Acute infection of Toxoplasma gondii and cytomegalovirus reactivation in a pediatric patient receiving liver transplant.

A 7-year-old Mexican boy with end-stage cirrhosis underwent liver transplantation and was maintained with cyclosporine and prednisolone. No specific data about Toxoplasma gondii or cytomegalovirus (CMV) infections in the cadaver donor were available. The recipient was seronegative for Toxoplasma, but CMV-IgG positive before transplantation. Ganciclovir was administered for prophylaxis during 3 months, but 5 months later he presented with icterus and increased transaminases. Acute transplant rejection was ruled out by biopsy. A seroconversion for T. gondii IgM and IgG and a small increase in CMV-IgM antibodies were observed, although the CMV-polymerase chain reaction (PCR) was negative. Ganciclovir was re-started, and the patient improved, but 6 months later he relapsed, and chorioretinitis lesions compatible both with T. gondii and CMV infections appeared. Pyrimethamine, sulfadiazine, folinic acid, and ganciclovir were administered. The boy showed favorable clinical improvement and remained stable for 12 months. Then, new retinal CMV lesions appeared in both eyes and the PCR for CMV became positive; therefore, the patient received a new regimen of ganciclovir, and clinically improved. From these data we concluded that the child presented a reactivation of CMV and a primary infection with T. gondii after transplantation.

[Parasitoses in immune deficiences]. / Parazytozy w stanach niedoborów immunologicznych.

The congenital or acquired cause the state of immune deficiency. To acquired factors belong immunosuppressive therapy after grafting and in systemic diseases as infections with HIV. There is a number of parasitic organisms, mainly protozoa, which preferentially settle in immunocompromised persons. The opportunistic parasites are present in the nearest environment. Some of them were newly recognized as human invaders. The state of immune deficiency may reactivate latent infections, that occurs with Toxoplasma gondii infection. Some parasitic infections which are benign and self- resolving, when affecting immunocompetent hosts, become fulminant or disseminated and very often life - threatening in immunosuppressed individuals.

[The host-opportunistic protozoa system. The incidence of mixed infections (Pneumocystis and cytomegalovirus) in children living in radionuclide-contaminated areas]. / Sistema "khoziain-uslovno-patogennye prosteishie". Chastota smeshannykh infektsii (pneumotsistnoi i tsitomegalovirusnoi) u detei, prozhivaiushchikh na zagriaznennykh radionuklidami territoriiakh.

The purpose of our study was to determine the influence of ionized radiation onto the frequency of mixed infections (P. carinii and Cytomegalovirus) in children inhabitants of the settlements affected with radionuclide after Chernobyl accident. Two groups of children were under survey. 1) 103 inhabitants of Novozybkov (Bryansk Province, Russia) and 38 patients under observation in Moscow paediatric hospital from another affected villages (5-15 Ci/km2) were examined serologically by the diagnostic system "Pneumo-test" and "Cytomegatest" (Nyarmedic, Moscow, Russia). Cut-off titers for P. carinii were IgM-1: 200, IgG-1: 20, for CMV IgG-1: 200, 2) Retrospective study of 563 patients with respiratory pathology and 1809 died children after acute pneumonia during 14 years period. Sputum and mucus of the patients taken by laryngoscopy and bronchoscopy were studied for P. carinii by microscopy, the section of lungs--histologically. The sediments of urine and saliva were examined for CMV by microscopy and section of different organs_-histologically. Examinations were performed by one and the same highly qualified pathologist. The results of the study were as follows. 1. Of 563 children examined for both P. carinii and CMV 186 (33%) were positive for P. carinii and 189 (33.7%) for CMV. Both pathogens were found in 46 children (8.2%), mainly among 1-2 and 6-12 month age (8.5 and 14.5%, respectively). Retrospective analysis of 1809 autopsy results shows, that in 73 cases (4%) were found only P. carinii, in 200 (11.1%) only CMV and in 24 (1.3%) two pathogens simultaneously. 2. Of 103 children surveyed serologically P. carinii monoinfection was found in 7 (8.8%), CMV-in 25 (24.3%) and coinfection in 55 (53.4%). Estimated frequency for coinfection (if combination of two infections were to be accidental) should equal 46.8%. In control group consisted of 30 children from clean Moscow region the rate of coinfection was 16.7% and estimated rate 15% (the difference between empiric and estimated rates are statistically significant, t > 4). Thus it is clear that the rate of coinfection of P. carinii and CMV is always high either in clean or in affected by ionized radiation regions. This rate determined by microscopy was higher in patients (8.2%) than in autopsy cases (1.3%) and much higher in children from affected region (53.3%) than in control (16.7%), being determined serologically. Separate interest present geometric mean titers found in the cases of coinfection. The titer for anti-CMV IgG in children from affected regions was rather high (5884 vs. 1246 in control) and on the contrary titers for anti-P. carinii IgM and IgG were lower than in control (512 vs. 1245 and 58 vs. 159 respectively). We are incline to interpret the results of our study as evidence of increased susceptibility to P. carinii and CMV in those children whose immune system was suppressed by premorbid factors or ionized radiation and peculiar symbiotic relationships of P. carinii and CMV resulting in enhancement of their infectiousness.

[Value of the cytological examination of the bronchoalveolar lavage fluid in patients with acquired immunodeficiency syndrome and related syndromes]. / Apport de l'examen cytologique du liquide de lavage bronchoalvéolaire chez les patients atteints de syndrome d'immunodéficience acquise et de syndrome associé.

In AIDS a variety of severe pulmonary disorders may occur. The authors report 110 cases of bronchoalveolar lavage (BAL) in 43 AIDS and 41 ARC. In AIDS P. carinii pneumonia is the major cause of respiratory illness. BAL alone is a safe and valuable tool for diagnosis of P. carinii pneumonia and others opportunistic infections. Moreover, pulmonary hemorrhage diagnosed by the finding of hemosiderin laden macrophages, is very suggestive of broncho-pulmonary Kaposi' sarcoma. Finally, BAL demonstrates a severe depletion of T4 lymphocytes and an increased number of T8 lymphocytes. The T8 lymphocytosis is observed whatever the pulmonary involvement (nonspecific alveolitis, opportunistic infections, Kaposi's sarcoma), and is also found in ARC, and lymphocytosis, open lung biopsy shows a lymphoid interstitial infiltration with respect of the alveolar septa, thus differing from the classical lymphoid interstitial pneumonia described by Carrington. The prognosis of lymphocytosis in ARC remains unknown.