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PubMed1986

Clinicopathological features of a congenital murine model of ocular toxoplasmosis.

Sequential clinical examination was carried out upon the eyes of mice that had been infected in utero with Toxoplasma gondii. Three patterns of clinical disease were seen. First, crystalliform cataracts, which either remained unchanged in character or occasionally became more extensive, were observed. Second, acute uveitis occurred in a small proportion of eyes, progressing into a chronic inflammatory disease with secondary opaque cataract. The third pattern comprised multiple discrete foci of deep retinal disturbance. It is suggested that these lesions were attributable to focal macrophage clusters in the sub-retinal space with overlying dome-shaped elevations of the photoreceptor matrix. The severity of disease, as assessed clinically, correlated with the underlying histopathology but not with the serological titres against Toxoplasma. Immunocytochemical staining for Toxoplasma antigen revealed only intra-retinal Toxoplasma cysts, but no free organisms or extracystic antigen were demonstrated. Selective photoreceptor destruction was the most prominent histopathological feature, implicating auto-immune mechanisms of tissue destruction.

Acute Disease↗
PubMed1998

[Toxoplasmosis in families. II. Clinical analysis].

Clinical and serological analysis was conducted on 102 families including index-cases of lymphonodular toxoplasmosis (102 patients-group A) and 286 family members (group B). The studies included a total of 388 persons (167 children and 221 adults), originating mainly from Wielkopolska region (West Poland). The lymphonodular form of toxoplasmosis represented the dominating pattern among adult cases but among children the clinical pathology pattern was variable: in 14 out of 49 children (group A) lymphadenopathy was not dominating sign and clinically signs and symptoms of central nervous system or organ of vision involvement prevailed; in 6 cases clinical pattern pointed to congenital toxoplasmosis and in 8 cases it indicated sequele of acquired toxoplasmosis. In group B, among 35 children with lymphadenopathy, 7 presented also neurological signs/symptoms, in 5 children the pattern suggested acquired neurotoxoplasmosis in 2 cases congenital form of toxoplasmosis. In 11 adults of the group, lymphonodular form of the disease was diagnosed. In both groups (A and B), the pattern lymphonodular toxoplasmosis was detected also in 5 pregnant women (1.3% of studied persons and 2.7% of all adults). Four of the pregnant women manifested active stage of the disease, confirmed by the presence of IgM class antibodies. Thus, among 286 family members clinical pathology was demonstrated in 46 patients (16.1%) and in 35 patients (12.2%) activity of the disease presented indications for a specialistic therapy.

Adolescent↗
PubMed1989

Ocular manifestations of the congenital varicella syndrome.

Three children developed the congenital varicella syndrome following a maternal varicella infection during the second trimester of pregnancy. Systemic findings included a bulbar palsy, mild hemiparesis, cicatricial skin lesions, developmental delay, and learning difficulties. Ocular findings included chorioretinitis, atrophy and hypoplasia of the optic discs, a congenital cataract, and Horner's syndrome. Electroretinograms and pattern-reversal visual-evoked potentials recorded from the four eyes with chorioretinitis were attenuated and degraded. Two of the children had been misdiagnosed as having congenital toxoplasmosis. Chorioretinal scars probably occur more frequently with the congenital varicella syndrome than has been previously recognized and should be included in the differential diagnosis of congenital chorioretinal scars. Hypoplasia of the optic disc may develop after an intrauterine varicella infection during the 16th week of gestation. Children with the congenital varicella syndrome should be examined by an ophthalmologist to exclude ocular abnormalities. These abnormalities are often subtle and difficult to diagnose correctly.

Chickenpox↗
PubMed1992

Infantile hydrocephalus in the south-western region of Saudi Arabia.

