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Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán

2003, Number 2

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Rev Biomed 2003; 14 (2)

Toxoplasmosis: oportunistic infection in patients with acquired immunodeficiency syndrome

Martín-Hernández I, García-Izquierdo SM

Language: Spanish
References: 60
Page: 101-111
PDF size: 50.20 Kb.


ABSTRACT

Objectives: To provide the reader with general aspects of toxoplasmosis in AIDS.
Sources of information: Updated articles and books related to the theme. Internet consultation.
Results: Toxoplasmosis is the disease caused by obligate intracellular parasite Toxoplasma gondii and constitutes an opportunistic infection in HIV-infected individuals with less than 100 CD4 T lymphocytes/µL. This parasitical infection involves a variety of host organs, particularly gastrointestinal tract, lungs, myocardium, brain and eyes. Between 10-50% of HIV-infected patients who are seropositive for T. gondii develop toxoplasma encephalitis. Toxoplasma retinitis is the second localization of toxoplasmosis in AIDS-patients. The demonstration of toxoplasmosis indicative serology is rarely possible. In the presence of neurotoxoplasmosis clinical suspicion computed tomography and magnetic resonance imaging are recomended. The definitive diagnosis is obtained by biopsy and parasite demonstration. Given the morbidity and mortality of toxoplasmosis in HIVinfected population, there is a great need to develop effective treatments and prophylaxis that permit the prolongation and improvement of these patients' lives.
Conclusions: The frequency of this parasitical infection and the damage it causes in immunocompromised individuals implies the need for a profound analysis of it.


REFERENCES

  1. Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000; 30: 1217–58.

  2. Remington JS, McLeod R., Desmonts G. Toxoplasmosis. En: Remington JS, Klein JO, editores. Infectious diseases of the fetus and newborn. 5a ed. Philadelphia: W.B. Saunders; 2001. p. 205–346.

  3. Kitahata MM, Koepsell TD, Deyo RA. Physician's experience with adquired immunodeficiency syndrome as a factor in patient's survival. N Engl J Med 1996; 334: 701-6.

  4. Okome-Nkoumou M, Mbounja-Loclo ME, Kombila M. Spectrum of opportunistic infections in subjects infected with HIV. Santé 2000;10: 329–37.

  5. Wong S Y, Remington J. S.: Biology of Toxoplasma gondii, AIDS, 1993; 7: 299-318.

  6. Maïga I, Kiemtoré P, Tounkara A. Prévalence des anticorps antitoxoplasmiques chez les malades atteints du syndrome d’immunodéficience acquise et les donneurs de sang à Bamako. Bull Soc Pathol Exot 2001, 94 (3): 268-70.

  7. Góngora-Biachi RA, Gónzalez-Martínez P, Castro-Sansores C, Lara-Perera D, Alonzo G, Pavía N, et al. Prevalencia de anticuerpos contra Toxoplasma gondii en donadores de sangre y pacientes con la infección del virus de la inmunodeficiencia humana en Yucatán, México. Enf Infec Microbiol 1996; 16:13-6.

  8. Góngora-Biachi RA, Gónzalez-Martínez P, Castro-Sansores C, Alvarez R, Pavia-Ruz N, Lara-Perera D, et al. Anticuerpos contra Toxoplasma gondii en pacientes con VIH en Yucatán. Rev Invest Clin 1998; 50: 419-22.

  9. Luft BJ, Hafner R, Korzun AH. Toxoplasmic encefalitis in patients with adquired immunodeficiency syndrome. N Engl J Med 1993; 329: 995-1000.

  10. Couvreur J, Thulliez P, Daffos FD. Toxoplasmosis. Manual de enfermedades Infecciosas. Infecciones obstétricas y perinatales. 2a ed. México: Mosby Doyma Libros; 1994. p.160-81.

  11. Petersen E, Pollak A, Reiter-Owona I. Recent trends in research on congenital toxoplasmosis. Int J Parasitol 2001;31:115–44.

  12. Kasper LH. Toxoplasma infection. En: Braunwald E, Fauci A, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 15 ed. New York: McGraw-Hill; 2001. p. 1222-7.

  13. Fauci A, Lane HC. Human Immunodeficiency virus (HIV) disease: AIDS and related disorders. En: Braunwald E, Fauci A, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 15 ed. New York: McGraw-Hill; 2001. p. 1852-913.

  14. Chardes T, Buzoni D, Lepage A. Toxoplasma gondii oral infection induces specific cytotocic CD8 a Thy 1 gut intraepithelial lymphocytes lytic for parasites infected enterocytes. J Immunol 1994; 50: 4596-603.

