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Vidal JE. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease. J Int Assoc Provid AIDS Care 2019; 18:2325958219867315. [PMID: 31429353 PMCID: PMC6900575 DOI: 10.1177/2325958219867315] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 01/06/2023] Open
Abstract
Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.
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Affiliation(s)
- José Ernesto Vidal
- Departamento de Neurologia, Instituto de Infectologia Emílio Ribas, São
Paulo, Brazil
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas
HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e
Resistência Antimicrobiana (LIM 49), Instituto de Medicina Tropical, Universidade de São
Paulo, São Paulo, Brazil
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2
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Karanis P, Aldeyarbi HM, Mirhashemi ME, Khalil KM. The impact of the waterborne transmission of Toxoplasma gondii and analysis efforts for water detection: an overview and update. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2013; 20:86-99. [PMID: 22990578 DOI: 10.1007/s11356-012-1177-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/30/2012] [Indexed: 06/01/2023]
Abstract
The ubiquitous protozoa Toxoplasma gondii is now the subject of renewed interest, due to the spread of oocysts via water causing waterborne outbreaks of toxoplasmosis in different parts of the world. This overview discusses the different methods for detection of Toxoplasma in drinking and environmental water. It includes a combination of conventional and molecular tools for effective oocyst recovery and detection in water sources as well as factors hindering the detection of this parasite and shedding light on a promising new molecular assay for the diagnosis of Toxoplasma in environmental samples. Hopefully, this attempt will facilitate future approaches for better recovery, concentration, and detection of Toxoplasma oocysts in environmental waters.
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Affiliation(s)
- Panagiotis Karanis
- Medical and Molecular Parasitology, University Clinics of Cologne, Center of Anatomy, Institute II, Joseph-Stelzmann-Str 9, 50937 Cologne, Germany.
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3
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Goto M, Takahashi T, Kanda T, Iwamoto A. Detection of Toxoplasma gondii by Polymerase Chain Reaction in Cerebrospinal Fluid from Human Immunodeficiency Virus-1-infected Japanese Patients with Focal Neurological Signs. J Int Med Res 2004; 32:665-70. [PMID: 15587761 DOI: 10.1177/147323000403200612] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We aimed to determine the effectiveness of using the polymerase chain reaction (PCR) to detect Toxoplasma gondii in cerebrospinal fluid (CSF) specimens from Japanese patients infected with human immunodeficiency virus (HIV)-1. Twenty-six HIV-positive individuals presenting with focal neurological signs and a possible diagnosis of T. gondii encephalitis (TE) were enrolled in the study between April 1997 and March 2003. Eight patients were diagnosed as having TE using the accepted diagnostic criteria; PCR amplified the T. gondii B1 gene in CSF samples from five of these eight patients. CSF samples from the 18 patients without TE were negative for T. gondii DNA. The sensitivity, specificity and positive and negative predictive values for detecting T. gondii in CSF using PCR were 62.5%, 100%, 100% and 85.7%, respectively. These results suggest that PCR might be a clinically useful technique for detecting T. gondii DNA in patients infected with HIV showing focal neurological signs. Improvements in sensitivity are needed, however.
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Affiliation(s)
- M Goto
- Division of Infectious Diseases, Advanced Clinical Research Centre, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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4
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Bretagne S. Molecular diagnostics in clinical parasitology and mycology: limits of the current polymerase chain reaction (PCR) assays and interest of the real-time PCR assays. Clin Microbiol Infect 2003; 9:505-11. [PMID: 12848725 DOI: 10.1046/j.1469-0691.2003.00677.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Polymerase chain reaction (PCR) represents a major breakthrough for the diagnosis of infectious diseases. However, the absence of standardized kits for commercially unattractive targets, such as most of the parasites and the fungi, has led to the development of numerous in-house PCR assays. The performances reported, both for the sensitivity and the specificity of these assays are very divergent. For instance, for the antenatal diagnosis of toxoplasmosis, the sensitivity is either 97.4%, or 64%. For the diagnosis of toxoplasmosis in HIV-positive patients, the PCR on blood is either of limited value with a sensitivity of 13% or of excellent yield with a sensitivity of 87.5%. Similar results are reported for the diagnosis of invasive aspergillosis in bone-marrow-transplant recipients. The patients and the clinical specimens tested are often different. This can explain some of the discrepancies. However, when performed, the quality controls on identical specimens show different results depending on the laboratories. An analysis of the PCR techniques used shows that the control of false positive results as a result of carry-over and false negative results owing to PCR inhibitors is far from being systematic. These shortcomings of 'classical' PCR should be solved when real-time PCR assays are developed, leading to some standardization. Automated DNA extraction should also be useful to achieve this goal. Comparison between laboratories should then be possible and regular quality controls will be necessary to ensure the reliability of real-time PCR assays.
