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Lasica R, Djukanovic L, Savic L, Krljanac G, Zdravkovic M, Ristic M, Lasica A, Asanin M, Ristic A. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Diagnostics (Basel) 2023; 13:3073. [PMID: 37835816 PMCID: PMC10572782 DOI: 10.3390/diagnostics13193073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marko Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | | | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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Xie L, Xing Y, Yang J, Liu M, Cai Y. Toxoplasma gondii Reactivation Aggravating Cardiac Function Impairment in Mice. Pathogens 2023; 12:1025. [PMID: 37623985 PMCID: PMC10458591 DOI: 10.3390/pathogens12081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Toxoplasma gondii (T. gondii) reactivation is common, especially among immunocompromised individuals, such as AIDS patients. The cardiac involvement associated with toxoplasmosis, however, is usually obscured by neurological deterioration. The aim of this study was to observe the alterations in cardiac functions in various landmark periods after infection and to assess whether reactivation more seriously damages the heart. METHODS We established three infection models in mice using TgCtwh6, a major strain of T. gondii prevalent in China. The groups included an acute group, chronic latent group, and reactivation group. We evaluated the cardiac function impairment via H & E staining, Masson staining, echocardiography, myocardial enzyme profiles, and cardiac troponin, and detected the expression of inflammatory factors and antioxidant factors with Western blotting. Immunofluorescence was used to detect the expression of the macrophage marker F4/80. RESULTS Our results showed that damage to the heart occurred in the acute and reactivation groups. Impaired cardiac function manifested as a decrease in heart rate and a compensatory increase in left ventricular systolic function. Serum levels of cardiac enzymes also increased dramatically. In the chronic phase, myocardial fibrosis developed, diastolic functions became severely impaired, inflammation persisted, and macrophage expression was slightly reduced. Ultimately, reactivation infection exacerbated damage to cardiac function in mice, potentially leading to diastolic heart failure. Macrophages were strongly activated, and myocardial fibrosis was increased. In addition, the antioxidant capacity of the heart was severely affected by the infection. CONCLUSIONS Taken together, these results suggested that the reactivation of T. gondii infection could aggravate injury to the heart, which could be associated with a host-cell-mediated immune response and strong cytokine production by macrophages, thus representing a novel insight into the pathogenic mechanism of toxoplasmosis.
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Affiliation(s)
- Linding Xie
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Microbiology and Parasitology, the Provincial Laboratory of Pathogen Biology of Anhui, and the Key Laboratory of Zoonoses of Anhui, Anhui Medical University, Hefei 230032, China
| | - Yien Xing
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Microbiology and Parasitology, the Provincial Laboratory of Pathogen Biology of Anhui, and the Key Laboratory of Zoonoses of Anhui, Anhui Medical University, Hefei 230032, China
| | - Jun Yang
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Microbiology and Parasitology, the Provincial Laboratory of Pathogen Biology of Anhui, and the Key Laboratory of Zoonoses of Anhui, Anhui Medical University, Hefei 230032, China
| | - Min Liu
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Microbiology and Parasitology, the Provincial Laboratory of Pathogen Biology of Anhui, and the Key Laboratory of Zoonoses of Anhui, Anhui Medical University, Hefei 230032, China
| | - Yihong Cai
- Department of Health Inspection and Quarantine, School of Public Health, Anhui Medical University, Hefei 230032, China
- Department of Microbiology and Parasitology, the Provincial Laboratory of Pathogen Biology of Anhui, and the Key Laboratory of Zoonoses of Anhui, Anhui Medical University, Hefei 230032, China
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Dragomir A, Lupu MA, Lighezan R, Paduraru AA, Olariu TR. Toxoplasma gondii Infection in Patients with Cardiovascular Diseases from Western Romania: A Case-Control Study. Life (Basel) 2023; 13:1575. [PMID: 37511950 PMCID: PMC10382031 DOI: 10.3390/life13071575] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Toxoplasma gondii infects approximately one third of the world's human population. The seroepidemiology of T. gondii in cardiovascular patients is poorly discussed in the existing literature. We aimed to evaluate, for the first time, the seroprevalence of T. gondii in cardiovascular patients from Western Romania. (2) Methods: Serologic testing to demonstrate the presence of T. gondii antibodies was conducted in 256 patients with cardiovascular diseases and 261 matched blood donors. (3) Results: The overall seroprevalence of T. gondii antibodies was 64.06% in patients with cardiovascular diseases and 52.88% in blood donors and tended to increase with age in both groups. The seroprevalence of T. gondii antibodies was significantly higher in cardiovascular male patients (69.94%) compared to male blood donors (55.69%) (p = 0.006). When compared to the control group, a significantly higher prevalence of T. gondii antibodies was found among patients with hypertension (82.35%; p = 0.01) and unstable angina (67.56%; p = 0.02). (4) Conclusions: This study brings new epidemiological information on the prevalence of T. gondii in Romanian cardiovascular patients. T. gondii seroprevalence was significantly higher in patients with hypertension and unstable angina, suggesting that individuals with these diagnoses may be more frequently infected with T. gondii. This study may be a valuable starting point for further research to better evaluate the impact of T. gondii exposure on patients with cardiovascular diseases.
