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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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Oya Y, Futami H, Nakazawa T, Ishijima K, Umemiya K, Takizawa F, Imai N, Kitamura H, Matsumura R. Tubulointerstitial nephritis and uveitis syndrome following meningitis and systemic lymphadenopathy with persistent Toxoplasma immunoglobulin M: a case report. J Med Case Rep 2021; 15:482. [PMID: 34556154 PMCID: PMC8461971 DOI: 10.1186/s13256-021-02909-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Background Tubulointerstitial nephritis and uveitis syndrome is a rare lymphocyte-related oculorenal inflammatory disease presumed to be associated with drug use and infectious agents. Toxoplasma gondii is one of such pathogens that could exhibit encephalitis, meningitis, and uveitis in immunocompromised or in some immunocompetent individuals. If the immunoglobulin M of Toxoplasma is positive on screening, the interpretation of the result is not simple, especially when immunoglobulin M stays positive persistently. Case presentation A 34-year-old Asian male developed fever, headache, and lymphadenopathy with tenderness, which was initially diagnosed as meningitis. Antibiotics were started, and diclofenac sodium was used for the fever. Although his symptoms were alleviated in a week by the treatment, gradual decline in renal function was noted, prompting a renal biopsy that indicated acute granulomatous interstitial nephritis. A week later, tenderness in both eyes with blurred vision appeared and revealed iritis and keratic precipitations in both eyes; hence, the diagnosis of acute tubulointerstitial nephritis and bilateral uveitis syndrome was made. Toxoplasma gondii-specific immunoglobulin G and immunoglobulin M titers were both positive. Although we could not rule out recent infection of Toxoplasma gondii, which may cause uveitis initially, Toxoplasma immunoglobulin G avidity test indicated a distant infection, which allowed us to rule out meningitis and uveitis as responsible for the complication of recent Toxoplasma gondii infection. Drug-induced lymphocyte stimulation test, or lymphocyte transformation test of diclofenac sodium, was solely positive among the tested drugs. Uveitis was alleviated only with ophthalmic steroid, and renal function returned to normal without administration of systemic steroid. Conclusions We experienced a case of diclofenac-induced tubulointerstitial nephritis and uveitis syndrome. In ruling out infections, Toxoplasma immunoglobulin M was persistently positive, and Toxoplasma immunoglobulin G avidity test indicated a “distant” infection. From these two results, we ruled out recent infection. However, it should be noted that “distant” infection indicated by commercial immunoglobulin G avidity is still a multiplex profile consisting of reinfection, reactivation, and latent infection. Narrowing down the infection profile of Toxoplasma is challenging in some cases. Therefore, careful diagnosis and extended follow-up of such patients are needed.
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Affiliation(s)
- Yoshihiro Oya
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan. .,Laboratory of Autoimmune diseases, Department of Clinical Research, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan.
| | - Hidekazu Futami
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Takuya Nakazawa
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Kazuyuki Ishijima
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Keiko Umemiya
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
| | - Fumiyoshi Takizawa
- Department of Internal Medicine, Seikeikai Chiba Medical Center, Chiba City, Chiba, 260-0842, Japan
| | - Naoki Imai
- Department of Ophthalmology, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan
| | - Hiroshi Kitamura
- Department of Pathology, National Hospital Organization Chibahigashi National Hospital, Chiba City, Chiba, 260-8712, Japan
| | - Ryutaro Matsumura
- Department of Rheumatology, Allergy and Clinical Immunology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuou-ku, Chiba City, Chiba, 260-8712, Japan
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Kalogeropoulos D, Kalogeropoulos C, Sakkas H, Mohammed B, Vartholomatos G, Malamos K, Sreekantam S, Kanavaros P, de-la-Torre A. Pathophysiological Aspects of Ocular Toxoplasmosis: Host-parasite Interactions. Ocul Immunol Inflamm 2021; 30:560-569. [PMID: 34242103 DOI: 10.1080/09273948.2021.1922706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: This review aims to present the state of the art to understand the pathophysiology of ocular toxoplasmosis (OT), providing further foundations that would help to improve the future treatment and prognosis of this potentially blinding disease.Methods: A thorough literature search was performed in PubMed database. An additional search was made in Google Scholar to complete the collected items.Results: Toxoplasma gondii ocular infection is one of the most frequent causes of posterior uveitis. Despite the ocular barriers, the parasite reaches the eye through different mechanisms. Once inside, it remains encysted livelong within the retina, and recurrences cannot be completely avoided. The complexity of host-parasite interactions, leading to the success of this parasite, encompasses host factors such as genetic predisposition, immune status, and age; and parasite factors such as strain diversity, virulence, phylogenetic origin, and geographical distribution. These factors influence the clinical presentation, course, and progression of the disease. Additional elements, such as pregnancy, eating behavior, and environmental, social, and cultural factors may also contribute to this complex balance.Conclusions: The host-parasite interaction in OT is a complex and multifactorial relationship, with the parasite always on the driving edge of the game. There are still multiple incompletely understood fields to be investigated. Future research would permit further insight into the immune-biology of the parasite and recognition of the host-parasite interplay to improve the diagnostic and management performance.