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Affiliation(s)
- S Bretagne
- Laboratoire de Parasitologie-Mycologie, Hôpital Henri Mondor, Créteil, France.
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5
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Joseph P, Calderón MM, Gilman RH, Quispe ML, Cok J, Ticona E, Chavez V, Jimenez JA, Chang MC, Lopez MJ, Evans CA. Optimization and evaluation of a PCR assay for detecting toxoplasmic encephalitis in patients with AIDS. J Clin Microbiol 2002; 40:4499-503. [PMID: 12454142 PMCID: PMC154600 DOI: 10.1128/jcm.40.12.4499-4503.2002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Toxoplasma gondii is a common life-threatening opportunistic infection. We used experimental murine T. gondii infection to optimize the PCR for diagnostic use, define its sensitivity, and characterize the time course and tissue distribution of experimental toxoplasmosis. PCR conditions were adjusted until the assay reliably detected quantities of DNA derived from less than a single parasite. Forty-two mice were inoculated intraperitoneally with T. gondii tachyzoites and sacrificed from 6 to 72 h later. Examination of tissues with PCR and histology revealed progression of infection from blood to lung, heart, liver, and brain, with PCR consistently detecting parasites earlier than microscopy and with no false-positive results. We then evaluated the diagnostic value of this PCR assay in human patients. We studied cerebrospinal fluid and serum samples from 12 patients with AIDS and confirmed toxoplasmic encephalitis (defined as positive mouse inoculation and/or all of the Centers for Disease Control clinical diagnostic criteria), 12 human immunodeficiency virus-infected patients with suspected cerebral toxoplasmosis who had neither CDC diagnostic criteria nor positive mouse inoculation, 26 human immunodeficiency virus-infected patients with other opportunistic infections and no signs of cerebral toxoplasmosis, and 18 immunocompetent patients with neurocysticercosis. Eleven of the 12 patients with confirmed toxoplasmosis had positive PCR results in either blood or cerebrospinal fluid samples (6 of 9 blood samples and 8 of 12 cerebrospinal fluid samples). All samples from control patients were negative. This study demonstrates the high sensitivity, specificity, and clinical utility of PCR in the diagnosis of toxoplasmic encephalitis in a resource-poor setting.
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Affiliation(s)
- Priya Joseph
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Maritza M. Calderón
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Robert H. Gilman
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
- Corresponding author. Mailing address: Asociacion Benéfica PRISMA (Proyectos en Informatica, Salud, Medicina y Agricultura), Carlos Gonzales 251 Urb, Maranga, San Miguel, Lima, Perú. Phone: 51 1 424 0221. Fax: 51 1 464 0781. E-mail:
| | - Monica L. Quispe
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Jaime Cok
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Eduardo Ticona
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Victor Chavez
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Juan A. Jimenez
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Maria C. Chang
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Martín J. Lopez
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
| | - Carlton A. Evans
- Northwestern University Medical School, Chicago, Illinois, Departments of Pathology & Microbiology, Universidad Peruana Cayetano Heredia, Asociacion Benefica Proyectos en Informatica, Salud, Medicina y Agricultura, Hospital Dos de Mayo, Department of Physiological Sciences and Tropical Medicine, Institute “Alexander Von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, Wellcome Center for Clinical Tropical Medicine, Imperial College, London, United Kingdom
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6
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Abstract
Toxoplasmosis is an anthropozoonotic disease endemic world-wide, caused by the apicomplexan Toxoplasma gondii. Although the course of infection is generally benign, it can cause significant morbidity and mortality in the developing fetus and in immunocompromised individuals. Biological diagnosis classically relies upon serology and direct detection of the parasite by inoculation to laboratory animals. In the past decade, the use of the polymerase chain reaction (PCR) has made a significant improvement in both the prenatal diagnosis of congenital toxoplasmosis and the detection of acute disease in the immunocompromised patient. Nevertheless, like many 'in-house' PCR assays, the PCR-Toxoplasma suffers from lack of standardization and variable performance according to the laboratory. A wide variety of primers has been used in different assays, but few comparative tests have been performed. Moreover, in contrast to other parasitic diseases, PCR-Toxoplasma has not yet attained a sufficient level of sensitivity, regardless of the clinical condition considered. These drawbacks are discussed, together with the undoubted gain that PCR has brought to this difficult diagnosis.