During the period January 1988 to December 1990, the overall incidence of infantile hydrocephalus in the south-western region of Saudi Arabia was 0.81/1000. The series comprised 61 infants affected by infantile hydrocephalus. The total number of live births in this period was 74,923. Hydrocephalus associated with spinal dysraphism (spina bifida cystica and encephalocoele) constituted 24 cases (39.3%), and there was aqueduct stenosis in 10 cases (16.4%). Nine cases (11.9%) were post-meningitic, and seven (14.8%) post-haemorrhagic. There was Dandy-Walker malformation in five cases (8.2%), three (4.9%) had congenital idiopathic hydrocephalus, two (3.3%) congenital toxoplasmosis, and one (1.6%) isolated Arnold Chiari malformation. There were congenital causes in 45 cases, 73.7% of all the cases in this series (incidence: 0.6/1000 births). Of the remaining 16 cases (26.3%) which were due to postnatal factors, seven (11.5%) were caused by acquired cerebral haemorrhage, only two of them being premature, and the other nine (14.8%) were due to meningitis. The data indicate the predominance of prenatal causes of infantile hydrocephalus and the relatively low contribution of extreme prematurity. This is possibly due to the high mortality of this group of infants in this region.

Cerebral Hemorrhage↗
PubMed1996

Pathomechanism of cerebral hypoplasia in experimental toxoplasmosis in murine fetuses.

In order to elucidate the pathological mechanism of cerebral hypoplasia in congenital toxoplasmosis, fetal toxoplasmosis was induced by intraperitoneal injection of Toxoplasma gondii into five pregnant mice on embryonal Day 5 (E5). The maternal and fetal brains were examined histologically and immunohistochemically; six fetuses were examined on E16 and 21 on E18. T. gondii organisms were immunohistochemically detected in the maternal brains, placentas and the ventricular zone of the fetal cerebrum. In none of the fetal brains was any gross deformity observed, except for cerebral hypoplasia. On E16 and E18, the cerebral cortices were seen to consist of immature laminations, and the cells had less cytoplasm and rounder hyperchromatic nuclei than those in the control mice. The cerebral walls and the cortical layers, except in the ventricular zone, were thinner than in the controls (P < 0.01 in each case). On E18, the proliferating cell nuclear antigen immunolabeling index was higher, and the cytoplasm of more cells in the cortical plate was immunoreactive with anti-beta-tubulin antibody compared with control mice. Using an in situ end-labeling technique, apoptotic cells were not observed in the cortices in mice of both groups. It is suggested that the cerebral hypoplasia following Toxoplasma infection is related to delayed maturation.

Animals↗
PubMed1990

Histopathological studies of acute, chronic and congenital infections of toxoplasmosis in mice.

The histopathological picture of Toxoplasma gondü RH strain (virulent) and Beverley strain (a virulent) was experimentally studied in mice. Nearly all the internal organs and tissues showed pathological changes ranging between the mild congestion to the severe degeneration. However, the changes were more serious in mice infected with RH strain than those infected with Beverley strain. The lungs showed massive consolidation and severe congestion. The heart showed hyaline degeneration of a cardiac muscle fibers. Focal areas of necrosis were seen in the liver, spleen and kidneys which were enlarged as well as in the cerebral cortex of the brain. The bone marrow and skeletal muscles were infiltrated by mononuclear inflammatory cells. The eyes showed mononuclear inflammatory cells in the retina consisted mainly of lymphocytes and the photo receptors were damaged. In congenital toxoplasmosis the brain showed perivascular mononuclear inflammatory infiltrate as well as multiple areas of necrosis. Microglial nodules were sometimes seen. The eyes showed no pathological lesion.

Acute Disease↗
PubMed2005

An estimation of the frequency of gestational toxoplasmosis in the Brazilian Federal District.

Acute infections by the protozoan Toxoplasma gondii during pregnancy (gestational toxoplasmosis) are known to cause serious health problems to the fetus (congenital toxoplasmosis). In Brasília, there have been few studies on the incidence of toxoplasmosis. This report summarizes a retrospective study performed on 2,636 selected pregnant women attended by the public health system of Guará, a satellite-city of Brasília. In this survey, 17 cases of gestational toxoplasmosis were detected; 15 of which were primary maternal infection and the remaining 2 were consistent with secondary maternal infection. These results suggest an annual seroconversion rate of 0.64 percent (90 percent confidence interval: 0.38, 0.90).

