La clínica en el diagnóstico de la neurotoxoplasmosis / Clinic in the diagnosis of neurotoxoplasmosis

RESUMEN La toxoplasmosis cerebral o neurotoxoplasmosis es una de las infecciones oportunistas más frecuentes en los pacientes positivos al VIH. Se produce aproximadamente en el 10 % de los pacientes con sida no tratados. La localización de la infección, causada por el parásito Toxoplasma gondii, indica inmunodeficiencia severa, con linfocitos T CD4+ menor a 100 cel/mm3. El objetivo de este trabajo fue describir la evolución clínica e imagenológica de un paciente con diagnóstico de neurotoxoplasmosis, atendido en el Hospital Militar Dr. Carlos J. Finlay: hombre de 33 años, con síntomas neurológicos focales, sin factor de riesgo vascular, con estudios de imagen sugestiva de proceso expansivo intracraneal. Durante su ingreso se recibe el resultado de positivo al VIH y se interpreta como una neurotoxoplasmosis. Se empleó tratamiento antiparasitario con mejoría del trastorno neurológico y de las neuroimágenes. Ante un paciente con VIH y síntomas neurológicos focales se debe pensar en una neurotoxoplasmosis. La respuesta al tratamiento en el caso estudiado confirmó el diagnóstico (AU).

ABSTRACT Cerebral toxoplasmosis or neurotoxoplasmosis is one of the most common opportunistic infections in HIV-positive patients. It occurs in approximately 10 % of untreated AIDS patients. The location of the infection, caused by the parasite Toxoplasma gondii, indicates severe immunodeficiency, with CD4+ T lymphocytes less than 100 cell/mm3. The objective of this work was to describe the clinical and imaging evolution of a patient with diagnosis of neurotoxoplasmosis, attended at the Military Hospital Dr. Carlos J. Finlay: 33-year-old man, with focal neurological symptoms, without vascular risk factor, with studies of suggestive imaging of intracranial expansive process. During admission, the HIV positive result is received and interpreted as a neurotoxoplasmosis. Antiparasitic treatment was used with improvement of neurological disorder and neuroimagens. In the case of a patient with HIV and focal neurological symptoms doctors should think about neurotoxoplasmosis. The response to treatment in the case studied confirmed the diagnosis (AU).

Toxoplasmosis cerebral congénita e infección por el virus del Zika y del chikunguña: reporte de un caso / Congenital cerebral toxoplasmosis, Zika and chikungunya virus infections: A case report

Resumen En este artículo se describe el caso clínico de una mujer colombiana del sur del país con diagnóstico de infección intrauterina por Toxoplasma gondii y por los virus del chikungunya y del Zika. La mujer acudió al control prenatal en el segundo trimestre de su embarazo e informó que durante el primer trimestre había presentado síntomas indicativos de infección por el virus del Zika. Mediante reacción en cadena de la polimerasa (PCR) en líquido amniótico, se demostró infección por Toxoplasma gondii así como por los virus del chikungunya y del Zika. En las imágenes diagnósticas se observaron malformaciones del sistema nervioso central en el feto. A las 29 semanas de gestación se dio por terminado el embarazo mediante procedimiento médico.

Abstract We report a case of intrauterine infection by Toxoplasma gondii, Chikungunya and Zika viruses in a Colombian woman from the southern part of the country. The patient attended prenatal care in the second trimester of her pregnancy and she informed that in the first trimester she had presented with clinical symptoms compatible with Zika virus infection. Amniotic fluid PCR assays showed infection by T. gondii, chikungunya and Zika viruses. Diagnostic imaging showed fetal malformation of the central nervous system. At 29 weeks of gestation, pregnancy was terminated medically.