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Affiliation(s)
- Patrick Bastien
- CNRS UMR 5093 Gènome des Protozoaires Parasites, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Faculté de Médecine, 163 Rue A. Broussonet, 34090 Montpellier, France.
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7
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Cultrera R, Seraceni S, Contini C. Efficacy of a novel reverse transcriptase-polymerase chain reaction (RT-PCR) for detecting Toxoplasma gondii bradyzoite gene expression in human clinical specimens. Mol Cell Probes 2002; 16:31-9. [PMID: 12005445 DOI: 10.1006/mcpr.2001.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A reverse transcriptase-polymerase chain reaction (RT-PCR) assay, was performed to evaluate the transcription degree of bradyzoite- or tachyzoite-specific genes of Toxoplasma gondii on cerebrospinal fluid (CSF) specimens from AIDS patients with toxoplasmic encephalitis (TE), and to distinguish an asymptomatic latent infection from a reactivated disease. This method was compared with nested DNA amplification (n)-PCR. The mRNA expression of the representative T. gondii cystic matrix (MAG1) or bradyzoite-specific (SAG4) genes was investigated on CSF obtained from AIDS patients with first episode (no. 11) or relapse (no. 8) of TE. The mRNA expression of tachyzoite-specific (SAG1) gene was also studied. New designed oligonucleotide primers and probes, which identify a 212 bp fragment inside to the open reading MAG1 sequence, were employed in both RT-PCR and n-PCR assays. Oligo-dT primed cDNA synthesis appeared a suitable method for subsequent analysis by n-PCR. RT-PCR has been shown to be more sensitive and specific than n-PCR. MAG1 and SAG4 gene expression was detected in 8 (100%) and 6 (75%) patients with TE relapses, respectively, while SAG1 detected 7 (63%) patients with TE first episode. These findings suggest that RT-PCR method is able to identify the bradyzoite stage of T. gondii especially in patients who are at risk for TE relapse.
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Affiliation(s)
- R Cultrera
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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8
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Costa JM, Munoz C, Krüger D, Martino R, Held TK, Dardé ML, Cordonnier C, Bretagne S. Quality control for the diagnosis of Toxoplasma gondii reactivation in SCT patients using PCR assays. Bone Marrow Transplant 2001; 28:527-8. [PMID: 11593329 DOI: 10.1038/sj.bmt.1703175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2001] [Accepted: 06/26/2001] [Indexed: 11/09/2022]
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9
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Chaves-Borges FA, Souza MA, Silva DA, Kasper LH, Mineo JR. Detection of Toxoplasma gondii soluble antigen, SAG-1(p30), antibody and immune complex in the cerebrospinal fluid of HIV positive or negative individuals. Rev Inst Med Trop Sao Paulo 1999; 41:329-38. [PMID: 10671285 DOI: 10.1590/s0036-46651999000600001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Active infection by T. gondii was evaluated by immunoassay for soluble SAG-1 (p30), the major surface antigen from T. gondii, specific antibodies and immune complexes in human cerebrospinal fluid (CSF) samples. A total of 263 samples of CSF were collected from hospitalized patients presenting neurological disorders and analyzed for antibodies to HIV. Patients were divided into two groups: HIV positive (n = 96) or HIV negative (n =167). The results of the assays showed that 45% of all samples were positive for soluble SAG-1. Toxoplasma Ag/Ab immune complexes were detected in 19% of the CSF samples and 62% were positive for T. gondii- specific IgG. A combination of these assays in the presence of clinical findings consistent with active Toxoplasma infection may predict the presence of toxoplasmic encephalitis. Moreover, detection of soluble SAG-1 in the CSF of these individuals appears consistent with active infection.
