Invasion with Toxoplasma gondii can promote pneumocystis pneumonia in individuals with HIV/AIDS

Abstract

Pulmonary pathology is common in HIV-infected individuals, but the possible role of the parasitic protist Toxoplasma gondii (Nicolle et Manceaux, 1908) is not completely known. The present account reports result of a retrospective cohort study. Medical cards of 907 HIV-positive people, which included 120 deceased patients, were analysed. During a three-year follow-up, the pulmonary pathology was diagnosed in 306 patients (33.7 ± 1.6%): pneumocystis pneumonia in 124 (13.7 ± 1.1%), primary pulmonary tuberculosis in 113 (12.5 ± 1.1%), bacterial pneumonia in 58 (6.4 ± 0.8%) toxoplasmosis pneumonia in two (0.2 ± 0.2%), and others. All patients were divided into two cohorts: 531 individuals seropositive for T. gondii and 376 seronegative ones. It has been found out that general lung pathology is more common in patients with seropositivity to T. gondii than in seronegative ones (43.3 ± 2.2% vs. 20.1 ± 2.0%, p < 0.001). The diagnosis of pneumocystis pneumonia was made ten times more often in the cohort of seropositive patients than in the cohort of seronegative ones (21.9 ± 1.8% vs. 2.1 ± 0.7%, respectively, p < 0.001) and in deceased patients of these cohorts it was 5.5 times more (45.1 ± 5.9% vs. 8.2 ± 3.9, respectively, p < 0.001). In patients with fatal outcome and seropositivity to T. gondii, the incidences of pneumocystis pneumonia increased by 23.2% (p < 0.001) and bacterial pneumonia by 12.4% (p < 0.05), whereas in seronegative individuals only pulmonary tuberculosis increased by 13.1% (p < 0.05) сompared with corresponding whole cohorts. Pearson's contingency coefficient showed the mean strength association between infection with T. gondii and incidence of pneumocystis pneumonia both in whole cohort (C = 0.272) and in patients with fatal outcomes (C = 0.368). In сonclusion, significantly increasing rate of pneumocystis pneumonia in patients with HIV/AIDS and T. gondii infection can be caused by certain synergism between T. gondii and Pneumocystis jirovecii and in some cases overdiagnosis pneumocystis pneumonia due to undiagnosed toxoplasmosis pneumonia.

Case report: Urbanized non-human primates as sentinels for human zoonotic diseases: a case of acute fatal toxoplasmosis in a free-ranging marmoset in coinfection with yellow fever virus

“…As observed in the marmoset of this study, New World NHPs are considered very susceptible to acute fatal toxoplasmosis, developing severe liver damage, interstitial pneumonia, and other systemic lesions in different organs ( 7 , 10 , 23 ). Severe toxoplasmosis is often associated with immunosuppression in humans, causing systemic lesions such as encephalitis, pneumonia, and hepatitis ( 28 – 30 ), but no such association has been documented in NHPs ( 31 ).…”

Cerebral Toxoplasmosis in a patient with Pneumocystis: a case report

“…This synergism could explain the increase in cases of co-infection of these two pathogens in HIV-positive patients, and also the increase in diagnoses of pneumocystis pneumonia due to undiagnosed toxoplasmosis pneumonia. Therefore, the recognition and treatment of T. gondii in HIV-positive people is important not only to prevent lung lesions due to toxoplasmosis but may also play a role in preventing pneumocystis pneumonia [13].…”

“…Behcet's Syndrome is a pathological condition that encompasses a diverse spectrum of clinical manifestations of a polysystemic nature. The disease usually manifests itself in the 30s and 40s, with a predominance of males [12,13]. However, the above-mentioned patient is in his second decade of life and has no positive laboratory or imaging results for BD but has ocular symptoms such as neuritis and genital ulcers.…”