  15. Chardes T, Bout D. Mucosal immune response in toxoplasmosis. Res Immunol 1993 ; 144 : 57-60.

  16. Purner M, Berens R, Tomavo S, Lecordier L, Cesbron-Delauw MF, Kotzin B, et al. Stimulation of human lymphocytes obtained from Toxoplasma gondii-seronegative persons by proteins derived from T. gondii. J Infec Dis 1998; 177: 746-53.

  17. Cochereau-Massin I, LeHoang P, Lautier-Frau M. Ocular toxoplasmosis in human immunodeficiency virus-infected patients. Am J Ophthalmol 1992; 114: 130-5.

  18. Hernández O, Braselli A, Purtscher H. Toxoplasmosis encefálica en pacientes con síndrome de inmunodeficiencia adquirida (SIDA). Rev Med U 1990; 6(3): 192-6.

  19. McCabe R, Chirurgi V. Issues in toxoplasmosis. Infect Dis N A 1993; 7: 587-604.

  20. Frenkel JK. Toxoplasmose. En: Veronesi R., Focaccia, editores. Tratado de Infectología. Sao Paulo: Atheneu; 1997. p.1290-305.

  21. Guerrero-Flores A. Encefalitis toxoplásmica en el SIDA. Treinta y nueve casos clínicos. Enferm Infec Microbiol 1997; 17: 65-7.

  22. Holland G, Engstrom RE, Glasgow BJ. Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 1988; 106: 653-67.

  23. Autelitano A. Diffuse necrotizing retinochoroiditis in a child with AIDS and toxoplasmic encephalitis. Graefe's Clin Exp Ophthalmol 1990; 228: 36-9.

  24. Grossniklaus HE, Specht CS, Allaire G. Toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome: report a case. Ophthalmol 1990; 97: 1342-6

  25. Berger BB, Egwuagu CE, Freeman WR. Military toxoplasmic retinitis in acquired immunodeficiency syndrome. Arch Ophthalmol 1993;111: 373-6.

  26. Moorthy RS, Smitth RE, Rao NA. Progressive ocular toxoplasmosis in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 1993; 115:742-7.

  27. Pivetti-Pezzi P, Accorinti M, Tamburi S. Clinical features of toxoplasmic retinochoroiditis in patients with acquired immunodeficiency syndrome. Ann Ophthalmol 1994; 26: 73-84.

  28. Oréfice F, Bonfioli AA. . Uveíte clínica e cirúrgica. En: Oréfice F, editor. Toxoplasmose. Rio de Janeiro: Editora Cultura Médica; 2000. p. 619–80.

  29. Smart P, Weinfel d A, Tompson NE. Toxoplasmosis of the stomach : a cause of antral narrowing. Radiology 1990; 174: 369-70.

  30. Florencio RFC, Alburquerque Filho FB, Moraes MAP. Toxoplasma gondii na mucosa gástrica como primeiro achado em paciente aidetico. Rev Soc Brasil Med Trop 1992;25: 275-6.

  31. Peraire J, Vidal F, Mayayo E. Gastric toxoplasmosis in the acquired immunodeficiency syndrome. Am J Gastroenterol 1993; 88: 1464-5.

  32. Alpert L, Millar M, Alpert E. Gastric toxoplasmosis in the acquired immunodeficiency syndrome: antemortem diagnosis with histophatologic characterization. Am J Gastroenterol 1996; 110: 258-64.

  33. Kofman E, Khorsandi A, Sarlin J. Gastric toxoplasmosis: case report and review of the literature. Am J Gastroenterol 1996; 91: 2436-38.

  34. Guerrero-Flores A, Vega-Ramos B. Toxoplasmosis gástrica en el síndrome de inmunodeficiencia adquirida. Rev Biomed 2002; 13:37-41.

  35. Mirlesse V, Jacquemard F, Daffos F. Toxoplasmose au cours de la grossesse. Diagnostic et nouvelles posibilités thérapeutiques. Presse Méd. 1993; 22:258-62.

  36. Ammasari A, Murri R, Cingolani A, De Luca A, Antinori A. AIDS-Associated Cerebral Toxoplasmosis En: Gross U, editor. Toxoplasma gondii: An Update on diagnosis and treatment. Berlin : Springer; 1996. p. 209-222.

  37. Renold C, Sugar A, Chave JP. Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Medicine 1992; 71: 224-39.

  38. Ciricillo SF, Rosenblum ML.Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 1990; 73:720-4.

  39. Katlama C. Diagnosis and treatment of toxoplasmosis of the CNS in patients with AIDS. CNS Drugs 1996; 5: 331-343.

  40. Raffi F, Aboulker JP, Michelet C, Reliquet V, Pelloux H, Huart A, et al. A prospective study of criteria for the diagnosis of toxoplasmic encephalitis in 186 AIDS patients. AIDS 1997; 11: 177-84.