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Affiliation(s)
- F A Chaves-Borges
- Laboratory of Immunology, Department of Pathology, Universidade Federal de Uberlândia, Uberlândia, MG, 38400-902, Brazil
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10
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Ellis JT. Polymerase chain reaction approaches for the detection of Neospora caninum and Toxoplasma gondii. Int J Parasitol 1998; 28:1053-60. [PMID: 9724876 DOI: 10.1016/s0020-7519(98)00096-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review summarizes existing knowledge on the development and use of the polymerase chain reaction for the detection of DNA from Neospora and Toxoplasma. Several strategies which utilise the polymerase chain reaction for the diagnosis of toxoplasmosis in humans and livestock have been described and they principally target the B1 repetitive sequence, the P30 gene or ribosomal DNA. Experience has shown that the polymerase chain reaction has proven insufficiently robust to serve as a diagnostic test alone although when used in conjunction with other diagnostic techniques it does prove to be a useful aid. The marketing of a commercial polymerase chain reaction kit may well solve some of the inadequacies seen using "home made" polymerase chain reaction technology which are commonly used in diagnostic laboratories around the world. Recent progress on the development of polymerase chain reaction diagnostics for Neospora has been rapid and is discussed in detail.
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Affiliation(s)
- J T Ellis
- Department of Cell and Molecular Biology, University of Technology, Sydney, NSW, Australia.
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11
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Garly ML, Petersen E, Pedersen C, Lundgren JD, Gerstoft J. Toxoplasmosis in Danish AIDS patients. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 29:597-600. [PMID: 9571741 DOI: 10.3109/00365549709035902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infection with Toxoplasma gondii was studied in 600 patients with AIDS, diagnosed in the eastern part of Denmark from 1980 up to and including 1990. The median age was 38 years, and 223 (44%) had anti-T. gondii IgG antibodies. Of the patients seropositive to T. gondii 61 (27%) developed toxoplasma encephalitis (TE). Few patients received prophylactic treatment with sulfamethoxazole-trimetoprim. In total, 66 patients were diagnosed with TE. One had no serological test performed, and of the remaining 65, 4 (6%) had no anti-T. gondii IgG antibodies. The predictive value of a negative Sabin-Feldman dye test was 99%. The geometric mean dye test titer was higher in patients with TE than in patients without TE. Of the patients with TE 34% had serological reactivation of their T. gondii infection at the time of TE diagnosis, and 34% had detectable T. gondii-specific antibodies in the cerebrospinal fluid. Specific IgM antibodies were found to have little value in the diagnosis of TE, as only 3% had detectable IgM antibodies. Acute toxoplasmosis was the AIDS-defining diagnosis for 23 (35%) of the patients with TE. The median CD4 count at the time of TE was 30 x 10(6)/l, and the median survival time from diagnosis of TE was 9 months.
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Affiliation(s)
- M L Garly
- Department of Medicine B, Frederiksberg Hospital, Denmark
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12
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Angel SO, Matrajt M, Margarit J, Nigro M, Illescas E, Pszenny V, Amendoeira MR, Guarnera E, Garberi JC. Screening for active toxoplasmosis in patients by DNA hybridization with the ABGTg7 probe in blood samples. J Clin Microbiol 1997; 35:591-5. [PMID: 9041395 PMCID: PMC229633 DOI: 10.1128/jcm.35.3.591-595.1997] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We report the potential use of a specific Toxoplasma gondii DNA probe (ABGTg7). We applied a dot blot hybridization assay to blood samples for the diagnosis of cerebral toxoplasmosis (CT), acute toxoplasmic lymphadenopathy (ATL), and disseminated toxoplasmosis in transplant recipients (TRs). We studied a total of 84 individuals: 38 patients and 46 controls. We found positive hybridization signals for 12 (66.7%) of 18 patients with confirmed CT, 9 (52.9%) of 17 patients with ATL, and 2 (66.7%) of 3 TRs. PCR assays were performed in parallel for patients with ATL, resulting in T. gondii DNA detection for 10 patients (58.8%). A comparative study between dot blot and PCR assays performed with the blood of mice that had been experimentally infected with tachyzoites gave similar results: 60 and 70% positive results, respectively. Finally, the sum of positive values obtained by both DNA tests (dot blot assay plus PCR) increased the rate of positivity for ATL patients to 76.4%. These results demonstrate that the T. gondii ABGTg7 repetitive DNA element is an additional useful resource for diagnosing Toxoplasma parasitemia in patients with CT and ATL and in TRs. Thus, our ABGTg7-based dot blot test may lead to an improvement in T. gondii detection methods in patients with acute toxoplasmosis.
