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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.
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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
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Toxoplasma gondii in humans and animals in Japan: An epidemiological overview. Parasitol Int 2021; 87:102533. [PMID: 34968753 DOI: 10.1016/j.parint.2021.102533] [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: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
Toxoplasmosis is a cosmopolitan protozoan zoonosis caused by Toxoplasma gondii infamous for inducing severe clinical manifestations in humans. Although the disease affects at least one billion people worldwide, it is neglected in many countries including developed ones. In literature, the epidemiological data documenting the actual incidence of the disease in humans and domestic animals from Japan are limited and importantly many earlier papers on T. gondii infections were published in Japanese and a considerable part is not available online. Herein, we review the current summary about the epidemiological situation of T. gondii infection in Japan and the potential associated risk factors in humans and animals as well as the different T. gondii genotypes isolated in Japan. Several T. gondii isolates have been identified among cats (TgCatJpTy1/k-3, TgCatJpGi1/TaJ, TgCatJpObi1 and TgCatJpOk1-4) and goats (TgGoatJpOk1-13). This literature review underscores the need for a nationwide investigation of T. gondii infection in Japanese people and assessment of the socioeconomic impact of the disease burden. Furthermore, epidemiological studies in domestic and wild animals and estimation of degree of contamination of soil or water with T. gondii oocysts are needed, for a better understanding of the scope of this public health concern.
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Omori K, Imoto N, Norose K, Maeda M, Hikosaka K, Kurahashi S. Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia: A case report and literature review. Medicine (Baltimore) 2021; 100:e28430. [PMID: 34941194 PMCID: PMC8702251 DOI: 10.1097/md.0000000000028430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pulmonary toxoplasmosis (PT) is an infectious disease that can be fatal if reactivation occurs in the recipients of hematopoietic stem cell transplantation (HSCT) who were previously infected with Toxoplasma gondii. However, whether the toxoplasmosis reactivation is an actual risk factor for patients receiving immunosuppressive therapies without HSCT remains unclear. Therefore, reactivated PT is not typically considered as a differential diagnosis for pneumonia other than in patients with HSCT or human immunodeficiency virus (HIV). PATIENT CONCERNS A 77-year-old man presented with fever and nonproductive cough for several days. He was hospitalized due to atypical pneumonia that worsened immediately despite antibiotic therapy. Before 4 months, he was diagnosed with immune thrombocytopenia (ITP) and received corticosteroid therapy. Trimethoprim-sulfamethoxazole (ST) was administered to prevent pneumocystis pneumonia resulting from corticosteroid therapy. DIAGNOSIS The serological and culture test results were negative for all pathogens except T. gondii immunoglobulin G antibody. Polymerase chain reaction, which can detect T. gondii from frozen bronchoalveolar lavage fluid, showed positive results. Therefore, he was diagnosed with PT. INTERVENTION ST, clindamycin, and azithromycin were administered. Pyrimethamine and sulfadiazine could not be administered because his general condition significantly worsened at the time of polymerase chain reaction (PCR) examination. OUTCOMES The patient died of acute respiratory distress syndrome despite anti-T. gondii treatment. An autopsy revealed a severe organizing pneumonia and a small area of bronchopneumonia. LESSONS PT should be considered as a differential diagnosis in patients with pneumonia, particularly in seropositive patients who receive immunosuppressive therapies even for other than HSCT or HIV.