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Bashar Mohammed
- Department of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, UK
| | - Georgios Vartholomatos
- Hematology Laboratory, Unit of Molecular Biology, University Hospital of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Greece
| | | | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alejandra de-la-Torre
- Immunology Unit, NeURos Research Group, NeuroVitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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Tsui I, Neves LM, Adachi K, Gaw SL, Pereira JP, Brasil P, Nielsen-Saines K, Moreira MEL, Zin AA. Overlapping Spectrum of Retinochoroidal Scarring in Congenital Zika Virus and Toxoplasmosis Infections. Ophthalmic Surg Lasers Imaging Retina 2020; 50:779-784. [PMID: 31877223 DOI: 10.3928/23258160-20191119-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/27/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Antenatal Zika virus (ZIKV) or toxoplasmosis infections may present with isolated eye abnormalities with absence of other apparent birth defects. The purpose of this article is to discuss the overlapping spectrum of clinical presentation and retinochoroidal scarring in congenital ZIKV and toxoplasmosis infections. PATIENTS AND METHODS Prenatal ultrasound abnormalities seen from antenatal ZIKV and toxoplasmosis infections overlap and may include intracranial calcifications, microcephaly, and intrauterine growth restriction. The clinical spectrum of both infections in less severely affected infants and children may include nonspecific neurological impairment such as developmental delay and seizures. RESULTS Inherent limitations in serological testing pose additional barriers in establishing a diagnosis. Retinal pigment epithelium (RPE) mottling in ZIKV infection can occur in isolation or adjacent to retinochoroidal atrophy. In contrast, RPE mottling outside of the borders of retinochoroidal atrophy is not typically seen in toxoplasmosis. To date, postnatal reactivation of congenital eye lesions as seen in toxoplasmosis have not been reported with ZIKV infection. CONCLUSIONS As children infected with congenital ZIKV grow older, subclinical eye abnormalities may be indistinguishable from toxoplasmosis. Brazil has had high prevalence of both diseases with long-term information available on toxoplasmosis only. Surveillance guidelines for asymptomatic eye abnormalities will likely evolve. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:779-784.].
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Nakashima F, Brandão de Mattos CC, Ferreira AIC, Spergiorin LCJF, Meira-Strejevitch CS, Oliani AH, Vaz-Oliani DCM, Pereira-Chioccola VL, de Mattos LC. FUT3 and FUT2 genotyping and glycoconjugate profile Lewis b as a protective factor to Toxoplasma gondii infection. Acta Trop 2019; 193:92-98. [PMID: 30831115 DOI: 10.1016/j.actatropica.2019.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/22/2019] [Accepted: 02/28/2019] [Indexed: 11/23/2022]
Abstract
The interaction between the ABO, FUT2 and FUT3 genes results in the synthesis of different glycoconjugates profiles expressed in gastrointestinal tract. Moreover, the protozoan Toxoplasma gondii, which causes toxoplasmosis, utilizes this organ as an infection route. We analyzed the frequencies of the different glycoconjugate profiles which were determined by phenotyping ABO and genotyping the status secretor (FUT2; substitution G428A) and Lewis (FUT3; substitution T202C and C314T) histo-blood systems, assessed by PCR-RFLP and PCR-SSP, respectively. A total of 244 pregnant women (G1: Seropositive; G2: Seronegative) for IgG T. gondii antibodies were enrolled. IgG anti-T. gondii antibodies were determined by ELISA. G1 was composed of 158 (64.8%) sample and G2 by 86 (36.2%). The glycoconjugate profile was accessed in 151 seropositive and 85 seronegative samples by the combination of ABO and Lewis phenotyping as well as FUT2 and FUT3 genotyping. In G1, 36 (22.8%) presented the glycoconjugate profile ALeb, 5 (3.3%) A, 13 (8.6) BLeb, 1 (0.6%) B, 41 (27.1%) Leb, 13(8.6%) H, 38(25.2%) Lea and 4 (2.6%) Lec. G2 was composed of 13 (15.3%) of ALeb, 15 (17.6%) BLeb, 1 (1.2%) B, 42 (49,4%) Leb and 14 (16.5) Lea. H and Lec glycoconjugate profiles were not found in G2. The frequencies of the glycoconjugates profiles Leb (p = 0.001) and H (p = 0.005) were significantly different compared between G1 and G2. The glycoconjugate profile H inferred from the ABO phenotyping and FUT3 and FUT2 genotyping is associated with infection by T. gondii in pregnant women and the Leb profile appears to protect the infection by this parasite.