Animals↗
PubMed2006

Outbreak of ocular toxoplasmosis in Coimbatore, India.

Toxoplasma gondii is a protozoan parasite that infects up to a third of the world's population. Infection is mainly acquired by ingestion of food that is contaminated with oocysts. We report an outbreak of ocular toxoplasmosis, which is an acute acquired type rather than reactivation of congenital toxoplasmosis. Our preliminary investigation points to municipal water contamination. This outbreak only proves the need of an effective public health system and health education in curtailing any outbreak.

Adolescent↗
PubMed1992

Anti-P30 IgA antibodies as prenatal markers of congenital toxoplasma infection.

This study extends a previous study and confirms that the detection of anti-P30 IgA antibodies is very helpful in the diagnosis of acute acquired or congenital toxoplasmosis. Moreover, we demonstrate that an anti-P30 IgA response can be mounted in the fetuses infected by Toxoplasma gondii during their intra-uterine life as early as week 23 of gestation. A double-sandwich ELISA described in our previous work was used to detect anti-P30 IgA antibodies in 1378 human serum samples collected from 551 patients, including 162 fetuses whose mothers had been infected by T. gondii during pregnancy, 46 congenitally infected and 90 uninfected newborns and 253 women suspected of having been infected during pregnancy, including the mothers of fetuses and newborns previously described. Anti-P30 IgA antibodies were detected in all cases of acute toxoplasmosis but in no case of chronic toxoplasmosis: in the majority of cases, the IgA antibody titre fell below cut-off in 3-9 months. Among the 46 congenitally infected newborns, anti-P30 IgA antibodies were detected in sera of 41 infected newborns (38 at birth, two in the first months of life, one in the seventh month of life), while anti-P30 IgM antibodies were detected in only 30 cases at birth and in one case during the first month of life. Among 162 fetuses, anti-P30 IgA response was observed in five infected fetuses, but was not detected in either 152 uninfected fetuses or in five fetuses considered as infected. The absence or presence of anti-P30 IgA antibodies in the fetus is discussed in relation to the date of maternal infection and collection of the fetal blood. It clearly appears from our study that the combined testing of both IgM and IgA in the fetus and the newborn is essential for a more efficient diagnosis of infection.

Acute Disease↗
PubMed1990

Toxoplasma gondii.

Toxoplasmosis encompasses a variety of clinical conditions. Serious sequelae are seen in congenital toxoplasmosis and in infections of the immunocompromised host. In the former, prevention of maternal acquisition of toxoplasmosis during pregnancy is paramount. Infection in the compromised host often presents with neurologic abnormalities. Unfortunately, the HIV syndrome itself or other opportunistic infections can present in a similar manner. Often, empiric treatment for toxoplasmosis is begun based on clinical findings and an enhancing lesion noted on the head CT. Pyrimethamine and sulfadiazine remain the drugs of choice for toxoplasmosis and are able to penetrate blood-brain barriers. Currently, trials using other agents are in progress.

Animals↗
PubMedDate not supplied

Staphylococcal protein A in the serologic diagnosis of congenital rubella and toxoplasmosis.

Staphylococcal protein A (SPA) has been used to remove maternal IgG from cord or neonatal sera to make serologic testing for congenital infection more IgM specific. To evaluate the clinical usefulness of this procedure, sera sent for TORCH titers that had rubella hemagglutination inhibition (RHI) reciprocal titers greater than or equal to 8 or toxoplasmosis indirect fluorescent antibody (TFA) titers greater than or equal to 16 were adsorbed with SPA and retested. Nine of 109 sera were TFA positive by routine testing, and all but one from an infant with congenital toxoplasmosis became negative after SPA adsorption. A repeat TFA at 4 to 26 months of age was negative in all six children without evidence of toxoplasmosis who returned for follow-up. Fifty of 55 sera were RHI positive by routine testing, and all but one from an infant with congenital rubella became negative after SPA adsorption. The repeat routine RHI was negative in 32 of 35 children whose sera were initially negative after SPA adsorption. SPA adsorption greatly increased the specificity of routine RHI and TFA tests in the diagnosis of congenital rubella and toxoplasmosis.

