Validation of dried blood spots in monitoring toxoplasmosis.

Due to the growing importance of toxoplasmosis worldwide, simple methods of diagnosis are important for epidemiologic studies. Dried blood spot (DBS) is a useful tool that surpasses venipuncture. DBS-Toxoplasma testing via a finger-stick could also be used in setting where phlebotomies might not be feasible, such as worldwide prenatal and newborn screening for congenital toxoplasmosis. This study included 101 study subjects were occupationally at-risk to Toxoplasma gondii infection and 33 as controls. Serum was collected from both groups for the detection of anti-Toxoplasma IgG antibodies by ELISA as a reference gold standard test. For the occupational at-risk group, capillary finger stick derived blood was blotted onto five sets of Whatman protein saver cards. Discs were stored as four sets; three sets at 4°C and eluted 1, 2 and 3 months of storage and one set at -20°C for 3 months then eluted. Additionally, one set was eluted immediately. Anti-Toxoplasma IgG antibodies were evaluated by ELISA from DBS eluted samples and compared to matched sera. DBS elutes from discs that were freshly prepared for anti-Toxoplasma IgG showed 100% sensitivity, specificity and diagnostic accuracy. Serologic testing using DBS showed very good diagnostic accuracy under all mentioned conditions of storage. Higher stability was obtained when the blood discs stored at 4°C for 1 month and up to 3 months at -20°C, with 98.18% sensitivity, 100% specificity and 99% diagnostic accuracy. DBS-Toxoplasma testing is characterized by simplicity in performance, cost-effectiveness and the ease of handling, to store and to transport, with high diagnostic accuracy.

The course of infection with Toxoplasma gondii RH strain in mice pre-vaccinated with gamma irradiated tachyzoites.

Toxoplasma gondii is a ubiquitous protozoan of major medical and veterinary importance. Its treatment is difficult since the available drugs have severe side effects and reactivation may occur anytime. Vaccination with irradiated parasites exhibits ideal characteristics for vaccine development. In our experimental mice model, the protection against challenge with the virulent RH strain was assessed, using 255Gy irradiated tachyzoites. Eighty mice were allocated into 3 groups: naive control group, challenged with virulent RH tachyzoites group and a third group which is challenged with 1 × 106 irradiated tachyzoites, administered as two biweekly doses intraperitoneally. Protection was tested by challenging vaccinated mice with the virulent type RH tachyzoites 30 days after the 2nd vaccination dose. The assessment was built on qualitative clinical, quantitative parasitological, histopathological parameters and measurement of serum Nitric Oxide (NO). The results showed prolonged survival rate, absence of tachyzoites in the peritoneal aspirate by counting, absence of tachyzoites in all examined organs by impression smears, amelioration of histopathological changes in the liver, spleen, brain and lung specimens and increase of the serum NO level in the vaccinated group. Therefore, we propose that irradiated Toxoplasma tachyzoites confer protection for challenged mice and could be an alternative immunization schedule for vaccine development especially for who are at risk of severe immunosuppression.

Sex dichotomy in the course of experimental latent toxoplasmosis.

Toxoplasma gondii is an opportunistic zoonotic protozoan that exceeds neurological and congenital impact sequence to reactivating latent toxoplasmosis especially under immunosuppression. Sex-associated hormones influence the severity of Toxoplasma infection. Thus, our study aimed to compare toxoplasmosis associated morbidity in both male and female mice and to monitor the response to anti-Toxoplasma therapeutics fortified with sex hormones in comparison to presently used drugs. Twenty male and 20 female mice were infected with ME49 Toxoplasma strain. The morbidity was assessed in the chronic stage in both sexes by estimating brain cyst burden, brain histopathological examination and monitoring serum anti-Toxoplasma IL-12 using ELISA method. Another 40 male and 40 female mice were infected with ME49 Toxoplasma strain then after 6 weeks received different treatment regimens including Atovaquone, Spiramycin, Metronidazole, Estradiol benzoate and Testoserone propionate either as a monotherapy or as a combination. Treatment response was monitored by scoring mice activity and brain cyst burden. This study showed that female mice demonstrated higher cyst burden and manifested more pathological reactions than male mice. While, the IL-12 serum level was significantly higher in male than female mice. Also, it is proved that the Toxoplasma cyst number was reduced significantly when used testosterone/atovaquone, or testosterone/spiramycin/metronidazole combined regimen in female mice groups. While for male mice, the combined therapy of spiramycin/metronidazole was the superior one. Accordingly, combined therapy with sex hormones is a promising strategy for discovering new therapeutic regimens for treating latent toxoplasmosis especially in female.