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Affiliation(s)
- Fabiana Nakashima
- Biology Department, Bioscience, Languages and Exact Sciences Institute of the Universidade Estadual Paulista "Júlio de Mesquita Filho" (IBILCE/UNESP), São José do Rio Preto, São Paulo, Brazil; Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil.
| | - Cinara Cássia Brandão de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil; FAMERP Toxoplasma Research Group, Brazil.
| | - Ana Iara Costa Ferreira
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil.
| | - Lígia Cosentino Junqueira Franco Spergiorin
- Gynecology and Obstetrics Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil; FAMERP Toxoplasma Research Group, Brazil.
| | | | - Antonio Hélio Oliani
- Gynecology and Obstetrics Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil.
| | - Denise Cristina Mós Vaz-Oliani
- Gynecology and Obstetrics Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil.
| | | | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil; FAMERP Toxoplasma Research Group, Brazil.
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Avelar MV, Martinez VO, Moura DLD, Barros IA, Primo AADS, Duarte AO, Soares NM, Lima FWDM. Association between seroprevalence of IgG anti-Toxoplasma gondii and risk factors for infection among pregnant women in Climério de Oliveira Maternity, Salvador, Bahia, Brazil. Rev Inst Med Trop Sao Paulo 2017; 59:e90. [PMID: 29267598 PMCID: PMC5738996 DOI: 10.1590/s1678-9946201759090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Maternal Toxoplasma gondii (T. gondii) infection can lead to spontaneous abortion, fetal malformation, and numerous sequelae in the newborn, including visual and hearing impairment. T. gondii serology was determined in pregnant women and their newborns who were referred to Climério de Oliveira Maternity, Federal University of Bahia, and the possible associations with the risk factors for maternal infection were investigated. This cross-sectional study was conducted from January to December 2014 and included 712 pregnant women, aged 15 to 49 years, and 235 newborns. Seroprevalence was determined by the detection of T. gondii-specific immunoglobulin (Ig) M (IgM) and IgG antibodies using enzyme-linked immunoassay. In addition, mothers completed a questionnaire that focused on socioeconomic aspects, and survey data were tabulated using the SPSS statistical software program (version 21.0 for Windows). The seroprevalence rate for specific IgG antibodies was 51% (362) among mothers and 93% (219) among neonates. All the mothers and their newborns were negative for specific-IgM antibodies. Higher age group and lower maternal education were the only risk factors statistically associated with the presence of specific IgG. In summary, high levels of specific IgG antibodies were observed in pregnant women. The knowledge of risk factors for toxoplasmosis can help in the orientation of newly pregnant women.