Coinfección SIDA / Enfermedad de Chagas. Presentación de caso y revisión de la bibliografía / 9 CO-INFECTION AIDS / CHAGA'S DISEASE. REPORT OF A CASE AND LITERATURE REVISION

Chagas' disease caused by "Trypanosoma cruzi" (T. cruzi), is well recognized as an opportunistic infection in the setting of HIV / AIDS. More patients with Chagas' disease, live in countries of Central and South America, That's why, it is also called "American Trypanosomiasis ". T. cruzi is mainly transmitted by vectors ("Triatoma infestans" in Argentina) specially in the "endemic american area" and secondarily, by blood transfusion, not only in America, but also in the rest of the world. Many people have migrated from the endemic area of America to others countries around the world. Perhaps, some of them were asyntomatic "chagasic" patients and may have transmitted T. cruzi by blood transfusions in those non-endemic areas.. So that, Chagas' disease should be considered nowadays, as a "global pathology". In severely inmunocompromissed patients with AIDS, chronic Chagas' disease may have reactivated, affecting central nervous system (CNS) with brain mass lesions (called "chagomas"), similar to others necrotizing encephalitis like Toxoplasmosis.. We report a 32 year-old woman assisted in the Rawson Hospital of Córdoba City (Argentina), with AIDS and reactivation of Chagas' disease. Patient coming from Catamarca (north-western region of Argentina) with severe headache, unisocoria, desorientation in time and space, fine tremor, nistagmus, clonus, hiperreflexia and fascial-braquial-crural hemiparesia. Patient was afebrile and the rest of physical examination was normal. She had low count of CD4 cells and high HIV-viral load. Magnetic resonance imagin (MRI) showed: several enhanced rounded lesions surrounded by edema along the whole brain. Treatment with sulfadiacina + Pyrimethamine and Dexametasone, for a presuntive cerebral toxoplasmosis was implemented but, patient did not improve. So, cerebral biopsie was performed and it showed: intra and extracellular " AMASTIGOTES" of T. cruzi..Treatment with Benznidazol was prescribed, but in a few days, patient died.

No todo es Zika: toxoplasmosis congénita, ¿aún prevalente en Colombia? / Not everything is Zika: congenital toxoplasmosis, still prevalent in Colombia?

RESUMEN La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun existiendo guías plenamente divulgadas y conocidas, se observa poca implementación de las mismas y falta de adecuada interpretación de pruebas serológicas en gestantes Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Reportamos una serie de casos, con compromiso neurológico y sistémico (dificultad respiratoria, hepatoesplenomegalia, enterocolitis, calcificaciones cerebrales, trombocitopenia, corioretinis, ascitis, choque). Si bien el virus de Zika causó epidemia en 2015-2016 en Brasil, Colombia y otros países, toxoplasmosis es un diagnóstico diferencial aún prevalente en estos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Adicionalmente, existen algunas variedades de cepas de T. gondii con comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos, incluyendo además mayor riesgo de muerte.

ABSTRACT Congenital toxoplasmosis continues to be a public health threat. Even existing guidelines, publicly known, its implementation and lack of appropriate interpretation of serological tests in pregnancy is often observed. This leds to failure in opportunities for positive and known interventions to decrease the fetal risk due to Toxoplasma gondii infection. We reported herein a case series, with variable neurological and systemic compromise (respiratory distress, hepatosplenomegaly, enterocolitis, brain calcifications, thrombocytopenia, ascites, shock), even fatal, calling for awareness about the fact that despite the Zika epidemics in 2015-2016 in Brazil, Colombia and other countries, precisely toxoplasmosis, is a differential diagnosis still prevalent in these territories, that can leds to severe consequences, with neurological disability and risk of ocular damage, even lately. Additionally, with varieties of T. gondii with more aggressive patterns in Latin America, which make worse those cases, including also a higher risk of death.

Neurotoxoplasmose em paciente imunocompetente: relato de caso / Neurotoxoplasmosis in an Immunocompetent Patient: Case Report

A toxoplasmose é uma doença causada pelo protozoário Toxoplasma gondii e é a principal causa de lesão com efeito de massa no sistema nervoso central (SNC) em pacientes imunodeprimidos, causando sintomas neurológicos significativos. Em pacientes imunocompetentes, a evolução clínica da toxoplasmose é habitualmente benigna e a infecção é, na maioria das vezes, assintomática. O diagnóstico da neurotoxoplasmose é presuntivo, baseado nos achados de tomografia computadorizada (TC) ou de ressonância magnética (RM), e emcasos inconclusivos, pode-se utilizar a biópsia cerebral estereotáxica. O paciente relatado apresentava lesões sugestivas de neurotoxoplasmose na RM de encéfalo, porém era imunocompetente, e a sorologia para neurotoxoplasmose era negativa para o IgM. Foi submetido então a biópsia estereotáxica como extensão de propedêutica. O presente trabalho visa, a partir do relato de um caso raro, discutir sobre as formas de diagnóstico e tratamento de uma infecção em paciente previamente sadio, cuja evolução foi benigna devido ao diagnóstico e tratamento precoces.