  41. Montoya MT, Gómez JE, Castaño JC, Marx C, Aubert D, Bonhomme A, et al. Avances diagnósticos en Toxoplasmosis. PCR, nuevos marcadores de infección evolutiva y otras técnicas. Acta Med Colomb 1996; 21: 127-38.

  42. Brézin AP, Egwuagu CE, Burnier M. Identification of Toxoplasma gondii in paraffin-embedded sections by the polymerase chain reaction. Am J Ophthalmol 1990;110:599.

  43. Hayde M, Salzer HR, Gittler G, Aspock H, Pollak A. Microparticle enzyme immunoassay (MEIA) for Toxoplasma specific immunoglobulin G in comparison to the Sabin- Feldman dye test. A pilot study. Wien Klin Wochenschr 1995; 107:133-6.

  44. Vincent K, Van Doornik C, Ongkosuwito J, feron EJ, Kiljstra A. Differences between intraocular and serum antibody response in patients with ocular toxoplasmosis. Am J Ophthalmol 1998; 126: 698-706.

  45. Chan CC, Palestine AG, Li Q. Diagnosis of ocular toxoplasmosis by the use of immunocitology and the polymerase chain reaction. Am J Ophthalmol 1994;117: 803-45.

  46. Manners RM, O'Connell S, Guy EC. Use of polymerase chain reaction in the diagnosis of acquired ocular toxoplasmosis in an immunocompetent adult. Br J Ophthalmol 1994;78:583-4.

  47. Valdés MC, Díaz AG, Svarch N. Actualidades en el tratamiento y profilaxis de la toxoplasmosis. Rev Cubana Med Gen Inegr 1996;12: 4-6.

  48. Schimkat M, Althaus C, Armbrecht C. Treatment of ocular toxoplasmosis with atovaquone in a patient with AIDS. Klin Monastsbl Augenheilkd 1995;206: 173-7.

  49. Podzamczer D, Miro JM, Bolao F. Twice-weekly maintenance therapy with sulfadiazine-pyrimethamine to prevent recurrent toxoplasmic encephalitis in patients with AIDS. Spanish Toxoplasmosis Study Group. Ann Intern Med 1995; 123: 175-80.

  50. Guerina NG, Hsu H, Meissner HC, Maguire JH, Lynfield R, Stechenberg B. Neonatal screening and early treatment for congenital Toxoplasma gondii infection. N Engl J Med 1994; 330: 1858-963.

  51. Payen MC, Dewit S, Sommereijns B, Clumerk N. A controlled trial of dapsone versus pyrimethamine-sulfadoxine for primary prophylaxis of Pneumocystis carinii, pneumonia and toxoplasmosis in patients with AIDS. Biomed Pharm 1997; 51: 439-45.

  52. Podzamczer D, Miro JM, Ferrer E, Gatell JM. Thrice-weekly vs. daily sulfadiazine-pyrimethamine (SP) for maintenance therapy of toxoplasmic encephalitis (TE). 5th Conference on Retroviruses and Opportunistic Infections, Chicago, IL; January 31 to February 5, 1998. Abstract 468.

  53. Carr A, Tindall B, Brew BJ. Low-dose trimethoprimsulfamethoxazole prophylaxis for toxoplasmic encephalitis in patients with AIDS. Ann Intern Med 1992; 117: 106-11.

  54. Lane HC, Laughon BE, Falloon J, Kovacs JA, Davey RT, Polis MA. Recent advances in the management of AIDSrelated opportunistic infections. Ann Intern Med 1994; 120:945-55.

  55. Gallart JE, Moore RD, Chaisson RE. Prophylaxis for opportunistic infections in patients with HIV infection. Ann Intern Med 1994; 120: 932-44.

  56. Iñigo MA, Sánchez A, Gónzalez M. Profilaxis de las infecciones oportunistas asociadas al SIDA. Farm Hosp 1996; 20: 337-42.

  57. Bowie WR, King AS, Werker DH, Isaac-Renton JL, Bell A, Eng SB, et al. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet 1997, 350: 173-7.

  58. Leport C, Chene G, Morlat P. Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double–blind, randomized trial. J Infect Dis 1996; 173: 91-7.

  59. Antinori A, Murri R, Ammassari A. Aerosolized pentamidine, cotrimoxazole and dapsone-pyrimethamine for primary prophylaxis of Pneumocystis carinii pneumonia and toxoplasmic encephalitis. AIDS 1995; 9: 1343-50.

  60. Podzamczer D, Salazar A, Jimenez J, Consiglio E, Santin M, Casanova A, et al. Intermittent trimethoprim–sulfamethaxozole compare with dapsone-pyrimethamine for the simultaneous primary prophylaxis of Pneumocystis pneumonia and toxoplasmosis in patients infected with HIV. Ann Intern Med 1995;122: 755-61.




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