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Affiliation(s)
- Maria Virginia Avelar
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Victor Otero Martinez
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Daniel Lima de Moura
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Indira Alves Barros
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Anderson Alves da Silva Primo
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Alan Oliveira Duarte
- Universidade Federal da Bahia, Faculdade de Farmácia, Serviço de Imunologia das Doenças Infecciosas, Salvador, Bahia, Brazil
| | - Neci Matos Soares
- Universidade Federal da Bahia, Faculdade de Farmácia, Laboratório de Parasitologia Clínica, Salvador, Bahia, Brazil
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Han Y, Zhou A, Lu G, Zhao G, Sha W, Wang L, Guo J, Zhou J, Zhou H, Cong H, He S. DNA Vaccines Encoding Toxoplasma gondii Cathepsin C 1 Induce Protection against Toxoplasmosis in Mice. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:505-512. [PMID: 29103265 PMCID: PMC5678475 DOI: 10.3347/kjp.2017.55.5.505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Abstract
Toxoplasma gondii cathepsin C proteases (TgCPC1, 2, and 3) are important for the growth and survival of T. gondii. In the present study, B-cell and T-cell epitopes of TgCPC1 were predicted using DNAstar and the Immune Epitope Database. A TgCPC1 DNA vaccine was constructed, and its ability to induce protective immune responses against toxoplasmosis in BALB/c mice was evaluated in the presence or absence of the adjuvant α-GalCer. As results, TgCPC1 DNA vaccine with or without adjuvant α-GalCer showed higher levels of IgG and IgG2a in the serum, as well as IL-2 and IFN-γ in the spleen compared to controls (PBS, pEGFP-C1, and α-Galcer). Upon challenge infection with tachyzoites of T. gondii (RH), pCPC1/α-Galcer immunized mice showed the longest survival among all the groups. Mice vaccinated with DNA vaccine without adjuvant (pCPC1) showed better protective immunity compared to other controls (PBS, pEGFP-C1, and α-Galcer). These results indicate that a DNA vaccine encoding TgCPC1 is a potential vaccine candidate against toxoplasmosis.
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Affiliation(s)
- Yali Han
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Aihua Zhou
- Department of Pediatrics, Provincial Hospital Affiliated to Shandong University, Shandong University School of Medicine, Jinan, Shandong, 250021, P. R. China
| | - Gang Lu
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Guanghui Zhao
- Qilu Hospital of Shandong University, Qingdao, Shandong, 266035, P. R. China
| | - Wenchao Sha
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Lin Wang
- Department of Jinan Children's Hospital, Jinan, Shandong, 250022, P. R. China
| | - Jingjing Guo
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Jian Zhou
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Huaiyu Zhou
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Hua Cong
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
| | - Shenyi He
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong, 250012, P. R. China
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Ayo CM, Camargo AVDS, Frederico FB, Siqueira RC, Previato M, Murata FHA, Silveira-Carvalho AP, Barbosa AP, Brandão de Mattos CDC, de Mattos LC. MHC Class I Chain-Related Gene A Polymorphisms and Linkage Disequilibrium with HLA-B and HLA-C Alleles in Ocular Toxoplasmosis. PLoS One 2015; 10:e0144534. [PMID: 26672749 PMCID: PMC4682939 DOI: 10.1371/journal.pone.0144534] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 11/19/2015] [Indexed: 12/05/2022] Open
Abstract
This study investigated whether polymorphisms of the MICA (major histocompatibility complex class I chain-related gene A) gene are associated with eye lesions due to Toxoplasma gondii infection in a group of immunocompetent patients from southeastern Brazil. The study enrolled 297 patients with serological diagnosis of toxoplasmosis. Participants were classified into two distinct groups after conducting fundoscopic exams according to the presence (n = 148) or absence (n = 149) of ocular scars/lesions due to toxoplasmosis. The group of patients with scars/lesions was further subdivided into two groups according to the type of the ocular manifestation observed: primary (n = 120) or recurrent (n = 28). Genotyping of the MICA and HLA alleles was performed by the polymerase chain reaction-sequence specific oligonucleotide technique (PCR-SSO; One Lambda®) and the MICA-129 polymorphism (rs1051792) was identified by nested polymerase chain reaction (PCR-RFLP). Significant associations involving MICA polymorphisms were not found. Although the MICA*002~HLA-B*35 haplotype was associated with increased risk of developing ocular toxoplasmosis (P-value = 0.04; OR = 2.20; 95% CI = 1.05–4.60), and the MICA*008~HLA-C*07 haplotype was associated with protection against the development of manifestations of ocular toxoplasmosis (P-value = 0.009; OR: 0.44; 95% CI: 0.22–0.76), these associations were not statistically significant after adjusting for multiple comparisons. MICA polymorphisms do not appear to influence the development of ocular lesions in patients diagnosed with toxoplasmosis in this study population.