Toxoplasmosis is a disease caused by the protozoan Toxoplasma Gondii and is the leading cause of injury with mass effect on the central nervous system (CNS) in immunocompromised patients, that causes significant neurological symptoms. In immunocompetent patients, the clinical course of toxoplasmosis is usually benign and the infection is most often asymptomatic. The presumptive diagnosis of toxoplasmosis is based on findings of computed tomography (CT) or magnetic resonance imaging (MRI), and inconclusive cases, can use stereotactic brain biopsy . The reported patient had lesions suggestive of cerebral toxoplasmosis in brain MRI, but was immunocompetent and toxoplasmosis serology was negative for IgM. The, he underwent a stereotactic biopsy as an extension of workup. The present work aims, from a rare case description, discuss ways of diagnosing and treating an infection in a previously healthy patient whose evolution was benign diagnosis because early treatment.

Features to validate cerebral toxoplasmosis

Introduction Neurotoxoplasmosis (NT) sometimes manifests unusual characteristics. Methods We analyzed 85 patients with NT and AIDS according to clinical, cerebrospinal fluid, cranial magnetic resonance, and polymerase chain reaction (PCR) characteristics. Results In 8.5%, focal neurological deficits were absent and 16.4% had single cerebral lesions. Increased sensitivity of PCR for Toxoplasma gondii DNA in the central nervous system was associated with pleocytosis and presence of >4 encephalic lesions. Conclusions Patients with NT may present without focal neurological deficit and NT may occur with presence of a single cerebral lesion. Greater numbers of lesions and greater cellularity in cerebrospinal fluid improve the sensitivity of PCR to T gondii. .

Evaluation of seroepidemiological toxoplasmosis in HIV/AIDS patients in the south of Brazil / Avaliação soroepidemiológica de toxoplasmose em pacientes HIV/SIDA no sul do Brasil

Toxoplasmosis is considered one of the opportunistic infections for individuals with the Acquired Immunodeficiency Syndrome (AIDS), and is also a major cause of morbidity and mortality. The aim of this study was to evaluate the prevalence of neurotoxoplasmosis, ocular toxoplasmosis and antibodies for Toxoplasma gondii in HIV-positive patients attending the SAE (Specialized Assistance Service for HIV/AIDS), as well as to associate their serological profile with epidemiological and clinical data. A total of 250 patients participated in the study from December, 2009 to November, 2010. Serological analysis was performed using the indirect immunofluorescent technique; epidemiological data were gathered by a questionnaire, and clinical history was based on the analysis of medical charts. Prevalence of seropositivity was 80%, with history of neurotoxoplasmosis in 4.8% and of ocular toxoplasmosis in 1.6% of the patients. The Highly Active Antiretroviral Treatment (HAART) was not used by 32% of the patients, 18.4% of the patients had CD4+ T- lymphocyte count less than 200 cells/mm³ and 96.8% of them were not aware of the modes of disease transmission. These findings led us to conclude that the study population is at high risk of clinical toxoplasmosis, because of both reactivation of infection in the seropositive patients who do not make a regular use of HAART, and primo-infection in seronegative patients worsened by an unawareness of the modes of infection reported in this study.