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Affiliation(s)
- Angela Dragomir
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Laboratory, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria Alina Lupu
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Clinical Laboratory, Institute of Cardiovascular Diseases, 300310 Timisoara, Romania
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
| | - Rodica Lighezan
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Regional Blood Transfusion Center, 300737 Timisoara, Romania
| | - Ana Alexandra Paduraru
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
| | - Tudor Rares Olariu
- Discipline of Parasitology, Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Diagnosis and Study of Parasitic Diseases, Department of Infectious Disease, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Patogen Preventia, 300124 Timisoara, Romania
- Clinical Laboratory, Municipal Clinical Emergency Teaching Hospital, 300254 Timisoara, Romania
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Stage-Specific Oligonucleotide Primers for the Diagnosis of Toxoplasmosis Among Iranian Pediatric Heart Transplant Recipients; Evaluation of Cotrimoxazole as a Preventive Therapy. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.111940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Toxoplasmosis is an opportunistic infection that affects solid organ transplant (SOT) recipients. The parasite transmission may be occurred from a Toxoplasma-seropositive donor to a Toxoplasma-seronegative recipient by organ transplantation. Objectives: In this study, a nested PCR was carried out using different primers targeting the B1, SAG4, and MAG1 genes to assess Toxoplasma infection in pediatric heart transplantation at Shahid Rajaei Heart Center in Tehran. Methods: Blood samples were collected from 46 pediatric heart transplant patients aged 1 - 17 years referring to Rajaei Cardiovascular and Medical Research Center from 2018 - 2019. All patients were on oral administration of Trimethoprim-sulfamethoxazole (cotrimoxazole). Blood samples were collected, and peripheral blood mononuclear cell (PBMC) isolation using the Ficoll gradient method was performed. DNA was extracted from PBMC, and nested PCR was carried out. Serologic tests were performed using ELISA to determine IgG and IgM anti - Toxoplasma gondii antibodies. Results: The results of serologic tests showed that all 46 patients had negative anti-T. gondii IgM antibody. Furthermore, 6 (13.05%) and 3 (6.5 %) out of the 46 patients were positive for IgG T. gondii antibody before and after transplantation, respectively. All 46 patients were evaluated using PCR using B1, MAG-1, and SAG-4 genes, and PCR results were negative. Conclusions: In general, due to the negative results of Toxoplasma with PCR using B1 and bradyzoite-specific genes (SAG-4 and MAG-1), it is possible that the results obtained in this study are because of prophylaxis with cotrimoxazole.