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Affiliation(s)
- Christiane Maria Ayo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Ana Vitória da Silveira Camargo
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Fábio Batista Frederico
- Ophthalmology Outpatient Clinic, Hospital de Base de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Rubens Camargo Siqueira
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
| | - Mariana Previato
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Fernando Henrique Antunes Murata
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | | | - Amanda Pires Barbosa
- Ophthalmology Outpatient Clinic, Hospital de Base de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Cinara de Cássia Brandão de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Molecular Biology Department, Faculdade de Medicina de São José do Rio Preto de São José do Rio Preto, SP, Brazil
- FAMERP Toxoplasma Research Group, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
- * E-mail: or (LCM)
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9
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Previato M, Frederico FB, Murata FHA, Siqueira RC, Barbosa AP, Silveira-Carvalho AP, Meira CDS, Pereira-Chioccola VL, Gava R, Martins Neto PP, de Mattos LC, de Mattos CCB. A Brazilian report using serological and molecular diagnosis to monitoring acute ocular toxoplasmosis. BMC Res Notes 2015; 8:746. [PMID: 26643197 PMCID: PMC4671220 DOI: 10.1186/s13104-015-1650-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/29/2015] [Indexed: 12/04/2022] Open
Abstract
Background Toxoplasmosis was recently included as a neglected disease by the Center for Disease Control. Ocular toxoplasmosis is one clinical presentation of congenital or acquired infection. The laboratory diagnosis is being used worldwide to support the clinical diagnosis and imaging. The aim of this study was to evaluate the use of serology and molecular methods to monitor acute OT in immunocompetent patients during treatment. Methods Five immunocompetent patients were clinically diagnosed with acute OT. The clinical evaluation was performed by ophthalmologic examination using the Early Treatment Diabetic Retinopathy Study, best-corrected visual acuity, slit lamp biomicroscopy, fundoscopic examination with indirect binocular ophthalmoscopy color fundus photography, fluorescein angiography and spectral optical coherence tomography (OCT). Serology were performed by ELISA (IgA, IgM, IgG) and confirmed by ELFA (IgG, IgM). Molecular diagnoses were performed in peripheral blood by cPCR using the Toxoplasma gondiiB1 gene as the marker. Follow-up exams were performed on day +15 and day +45. Results Only five non-immunocompromised male patients completed the follow up and their data were used for analysis. The mean age was 41.2 ± 11.3 years (median: 35; range 31–54 years). All of them were positive for IgG antibodies but with different profiles for IgM and IgA, as well as PCR. For all patients the OCT exam showed active lesions with the inner retinal layers being abnormally hyper-reflective with full-thickness disorganization of the retinal reflective layers, which assumed a blurred reflective appearance and the retina was thickened. Conclusions The presence of IgA and IgM confirmed the acute infection and thus was in agreement with the clinical evaluation. Our results show the adopted treatment modified the serological profile of IgM antibodies and the PCR results, but not the IgG and IgA antibodies and that imaging is a good tool to follow-up patients. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1650-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariana Previato
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Fábio Batista Frederico
- Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Fernando Henrique Antunes Murata
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Rubens Camargo Siqueira
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Amanda Pires Barbosa
- Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Aparecida Perpétuo Silveira-Carvalho
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Cristina da Silva Meira
- Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. .,IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil.
| | - Vera Lúcia Pereira-Chioccola
- Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. .,IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil.
| | - Ricardo Gava
- Laboratory of Molecular Biology, of Parasites and Fungi, Instituto Adolfo Lutz-IAL, Aenida Dr Arnaldo,355, São Paulo, São Paulo state, 01246-000, Brazil. .,IAL Toxoplasma Research Group, Instituto Adolfo Lutz, Avenida Dr Arnaldo, 355, São Paulo, Sao Paulo state, 01246-000, Brazil.
| | - Plínio Pereira Martins Neto
- Retinopathy Outpatient Clinic, Hospital de Base da Fundação Faculdade Regional de Medicina-HB-FUNFARME, Avenida Brigadeiro Faria Lima, 5544, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Luiz Carlos de Mattos
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
| | - Cinara Cássia Brandão de Mattos
- Immunogenetics Laboratory, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto-FAMERP, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil. .,FAMERP Toxoplasma Research Group, Avenida Brigadeiro Faria Lima, 5416, São José do Rio Preto, Sao Paulo state, 15090-000, Brazil.
