Schizophrenia and serological methods for diagnosis of toxoplasmosis

Toxoplasma gondii: 25 years and 25 major advances for the field

This article is an attempt to identify the most significant highlights of Toxoplasma research over the last 25 years. It has been a period of enormous progress and the top 25 most significant advances, in the view of this author, are described. These range from the bench to the bedside and represent a tremendous body of work from countless investigators. And, having laid out so much that has been discovered, it is impossible not to also reflect on the challenges that lie ahead. These, too, are briefly discussed. Finally, while every effort has been made to view the field as a whole, the molecular biology background of the author almost certainly will have skewed the relative importance attached to past and future advances. Despite this, it is hoped that the reader will agree with, or at least not disagree too strongly with, most of the choices presented here.

Neurological and behavioral abnormalities, ventricular dilatation, altered cellular functions, inflammation, and neuronal injury in brains of mice due to common, persistent, parasitic infection

BACKGROUND

Worldwide, approximately two billion people are chronically infected with Toxoplasma gondii with largely unknown consequences.

METHODS

To better understand long-term effects and pathogenesis of this common, persistent brain infection, mice were infected at a time in human years equivalent to early to mid adulthood and studied 5-12 months later. Appearance, behavior, neurologic function and brain MRIs were studied. Additional analyses of pathogenesis included: correlation of brain weight and neurologic findings; histopathology focusing on brain regions; full genome microarrays; immunohistochemistry characterizing inflammatory cells; determination of presence of tachyzoites and bradyzoites; electron microscopy; and study of markers of inflammation in serum. Histopathology in genetically resistant mice and cytokine and NRAMP knockout mice, effects of inoculation of isolated parasites, and treatment with sulfadiazine or alphaPD1 ligand were studied.

RESULTS

Twelve months after infection, a time equivalent to middle to early elderly ages, mice had behavioral and neurological deficits, and brain MRIs showed mild to moderate ventricular dilatation. Lower brain weight correlated with greater magnitude of neurologic abnormalities and inflammation. Full genome microarrays of brains reflected inflammation causing neuronal damage (Gfap), effects on host cell protein processing (ubiquitin ligase), synapse remodeling (Complement 1q), and also increased expression of PD-1L (a ligand that allows persistent LCMV brain infection) and CD 36 (a fatty acid translocase and oxidized LDL receptor that mediates innate immune response to beta amyloid which is associated with pro-inflammation in Alzheimer's disease). Immunostaining detected no inflammation around intra-neuronal cysts, practically no free tachyzoites, and only rare bradyzoites. Nonetheless, there were perivascular, leptomeningeal inflammatory cells, particularly contiguous to the aqueduct of Sylvius and hippocampus, CD4+ and CD8+ T cells, and activated microglia in perivascular areas and brain parenchyma. Genetically resistant, chronically infected mice had substantially less inflammation.

CONCLUSION

In outbred mice, chronic, adult acquired T. gondii infection causes neurologic and behavioral abnormalities secondary to inflammation and loss of brain parenchyma. Perivascular inflammation is prominent particularly contiguous to the aqueduct of Sylvius and hippocampus. Even resistant mice have perivascular inflammation. This mouse model of chronic T. gondii infection raises questions of whether persistence of this parasite in brain can cause inflammation or neurodegeneration in genetically susceptible hosts.

What are the respective host and parasite contributions to toxoplasmosis?

The toxoplasmosis pathogenesis mechanism is complex because parasite and host specificities are interrelated. Advances in fundamental research (including strain genotyping, analyzing the progeny from crosses of different strains and exploring the implication of epigenetic effects on the parasite) have contributed greatly to our current knowledge of this mechanism. At the same time new data on the clinical characteristics of the disease have come to light. For example, highly virulent strains have been isolated recently in immunocompetent patients, and some studies suggest that toxoplasmosis also might be implicated in brain disorders. These recent tools and discoveries are likely to cast new light on the pathogenicity of Toxoplasma parasites and provide the key to understanding this unique form of parasitism.

Toxoplasma seropositivity and depression: a case report

BACKGROUND

The association between toxoplasmosis and psychiatric disorders has been reported in a few anecdotal reports.

CASE PRESENTATION

A case of depression with toxoplasma seropositivity is presented. The patient with depression showed poor response to antidepressants, for which he was investigated and was found positive on the serological test for the toxoplasma. The response to antidepressant treatment improved only after adequate treatment for toxoplasma.

CONCLUSIONS

The case suggests a probable association between toxoplasmosis and depression.