A toxoplasmose é considerada uma das infecções oportunistas em indivíduos com a Síndrome da Imunodeficiência Adquirida (SIDA), constituindo importante causa de morbidade e mortalidade. Este trabalho objetivou conhecer a prevalência de neurotoxoplasmose, toxoplasmose ocular e de anticorpos para Toxoplasma gondii, em pacientes HIV positivos em atendimento no SAE (Serviço de Assistência Especializada em HIV/AIDS) além de correlacionar seu perfil sorológico com dados epidemiológicos e clínicos. Foram analisados 250 pacientes no período de dezembro de 2009 a novembro de 2010. A análise sorológica foi realizada pela técnica de imunofluorescência indireta, os dados epidemiológicos foram obtidos pela aplicação de um questionário e o histórico clínico, pela análise dos prontuários. A prevalência de soropositividade foi de 80%, com histórico de neurotoxoplasmose em 4,8% e de toxoplasmose ocular em 1,6%. Observou-se que 32% dos pacientes não faziam uso regular de HAART, 18,4% apresentaram contagem de linfócitos T CD4+ inferior a 200 céls/mm³ e 96,8% desconheciam os modos de transmissão da doença. Conclui-se que o risco de toxoplasmose clínica grave é alto na população estudada, tanto por reativação da infecção nos soropositivos que não fazem uso regular do HAART, quanto por primoinfecção dos soronegativos, agravado pela desinformação sobre as formas de infecção constatada na pesquisa.

Toxoplasma Encephalitis in an Allogeneic Hematopoietic Stem Cell Transplant Recipient in Korea

No abstract available.

Importance of high IgG anti-Toxoplasma gondii titers and PCR detection of T. gondii DNA in peripheral blood samples for the diagnosis of AIDS-related cerebral toxoplasmosis: a case-control study

BACKGROUND: Cerebral toxoplasmosis (CT) continues to cause significant morbidity and mortality in human immunodeficiency virus (HIV)-infected patients in Brazil. In clinical practice, the initial diagnosis is usually presumptive and alternative diagnosis tools are necessary. Our objective was to evaluate whether the detection of high titers of IgG anti-Toxoplasma gondii and T. gondii DNA in blood samples are associated with the diagnosis of CT. METHODS: In this case-control study we included 192 patients with HIV-1 infection: 64 patients with presumptive CT (cases) and 128 patients with other diseases (controls). Blood samples to perform indirect immunofluorescense reaction (IFI) to detect anti-T. gondii IgG antibodies and polymerase chain reaction (PCR) were collected before or within the first three days of anti-Toxoplasma therapy. Two multivariate logistic regression models were performed: one including the variable qualitative serology and another including quantitative serology. RESULTS: In the first model, positive IgG anti-T. gondii (OR 4.7, 95 percent CI 1.2-18.3; p = 0.027) and a positive T. gondii PCR result (OR 132, 95 percent CI 35-505; p < 0.001) were associated with the diagnosis. In the second model, IgG anti-T. gondii titres > 1:1024 (OR 7.6, 95 percent CI 2.3-25.1; p = 0.001) and a positive T. gondii PCR result (OR 147, 95 percent CI 35-613; p < 0.001) were associated with the diagnosis. CONCLUSIONS: Quantitative serology and molecular diagnosis in peripheral blood samples were independently associated with the diagnosis of CT in HIV-infected patients. These diagnostic tools can contribute to a timely diagnosis of CT in settings where Toxoplasma infection is common in the general population.

Molecular diagnosis of cerebral toxoplasmosis: comparing markers that determine Toxoplasma gondii by PCR in peripheral blood from HIV-infected patients

As cerebral toxoplasmosis is the most common cerebral focal lesion in AIDS patients, this study evaluated three PCR markers for diagnosis, since some limitations remain present, such as low parasite levels in some clinical samples. The molecular markers were B22-B23 and Tg1-Tg2 (based on the B1 gene) and Tox4-Tox5 (non-coding fragment, repeated 200-300-fold). DNA samples from 102 AIDS patients with previously known diagnosis were analyzed. The cerebral toxoplasmosis group was constituted of DNA extracted from the blood of 66 AIDS patients, which was collected before or until the third day of the therapy for toxoplasmosis. DNA from the blood of 36 AIDS patients with other neurologic opportunistic infections was used as control group. Sensitivities of B22-B23, Tg1-Tg2, and Tox4-Tox5 markers were of 95.5 percent, 93.9 percent, and 89.3 percent, respectively. In the control group, the specificities were of 97.2 percent (B22-B23), 88.9 percent (Tg1-Tg2), and 91.7 percent (Tox4-Tox5). The association of at least two markers increased the PCR sensitivity and specificity. The concordance index between two markers varied from 83.3 percent to 93.1 percent. These data demonstrated that all markers evaluated here were highly sensitive for T. gondii determination, although B22-B23 has been shown to be the best. The association of two markers increases PCR sensitivity, but the procedure was more expensive and time-consuming.