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Franco PS, da Silva NM, de Freitas Barbosa B, de Oliveira Gomes A, Ietta F, Shwab EK, Su C, Mineo JR, Ferro EAV. Calomys callosus chronically infected by Toxoplasma gondii clonal type II strain and reinfected by Brazilian strains is not able to prevent vertical transmission. Front Microbiol 2015; 6:181. [PMID: 25806028 PMCID: PMC4354403 DOI: 10.3389/fmicb.2015.00181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
Abstract
Considering that Toxoplasma gondii has shown high genetic diversity in Brazil, the aim of this study was to determine whether Calomys callosus chronically infected by the ME-49 strain might be susceptible to reinfection by these Brazilian strains, including vertical transmission of the parasite. Survival curves were analyzed in non-pregnant females chronically infected with ME-49 and reinfected with the TgChBrUD1 or TgChBrUD2 strain, and vertical transmission was analyzed after reinfection of pregnant females with these same strains. On the 19th day of pregnancy (dop), placentas, uteri, fetuses, liver, spleen, and lung were processed for detection of the parasite. Blood samples were collected for humoral and cellular immune response analyses. All non-pregnant females survived after reinfection and no changes were observed in body weight and morbidity scores. In pregnant females, parasites were detected in the placentas of ME-49 chronically infected females and reinfected females, but were only detected in the fetuses of reinfected females. TgChBrUD2 reinfected females showed more impaired pregnancy outcomes, presenting higher numbers of animals with fetal loss and a higher resorption rate, in parallel with higher levels of pro-inflammatory cytokines and IgG2a subclass antibodies. Vertical transmission resulting from chronic infection of immunocompetent C. callosus is considered a rare event, being attributed instead to either reactivation or reinfection. That is, the pregnancy may be responsible for reactivation of the latent infection or the reinfection may promote T. gondii vertical transmission. Our results clearly demonstrate that, during pregnancy, protection against T. gondii can be breached after reinfection with parasites belonging to different genotypes, particularly when non-clonal strains are involved in this process and in this case the reinfection promoted vertical transmission of both type II and Brazilian T. gondii strains.
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Affiliation(s)
- Priscila S Franco
- Laboratory of Immunophysiology of Reproduction, Department of Histology and Embryology, Federal University of Uberlândia , Uberlândia, Brazil
| | - Neide M da Silva
- Laboratory of Immunopathology, Institute of Biomedical Sciences, Federal University of Uberlândia , Uberlândia, Brazil
| | - Bellisa de Freitas Barbosa
- Laboratory of Immunophysiology of Reproduction, Department of Histology and Embryology, Federal University of Uberlândia , Uberlândia, Brazil
| | - Angelica de Oliveira Gomes
- Laboratory of Immunophysiology of Reproduction, Department of Histology and Embryology, Federal University of Uberlândia , Uberlândia, Brazil
| | - Francesca Ietta
- Department of Life Sciences, University of Siena , Siena, Italy
| | - E K Shwab
- Department of Microbiology, The University of Tennessee , Knoxville, TN, USA
| | - Chunlei Su
- Department of Microbiology, The University of Tennessee , Knoxville, TN, USA
| | - José R Mineo
- Laboratory of Immunoparasitology, Department of Immunology, Microbiology and Parasitology, Federal University of Uberlândia , Uberlândia, Brazil
| | - Eloisa A V Ferro
- Laboratory of Immunophysiology of Reproduction, Department of Histology and Embryology, Federal University of Uberlândia , Uberlândia, Brazil
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Brydak-Godowska J, Moneta-Wielgoś J, Kęcik D, Borkowski PK. Management of toxoplasmic retinochoroiditis during pregnancy, postpartum period and lactation: clinical observations. Med Sci Monit 2015; 21:598-603. [PMID: 25711713 PMCID: PMC4350878 DOI: 10.12659/msm.892219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background During pregnancy and labor, the immune response is physiologically impaired and women are more susceptible to infections. Since many drugs may have potentially adverse effects on the fetus and newborn, less aggressive treatment regimens should be considered in pregnant and lactating patients. The aim of our study was to present the management of toxoplasmic retinochoroiditis during pregnancy, postpartum period, and lactation. Material/Methods A retrospective study was undertaken of the clinical records of 24 women during pregnancy, postpartum period, and lactation who were referred in the years 1994–2014 to the Department of Zoonoses and Tropical Diseases or the Department of Ophthalmology, Medical University of Warsaw for toxoplasmic retinochoroiditis. The diagnosis was based on the typical ophthalmoscopic picture, confirmed by serological testing using an ELISA method. Results A total of 28 attacks of toxoplasmic retinochoroiditis were observed in 24 patients during pregnancy, postpartum period, and lactation. The choice of treatment was guided by the character and location of the inflammatory lesion and the gestational age. Topical (steroidal/nonsteroidal eye drops) and systemic treatments with spiramycin or azithromycin, Fansidar (pyrimethamine 25 mg/sulfadoxine 500 mg), and prednisone were used. Conclusions Management of toxoplasmic retinochoroiditis during pregnancy, postpartum period, or lactation must be individualized and guided by the gestational age and location of the active lesion. Women of childbearing age with toxoplasma ocular lesions should be informed by their doctors about possible active recurrences during pregnancy and followed carefully by an ophthalmologist when pregnant.