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Orang E, Sayyahfar S, Mahdavi M, Khanaliha K, Amiri M. Comparison of serologic status of Toxoplasma gondii infection in pre- and post-heart transplantation in a pediatric population: A preliminary study. Transpl Infect Dis 2020; 22:e13339. [PMID: 32445414 DOI: 10.1111/tid.13339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/18/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Toxoplasmosis is an important opportunistic infection in immunocompromised children, especially in heart transplant recipients. This study aimed to investigate pre- and post-transplant serology for toxoplasmosis along with post-transplant PCR in pediatric heart transplant patients. METHODS This cross-sectional study was performed on 38 heart transplant recipients aged 1-17 years, by the end of 2018. Pre- and post-transplant IgM and IgG titrations were measured using ELISA method. Nested PCR of B1 gene was performed to identify Toxoplasma gondii (T gondii) infection after transplant. RESULTS Totally, 11.4% of patients had positive IgG and 91.4% had negative IgM for toxoplasmosis before heart transplantation. The mean of pre-transplant IgG titration for seropositive and seronegative patients was 22.32 ± 15.30 IU/mL and 1.49 ± 1.15 IU/mL, respectively (P < .001). All cases were on chemoprophylaxis with trimethoprim-sulfamethoxazole (TMP/SMX). The mean of post-transplant IgG titration was 1.62 ± 1.87 IU/mL, which was negative for all cases. Investigating pre-transplant, IgM titration, 5.7% were positive, 91.4% were negative, and 2.9% were borderline. All cases were post-transplant IgM negative. The mean of post-transplant IgG titrations was significantly higher in the first 6 months (3.26 ± 2.68 IU/mL) compared to 6-12 (1.30 ± 1.34 IU/mL; P = .039) and > 12 months (1.07 ± 1.27 IU/mL; P = .004) time periods. The result of PCR for B1 gene in all cases was negative. CONCLUSIONS Chemoprophylaxis with TMP/SMX seems to be effective in prevention of T gondii infection or reactivation among pediatric heart transplantation population. Anti-T. gondii-IgG level alone may not be sensitive enough for evaluation of the infection at least after 6 months post-transplantation.
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Affiliation(s)
- Elahe Orang
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Sayyahfar
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mehri Amiri
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Conway J, Ballweg JA, Fenton M, Kindel S, Chrisant M, Weintraub RG, Danziger-Isakov L, Kirk R, Meira O, Davies RR, Dipchand AI. Review of the impact of donor characteristics on pediatric heart transplant outcomes. Pediatr Transplant 2020; 24:e13680. [PMID: 32198824 DOI: 10.1111/petr.13680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
Heart transplantation (HTx) is a treatment option for end-stage heart failure in children. HTx is limited by the availability and acceptability of donor hearts. Refusal of donor hearts has been reported to be common with reasons for refusal including preexisting donor characteristics. This review will focus on the impact of donor characteristics and comorbidities on outcomes following pediatric HTx. A literature review was performed to identify articles on donor characteristics and comorbidities and pediatric HTx outcomes. There are many donor characteristics to consider when accepting a donor heart. Weight-based matching is the most common form of matching in pediatric HTx with a donor-recipient weight ratio between 0.7 and 3 having limited impact on outcomes. From an age perspective, donors <50 years can be carefully considered, but the impact of ischemic time needs to be understood. To increase the donor pool, with minimal impact on outcomes, ABO-incompatible donors should be considered in patients that are eligible. Other factors to be considered when accepting an organ is donor comorbidities. Little is known about donor comorbidities in pediatric HTx, with most of the data available focusing on infections. Being aware of the potential infections in the donor, understanding the testing available and risks of transmission, and treatment options for the recipient is essential. There are a number of donor characteristics that potentially impact outcomes following pediatric HTx, but these need to be taken into consideration along with their interactions with recipient factors when interpreting the outcomes following HTx.