Intravascular Schistosoma mansoni Cleave the Host Immune and Hemostatic Signaling Molecule Sphingosine-1-Phosphate via Tegumental Alkaline Phosphatase.

Schistosomes are parasitic flatworms that infect the vasculature of >200 million people around the world. These long-lived parasites do not appear to provoke blood clot formation or obvious inflammation around them in vivo. Proteins expressed at the host-parasite interface (such as Schistosoma mansoni alkaline phosphatase, SmAP) are likely key to these abilities. SmAP is a glycoprotein that hydrolyses the artificial substrate p-nitrophenyl phosphate in a reaction that requires Mg2+ and at an optimal pH of 9. SmAP additionally cleaves the nucleoside monophosphates AMP, CMP, GMP, and TMP, all with a similar Km (~600-650 µM). Living adult worms, incubated in murine plasma for 1 h, alter the plasma metabolome; a decrease in sphingosine-1-phosphate (S1P) is accompanied by an increase in the levels of its component parts-sphingosine and phosphate. To test the hypothesis that schistosomes can hydrolyze S1P (and not merely recruit or activate a host plasma enzyme with this function), living intravascular life-stage parasites were incubated with commercially obtained S1P and cleavage of S1P was detected. Parasites whose SmAP gene was suppressed using RNAi were impaired in their ability to cleave S1P compared to controls. In addition, recombinant SmAP hydrolyzed S1P. Since extracellular S1P plays key roles in controlling inflammation and platelet aggregation, we hypothesize that schistosome SmAP, by degrading S1P, can regulate the level of this bioactive lipid in the environment of the parasites to control these processes in the worm's local environment. This is the first report of any parasite being able to cleave S1P.

PDL-1 Blockade Prevents T Cell Exhaustion, Inhibits Autophagy, and Promotes Clearance of Leishmania donovani.

Leishmania donovani is a causative pathogen of potentially fatal visceral leishmaniasis (VL). Therapeutic agents are available; however, their use is limited because of high cost, serious side effects, and development of antimicrobial resistance. Protective immunity against VL depends on CD4+ Th1 cell-mediated immunity. Studies have shown that progression of VL is due to exhaustion of T cells; however, the mechanism involved is not clearly understood. Here, we examined the role of PD1/PDL-1 in the pathogenesis of VL by using a murine model of VL. Our data indicate that L. donovani is able to elicit initial expansion of gamma interferon-producing CD4+ Th1 and CD8+ T cells at day 7 postinfection (p.i.); however, the frequency of those cells and inflammatory response decreased at day 21 p.i., despite persistence of parasites. Persistent infection-induced expansion of interleukin-10+ FOXP3+ Treg and CD4+ and CD8+ T cells expressing PD1. Blocking of PDL-1 signaling in vivo resulted in restoration of protective type 1 responses by both CD4+ and CD8+ T cells, which resulted in a significant decrease in the parasite burden. Mechanistically, PDL-1 blocking inhibited autophagy, a cellular degradation process hijacked by Leishmania to acquire host cell nutrients for their survival. Inhibition of autophagy was marked by decreased lipidation of microtubule-associated protein 1 light chain 3, a marker of autophagosome formation, and P62 accumulation. Together, our findings show for the first time that anti-PDL-1 antibody is an effective therapeutic approach for restoration of effector arms of protective immunity against VL and subsequent parasite clearance.

Is toxoplasmosis a potential risk factor for liver cirrhosis?