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Affiliation(s)
- S O Angel
- Departamento Parasitología, Instituto Nacional de Microbiología Dr. Carlos G. Malbrán, CP 1281, Buenos Aires, Argentina
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13
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Cinque P, Scarpellini P, Vago L, Linde A, Lazzarin A. Diagnosis of central nervous system complications in HIV-infected patients: cerebrospinal fluid analysis by the polymerase chain reaction. AIDS 1997; 11:1-17. [PMID: 9110070 DOI: 10.1097/00002030-199701000-00003] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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14
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Roberts TC, Storch GA. Multiplex PCR for diagnosis of AIDS-related central nervous system lymphoma and toxoplasmosis. J Clin Microbiol 1997; 35:268-9. [PMID: 8968922 PMCID: PMC229553 DOI: 10.1128/jcm.35.1.268-269.1997] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A nested multiplex PCR assay was designed for the simultaneous detection of Epstein-Barr virus and Toxoplasma gondii DNA from the cerebrospinal fluid of AIDS patients. T. gondii DNA was detected in 8 of 8 patients with Toxoplasma encephalitis and in 0 of 6 patients without toxoplasmosis, and Epstein-Barr virus DNA was found in 9 of 14 patients with central nervous system lymphoma and in 2 of 38 patients without disease.
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Affiliation(s)
- T C Roberts
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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15
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Nicoll S, Burns SM, Brettle RP, Leen CS. A comparison of two methods of gene amplification for the diagnosis of Toxoplasma gondii in AIDS. J Infect 1996; 33:177-83. [PMID: 8945707 DOI: 10.1016/s0163-4453(96)92201-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Nicoll
- Centre for Tropical Veterinary Medicine, Edinburgh University, Roslin, Midlothian, U.K
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16
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Pelloux H, Weiss J, Simon J, Muet F, Fricker-Hidalgo H, Goullier-Fleuret A, Ambroise-Thomas P. A new set of primers for the detection of Toxoplasma gondii in amniotic fluid using polymerase chain reaction. FEMS Microbiol Lett 1996; 138:11-5. [PMID: 8674966 DOI: 10.1111/j.1574-6968.1996.tb08127.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A new PCR system including a pair of primers, a probe and an internal control were designed from the B1 gene of Toxoplasma gondii. The system described allowed the detection of less than 10 tachyzoites of the RH strain of T. gondii. Among 21 amniotic fluid samples, this system diagnosed the cases of congenital toxoplasmosis which were simultaneously diagnosed using mice inoculation, in vitro culture, and serology from both amniotic fluid and fetal blood. These results show that these new primers allow for a highly sensitive detection of T. gondii DNA.
