) overlaps with various parasitic infections. Uncovering the characteristics of coinfecting parasites that potentially affect the host susceptibility to TB is pertinent as it may provide input to current TB therapeutic and prophylactic measures. The present study was aimed at examining the types of parasitic infections in TB patients and healthy TB contacts (HC) in Orang Asli, Malaysian aborigines, who dwelled in the co-endemic areas. Stool and serum samples were collected from Orang Asli who fulfilled the selection criteria and provided written informed consents. Selected parasitic infections in the two study groups were determined by stool examination and commercial serum antibody immunoassays. The prevalence of parasitic infections in TB and HC participants were 100% (n = 82) and 94.6% (n = 55) respectively. The parasitic infections comprised toxocariasis, trichuriasis, amoebiasis, toxoplasmosis, hookworm infection, ascariasis, strongyloidiasis, and brugian filariasis, in decreasing order of prevalence. Overall, helminth or protozoa infection did not show any significant association with the study groups. However, when the species of the parasite was considered, individuals exposed to trichuriasis and toxoplasmosis showed significant odds reduction (odds ratio (OR) 0.338; 95% confidence interval (CI) 0.166, 0.688) and odds increment (OR 2.193; 95% CI 1.051, 4.576) to have active pulmonary TB, respectively. In conclusion, trichuriasis and toxoplasmosis may have distinct negative and positive associations respectively with the increase of host susceptibility to TB.

Human placental PPAR-γ and SOX-2 expression in serologically proved toxoplasmosis

To explore PPAR-γ and SOX-2 transcription factors expression in placenta according to maternal anti-Toxoplasma gondii serological profile during pregnancy and pregnancy outcome. The study included 240 placentas, grouped according to IgM and IgG serostatus and then subgrouped according to pregnancy outcome that varied between miscarriages, premature labour, stillbirth and giving birth to CNS anomaly or apparently healthy neonates. Samples were H&E stained and histopathologically scored blindly. PPAR-γ expression was measured by ELISA, while SOX-2-positive nuclei were stained immunohistochemically to be calculated by ImageJ. The mean pathological score was significantly higher in IgM+ve and IgG rising than IgG-ve and persistent low groups. Former groups showed significantly higher PPAR-γ (mean = 258.63, 227.11). However, PPAR-γ was higher in apparently healthy neonate subgroups. SOX-2 was significantly lower in IgM+ve and IgG rising groups (mean = 12.87, 43.13) and associated with obvious fibrosis. SOX-2 lowest count was in CNS anomaly subgroup. PPAR-γ and SOX-2 changes may give clues of how Toxoplasma induces pathogenesis during vertical transmission. Triggering PPAR-γ expression may be a tool to downregulate the inflammatory response and establish a metabolically permissive cellular environment for Toxoplasma persistence. Low SOX-2 is suspected to disturb placental mesenchymal stem cells pluripotency and neuroectoderm development.