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Abstract
BACKGROUND Amazonian toxoplasmosis is a recently described form of Toxoplasma gondii infection, characterized by severe clinical and biological features and involvement of atypical genetic strains circulating through a forest-based cycle. Though mostly reported in French Guiana since 1998, this disease is probably under-diagnosed in other areas of South America. Few data are available on its specific features in children. METHODS We retrospectively included all children seen in Cayenne between 2002 and 2017, diagnosed with acute toxoplasmosis due to an atypical strain. Clinical and biological features and risk factors of Amazonian toxoplasmosis were recorded. RESULTS Eleven children met the inclusion criteria. The main clinical features were fever, lymphadenopathy, hepatomegaly and splenomegaly, as reported in adults. Less expected signs such as rhinorrhea, pharyngitis and maculopapular rash were also frequent. Cutaneous signs were associated with the involvement of a genetically atypical strain. Respiratory involvement was rare but associated with respiratory distress. Outcome was always favorable. Treatment by pyrimethamine/sulfadiazine or trimethoprim/sulfamethoxazole was always justified, efficient and well tolerated. Genetic analysis suggested the involvement of wild mammals in disease transmission, and strain-dependent virulence as one of the prognostic risk factors. CONCLUSIONS As in adults, pediatric Amazonian toxoplasmosis requires a systematic treatment. Symptoms such as skin rash, rhinorrhea and pharyngitis should not be mistaken for viral infections, when associated with lymphadenopathy or fever. Pediatricians working in South America should be familiar with these clinical presentations and with the different risk factors of Amazonian toxoplasmosis.
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Pustorino G, Ferlazzo E, Carpentieri MS, Cianci V, Gasparini S, Campello M, Milardi GL, Gangemi A, Aguglia U. Cerebral toxoplasmosis diagnosed by brain tissue PCR analysis in an immunocompetent patient. Neurol Clin Pract 2017; 7:436-438. [PMID: 29620083 DOI: 10.1212/cpj.0000000000000364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/04/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Giuseppe Pustorino
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Edoardo Ferlazzo
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Maria Stella Carpentieri
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Vittoria Cianci
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Sara Gasparini
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Mauro Campello
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Giovanni Luigi Milardi
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Antonio Gangemi
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
| | - Umberto Aguglia
- "Magna Græcia" University of Catanzaro (GP, EF, SG, UA); "Bianchi-Melacrino-Morelli" Hospital (EF, MSC, VC, SG, MC, AG, UA), Reggio Calabria; and "Sapienza" University (GLM), Rome, Italy
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Beltrame A, Venturini S, Crichiutti G, Meroni V, Buonfrate D, Bassetti M. Recurrent seizures during acute acquired toxoplasmosis in an immunocompetent traveller returning from Africa. Infection 2015; 44:259-62. [PMID: 26168861 DOI: 10.1007/s15010-015-0821-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/30/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We report an unusual case of acute acquired toxoplasmosis (AAT) presenting as lymphadenopathy and recurrent seizures in an immunocompetent 15-year-old boy. MATERIALS AND METHODS The patient reported an 18-day vacation to Africa (Ethiopia), 39 days prior to the first seizure. Electroencephalogram (EEG) showed sporadic single-spike or sharp-wave paroxysms and the magnetic resonance imaging (RMI) of the brain was negative. The serology for T. gondii was compatible with an acute infection defined as positive for both toxoplasma-specific IgG and IgM and a low avidity (6 %), confirmed by a reference laboratory. The patient reported other two episodes of seizures, occurring 7 days apart. He was treated with pyrimethamine plus sulfadiazine and leucovorin for 4 weeks, with an improvement of lymphadenitis and normalization of EEG. After 5 months, new seizures were reported and a diagnosis of epilepsy was done. Toxoplasma polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and blood were negative. A treatment with valproic acid was started, obtaining control of the neurological disease. CONCLUSION Awareness of this neurologic manifestation by clinicians is required, also in immunocompetent patients. The relationship between toxoplasmosis and recurrent seizure needs to be investigated by new studies.
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Affiliation(s)
- Anna Beltrame
- Centre for Tropical Diseases, Sacro Cuore Hospital, via Sempreboni 5, 37024, Negrar, Italy. .,Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.
| | - Sergio Venturini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Giovanni Crichiutti
- Department of Paediatrics, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
| | - Valeria Meroni
- Department of Internal Medicine and Therapeutics, Microbiology and Virology Department Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, via Sempreboni 5, 37024, Negrar, Italy
| | - Matteo Bassetti
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy
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