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Affiliation(s)
- H Pelloux
- Département de Parasitologie-Myocologie Médicale et Moléculaire, Faculté de Médecine, Université Joseph Fourier, Grenoble, France
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17
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Ammassari A, Murri R, Cingolani A, De Luca A, Antinori A. AIDS-associated cerebral toxoplasmosis: an update on diagnosis and treatment. Curr Top Microbiol Immunol 1996; 219:209-22. [PMID: 8791702 DOI: 10.1007/978-3-642-51014-4_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Ammassari
- Department of Infectious Diseases, Catholic University, Rome, Italy
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18
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Eggers C, Gross U, Klinker H, Schalke B, Stellbrink HJ, Kunze K. Limited value of cerebrospinal fluid for direct detection of Toxoplasma gondii in toxoplasmic encephalitis associated with AIDS. J Neurol 1995; 242:644-9. [PMID: 8568525 DOI: 10.1007/bf00866914] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The diagnosis of acquired immunodeficiency syndrome-associated toxoplasmic encephalitis (TE), a typically focal disease resulting from reactivation of tissue cysts, relies mainly on indirect diagnostic methods. In a prospective study, we investigated the value of detection of Toxoplasma gondii in cerebrospinal fluid (CSF) by using the polymerase chain reaction and the mouse inoculation test. Twenty-four patients with 26 episodes of TE, 2 HIV-infected patients with primary acute Toxoplasma infection, and 38 HIV-infected control patients with latent Toxoplasma infection were investigated. Detection of T. gondii in CSF by both methods was possible in only 3 of the TE patients (11.5%), the remaining patients being negative with either of the methods. In contrast, T. gondii DNA was detected in both of the acutely infected patients, indicating that in primary acute toxoplasmosis parasites may easily be found in the CSF, whereas in the majority of TE cases in immunocompromised patients, T. gondii parasites do not gain access to the CSF drawn by lumbar puncture.
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Affiliation(s)
- C Eggers
- Department of Neurology, University Hospital, Hamburg, Germany
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19
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Dupon M, Cazenave J, Pellegrin JL, Ragnaud JM, Cheyrou A, Fischer I, Leng B, Lacut JY. Detection of Toxoplasma gondii by PCR and tissue culture in cerebrospinal fluid and blood of human immunodeficiency virus-seropositive patients. J Clin Microbiol 1995; 33:2421-6. [PMID: 7494040 PMCID: PMC228429 DOI: 10.1128/jcm.33.9.2421-2426.1995] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
To investigate whether both tissue culture and PCR on a sequence from the repetitive rDNA could contribute to the diagnosis of toxoplasmosis, blood samples and, if they were available, cerebrospinal fluid (CSF) and aqueous humor samples from 72 human immunodeficiency virus-seropositive patients with suspected toxoplasmosis were prospectively tested. For 10 patients with fever of unknown origin but without confirmed toxoplasmosis, no Toxoplasma gondii was detected. For two patients with confirmed toxoplasmic uveitis, only PCR of aqueous humor samples was positive. Of 60 patients (48 with CSF samples) with neurological signs, 25 (from 13 of whom CSF samples were available) had confirmed cerebral toxoplasmosis and 10 had a positive PCR of CSF and/or blood samples, while for 1 patient culture of the CSF sample was also positive. Unlike tissue culture, PCR of rDNA is of value for the detection of cerebral toxoplasmosis in human immunodeficiency virus-seropositive patients, provided that both CSF and blood samples are available (sensitivity, 76.9%; specificity, 100%).
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Affiliation(s)
- M Dupon
- Service de Médecine Interne, Hôpital Pellegrin, Bordeaux, France
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20
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21
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Bougnoux M, Dupouy-Camet J. 2.3. Apport de l'étude du liquide céphalo-rachidien. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)80649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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23
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Filice GA, Hitt JA, Mitchell CD, Blackstad M, Sorensen SW. Diagnosis of Toxoplasma parasitemia in patients with AIDS by gene detection after amplification with polymerase chain reaction. J Clin Microbiol 1993; 31:2327-31. [PMID: 8408550 PMCID: PMC265755 DOI: 10.1128/jcm.31.9.2327-2331.1993] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We sought evidence of toxoplasma parasitemia among 37 people with active or dormant Toxoplasma gondii infection or no evidence of infection. DNA was extracted from erythrocyte-free portions of blood samples, and the T. gondii B1 gene was amplified by the polymerase chain reaction. Evidence of T. gondii parasitemia was found in six patients with severe immunosuppression from AIDS and clinical evidence suggestive of or compatible with toxoplasmosis. Results were negative for patients unlikely to have active toxoplasmosis. Gene detection after amplification with the polymerase chain reaction is a promising test for detection of parasitemia, and parasitemia should be tested for in patients with AIDS and unexplained fever or central nervous system abnormalities.