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Affiliation(s)
- Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jean A Ballweg
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, UK
| | - Steve Kindel
- Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Maryanne Chrisant
- The Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Robert G Weintraub
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic, Australia.,Department of Cardiology, The Royal Children's Hospital, Melbourne Heart Research Group, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Meira
- Department of Congenital Heart Disease/Pediatric Cardiology, Berlin, Germany
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Toxoplasmosis in the non-orthotopic heart transplant recipient population, how common is it? Any indication for prophylaxis? Curr Opin Organ Transplant 2019; 23:407-416. [PMID: 29878911 DOI: 10.1097/mot.0000000000000550] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Unlike in orthotopic heart transplant (OHT) setting where toxoplasma prophylaxis is a standard practice in pretransplant toxoplasma seronegative recipients who have received donor hearts from seropositive donors (D+/R-), there is no consensus regarding prophylaxis in non-OHT recipients. RECENT FINDINGS The incidence of toxoplasma disease in non-OHT recipients is less than 1% but its true burden is underestimated. Among 31 cases of toxoplasma disease reported from 2004 through 2017, renal and liver transplant recipients comprised of 90% of cases. A total of 94% of 18 recipients with known pretransplant serology were seronegative recipients (mostly D+/R-). Out of 16 recipients with adequate information, 10 (63%) and five (31%) were deemed to be donor derived and nondonor-derived primary toxoplasmosis respectively. Tissue invasive reactivation was uncommon. Almost all cases were described in patients not on prophylaxis at the time of presentation. Universal screening of donor/recipient toxoplasma serology for risk stratification is beneficial as illustrated by reports of fatal cases of toxoplasmosis due to unavailability of positive donor serology results. SUMMARY Toxoplasma disease in non-OHT predominantly occurs in pretransplant seronegative recipients- mostly in D+/R- group and is rare in seropositive recipients. Posttransplant prophylaxis should be targeted against the high-risk D+/R- group and should be considered in seropositive recipients in whom unusually high immunosuppression is implemented. Toxoplasma serologies and PCR should be used in combination for the diagnosis of toxoplasmosis in non-OHT patients.
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Rajapakse S, Weeratunga P, Rodrigo C, de Silva NL, Fernando SD. Prophylaxis of human toxoplasmosis: a systematic review. Pathog Glob Health 2017; 111:333-342. [PMID: 28948861 DOI: 10.1080/20477724.2017.1370528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Toxoplasmosis is an infection caused by the intracellular protozoan parasite Toxoplasma gondii, and is associated with clinically significant infection in immunocompromised individuals. Vertical transmission during pregnancy can manifest as congenital toxoplasmosis in the neonate, and can have serious consequences. This review aims to describe the modalities for prophylaxis of toxoplasmosis in susceptible populations, and focuses on the following: (1) prophylaxis of congenital toxoplasmosis; (2) prophylaxis of toxoplasmosis in patients with HIV/AIDS; and (3) prophylaxis of toxoplasmosis in transplant recipients.
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Affiliation(s)
- Senaka Rajapakse
- a University Medical Unit, National Hospital Colombo , Colombo , Sri Lanka.,b Faculty of Medicine, Department of Clinical Medicine , University of Colombo , Colombo , Sri Lanka
| | - Praveen Weeratunga
- a University Medical Unit, National Hospital Colombo , Colombo , Sri Lanka.,b Faculty of Medicine, Department of Clinical Medicine , University of Colombo , Colombo , Sri Lanka
| | - Chaturaka Rodrigo
- b Faculty of Medicine, Department of Clinical Medicine , University of Colombo , Colombo , Sri Lanka.,c Department of Pathology, School of Medical Sciences , University of New South Wales , Sydney , Australia
| | - Nipun Lakshitha de Silva
- a University Medical Unit, National Hospital Colombo , Colombo , Sri Lanka.,d Faculty of Medicine, Department of Medicine , General Sir John Kotelawala Defence University , Rathmalana , Sri Lanka
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McEachern W, Godown J, Dodd DA, Dipchand AI, Conway JL, Wilson GJ, Hoffman RD. Sudden death in a pediatric heart transplant recipient with peripheral eosinophilia and eosinophilic myocardial infiltrates. Pediatr Transplant 2017; 21. [PMID: 28504342 DOI: 10.1111/petr.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
Eosinophilia has been rarely reported in pediatric heart transplant recipients and has been suggested to play a role in graft rejection. We report a case of a young female patient with peripheral blood eosinophilia who died suddenly 2 years following ABO-incompatible heart transplantation. She was found at autopsy to have myocardial infiltration of not only T-lymphocytes and macrophages expected in acute cellular rejection but also of eosinophils, B-lymphocytes, and plasma cells indicating myocarditis.