Retinocoroidite toxoplásmica em pacientes com AIDS e neurotoxoplasmose / Toxoplasmic retinochoroiditis in patients with AIDS and neurotoxoplasmosis

OBJETIVO: A neurotoxoplasmose é a alteração do sistema nervoso central mais frequente observada em pacientes com AIDS. A ocorrência de toxoplasmose ocular em neurotoxoplasmose ainda é pouco estudada. O objetivo deste estudo foi de investigar a ocorrência de retinocoroidite toxoplásmica, típica ou provável, em pacientes com AIDS e neurotoxoplasmose. MÉTODOS: Foi desenvolvido estudo prospectivo, tipo série de casos incluindo 70 pacientes, de ambos os sexos, com idade variando de 20 a 63 anos, internados nas enfermarias de três hospitais públicos da cidade do Recife, Pernambuco, com tais diagnósticos firmados segundo os critérios do CDC (1992), no período de janeiro a outubro de 2008. Os pacientes caracterizavam-se por: primeiro episódio de neurotoxoplasmose (65; 92,9 por cento) ou recidiva (5; 7,1 por cento); desconhecimento de ter AIDS (23; 32,9 por cento), contagem média de linfócitos T CD4 de 139,8 ± 3,04 células/mm³ e carga viral média igual a 137.080 ± 39.380 cópias/mL. Todos os pacientes foram submetidos a exame oftalmológico, consistindo de: inspeção ocular; aferição da acuidade visual; investigação da função muscular extrínseca ocular e fundoscopia, empregando oftalmoscópio indireto binocular (modelo OHN 3.5 (Eyetec®) e lente externa de 20 dioptrias (Volk®). RESULTADOS: Foram diagnosticados 4 (5,7 por cento) pacientes com lesões cicatriciais de retinocoroidite, características de toxoplasmose ocular, sendo típica em 3 (75 por cento) pacientes e bilateral em 1. Não houve qualquer caso de retinocoroidite ativa, típica ou provável. As lesões oculares ativas foram raras comparadas às lesões cicatriciais, as quais se associam à presença de cistos na retina. CONCLUSÃO: Recomenda-se que mesmo lesões cicatriciais sejam valorizadas em pacientes com AIDS.

PURPOSE: Neurotoxoplasmosis is the most common central nervous system disorder in patients with AIDS. The occurrence of ocular toxoplasmosis in neurotoxoplasmosis is not well studied. The objective of this study was to investigate the occurrence of typical or probable toxoplasmic retinochoroiditis in patients with AIDS and neurotoxoplasmosis. METHODS: A prospective case series was performed, including 70 patients of both genders, aged from 20 to 63 years, hospitalized in three public hospitals in Recife, Pernambuco, with such diagnosis according to the CDC criteria (1992), from January to October, 2008. RESULTS: Patients were characterized by first neurotoxoplasmosis episode (65, 92.9 percent) or relapse (5, 7.1 percent), ignorance of AIDS diagnosis (23, 32.9 percent), mean CD4 T lymphocytes count of 139.8 ± 3.04 cells/mm³ and mean viral load of 137,080 ± 39,380 copies/mL. All patients underwent ophthalmologic examination, consisting of ocular inspection, visual acuity measurement, investigation of ocular extrinsic muscle function and fundoscopy, using binocular indirect ophthalmoscope (model OHN 3.5 (Eyetec®) and 20 diopters external lens (Volk®). Four (5.7 percent) patients presented retinochoroiditis scar lesions, characteristic of ocular toxoplasmosis, typical in 3 (75 percent) of them and bilateral in one. There was no case of typical or probable active retinochoroiditis. Active ocular lesions were rare compared to scarring, which are associated with the presence of retinal cysts. CONCLUSION: Scarring lesions should be valued in patients with AIDS.