OBJECTIVE: To document Toxoplasma gondii (T. gondii) antibody status in patients with liver disease, blood samples were taken from 180 hepatic patients and 180 healthy controls. METHODS: Toxoplasma IgG antibody was detected using enzyme-linked immunosorbent assay and histopathological assessment of liver biopsy METAVIR score was applied. RESULTS: Anti-T. gondii IgG antibodies were found in 32.8% of patients and in 22.2% of controls (P = 0.02). Toxoplasma seropositivity was significantly associated with lymphadenopathy, history of blood transfusion and reflex impairment in patients. Chronic hepatitis C virus (HCV) and chronic HCV-related cirrhosis groups compared to chronic HBV and chronic HBV-related cirrhosis groups expressed significantly higher prevalence of T. gondii seropositivity (odds ratio (OR) = 4; 95% confidence interval (CI): 1.3-12.6; P = 0.013, OR = 4.8; 95% CI: 1.5-14.9; P = 0.006, respectively). Within the chronic HCV group, T. gondii seropositivity significantly associated disease evolution as regards to METAVIR histopathological system for fibrosis and inflammation (OR = 19.4; 95% CI: 2.3-165.2; P = 0.0008, OR = 0.29; 95% CI: 0.1-0.8; P = 0.01, respectively). Albumin, international normalized ratio (INR) and platelets count were the laboratory parameters significantly altered in Toxoplasma-positive chronic HCV patients (P = 0.001, 0.03, 0.04, respectively). Child-Pugh scoring for cirrhosis in chronic HCV group placed the majority of seropositive patient in class C with significant statistical difference compared to Child A reference group (OR = 0.08; 95% CI: 0.01-0.5; P = 0.003). CONCLUSIONS: Toxoplasma seropositivity was high in patients with cirrhosis and associated higher grades of inflammation and necrosis signifying disease evolution, suggesting that cirrhotic patients may thus form a risk group for toxoplasmosis.

Present-day anthelmintics and perspectives on future new targets.

In absence of vaccines for the majority of helminths, chemotherapy is still the mainstay for controlling human helminthiases. However, a limited number of drugs are available in the market to combat parasitic helminths in human. Besides, the development and spread of drug resistance have declined the use of most currently available anthelmintics. Clearly, availability of new anthelmintic agents will be essential in the next few years. More research into the mechanisms of drug actions and their targets are eminent for the discovery and development of novel anthelmintic agents. Recent drug discovery techniques mostly rely on mechanism-based screening of compounds on heterologously expressed targets in bacterial, mammalian or yeast cells. Although this is usually a successful approach, it is money- and time-consuming; meanwhile, pharmaceutical companies prefer the tested target that is chosen based on basic research. The nervous system is the site of action of several chemotherapeutics including pesticides and antinematode drugs; accordingly, the nervous system continues to be a promising target. Recent advances in exploring helminths' nervous system, neurotransmitters and receptors have paved the way for the development of potential agents targeting the nervous system and its components.

In vivo effect of single oral dose of artemether against early juvenile stages of Schistosoma mansoni Egyptian strain.

The current treatment and control of schistosomiasis, rely on a single drug, praziquantel, although, it has minor activity against juvenile stages of the parasite. Studies have shown that artemether (ART) exhibits effects against juveniles of Schistosoma mansoni Liberian and Puerto Rican strains, Schistosoma japonicum and Schistosoma haematobium. Aiming to assess the in vivo activity of single oral dose of ART against early juvenile stages of S. mansoni Egyptian strain, this study was established. Mice were treated with ART (400 mg/kg) at two time points evenly spaced over the period of larval development (7 and 21 days post-infection; pi), and a third treatment point (day 49 pi) was included to elucidate when susceptibility decreases. Administration of ART on day 7 pi reduced the total worm burden by 85.94%. The greatest reductions were seen when treatment was given on day 21 pi, with total and female worm burden reductions of 91.52% and 90.57%, respectively, and cessation of oviposition. Similar dose given on day 49 pi reduced total worm burden by 55.17% and female worm burden by 66.51%. Moreover, it induced significant reduction in the tissue egg load and significant alterations in the oogram pattern with decreased immature eggs and increased dead eggs. Antipathological activities were evident in significant reductions in granulomata count and diameter. In conclusion, ART exhibits major in vivo schistosomicidal effects against the early larval migratory stages of S. mansoni Egyptian strain, mainly the 21-day old schistosomula, hence preventing disease progression and morbidity.

First insight into the effect of single oral dose therapy with artemisinin-naphthoquine phosphate combination in a mouse model of Schistosoma mansoni infection.