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Affiliation(s)
- William McEachern
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Anne I Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer L Conway
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Gregory J Wilson
- Division of Pathology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert D Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Evans NA, Walker JM, Manchester AC, Bach JF. Acute respiratory distress syndrome and septic shock in a cat with disseminated toxoplasmosis. J Vet Emerg Crit Care (San Antonio) 2017; 27:472-478. [DOI: 10.1111/vec.12621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/14/2015] [Accepted: 08/27/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Natashia A. Evans
- Department of Medical Sciences, School of Veterinary Medicine; University of Wisconsin; Madison WI 53706
| | - Julie M. Walker
- Department of Medical Sciences, School of Veterinary Medicine; University of Wisconsin; Madison WI 53706
| | - Alison C. Manchester
- Department of Medical Sciences, School of Veterinary Medicine; University of Wisconsin; Madison WI 53706
| | - Jonathan F. Bach
- Department of Medical Sciences, School of Veterinary Medicine; University of Wisconsin; Madison WI 53706
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Alvarado-Esquivel C, Salcedo-Jaquez M, Sanchez-Anguiano LF, Hernandez-Tinoco J, Rabago-Sanchez E, Beristain-Garcia I, Liesenfeld O, Estrada-Martinez S, Perez-Alamos AR, Alvarado-Soto E. Association Between Toxoplasma gondii Exposure and Heart Disease: A Case-Control Study. J Clin Med Res 2016; 8:402-9. [PMID: 27081427 PMCID: PMC4817581 DOI: 10.14740/jocmr2525w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 11/11/2022] Open
Abstract
Background The parasite Toxoplasma gondii causes infections all around the world. Infections with T. gondii are systemic and the parasite can persist in the heart muscle. Very little is known about the impact of T. gondii on patients with heart disease. We determined the association between T. gondii exposure and patients suffering from heart diseases attending in a public hospital in Durango, Mexico; the association of T. gondii exposure with socio-demographic, behavioral, and clinical characteristics of these patients was also investigated. Methods Through a case-control study, we examined the seroprevalence of anti-T. gondii IgG and IgM antibodies in 400 patients with heart diseases and 400 age- and gender-matched controls using enzyme-linked immunoassays. In addition, we analyzed the association of patient characteristics as determined by a standardized questionnaire with T. gondii exposure by bivariate and multivariate analyses. Results Fifty-five (13.8%) of 400 patients and 32 (8.0%) of 400 controls had anti-T. gondii IgG antibodies (odds ratio (OR) = 1.83; 95% confidence interval (CI): 1.15 - 2.90; P = 0.01). High anti-T. gondii IgG levels (> 150 IU/mL) were found in 28 (50.9%) of the 55 positive cases and in 14 (43.8%) of the 32 positive controls (P = 0.51). Anti-T. gondii IgM antibodies were found in 13 (23.6%) of the 55 anti-T. gondii IgG positive patients and in 19 (59.4%) of 32 anti-T. gondii IgG positive controls (OR = 0.21; 95% CI: 0.08 - 0.54; P = 0.0008). Multivariate analysis showed that T. gondii exposure was positively associated with being born out of Durango State (OR = 2.93; 95% CI: 1.40 - 6.13; P = 0.004), and with consumption of alcohol (OR = 2.04; 95% CI: 1.01 - 4.12; P = 0.04). Conclusions Results obtained in this study indicate that T. gondii infection is associated with heart disease, and suggest that heart disease might be related with a chronic infection. This is the first report of an association of T. gondii exposure with alcohol consumption in this population. Results warrant for further research to determine the epidemiological impact of T. gondii exposure on patients with heart diseases. Risk factors associated with T. gondii exposure are critical to design future prevention strategies against T. gondii exposure.