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Affiliation(s)
- G A Filice
- Infectious Disease Section (111F), Veterans Affairs Medical Center, Minneapolis, Minnesota 55417
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24
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Dupouy-Camet J, de Souza SL, Maslo C, Paugam A, Saimot AG, Benarous R, Tourte-Schaefer C, Derouin F. Detection of Toxoplasma gondii in venous blood from AIDS patients by polymerase chain reaction. J Clin Microbiol 1993; 31:1866-9. [PMID: 8349765 PMCID: PMC265647 DOI: 10.1128/jcm.31.7.1866-1869.1993] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Detection of Toxoplasma gondii in blood by means of the polymerase chain reaction (PCR) may facilitate the diagnosis and follow-up of cerebral toxoplasmosis in patients with AIDS. We evaluated this approach with seven patients with tissue culture-proven parasitemia, 14 patients with presumptive cerebral toxoplasmosis, and 17 healthy human immunodeficiency virus-positive controls. Each sample of blood was assayed on three different occasions by a PCR assay based on detection of the gene encoding the P30 surface protein. A positive PCR diagnosis required positivity in at least two of the three PCR tests. None of the controls had a positive PCR diagnosis, but six of the seven patients with parasitemia did. Cerebral toxoplasmosis was confirmed in 13 of the 14 patients with a presumptive diagnosis; diagnosis by PCR was positive before treatment for 9 of these 13 patients, whereas tissue culture was positive for only 1 patient. During treatment, blood samples were taken from 14 patients at regular intervals until day 12. PCR diagnosis became negative on ethidium-stained gels, but persistent signals were observed after hybridization, in some cases, for up to 12 days after initiation of therapy. PCR on venous blood could thus be a sensitive and noninvasive method for the diagnosis of cerebral and disseminated toxoplasmosis in AIDS patients and could be a potential tool for monitoring the effects of treatment.
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Affiliation(s)
- J Dupouy-Camet
- Laboratoire de Parasitologie, Hôpital Cochin, Paris, France
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25
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Decker CF, Tuazon CU. Toxoplasmosis: an update on clinical and therapeutic aspects. PROGRESS IN CLINICAL PARASITOLOGY 1993; 3:21-41. [PMID: 8420603 DOI: 10.1007/978-1-4612-2732-8_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- C F Decker
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, MD
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26
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Caramello P, Forno B, Lucchini A, Pollono AM, Sinicco A, Gioannini P. Meningoencephalitis caused by Toxoplasma gondii diagnosed by isolation from cerebrospinal fluid in an HIV-positive patient. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1993; 25:663-6. [PMID: 8284653 DOI: 10.3109/00365549309008558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Toxoplasmosis of the central nervous system is a frequent opportunistic infection in AIDS patients, usually presenting as a mass brain lesion detected by computerized axial tomography scanning or magnetic resonance imaging. A case of diffuse meningoencephalitis with no radiological evidence of brain lesions is described. Diagnosis was made by culturing cerebrospinal fluid (CSF) on THP1 cells where tachyzoites of Toxoplasma gondii were demonstrated after 8 days of incubation by both direct observation and immunofluorescence. CSF examination with culture should be considered in AIDS patients with neurological signs and symptoms but without radiological evidence of cerebral lesions.
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Affiliation(s)
- P Caramello
- Istitute of Infectious Diseases, University of Turin, Italy
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27
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Parmley SF, Goebel FD, Remington JS. Detection of Toxoplasma gondii in cerebrospinal fluid from AIDS patients by polymerase chain reaction. J Clin Microbiol 1992; 30:3000-2. [PMID: 1452673 PMCID: PMC270569 DOI: 10.1128/jcm.30.11.3000-3002.1992] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The polymerase chain reaction (PCR) was used to detect Toxoplasma gondii DNA in cerebrospinal fluid (CSF) from 14 patients with AIDS by amplification of the repetitive B1 gene. Positive PCRs were obtained in CSF from four of nine patients with toxoplasmic encephalitis. CSF samples from five control patients were negative for T. gondii DNA by PCR.
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Affiliation(s)
- S F Parmley
- Department of Immunology and Infectious Diseases, Research Institute, Palo Alto, California 94301
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