The Importance of Toxoplasma Gondii Infection in Diseases Presenting With Headaches. Headaches and Aseptic Meningitis May Be Manifestations of the Jarisch-Herxheimer Reaction

Abstract

Worldwide, approximately 2 billion people are chronically infected with T. gondii with largely unknown consequences. This review presents clinical symptoms, differential diagnosis, triggering factors, treatment, and pathomechanisms responsible for idiopathic intracranial hypertension, pseudotumor cerebri, and aseptic meningitis. Literature cited in this work illustrates that immune state and other biologic mediator imbalances due to various endogenous and exogenous triggering factors may markedly affect latent central nervous system T. gondii infection/inflammation intensity, and cause reactivation of cerebral toxoplasmosis (CT). Irregularities in pro- and anti-inflammatory processes may markedly disturb the host and/or T. gondii defense mechanisms important for immune control of the parasite thereby manifesting as a wide range of neurologic symptoms and signs observed in some patients with migraine, epilepsy, celiac disease, Henoch-Schönlein purpura, and other brain disorders. This is consistent with reactivation of CT in mice after treatment with dexamethasone associated with depression of type T(H)1 immune response, and development of CT after administration of etanercept or other bioproducts. It seems that various types of headaches, epilepsy, aseptic meningitis, systemic adverse reactions to drugs or other substances represent the Jarisch-Herxheimer reaction due to apoptosis of T. gondii tachyzoites. Also development of some brain tumors, such as ependymoma and glioma may be associated with a chronic course of CT. Thus, all these patients should be tested for T. gondii infection.

Toxoplasma gondii infection: seroprevalence and associated risk factors among primary schoolchildren in Lagos City, Southern Nigeria

“…Substantial evidence has established an association between T. gondii infection and headaches (44) ; however, in our study, no association was observed. Ocular disease has also been reported to be linked with T. gondii infection, particularly in the U.S. (45) .…”

Significant Reduction of Brain Cysts Caused by Toxoplasma gondii after Treatment with Spiramycin Coadministered with Metronidazole in a Mouse Model of Chronic Toxoplasmosis

“…In vitro studies that mimic an immunocompromised state have shown that the conversion occurs within 1 week regardless of the age of the brain cysts (5). In immunocompetent hosts, the presence of cysts caused by T. gondii (referred to here as "T. gondii cysts") in the brain seems to be associated with various neurological disorders (27), including cryptogenic epilepsy (37), migraine (25), schizophrenia (38), Malloret meningitis (26), and affective (36) and behavioral (11) disorders.…”

T. gondii Infection Acquired during Pregnancy and/or after Birth may be Responsible for Development of both Type 1 and 2 Diabetes Mellitus

“…Also, within a headache clinic population Tietjen et al [814] identified diabetes mellitus as a migraine comorbidity constellation. However, in a large population-based cross-sectional study performed in Norway, Aamodt et al [810] found the inverse relationship between migraine and diabetes. Prevalence odds ratios of migraine was lower amongst persons with diabetes compared with those without diabetes, the OR being 0.4 (95% CI: 0.2-0.9) for T1DM, and 0.7 (CI: 0.5-0.9) for T2DM.…”

“…The prevalence of migraine and tension-type headache in the patients with diabetes mellitus was found to be higher as compared with controls without diabetes [810][811][812]. The disease was more common amongst teenagers with migraine compared with those without migraine [813].…”