Antiretroviral activity of protease inhibitors against Toxoplasma gondii / Terapia antiretroviral de inibidores da protease contra Toxoplasma gondii

The introduction of highly active antiretroviral therapy (HAART) has caused a marked reduction in the occurrence and severity of parasitic infections, including the toxoplasmic encephalitis (TE). These changes have been attributed to the restoration of cell-mediated immunity. This study was developed to examine the activity of six antiretroviral protease inhibitors (API) on Toxoplasma gondii tachyzoites. The six API showed anti-Toxoplasma activity, with IC50 value between 1.4 and 6.6 µg/mL. Further studies at the molecular level should be performed to clarify if the use of API could be beneficial or not for AIDS patients with TE.

La introducción de la terapia antirretroviral de alta efectividad ha causada una marcada reducción en la ocurrencia y curso clínico de las infecciones parasitarias, incluyendo la toxoplasmosis encefálica (TE). Estos cambios han sido atribuidos a la restauración celular. Este estudio fue desarrollado para examinar la actividad de seis inhibidores de proteasas antirretrovirales (IPA) sobre taquizoitos de Toxoplasma gondii. Los seis IPA mostraron actividad anti-Toxoplasma, con valores de CI50 entre 1.4 y 6.6 µg/mL. Futuros estudios a nivel molecular deben ser realizados, los cuales podrán delucidar si el uso de IPA pudiera beneficiar o no a los pacientes que sufren de TE.

Cerebral Toxoplasmosis Combined with Disseminated Tuberculosis

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.

Clinical characteristics and prevalence of toxoplasma infection in human immunodeficiency virus-infected patients in South Korea / 대한내과학회지

BACKGROUND/AIMS: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. METHODS: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. RESULTS: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. CONCLUSIONS: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%).

A Case of Toxoplasmic Encephalitis in an Advanced AIDS Patient / 감염

Toxoplasmic encephalitis (TE) is the most common cause of opportunistic central nervous system infection in advanced acquired immunodeficiency syndrome (AIDS) patients. The incidence of TE has fallen markedly after the availability of highly active antiretroviral therapy and cotrimoxazole chemoprophylaxis. TE linked to AIDS is a rare entity in Korea, but we must consider TE in the differential diagnosis of the opportunistic infections in AIDS patients. We report a case of toxoplasmic encephalitis in an advanced AIDS patient presenting as progressive right facial palsy.

Diagnosis and Treatment of Major Protozoal Infections among Acquired Immune Deficiency Syndrome Patients / 中国寄生虫学与寄生虫病杂志

Protozoal infection is one of the most important opportunistic infections among patients with acquired immune deficiency syndrome(AIDS). In order to enhance the knowledge of protozoal infections in AIDS, the current status of diagnosis and treatment of toxoplasmic encephalitis, cryptosporidiosis, microsporidiosis and isosporiasis was reviewed in this paper.