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Affiliation(s)
- Koji Omori
- Department of Gastroenterology, Toyohashi Municipal Hospital, Aichi, Japan
| | - Naoto Imoto
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Aichi, Japan
| | - Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Matsuyoshi Maeda
- Department of Pathology, Toyohashi Municipal Hospital, Aichi, Japan
| | - Kenji Hikosaka
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Kurahashi
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Aichi, Japan
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Lund BM, Scott DGI. Toxoplasmosis and treatment for rheumatic diseases: what are the risks? Rheumatology (Oxford) 2021; 60:5-7. [PMID: 33211883 DOI: 10.1093/rheumatology/keaa614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/06/2020] [Accepted: 08/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barbara M Lund
- Microbes in the Food Chain, Quadram Institute Biosciences
| | - David G I Scott
- Norwich Medical School, University of East Anglia, Norwich, UK
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Graham AK, Fong C, Naqvi A, Lu JQ. Toxoplasmosis of the central nervous system: Manifestations vary with immune responses. J Neurol Sci 2020; 420:117223. [PMID: 33213861 DOI: 10.1016/j.jns.2020.117223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022]
Abstract
Toxoplasmosis is an opportunistic infection caused by Toxoplasma gondii (TG), which affects one third of the global human population and commonly involves the central nervous system (CNS)/brain despite the so-called CNS immune privilege. Symptomatic clinical disease of TG infection is much more commonly associated with immunodeficiency; clinicopathological manifestations of CNS toxoplasmosis are linked to individual immune responses including the CNS infiltration of T-cells that are thought to prevent the disease. In patients with autoimmune diseases, immune status is complicated mainly byimmunosuppressant and/or immunomodulatory treatment but typically accompanied by infiltration of T-cells that supposedly fight against toxoplasmosis. In this article, we review characteristics of CNS toxoplasmosis comparatively in immunocompromised patients, immunocompetent patients, and patients with coexisting autoimmune diseases, as well as CNS immune responses to toxoplasmosis with a representative case to demonstrate brain lesions at different stages. In addition to general understanding of CNS toxoplasmosis, our review reveals that clinical manifestations of CNS toxoplasmosis are commonly nonspecific, and incidental pathological findings of TG infection are relatively common in immunocompetent patients and patients with autoimmune diseases (compared to immunocompromised patients); CNS immune responses such as T-cell infiltrates vary in acute and chronic lesions of brain toxoplasmosis.
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Affiliation(s)
- Alice K Graham
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
| | - Crystal Fong
- Neuroradiology Division, Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Asghar Naqvi
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada; Neuropathology Section, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.
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Ferreira AIC, Brandão de Mattos CC, Frederico FB, Bernardo CR, de Almeida Junior GC, Siqueira RC, Meira-Strejevitch CS, Pereira-Chioccola VL, de Mattos LC. Duffy blood group system and ocular toxoplasmosis. INFECTION GENETICS AND EVOLUTION 2020; 85:104430. [PMID: 32565360 DOI: 10.1016/j.meegid.2020.104430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Duffy blood group phenotypes [Fy(a + b-), Fy(a-b+), Fy(a + b+), Fy(a-b-)], characterized by the expression of Fya, and Fyb antigens, are present in red blood cells. Therefore, we hypothesize that the non-hematopoietic expression of these antigens might influence cell invasion by T. gondii. 576 consecutive patients from both genders were enrolled. The presumed OT clinical diagnosis was performed. Duffy phenotyping was performed by hemagglutination in gel columns and for the correct molecular characterization Fy(a-b-) phenotype, using PCR-RFLP. Anti-T. gondii IgG antibodies were detected by ELISA. Chi-square, Fisher's exact tests were used to compare the proportions. OT was present in 22.9% (n = 132) and absent in 77.1% (n = 444) of patients. The frequencies of anti-T. gondii IgG antibodies were higher in OT (127/132, 96.2%) than those without this disease (321/444, 72.3%) (p < .0001). None of the Duffy antigens or phenotypes were associated with T. gondii infection (χ2: 2.222, GL: 3, p = .5276) as well as the risk of OT (χ2: 0.771, GL: 3, p = .8566). Duffy blood group system phenotypes and their antigens do not constitute risk factors for infection by T. gondii infection and the development of OT.
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Affiliation(s)
- Ana Iara Costa Ferreira
- Universidade Federal de Roraima. Brazil; Faculdade de Medicina de São Jose do Rio Preto, SP, Brazil
| | | | - Fábio Batista Frederico
- Ophthalmology Outpatient Clinic of Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
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