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Affiliation(s)
| | | | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Karol Borkowski
- Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Warsaw, Poland
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12
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Sex and reproduction in the transmission of infectious uveitis. J Ophthalmol 2014; 2014:683246. [PMID: 25105020 PMCID: PMC4106153 DOI: 10.1155/2014/683246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/16/2014] [Indexed: 12/17/2022] Open
Abstract
Current data permit only speculations regarding sex differences in the prevalence of infectious uveitis between women and men because uveitis case surveys do not uniformly report gender data. Differences in prevalence that are reported in the literature could relate to simple differences in the number of women and men at risk for infection or to biological differences between men and women. Compared to other types of uveitis, infectious uveitis may be directly related to occupational exposures or sexual behaviors, which differ between women and men, and may mask actual biological differences in susceptibility to ocular manifestations of the infection and its prognosis. In infectious uveitis for which there is no element of sexual transmission and data is available, prevalence of ocular disease is roughly equal between women and men. Women also have a unique relationship with infectious uveitis in their role as mothers. Vertical transmission of infections such as herpes simplex, toxoplasmosis, and cytomegalovirus can produce severe chorioretinitis in neonates.
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13
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Avelino MM, Amaral WN, Rodrigues IMX, Rassi AR, Gomes MBF, Costa TL, Castro AM. Congenital toxoplasmosis and prenatal care state programs. BMC Infect Dis 2014; 14:33. [PMID: 24438336 PMCID: PMC3918215 DOI: 10.1186/1471-2334-14-33] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Control programs have been executed in an attempt to reduce vertical transmission and the severity of congenital infection in regions with a high incidence of toxoplasmosis in pregnant women. We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. METHODS We performed a prospective cohort study with 246 newborns (NB) at risk for congenital toxoplasmosis in Goiânia (Brazil) between October 2003 and October 2011. We analyzed the efficacy of maternal treatment with spiramycin. RESULTS A total of 40.7% (66/162) of the neonates were born seriously infected. Vertical transmission associated with reactivation during pregnancy occurred in 5.5% (9/162) of the NB, with one showing severe infection (systemic). The presence of specific immunoglobulins (fetal IgM and NB IgA) suggested the worst prognosis. Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. Fetal IgM was associated with ocular impairment in 48.0% (12/25) of the fetuses and neonatal IgA-specific was related to the neuro-ophthalmologic and systemic forms of the disease. When acute toxoplasmosis was identified in the postpartum period, a lack of monitoring of seronegative pregnant women resulted in a higher risk of severe congenital infection. CONCLUSION Treatment of pregnant women with spiramycin reduces the possibility of transmission of infection to the fetus. However, a lack of proper treatment is associated with the onset of the neural-optical form of congenital infection. Primary preventive measures should be increased for all pregnant women during the prenatal period and secondary prophylaxis through surveillance of seroconversion in seronegative pregnant woman should be introduced to reduce the severity of congenital infection in the environment.