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Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Misael Salcedo-Jaquez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Luis Francisco Sanchez-Anguiano
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Jesus Hernandez-Tinoco
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Elizabeth Rabago-Sanchez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico; Hospital General, Servicios de Salud de Durango, Cuauhtemoc 225 norte. 34000 Durango, Mexico
| | - Isabel Beristain-Garcia
- Facultad de Enfermeria y Obstetricia, Juarez University of Durango State, Cuauhtemoc 223 norte, 34000 Durango, Mexico
| | - Oliver Liesenfeld
- Institute for Microbiology and Hygiene, Campus Benjamin Franklin, Charite Medical School, Hindenburgdamm 27, D-12203 Berlin, Germany; Present address: Roche Molecular Diagnostics, Pleasanton, CA, USA
| | - Sergio Estrada-Martinez
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Alma Rosa Perez-Alamos
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juarez University of Durango State, Avenida Universidad S/N, 34000 Durango, Mexico
| | - Ediyair Alvarado-Soto
- Facultad de Enfermeria y Obstetricia, Juarez University of Durango State, Cuauhtemoc 223 norte, 34000 Durango, Mexico
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Alvarado-Esquivel C, Sánchez-Anguiano LF, Mendoza-Larios A, Hernández-Tinoco J, Pérez-Ochoa JF, Antuna-Salcido EI, Rábago-Sánchez E, Liesenfeld O. Prevalence of Toxoplasma gondii infection in brain and heart by Immunohistochemistry in a hospital-based autopsy series in Durango, Mexico. Eur J Microbiol Immunol (Bp) 2015; 5:143-9. [PMID: 26185682 PMCID: PMC4500065 DOI: 10.1556/1886.2015.00014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
The presence of tissue cysts of Toxoplasma gondii has only poorly been investigated in autopsy series. We determined the presence of T. gondii cysts in a series of 51 autopsies in a public hospital using immunohistochemistry of brain and heart tissues. The association of tissue cysts with the general characteristics of the autopsy cases was also investigated. Of the 51 cases studied, five (9.8%) were positive by immunohistochemistry for T. gondii cysts in the brain. None of the heart specimens was positive for T. gondii cysts. The presence of T. gondii cysts in brains did not vary with age, sex, birthplace, residence, education, occupation, or the presence of pathology in the brain. In contrast, multivariate analysis showed that the presence of T. gondii cysts was associated with undernourishment (OR = 33.90; 95% CI: 2.82-406.32; P = 0.005). We demonstrated cerebral T. gondii cysts in an autopsy series in Durango City, Mexico. Results suggest that T. gondii can be more readily found in brain than in heart of infected individuals. This is the first report of an association between the presence of T. gondii in brains and undernourishment.
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Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juárez University of Durango State , Avenida Universidad S/N, 34000 Durango, Mexico
| | - Luis Francisco Sánchez-Anguiano
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juárez University of Durango State , Avenida Universidad S/N, 34000 Durango, Mexico
| | - Alejandra Mendoza-Larios
- Hospital General, Servicios de Salud de Durango , Durango, México, Cuauhtémoc 225 norte, 34000 Durango, Mexico
| | - Jesús Hernández-Tinoco
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juárez University of Durango State , Avenida Universidad S/N, 34000 Durango, Mexico
| | - José Francisco Pérez-Ochoa
- Hospital General, Servicios de Salud de Durango , Durango, México, Cuauhtémoc 225 norte, 34000 Durango, Mexico
| | - Elizabeth Irasema Antuna-Salcido
- Institute for Scientific Research "Dr. Roberto Rivera-Damm", Juárez University of Durango State , Avenida Universidad S/N, 34000 Durango, Mexico
| | - Elizabeth Rábago-Sánchez
- Hospital General, Servicios de Salud de Durango , Durango, México, Cuauhtémoc 225 norte, 34000 Durango, Mexico
| | - Oliver Liesenfeld
- Institute for Microbiology and Hygiene , Campus Benjamin Franklin, Charité Medical School, Hindenburgdamm 27, D-12203 Berlin, Germany
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13
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Toxoplasma gondii exposure in patients suffering from mental and behavioral disorders due to psychoactive substance use. BMC Infect Dis 2015; 15:172. [PMID: 25886154 PMCID: PMC4397680 DOI: 10.1186/s12879-015-0912-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/24/2015] [Indexed: 12/21/2022] Open
Abstract