Avaliação oftalmológica em pacientes com AIDS e neurotoxoplasmose / Ophthalmological evaluation of patients with AIDS and neurotoxoplasmosis

INTRODUÇÃO: Descrever os achados fundoscópicos em pacientes com AIDS e neurotoxoplasmose em fase ativa. MÉTODOS: Foi desenvolvido estudo prospectivo tipo série de casos incluindo 70 pacientes, de ambos os sexos, com idade variando de 20 a 63 anos, internados nas enfermarias de três hospitais públicos da Cidade do Recife, Pernambuco, com diagnósticos de AIDS e neurotoxoplasmose firmados segundo os critérios do Centers for Disease Control and Prevention (1992), no período de janeiro a outubro de 2008. Os pacientes se caracterizavam por: primeiro episódio de neurotoxoplasmose (65; 92,9 por cento) ou recidiva (5; 7,1 por cento); desconhecimento de ter AIDS (23; 32,9 por cento), contagem média de linfócitos T CD4 de 139,8 ± 3,04 células/mm3 e carga viral média igual a 137.080 ± 39.380 cópias/mL. Todos foram submetidos a exame oftalmológico, consistindo de: inspeção ocular; aferição da acuidade visual; investigação da função muscular extrínseca ocular e fundoscopia, empregando oftalmoscópio indireto binocular (modelo OHN 3.5 (Eyetec®) e lente externa de 20 dioptrias (Volk®). RESULTADOS: Os achados consistiram em: exsudatos algodonosos retinianos (8,6 por cento), constricção arteriolar difusa leve (8,6 por cento); lesões de retinocoroidite cicatricial, características de toxoplasmose ocular (5,7 por cento), atrofia do epitélio pigmentar retiniano (2,9 por cento), descolamento da retina (2,9 por cento), aumento de escavação papilar (1,4 por cento), degeneração periférica retiniana (1,4 por cento), macroaneurisma (1,4 por cento), papiledema bilateral (1,4 por cento), tração vítreo-retiniana (1,4 por cento). CONCLUSÕES: Pacientes com AIDS e neurotoxoplasmose podem apresentar alterações fundoscópicas características da toxoplasmose ocular, na forma ativa ou cicatricial, relacionadas ao HIV ou, ainda, a outras doenças oportunistas ou sistêmicas, podendo ser de grande auxílio num tratamento integral do paciente por uma equipe multiprofissional.

INTRODUCTION: To describe fundoscopic findings among patients with AIDS and active-phase neurotoxoplasmosis. METHODS: A prospective study of case series type was developed, including 70 patients of both sexes and ages ranging from 20 to 63 years who were admitted to the wards of three public hospitals in the city of Recife, Pernambuco, Brazil, from January to October 2008, with diagnoses of AIDS and neurotoxoplasmosis determined according to the criteria of the Centers for Disease Control and Prevention (1992). The patients were characterized by a first episode of neurotoxoplasmosis (65; 92.9 percent) or recurrence (5; 7.1 percent), unawareness of having AIDS (23; 32.9 percent), mean T CD4+ count of 139.8 ± 3.04 lymphocytes/mm³ and mean viral load of 137,080 ± 39,380 copies/ml. All patients underwent ophthalmological examination consisting of ocular inspection, gauging of visual acuity, investigation of ocular extrinsic muscle function and fundoscopy using a binocular indirect ophthalmoscope (model OHM 3.5 Eyetec®) and external lens of 20 diopters (Volk®). RESULTS: The findings consisted of retinal cotton-wool spot exudates (8.6 percent), slight diffuse arteriolar constriction (8.6 percent), retinochoroiditis scars characteristic of ocular toxoplasmosis (5.7 percent), atrophy of retinal pigment epithelium (2.9 percent), retinal detachment (2.9 percent), increased papillary excavation (1.4 percent), retinal peripheral degeneration (1,4 percent), macroaneurysm (1.4 percent), bilateral papilledema (1.4 percent) and vitreous-retinal traction (1.4 percent). CONCLUSIONS: Patients with AIDS and neurotoxoplasmosis may present fundoscopic abnormalities characteristic of ocular toxoplasmosis, either in active or in scar form, related to HIV or even to other opportunist or systemic diseases, which can be of great aid for integral treatment of patients by a multiprofessional team.