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Affiliation(s)
- Mariza M Avelino
- Pediatrics and Childcare Department of the Medical School of Federal University of Goiás (UFG), Goiânia, Brazil
- Department of Pediatrics and Puericulture MS/UFG and the Postgraduate Program from IPTSP/UFG, Rua 235 esq com 1a. Av. s/n Setor Leste Universitário, Goiânia-GO, Brazil
| | - Waldemar N Amaral
- Department of Gynecology and Obstetrics of the Medical School of Federal University of Goiás (UFG), Goiânia, Brazil
| | | | - Alan R Rassi
- Department of Ophthalmology of the Medical School (UFG), Goiânia, Brazil
| | | | - Tatiane L Costa
- Clinical Analyses Laboratory - Clinical Hospital of UFG, Goiânia, Brazil
| | - Ana M Castro
- Laboratory studies of the host-parasite relationship at the Institute for Tropical Pathology and Public Health (IPTSP) of the Federal University of Goiás (UFG), - LAERPH/IPTSP/UFG, Goiânia, Brazil
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14
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Zhao G, Zhou A, Lu G, Meng M, Sun M, Bai Y, Han Y, Wang L, Zhou H, Cong H, Zhao Q, Zhu XQ, He S. Identification and characterization of Toxoplasma gondii aspartic protease 1 as a novel vaccine candidate against toxoplasmosis. Parasit Vectors 2013; 6:175. [PMID: 23768047 PMCID: PMC3691725 DOI: 10.1186/1756-3305-6-175] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/09/2013] [Indexed: 11/26/2022] Open
Abstract
Background Toxoplasma gondii is an obligate intracellular parasite that can pose a serious threat to human health by causing toxoplasmosis. There are no drugs that target the chronic cyst stage of this infection; therefore, development of an effective vaccine would be an important advance. Aspartic proteases play essential roles in the T. gondii lifecycle. The parasite has four aspartic protease encoding genes, which are called toxomepsin 1, 2, 3 and 5 (TgASP1, 2, 3 and 5, respectively). Methods Bioinformatics approaches have enabled us to identify several promising linear-B cell epitopes and potential Th-cell epitopes on TgASP1, thus supporting its potential as a DNA vaccine against toxoplasmosis. We expressed TgASP1 in Escherichia coli and used the purified protein to immunize BALB/c mice. The antibodies obtained were used to determine where TgASP1 was localized in the parasite. We also made a TgASP1 DNA vaccine construct and evaluated it for the level of protection conferred to mice against infection with the virulent RH strain of T. gondii. Results TgASP1 appears to be a membrane protein located primarily at the tip of the T. gondii tachyzoite. Investigation of its potential as a DNA vaccine showed that it elicited strong humoral and cellular immune responses in mice, and that these responses were mediated by Th-1 cells. Mice immunized with the vaccine had greater levels of protection against mortality following challenge with T. gondii RH tachyzoites than did those immunized with PBS or the empty vector control. Conclusions TgASP1 is a novel candidate DNA vaccine that merits further investigation.
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Affiliation(s)
- Guanghui Zhao
- Department of Parasitology, Shandong University School of Medicine, Jinan, Shandong Province, People's Republic of China
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15
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Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264-96. [PMID: 22491772 PMCID: PMC3346298 DOI: 10.1128/cmr.05013-11] [Citation(s) in RCA: 969] [Impact Index Per Article: 80.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.
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Affiliation(s)
- Florence Robert-Gangneux
- Service de Parasitologie, Faculté de Médecine et Centre Hospitalier Universitaire de Rennes, Rennes, France.
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Röser D, Nielsen HV, Petersen E, Saugmann-Jensen P, Nørgaard-Pedersen B. Congenital toxoplasmosis--a report on the Danish neonatal screening programme 1999-2007. J Inherit Metab Dis 2010; 33:S241-7. [PMID: 20585987 DOI: 10.1007/s10545-010-9124-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 04/16/2010] [Accepted: 04/28/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This paper reports on the national neonatal screening programme for congenital toxoplasmosis (CT) in Denmark conducted from 1999 to 2007, including background, basis for initiation of screening, methods, results, and finally reasons for the discontinuation of the screening. METHODS A nationwide screening was conducted at Statens Serum Institut, including >98% newborns, and using filter paper eluates (Guthrie card, PKU card) obtained from newborns 5-10 days old. These were analysed for Toxoplasma gondii-specific antibodies (IgM), and if positive, then IgM (ISAGA). Confirmatory serology was performed on children and their mothers (IgM, IgG, IgA, dye test) where infection was suspected, and children with suspected or confirmed CT initiated a 3-month treatment regimen with pyrimethamine, sulfadiazine and folinic acid supplements. Selective cohorts were followed with regard to developmental and clinical outcome. RESULTS A total of 100 children were diagnosed with CT in the screening period, and only 2 cases were detected outside of the screening programme. CT prevalence was 1.6 per 10,000 live-born infants. Follow-up studies showed new retinochoroidal lesions in affected children despite treatment. CONCLUSION Screening was terminated August 2007, after it became apparent that no benefit of treatment could be shown. CT was evaluated using a Danish adaptation of the Uniform Screening Panel (ACMG), showing CT as an unlikely candidate for screening today. Whereas results might be comparable with other low-endemic countries with similar strains of T. gondii, neonatal screening and treatment might offer different results in regions with either high prevalence or different strains of T. gondii.
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Affiliation(s)
- Dennis Röser
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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