Praziquantel is the current drug of choice against schistosomiasis. The dependency on praziquantel exclusively is problematic, given the spread of the disease and the threat of drug resistance. This study investigates an alternative antischistosomal drug using the compound naphthoquine phosphate tablet, which is a novel single oral dose antimalarial drug, containing a combination of naphthoquine phosphate and artemisinin. In the present study, the therapeutic efficacies of different artemisinin-naphthoquine phosphate combination-dosing protocols were evaluated in experimentally infected mice harbouring juvenile or adult stages of Schistosoma mansoni (Egyptian strain). The study shows that the oral administration of artemisinin-naphthoquine phosphate combination in a single dose of 400 mg/kg on day 7 p.i. resulted in a significant worm burden reduction of 95.07%. When used at a dose of 600 mg/kg on day 21 p.i., all female worms were killed before depositing eggs, resulting in complete absence of eggs in hepatic and intestinal tissues. The same dose given on day 42 p.i. reduced total and female worm burdens by 93.36% and 94.17%, respectively. In addition, artemisinin-naphthoquine phosphate combination induced significant reductions of 80.18% and 76.73% in the hepatic and intestinal tissue egg loads, respectively. Artemisinin-naphthoquine phosphate combination also induced significant alterations in the oogram pattern with elevated levels of dead eggs. Antipathological activities were evident in the amelioration of hepatic granulomata. Our findings hold promise for the development of a novel antischistosomal drug using an artemisinin-naphthoquine phosphate combination. Further in vitro and in vivo studies should be launched to elucidate the possible mechanism/s of action and to study the effect of artemisinin-naphthoquine phosphate combination on other human schistosomes.

Correlation of Trichomonas vaginalis to bacterial vaginosis: a laboratory-based study.

BACKGROUND: This study aimed to define the occurrence of different organisms causing vulvovaginitis; to evaluate different laboratory methods used for diagnosis of Trichomonas vaginalis (T. vaginalis); and to evaluate the direct score system and clue cell method compared with culture for diagnosis of bacterial and T. vaginalis vaginosis. METHODOLOGY: Clinical and laboratory evaluations were performed for 110 patients. Laboratory methods used for bacteriological diagnosis were direct Gram staining for clue cells and scoring by Nugent score system and bacterial culture. T. vaginalis was identified by wet mount microscopic examination, culture, direct Gram, Giemsa staining and acridine orange (AO). RESULTS: The Nugent score method revealed that the sensitivity and specificity for diagnosis of vaginal discharge by direct rapid microscopic methods were 30% and 80% and for clue cells sensitivity and specificity were 37% and 75% respectively for diagnosis of bacterial vaginosis compared to culture. For diagnosis of T. vaginalis, the Nugent score method revealed that the sensitivity and specificity were 60% and 90% respectively, and for clue cells 75% and 80% respectively. For microcopic methods used for T. vaginalis only, the Gram stain and Giemsa stain sensitivities were poor (15.2% and 48.5%, respectively). Wet mount showed reasonable sensitivity of 75.8%. Acridine orange sensitivity was 93.9% and specificity was 97.5%, CONCLUSION: Prevalent pathogens associated with vaginitis were (Gardnerella vaginalis) G. vaginalis, T. vaginalis and Mycoplasma hominis (M. hominis). Wet mount microscopic examination, acridine orange, and high Nugent score were found as rapid and sensitive methods for diagnosis of T. vaginalis.

Soil-parasites particularly Toxocara eggs in Egypt.

Soil-transmitted helminths (STHs) remain a major threat to the human health throughout the world, mostly in developing nations. Soil is usually contaminated by different parasitic stages through promiscuous defecation of man particularly children. This is more liable to occur in fields, public gardens and sides of streets or canals. Also, feces of domestic and wild animals & birds play a role in soil contamination. This study was conducted at Mansoura city and Batra village & El-Minia city and Zohra village representing the urban and rural areas of Dakahlia Governorate, Lower Egypt and Minia Governorate, Upper Egypt respectively. The most common helminthic stage presents in the soil of the two Governorates was Toxocara eggs. No ova was detected in-door yards in the urban areas, but only in the sides of streets, crop fields and fruit gardens, around houses and canal banks of both Governorates, and the highest intensity was 13-19 eggs/10 gm soil at canal banks at Zohra village, El-Minia Governorate, Upper Egypt.

Past and present situation of human fascioliasis in Dakahlia Governorate, Egypt.

