1
|
Khalid S, Memon SF, Jumani L, Memon SA, Siddiqui MS. Neurotoxoplasmosis in the Immunocompetent: A Rare Occurrence. Cureus 2023; 15:e36782. [PMID: 37123766 PMCID: PMC10134001 DOI: 10.7759/cureus.36782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Cerebral toxoplasmosis is a rare condition that predominantly affects immunocompromised people and is relatively uncommon in immunocompetent individuals. Acute toxoplasmosis primarily presents with focal and diffuse neurological signs and symptoms depending on the site of the lesion, the degree of local damage, and the severity of inflammation. In this report, we present a case of cerebral toxoplasmosis in an immunocompetent adult female who presented with an altered level of consciousness, fever, headache, and shortness of breath. This case highlights the diagnostic challenges that may arise when dealing with patients who have a wide range of clinical manifestations.
Collapse
|
2
|
Patil A, Lu J, Kassir M, Babaei M, Goldust M. Adult and juvenile dermatomyositis treatment. J Cosmet Dermatol 2023; 22:395-401. [PMID: 36065712 DOI: 10.1111/jocd.15363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dermatomyositis is a rare autoimmune inflammatory condition affecting skin and muscles. The disease can be seen in both adults and children. It can be associated with malignancy. Considering involvement of skin in the disease, many patients consult dermatologists for its treatment. Hence, knowledge about its presentation, complications, prognosis, and treatment is necessary. OBJECTIVE The objective of this review article is to provide comprehensive information about treatment of dermatomyositis. METHODS In this review article, we reviewed the published literature on adult and juvenile dermatomyositis to highlight the treatment. Articles published in peer-reviewed journals including reviews, clinical trials, case series, and case reports published in electronic database (MEDLINE/PubMed) through January 2021, cross references of respective articles and trials from clinicaltrials.gov were included for qualitative analysis of the literature. RESULTS Treatment options for dermatomyositis include traditional immunosuppressive agents and immunomodulatory therapy. High-dose corticosteroids represent the first line of treatment while other immunosuppressive agents are also used, either in combination with or as an alternative to corticosteroids, after initial treatment failure. Some biological agents have been used for the treatment of dermatomyositis with variable responses. CONCLUSION Although several treatment options are available, several questions remain unanswered about the optimal treatment of dermatomyositis.
Collapse
Affiliation(s)
- Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Jun Lu
- UConn Health Department of Dermatology, Farmington, Connecticut, USA
| | | | - Mahsa Babaei
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
3
|
Durieux MF, Lopez JG, Banjari M, Passebosc-Faure K, Brenier-Pinchart MP, Paris L, Gargala G, Berthier S, Bonhomme J, Chemla C, Villena I, Flori P, Fréalle E, L’Ollivier C, Lussac-Sorton F, Montoya JG, Cateau E, Pomares C, Simon L, Quinio D, Robert-Gangneux F, Yera H, Labriffe M, Fauchais AL, Dardé ML. Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review. PLoS Negl Trop Dis 2022; 16:e0010691. [PMID: 35939518 PMCID: PMC9387931 DOI: 10.1371/journal.pntd.0010691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/18/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients.
Methods
A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted.
Results
61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases.
Conclusion
Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment.
Collapse
Affiliation(s)
- Marie-Fleur Durieux
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
- * E-mail:
| | - Jean-Guillaume Lopez
- Department of internal medicine, Dupuytren University Hospital, Limoges Cedex, France
| | - Maher Banjari
- Department of internal medicine faculty of medicine -Rabigh Campus- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Karine Passebosc-Faure
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
| | | | - Luc Paris
- Parasitology laboratory, AP-HP Pitié-Salpêtrière, Paris, France
| | - Gilles Gargala
- Parasitology laboratory, University hospital of Rouen, Rouen, France
| | - Sabine Berthier
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Julie Bonhomme
- Microbiology laboratory, University hospital of Caen, Caen, France
| | - Cathy Chemla
- Parasitology Laboratory, EA 7510, Reims Champagne Ardenne University, National Reference Centre on Toxoplasmosis CHU Reims, Reims, France
| | - Isabelle Villena
- Parasitology Laboratory, EA 7510, Reims Champagne Ardenne University, National Reference Centre on Toxoplasmosis CHU Reims, Reims, France
| | - Pierre Flori
- Parasitology laboratory, Hospital of Saint-Étienne, Saint-Étienne, France
| | - Emilie Fréalle
- Parasitology laboratory, University hospital of Lille, Lille, France
| | | | | | - José Gilberto Montoya
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto, California, United States of America
| | - Estelle Cateau
- Parasitology laboratory, University hospital of Poitiers, Poitiers, France
| | - Christelle Pomares
- Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, University hospital of Nice, Nice, France
| | - Loïc Simon
- Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, University hospital of Nice, Nice, France
| | - Dorothée Quinio
- Parasitology laboratory, University hospital of Brest, Brest, France
| | | | - Hélène Yera
- Parasitology laboratory, AP-HP Cochin, Paris, France
| | - Marc Labriffe
- Pharmacology & Transplantation, INSERM U1248, Université de Limoges, Limoges, France
| | - Anne-Laure Fauchais
- Department of internal medicine, Dupuytren University Hospital, Limoges Cedex, France
| | - Marie-Laure Dardé
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
| |
Collapse
|