Toxoplasmosis Myelopathy and Myopathy in an AIDS Patient

Kung, Doris; Hubenthal, Erica; Kwan, Justin; Shelburne, Samuel A.; Goodman, J. Clay; Kass, Joseph S.

doi:10.1097/nrl.0b013e3181d35c62

Cited by 21 publications

(18 citation statements)

References 14 publications

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“…Encephalitis, meningoencephalitis, ocular lesions, septic syndrome, myocarditis or hepatitis may be found occasionally [1, 3, 16, 17]. Symptoms are manifested mainly in immunocompromised people and newborns [18–21]. …”

Section: Introductionmentioning

confidence: 99%

Seroepidemiological analysis of toxoplasmosis in college students

Rodrigues

Frei

Navarro

et al. 2015

J Venom Anim Toxins Incl Trop Dis

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BackgroundToxoplasmosis is a zoonosis caused by an obligate intracellular parasite, Toxoplasma gondii, which affects warm-blooded animals including humans. Its prevalence rates usually vary in different regions of the planet.MethodsIn this study, an analysis of the seroprevalence of toxoplasmosis among Brazilian students was proposed by means of IgG specific antibodies detection. The presence of anti-Toxoplasma gondii antibodies by indirect fluorescent antibody test (IFAT) was also evaluated in order to compare it with enzyme-linked immunosorbent assay (ELISA) and to assess the use of 2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) and o-phenylenediamine dihydrochloride chromogens.ResultsThe IFAT method showed a seroprevalence of 22.3%. These results were similar to those obtained by ELISA (24.1%). The seroprevalence was directly estimated from the IgG avidity, which showed that in a sample of 112 students, three of them had acute infection, an incidence of 1.6% in the studied population.ConclusionIn this study, the use of different chromogenic substrates in immunoenzymatic ELISA assays did not display different sensitivity in the detection of T. gondii-reagent serum. The extrapolation of results to this population must be carefully considered, since the investigation was conducted on a reduced sample. However, it allows us to emphasize the importance of careful and well prepared studies to identify risk factors for toxoplasmosis, to adopt preventive measures and to offer guidance to at-risk populations about the disease.

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Section: Introductionmentioning

confidence: 99%

Seroepidemiological analysis of toxoplasmosis in college students

Rodrigues

Frei

Navarro

et al. 2015

J Venom Anim Toxins Incl Trop Dis

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“…Corticotherapy should be carefully considered in HIV-infected patients with CNS-IRIS since it increases the risk of opportunistic infections and may worsen an undiagnosed condition. Four of the 5 previously reported patients received corticosteroids: although 3 of these had a favourable evolution [15, 18], the other patient presented a fatal outcome [17]. There was no administration of corticotherapy in 2 cases (here and the one from Cabral et al [16]) and still patients had a favourable outcome.…”

Section: Discussionmentioning

confidence: 92%

“…CSF evaluation was performed after IRIS symptoms onset in the present CNS-IRIS case and in 3 of the previously reported cases [17, 18]. Though these analyses focus on increased levels of anti-toxoplasma IgG or IgM or the presence of T. gondii DNA, the negativity of these results does not exclude toxoplasmosis, given the limited sensitivity of the techniques used.…”

Section: Discussionmentioning

confidence: 99%

“…No differences in the immune pathogenesis or clinical evolution are expected due to this, since none was under HAART at the moment of toxoplasmosis diagnosis, except one patient that was non-compliant to therapy [17]. The neurologic symptoms of toxoplasmosis were relatively similar between the 6 cases: all patients presented weakness of upper or lower extremities.…”

Section: Discussionmentioning

confidence: 99%

“…No new lesions in spine. CSF studies: All within normal. Electromyogram/nerve conduction study: Results consistent with a sensorimotor neuropathy superimposed on a predominantly proximal myopathic process. Muscle biopsy: Necrosis, lymphocytic and plasma cell infiltrates with abundant T. gondii cysts. c Outcome: Multiorgan dysfunction and death 2 weeks after the diagnosis of toxoplasmosis myositis.[17]Case 4 Male, 35 yo At diagnosis: AIDS previously diagnosed, not on HAART or prophylaxis. Manifestations: Left upper extremity weakness for 3 weeks, associated to fever and respiratory symptoms for 1 week (concomitant respiratory infection). Brain MRI: Two ring-enhancing lesions in the right precentral and occipital temporal areas. Treatment: Ceftriaxone and azithromycin, ATT, HAART. Presentation: Progression of upper extremity weakness during the first 2 weeks on HAART. CSF studies: 6 WBC/mm 3 (96% lymphocytes; 4% monocytes); positive EBV PCR. Brain MRI: Enlargement of the two prior lesions and development of a third lesion. Brain biopsy: Rare T. gondii tachyzoites and numerous bradyzoites. CD8 + predominant lymphocytic infiltrates. Treatment: Corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

et al. 2017

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BackgroundHIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed.Case presentationA 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4+ T cells and higher percentage of activated CD4+ T cells at HAART initiation. The percentage of memory CD4+ T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8+ T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset.ConclusionAlthough both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2159-x) contains supplementary material, which is available to authorized users.

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Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?

et al. 2021

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Spondylodiscitis is a complex disease whose diagnosis and management are still challenging. The differentiation between infectious and non-infectious aetiology is mandatory to avoid delays in the treatment of life-threatening infectious conditions. Imaging methods, in particular magnetic resonance imaging (MRI), play a key role in differential diagnosis. MRI provides detailed anatomical information, especially regarding the epidural space and spinal cord, and may allow differential diagnosis by assessing the characteristics of certain infectious and inflammatory/degenerative lesions. In this article, we provide an overview of the radiological characteristics and differentiating features of non-infectious inflammatory spinal disorders and infectious spondylodiscitis, focussing on MRI results and presenting relevant clinical and pathological features that help early diagnosis.

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Toxoplasmosis Myelopathy and Myopathy in an AIDS Patient

Cited by 21 publications

References 14 publications

Seroepidemiological analysis of toxoplasmosis in college students

Seroepidemiological analysis of toxoplasmosis in college students

Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

Differentiation between infectious spondylodiscitis versus inflammatory or degenerative spinal changes: How can magnetic resonance imaging help the clinician?

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