Concentric and Eccentric Target MRI Signs in a Case of HIV-Associated Cerebral Toxoplasmosis

Roche, Adam D.; Rowley, Dominic; Brett, Francesca; Looby, Seamus

doi:10.1155/2018/9876514

Cited by 15 publications

(22 citation statements)

References 5 publications

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“…In humans, infection is thought to persist in the body in the chronic, latent form [ 17 ] after primary infection. It is a lifelong condition for humans who are not immunocompromised, contrary to those with autoimmune diseases [ 10 , 18 ], chronic corticosteroid applications [ 19 ], bone-marrow transplants or patients with AIDS [ 20 ]. In these cases the latent form can turn into an active, acute form, with consequences for the brain [ 21 ], eyes, senses and other structures.…”

Section: Discussionmentioning

confidence: 99%

Toxoplasmosis impact on prematurity and low birth weight

et al. 2022

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Background Toxoplasma gondii, one of the most common parasites, causes toxoplasmosis, one of the most frequent zoonotic diseases worldwide. T. gondii infects about one-third of the world’s population. T. gondii infection is generally considered a major risk for spontaneous abortion, prematurity and low birth weight in the animal sphere. Less commonly, a toxoplasma serological profile is correlated with the particular data of delivery. Acute T. gondii infection during pregnancy often leads to spontaneous abortion and/or a severe injury of the eyes, brain, and other structures of the foetus. Latent T. gondii infection of pregnant women could lead to less obvious but important changes during pregnancy, including the end product of pregnancy and the timing of labour. This study aimed to contribute to the current knowledge by comparing serological T. gondii profiles of pregnant women with prematurity and low birth weights of newborns. Material and methods A retrospective study design was adopted. The study participants included a cohort of 1733 pregnant women who consecutively gave birth to their children and underwent regular antenatal biochemical screening between the 14th and 16th weeks of pregnancy. Prematurity was defined as the liveborn preterm delivery in gestational age of pregnancy <37 weeks. Low birth weight was defined as weight at birth of ≤2499 grams. The complement-fixation test (CFT) provided serological profiles for toxoplasmosis that expresses the overall levels of toxoplasma immunoglobulins of all classes. Enzyme-linked immunosorbent assay (ELISA) tests for IgG and IgM were used simultaneously. IgM positivity helped to differentiate acute from the latent stage of toxoplasmosis. Birth data, especially the week of delivery and fetal weight, were evaluated accordingly. Results Of the 1733 pregnant women, 25% were diagnosed as latent toxoplasma positive, and 75% as toxoplasma negative. There were 87 premature deliveries versus 1646 timely births. We observed 88 low birth weights and 1645 normal fetal weights. We found a statistically significant association between latent toxoplasmosis and prematurity, χ2(1) = 5.471, p = .019 and between latent toxoplasmosis and low birth weight of newborns, χ2(1) = 7.663, p = .006. There was a 1.707 times higher risk of prematurity for toxoplasma-positive women, while the risk for low birth weight was 1.861 times higher. The strength of both tests of association was mild. We tested the correlation between the levels of CFT titres and week of delivery and weight of newborns. No association was found between the level of latent toxoplasmosis and the week of delivery and fetal weight. Conclusion Latent toxoplasmosis was associated with premature birth rate and lower birth weight of newborns. The odds of premature delivery was 1.7 and low birth weight 1.9 times higher in women with latent toxoplasmosis compared to toxoplasma negative women. Even though the strength of the association in our large sample is relatively mild, the combination of latent toxoplasmosis with other adverse factors could cause serious harm. Whole CFT and specific IgG levels of latent toxoplasmosis are not linked to the severity of prematurity or low birth weight in newborns.

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Section: Discussionmentioning

confidence: 99%

Toxoplasmosis impact on prematurity and low birth weight

et al. 2022

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“…The lesions of toxoplasmosis demonstrate decreased rCBV on perfusion imaging (which is typical for inflammatory and infectious lesions) and usually central high signal of increased diffusivity on ADC maps, in contrast to PCNSL, which is the main differential diagnosis in HIV-infected patients [ 98 , 99 ].…”

Section: Pathology Involving Both the Basal Ganglia And Thalamimentioning

confidence: 99%

Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

et al. 2020

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The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. In this comprehensive pictorial review, the most common and/or typical genetic, acquired metabolic/toxic, infectious, inflammatory, vascular and neoplastic pathologies affecting the central grey matter are subdivided according to the preferential location of the lesions: in the basal ganglia, in the thalami or both. The characteristic imaging findings are described with emphasis on the differential diagnosis and clinical context.

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“…The MRI study in our illustrative case shows both of these diagnostic radiological signs. Some authors have described a T2-weighted symmetric, concentric target sign with a hypointense core, an intermediate hyperintense core, and a peripheral hypointense zone as a more specific diagnostic pattern (Figure 1) [34][35][36][37]. A ring-shaped zone of peripheral enhancement with a small eccentric nodule alone, the wall of the lesion on the post-gadolinium T1-weighted sequence is considered to be an eccentric target sign (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

et al. 2020

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Unusual clinical course Background: One of the most common causes of central nervous system (CNS) opportunistic infections in immunocompromised patients is toxoplasmosis. It can cause focal or disseminated brain lesions leading to neurological deficit, coma, and death. Prompt management with optimal antibiotics is vital. However, the diagnosis of cerebral toxoplasmosis is challenging in infected individuals with human immunodeficiency virus (HIV). The possible diagnosis is based on clinical presentation, imaging, and specific serologic investigations. The diagnosis can be confirmed by histopathological examination and/or by finding nucleic material in the spinal cerebrospinal fluid (CSF) examination. Case Report: We present a review of the literature with a rare illustrative case of diffuse CNS toxoplasmosis as the first manifestation of HIV infection in a young patient. Brain MRI showed diffuse, ring-enhancing lesions, and significant midline shift. Decompressive hemicraniectomy for control of intracranial pressure and anti-infectious therapy were performed. Conclusions: This should raise awareness that cerebral toxoplasmosis can occur in pediatric patients with HIV infection, and, more importantly, as the first manifestation of AIDS. Although the prognosis is often poor, early diagnosis and immediate treatment of this life-threatening opportunistic infection can improve outcomes.

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Concentric and Eccentric Target MRI Signs in a Case of HIV-Associated Cerebral Toxoplasmosis

Cited by 15 publications

References 5 publications

Toxoplasmosis impact on prematurity and low birth weight

Toxoplasmosis impact on prematurity and low birth weight

Bilateral lesions of the basal ganglia and thalami (central grey matter)—pictorial review

Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature

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