Background Toxoplasma gondii infection has been associated with psychiatric diseases. However, there is no information about the link between this infection and patients with mental and behavioral disorders due to psychoactive substance use. Methods We performed a case-control study with 149 psychiatric patients suffering from mental and behavioral disorders due to psychoactive substance use and 149 age- and gender-matched control subjects of the general population. We searched for anti-T. gondii IgG and IgM antibodies in the sera of participants by means of commercially available enzyme-linked immunoassays. Seroprevalence association with socio-demographic, clinical and behavioral characteristics in psychiatric patients was also investigated. Results Anti-T. gondii IgG antibodies were present in 15 (10.1%) of 149 cases and in 14 (9.4%) of 149 controls (P = 1.0). Anti-T. gondii IgM antibodies were found in 11 (7.4%) of the 149 cases and in 16 (10.7%) of the 149 controls (P = 0.31). No association of T. gondii exposure with socio-demographic characteristics of patients was found. Multivariate analysis of clinical and behavioral characteristics of cases showed that T. gondii seropositivity was positively associated with consumption of opossum meat (OR = 10.78; 95% CI: 2.16-53.81; P = 0.003) and soil flooring at home (OR = 11.15; 95% CI: 1.58-78.92; P = 0.01), and negatively associated with suicidal ideation (OR = 0.17; 95% CI: 0.05-0.64; P = 0.008). Conclusions Mental and behavioral disorders due to psychoactive substance use do not appear to represent an increased risk for T. gondii exposure. This is the first report of a positive association of T. gondii exposure with consumption of opossum meat. Further studies to elucidate the role of T. gondii infection in suicidal ideation and behavior are needed to develop optimal strategies for the prevention of infection with T. gondii.
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14
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Baliu C, Sanclemente G, Cardona M, Castel MA, Perez-Villa F, Moreno A, Cervera C. Toxoplasmic encephalitis associated with meningitis in a heart transplant recipient. Transpl Infect Dis 2014; 16:631-3. [PMID: 24903646 DOI: 10.1111/tid.12242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/07/2014] [Accepted: 02/18/2014] [Indexed: 11/27/2022]
Abstract
Toxoplasma gondii is an opportunistic pathogen that causes neurologic and extraneurologic manifestations in immunosuppressed patients. Encephalitis and intracranial mass lesions are easily recognized as typical manifestations of toxoplasmosis. However, meningitis caused by T. gondii is a rare condition with very few cases described in the literature. We present the case of a heart transplant recipient who developed toxoplasmic encephalitis associated with meningitis. After an extensive review of the medical literature, we found only 1 case of meningitis in solid organ transplant recipients and <25 cases in immunosuppressed patients, such as patients infected with human immunodeficiency virus or those with Hodgkin's disease. In this report, we consider toxoplasmosis in the differential diagnosis of meningitis in immunocompromised individuals.
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Affiliation(s)
- C Baliu
- Department of Infectious Diseases, Hospital Clinic de Barcelona - University of Barcelona, Barcelona, Spain
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15
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Toxoplasma gondii within skeletal muscle cells: a critical interplay for food-borne parasite transmission. Int J Parasitol 2014; 44:91-8. [DOI: 10.1016/j.ijpara.2013.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/12/2013] [Accepted: 10/03/2013] [Indexed: 01/30/2023]
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16
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Abhilash KPP, Roshine MK, Vandana K, Varghese GM. A probable case of acquired toxoplasmosis presenting as pyrexia of unknown origin in an immunocompetent individual. Int J Infect Dis 2013; 17:e1067-8. [PMID: 23726282 DOI: 10.1016/j.ijid.2013.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 03/27/2013] [Accepted: 03/31/2013] [Indexed: 11/28/2022] Open
Abstract
Disseminated toxoplasmosis presenting as a prolonged febrile illness is rare in immunocompetent individuals. We report a probable case of acquired toxoplasmosis in an immunocompetent woman who presented with fever of 6 months duration with lymphadenopathy and splenomegaly. The diagnosis was confirmed by serology and the presence of Toxoplasma gondii tachyzoites on bone marrow aspirate. The patient was successfully treated with pyrimethamine plus clindamycin.
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Affiliation(s)
- K P P Abhilash
- Department of Medicine 1, Christian Medical College, Vellore 632 004, Tamilnadu, India.
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