Diagnóstico molecular da toxoplasmose cerebral: comparação de diferentes marcadores utilizados na PCR para detecção de Toxoplasma gondii em pacientes com aids / Molecular diagnosis of cerebral toxoplasmosis: comparison of different markers used in PCR for detection of Toxoplasma gondii in aids patients

Introdução: A toxoplasmose cerebral é uma das lesões focais cerebrais de maior importância em pacientes com aids. Este estudo teve como objetivo aprimorar o diagnóstico molecular da toxoplasmose cerebral. Métodos: Esta dissertação foi dividida em 2 partes: Uma retrospectiva, para PCR convencional (cnPCR), onde avaliou-se 2 marcadores moleculares de T. gondii (TG1-TG2 tendo como alvo um fragmento do gene B1 e TOX4-TOX5, um fragmento da região repetitiva de 529 pb); A outra, prospectiva, onde padronizou-se e validou-se 2 protocolos de PCR em tempo real qualitativa (qrtPCR) utilizando-se os marcadores B1TgF-B1TgR e RETgF-RETgR tendo como alvo, também, o gene B1 e o fragmento de 529 pb. Em ambas as etapas do estudo, o método controle foi a cnPCR utilizando-se o marcador B22-B23. Resultados: Na primeira etapa foram analisadas 102 amostras de DNA extraídas de sangue provenientes de pacientes com aids e com diagnóstico clínico já estabelecido. Destes, 66 possuíam toxoplasmose cerebral e 36, outras infecções oportunistas. Comparando os resultados dos 2 marcadores estudados com o B22-B23, obtiveram-se sensibilidades de 95.5%, 93.9% e 89.3%; especificidades de 97.2%, 88.9% e 91.7% para B22- B23, TG1-TG2 e TOX4-TOX5 respectivamente. A associação de pelo menos 2 marcadores aumentou a sensibilidade e especificidade. Os índices de concordância entre 2 marcadores variou de 83.3% a 93.1%. Apesar de todos os marcadores apresentarem boa sensibilidade na detecção de T. gondii, B22-B23 ainda foi o melhor. A associação de 2 marcadores aumentou a sensibilidade, porém demandou mais tempo e custo. Na segunda parte foram analisadas 149 amostras de DNA extraídas de sangue e liquidocefalorraquidiano provenientes de pacientes com aids, e achados clínicos e radiológicos conhecidos. O diagnóstico laboratorial incluiu cnPCR (B22-B23), imunofluorescência indireta e duas qrtPCR (B1Tg e RETg) com o sistema TaqMan probe FAM dye-labeled. A sensibilidade...

Diagnóstico molecular da toxoplasmose cerebral: comparação de diferentes marcadores utilizados na PCR para detecção de Toxoplasma gondii em pacientes com aids