Zoonotic fascioliasis is a problem not only in Dakahlia Governorate, but also in other Egyptian Governorates. This work was conducted in ten centers at Dakahlia Governorate, Egypt. Three thousand cases were randomly selected annually from each center representing five rural and five urban areas. Cases were examined for Fasciola infection by stool examination using, direct smear, formol ether sedimentation and Kato-Katz technique. Infection was higher in rural areas than urban areas. Female /male ratio was 1.5:1. Children between five and ten years old represent the highest infected group. The prevalence of infection was more among illiterate compared to educated individuals examined. Remarkable reduction in the prevalence rate was recorded in the last year of study compared to previous years, which is a good index of excellent control measures conducted by the Egyptian governorate to overcome parasitic infections.

Seroprevalence of and risk factors for Toxoplasma gondii antibodies among asymptomatic blood donors in Egypt.

A cross-sectional study was conducted to evaluate the seroprevalence of and risk factors for Toxoplasma gondii antibodies in 260 blood donors seen at blood banks in Mansoura University Hospital, Egypt. Blood donors were interviewed about sociodemographic characteristics and risk factors for T. gondii infection. A blood sample was taken to document their T. gondii antibody status using enzyme-linked immunosorbent assay. Overall, 155 (59.6%) of 260 blood donors were positive for anti-T. gondii IgG antibodies. Multivariate logistic regression analysis showed a significant association between T. gondii seropositivity and eating meat by-products (luncheon/shawerma) (adjusted odds ratio [OR] 80.82 [95% CI 18.62-350.81], P < 0.0001) or being non-educated (adjusted OR 32.25 [95% CI 7.46-139.44], P < 0.0001). These findings highlight that T. gondii is prevalent among blood donors in Egypt.

Hepatic hydatid disease: four case reports.

We report four cases who were referred to Mansoura University Teaching Hospital, Egypt suffering from abdominal pain and gastrointestinal manifestations. The patients' history was unremarkable, except that they had contact with dogs and live in rural communities. Laboratory findings showed peripheral blood eosinophilia, leucocytosis, and elevated liver enzymes. Serological tests were positive in three cases. Ultrasonography showed well-circumscribed cystic masses in the liver. Diagnosis of hydatid cysts was confirmed by computed tomography (CT). Surgical treatment along with chemotherapy was performed and all patients recovered well. The results of these cases support the notion that CT scan can led to increased clarity, regarding surgical management, because of discordance between radiographic and laboratory findings.

Helminthes of synanthropic rodents (Rodentia: Muridae) from Dakahlia and Menoufia, Egypt.

A cross-sectional survey was conducted to monitor and compare the prevalence of helminthes in rodents from Dakahlia and Menoufia governorates. The domestic rodents (271) were Rattus norvegicus, Rattus rattus frugivorous, Rattus r. alexandrinus, & Mus musculus. The overall prevalence of helminthes was 52.8%. In Dakahlia, 72/145 rats (49.6%) were infected. The highest prevalence of infection was in R. r. frugivorous 43 (60.4%), then R. r. alexandrinus 44 (47.7%), R. norvegicus 38 (44.7%), and the lowest was M. musculus 20 (40%). In Menoufia, 71/126 rats (56.3%) were infected. The highest prevalence of infection was in R. r. frugivorous 36 (77.7%), then M. musculus 27 (48.1%), R. norvegicus 23 (47.8%), and the lowest was in R. r. alexandrinus 40 (47.5%). A total of 24 species of helminthes (11 trematodes, 4 cestodes & 10 nematodes) were identified among the 271 rodents. The commonest trematode was Mesostephanus aegypticus followed by Stictodora tridactyla. The commonest cestode was Hymenolepis diminuta followed by Taenia taeniaformis. The commonest nematode was Capillaria hepatica followed by Trichurus muris. Given the zoonotic potential of rodents' parasites and since several residential, commercial, and agricultural sites exist in the examined geographic areas, the potential health risk should not be ignored.

Biochemical parameters in chronic fascioliasis.

Serum lipids, liver enzymes and total bile acids were measured in chronic Fasciola (cholestatic and non-cholestatic) patients. Variations in the biochemical parameters between infected and control groups were detected and typified by considerably higher serum triglycerides (TG, P < 0.001), alkaline phosphatase (ALP, P< 0.001) and total bile acids (TBA, P < 0.001) in the infected group. For cholestatic patients, TG, very low density lipoprotein (VLDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase (GGT) and ALP were statistically higher (P < 0.001 for each comparison) and total cholesterol (TC); low density lipoprotein (LDL) and high density lipoprotein (HDL), were statistically lower than non-cholestatic patients (P = 0.02, < 0.001, < 0.001 respectively). No statistically significant differences were found for the TC, HDL, VLDL, ALT, AST and GGT between non-cholestatic patients and healthy controls.