Female↗
PubMed2001

The clinical significance of fetal echogenic bowel.

OBJECTIVE: The purpose of this study was to determine the incidence of cystic fibrosis, aneuploidy, and intrauterine infection with toxoplasmosis and cytomegalovirus in second-trimester fetuses with the sonographic finding of echogenic bowel. STUDY DESIGN: All cases of echogenic bowel that were diagnosed in our ultrasound unit from 1993 to 2000 were identified. Only cases in which bowel echogenicity was as bright as bone with no associated major fetal anomalies were included. Patients who were referred from other hospitals were excluded. Echogenicity was classified as focal or multifocal. Fetal karyotypes, cystic fibrosis carrier testing, and maternal serologic test results were determined. RESULTS: One hundred seventy-five fetuses in 171 pregnancies met inclusion criteria. Cystic fibrosis mutations were identified in 7 of 138 mothers (5%) and 9 of 86 fathers (10.5%) who were tested. Five fetuses were affected with cystic fibrosis. Fetal karyotype was obtained in 139 cases, and autosomal trisomy was diagnosed in 5 cases (3.6%). One hundred sixty-six patients were tested for toxoplasmosis, and 111 patients were tested for cytomegalovirus. There were no cases of congenital toxoplasmosis. There was maternal serologic and fetal pathologic evidence of cytomegalovirus infection in 1 case. In all cases of cystic fibrosis and aneuploidy, echogenicity was multifocal; in the case of cytomegalovirus, echogenicity was focal. CONCLUSION: In our population, mid-trimester fetal echogenic bowel was associated with a high prevalence of cystic fibrosis, aneuploidy, and cytomegalovirus (11/175 fetuses [6.3%]). This information should be considered when counseling patients after mid-trimester echogenic bowel is diagnosed.

Aneuploidy↗
PubMed1989

Recent primary toxoplasma infection indicated by a low avidity of specific IgG.

An unusual assay was developed for the serologic diagnosis of recent primary infection by Toxoplasma gondii. This test measures the antigen-binding avidity of toxoplasma-specific IgG antibodies. Serum samples from 5 patients with recent primary toxoplasma infection were compared with those from 21 subjects with preexisting toxoplasma immunity. Patients with primary infection exhibited a low avidity of toxoplasma-specific IgG, which persisted for several months after the onset of symptoms of toxoplasmosis. In contrast, all subjects with past immunity had a high avidity of toxoplasma-IgG. This IgG avidity assay should assist in the diagnosis of acquired toxoplasmosis and may be used to identify pregnancies that are at risk for congenital toxoplasmosis.

Adult↗
PubMed1975

[Toxoplasmosis investigation of pregnant women and newborn infants (author's transl)].

In the serological screening of pregnant women for the prevention of congenital toxoplasmosis a positive test with low titre in the first trimester indicates almost with certainty a preconceptional infection. The probability that such a result derives from a very recent maternal infection leading to fetal infection is about 5 in 39,000. In view of the very high extra expenses involved and the unnecessary anxiety induced in many thousands of pregnant women and the sparse results the serological control of women showing positive tests with low or medium titre in the first trimester is not recommendable. There is no indication that preconceptional toxoplasma infection, especially the countless infections of longer standing with low titres, damage the fetus or lead to habitual abortion. Practically only H. Werner and his Berlin group, succeeded in isolating toxoplasma from abortion material of women not primarily infected during pregnancy but then in 20% of cases and in serologically-negative women also. The late importation of such opinions to Austria is deeply regrettable and should not be allowed to induce uncertainty in physicians and anxiety in our women. Accurate studies in very large numbers of preconceptionally-infected women did not reveal a single case of prenatal damage or congenital infection. Hence, the serological control of newborn infants of preconceptionally-infected women is not indicated. High titres (SF) detected during the first trimester indicate only a very low probability of damage to the fetus. Desmonts and Couvreur found not one infected infant amongst the offspring of 191 women with high titres at the beginning of pregnancy.

Female↗