Introdução: A toxoplasmose cerebral é uma das lesões focais cerebrais de maior importância em pacientes com aids. Este estudo teve como objetivo aprimorar o diagnóstico molecular da toxoplasmose cerebral. Métodos: Esta dissertação foi dividida em 2 partes: Uma retrospectiva, para PCR convencional (cnPCR), onde avaliou-se 2 marcadores moleculares de T. gondii (TG1-TG2 tendo como alvo um fragmento do gene B1 e TOX4-TOX5, um fragmento da região repetitiva de 529 pb); A outra, prospectiva, onde padronizou-se e validou-se 2 protocolos de PCR em tempo real qualitativa (qrtPCR) utilizando-se os marcadores B1TgF-B1TgR e RETgF-RETgR tendo como alvo, também, o gene B1 e o fragmento de 529 pb. Em ambas as etapas do estudo, o método controle foi a cnPCR utilizando-se o marcador B22-B23. Resultados: Na primeira etapa foram analisadas 102 amostras de DNA extraídas de sangue provenientes de pacientes com aids e com diagnóstico clínico já estabelecido. Destes, 66 possuíam toxoplasmose cerebral e 36, outras infecções oportunistas. Comparando os resultados dos 2 marcadores estudados com o B22-B23, obtiveram-se sensibilidades de 95.5%, 93.9% e 89.3%; especificidades de 97.2%, 88.9% e 91.7% para B22- B23, TG1-TG2 e TOX4-TOX5 respectivamente. A associação de pelo menos 2 marcadores aumentou a sensibilidade e especificidade. Os índices de concordância entre 2 marcadores variou de 83.3% a 93.1%. Apesar de todos os marcadores apresentarem boa sensibilidade na detecção de T. gondii, B22-B23 ainda foi o melhor. A associação de 2 marcadores aumentou a sensibilidade, porém demandou mais tempo e custo. Na segunda parte foram analisadas 149 amostras de DNA extraídas de sangue e liquidocefalorraquidiano provenientes de pacientes com aids, e achados clínicos e radiológicos conhecidos. O diagnóstico laboratorial incluiu cnPCR (B22-B23), imunofluorescência indireta e duas qrtPCR (B1Tg e RETg) com o sistema TaqMan probe FAM dye-labeled. A sensibilidade...

Non tuberculous mycobacteria and toxoplasma co-infection of the central nervous system in a patient with AIDS

New-onset seizures are frequent manifestations in patients infected with Human Immunodeficiency Virus (HIV). We describe the clinical and radiological findings in an 25yr old AIDS patient presenting with new onset seizures as the primary manifestation of cerebral toxoplasmosis and Non Tuberculous Mycobacterial [NTM] co-infection. Cranial computed tomography showed a subtle ventricular dilatation whereas magnetic resonance imaging disclosed prominent temporal horn. Toxoplasma tachyzoites and rapidly growing mycobacteria were recovered from CSF. Seizures were complex partial in nature and refractory to antiepileptic therapy.

Application of magnetic resonance spectroscopy in the differentiation of high-grade brain neoplasm and inflammatory brain lesions / Aplicação da espectroscopia por ressonância magnética na diferenciação de lesões expansivas encefálicas neoplásicas e inflamatórias

This study aims at evaluating the application of magnetic resonance spectroscopy (MRS) in the differential diagnosis of brain tumors and inflammatory brain lesions. The examinations of 81 individuals, who performed brain MRS and were retrospectively analyzed. The patients with ages between 10 and 80 years old, were divided into two groups. Group A consisted of 42 individuals with diagnoses of cerebral toxoplasmosis and Group B was formed of 39 individuals with diagnosis of glial neoplasms. On analyzing the ROC curve, the discriminatory boundary for the Cho/Cr ratio between inflammatory lesions and tumors was 1.97 and for the NAA/Cr ratio it was 1.12. RMS is an important method useful in the distinction of inflammatory brain lesions and high-degree tumors when the Cho/Cr ratio is greater than 1.97 and the NAA/Cr ratio is less than 1.12. And so this method is important in the planning of treatment and monitoring of the therapeutic efficiency.

O presente estudo tem como objetivo avaliar a aplicação da espectroscopia por ressonância magnética (ERM) no diagnóstico diferencial entre lesões expansivas encefálicas inflamatórias e neoplásicas. Foram analisados retrospectivamente 81 indivíduos que realizaram exames de ERM com idade entre 10 a 18 anos, divididos em dois grupos. O grupo A foi formado por 42 indivíduos com diagnóstico de neurotoxoplasmose e o grupo B foi formado por 39 indivíduos com diagnóstico de neoplasias gliais. Após análise da curva ROC observou-se que o valor discriminatório da relação Co/Cr entre lesões inflamatórias e neoplásicas foi de 1,97 e da relação Naa/Cr foi de 1,12. A espectroscopia por RM é um método útil na distinção de lesões expansivas inflamatórias e neoplasias de alto grau quando a relação Co/Cr é maior que 1,97 e a relação Naa/Cr é menor que 1,12, o que torna este método importante no planejamento do tratamento e monitorização da eficácia terapêutica.