Comparative study between immunohistochemical grading and giardia genotyping among symptomatic and asymptomatic humans.

In the last years, multiple studies indicated the potential effectiveness of the polymerase chain reaction (PCR) for detection of Giardia in pathological specimens. By using the difference at the triose phosphate isomerase (tpi) gene locus, we investigated the genotype groups of Giardia lamblia isolated directly from fecal specimens collected from humans living in Dakahlia Governorate, Egypt. Immunohistochemical staining for detection of Giardia local antigenic and cellular immune-determinants focusing on CD4 and CD8 T-lymphocytes was also applied. The sensitivity of the ABC (avidine-biotin-peroxidase complex) immunoperoxidase technique for detection of the antigen was 97.3% and the specificity was 100%. Our study clearly demonstrated a highly significant difference between patients and controls as regards the grade of CD4 and CD8 lymphocyte infiltration (p < 0.001 for each correlation) but no significant difference was found between Giardia symptomatic and asymptomatic patients. Using the PCR technique, 89.3% sensitivity, 100% specificity and diagnostic accuracy of 92% were reached. Nevertheless, there was statistically insignificant difference between symptomatic and asymptomatic groups regarding the prevalence of different Giardia genotypes and the prevalence of CD4 and CD8 lymphocyte infiltration grading in different Giardia genotypes.

Diagnostic criteria for house dust mites sensitized allergic patients.

House dust mites (HDM) contain a large number of components that react with IgE in individuals with allergies and induced sensi-tization and allergic diseases. The work aimed to correlate between clinical manifestations of HDM allergic patients and skin prick test (SPT) grading, and to clarify some markers denoting allergic disorders caused by HDM exposure. Thirty allergic patients with positive SPT reaction to HDM were selected, grading of disease severity according to SPT and clinical presentations. The results revealed bronchial asthma (40%), atopic dermatitis (26.7%), rhinitis (20%) and conjuncttivitis (13.3%). Serum ELISA-IgE showed mean level of 398.41 +/- 84.73, 369.87 +/- 86.76, 332.16 +/- 65.57 and 300.25 +/- 79.39 IU/ml respecttively, with highly statistically significant difference between cases and controls (p < 0.001). Eosinophila showed highly significant difference between atopic dermatitis cases and controls (p < or = 0.001).

Present situation of house dust mites in Dakahlia Governorate, Egypt.

House dust mites are common inhalant allergens, which can precipitate atopic disease episodes. The present study revealed presence of four mites. These are Dermatophagoides farinae, D. pteronyssinus, Acheles gracilis and Ornithonyssus bacoti. Population densities of different live adult mites were investigated in different house habitats. In urban houses, pyroglyphid mites were the predominant in bedrooms and D. farinae was the most abundant. A. gracilis was more abundant in living rooms followed by D. farinae then D. pteronyssinus. A. gracilis was the most prevalent in kitchens. While in rural houses, O. bacoti was the most abundant species followed by pyroglyphid mites. Since Dermatophagoides species and A. gracilis were present in numbers high enough to allow their ecological consideration, their seasonal abundance in urban bed-rooms was investigated and revealed that both D. farinae and D. pteronyssinus have two peaks of abundance, one slightly higher in spring and the second in autumn. A. gracilis has two peaks but the higher occurred in autumn and the second in spring.

Some molecular aspects in schistosomiasis mansoni and toxoplasmosis.

The IL-2 and IL-4 cytokines production represent cellular Th1 & Th2 immune responses respectively were associated with chronic schistosomiasis mansoni (stages 1-4) and chronic toxoplasmosis gondii. In the hepatosplenic schistosomiasis, the level of IL-2 and disease stage increased in parallel (P<0.05, <0.01, <0.01 & <0.001 in stages 1, 2, 3 & 4 respectively), whereas, IL-4 was highly significantly increased in stage 1 than control (P<0.001), then decreased to lower levels. The mean concentrations of IL-2 & IL-4 in patients with T. gondii were higher compared to control being more marked in IL-2 (P<0.001) versus IL-4 (P< 0.01). The data indicated that there are patterns of cytokine expression characteristic of type 1 & type 2 responses in vivo, with the ultimate goal of being able to manipulate the response to minimize inflammation and fibrosis for clinical benefit.