Molecular diagnosis of Toxoplasma gondii infection in cerebrospinal fluid from AIDS patients.

BACKGROUND: Toxoplasmic encephalitis (TE) is one of the most common opportunistic infections in immunocompromised patients. In Cuba, despite the highly active antiretroviral therapy, TE is still the most important cause of cerebral mass lesions in patients infected with the human immunodeficiency virus (HIV). The detection of Toxoplasma gondii by PCR may facilitate the diagnosis and follow-up of TE in acquired immunodeficiency syndrome (AIDS) patients by direct identification of parasite DNA in clinical samples. The aim of the present study was to evaluate a rapid PCR method using the B1 gene to detect T. gondii in cerebrospinal fluid (CSF) samples from patients with suspected TE. METHODS: CSF samples from AIDS and HIV-negative patients were analyzed. Patients were divided into two groups according to the Centre for Disease Control and Prevention (CDC) criteria for AIDS-related TE: AIDS patients with suspected neurotoxoplasmosis and AIDS and HIV-negative patients with other confirmed neurological diseases but no suspicions of TE. Predictive values, diagnostic accuracy, sensitivity and specificity of the PCR B1 method were calculated. RESULTS: The results obtained from 190 patients showed that this assay has a good sensitivity and specificity (83.3% and 95.7%, respectively) for the diagnosis of TE in AIDS patients. CONCLUSION: PCR using the B1 gene and B22/B23 set of primers is a single, rapid and reliable method that may be valuable for discrimination between toxoplasmosis and other central nervous system (CNS) diseases.

Detection of Toxoplasma gondii in cerebrospinal fluid from AIDS patients by nested PCR and rapid identification of type I allele at B1 gene by RFLP analysis.

Highly active antiretroviral therapy (HAART) has decreased the incidence of opportunistic infections in the central nervous system (CNS) in AIDS patients. However, toxoplasmic encephalitis (TE) still represents the most common cerebral mass lesion in patients infected with human immunodeficiency virus (HIV). The aim of this study was to evaluate nested PCR-B1 using cerebrospinal fluid (CSF) to detect Toxoplasma gondii DNA for the diagnosis of TE. A total of 114 samples were evaluated, and 33/44 samples from patients with TE were positive by PCR (sensitivity 75%), demonstrating the diagnostic usefulness of PCR technique. PCR-B1 products were analyzed by restriction fragment length polymorphism (RFLP) in 30 samples. Only type I allele at B1 was identified in these samples according banding patterns. This is the first report of evaluation of S1-AS1/S2-AS2 set of primers in more than 100 clinical samples as well as the first genotyping study of T. gondii in Cuba.

Antiretroviral activity of protease inhibitors against 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.

Efecto in vitro del antirretroviral tipranavir sobre taquizoitos de Toxoplasma gondii

La introducción de la terapia antirretroviral de alta eficiencia ha conllevado a una disminución en la frecuencia de neurotoxoplasmosis en personas con VIH. Experimentalmente se demostró que los antirretrovirales inhibidores de proteasas pueden tener además una acción directa sobre el parásito, en este caso Toxoplasma gondii. El objetivo es evaluar la actividad antitoxoplasma in vitro del tipranavir, un antirretroviral inhibidor de proteasa de tercera generación. Para ello se determinó la inhibición del crecimiento causada por el tipranavir sobre taquizoitos intracelulares de Toxoplasma gondii, así como su citotoxicidad frente a macrófagos residentes en el peritoneo de ratones OF-1. En paralelo, se evaluaron el atazanavir, la sulfadiazina y pirimetamina como fármacos de referencia. El tipranavir mostró actividad inhibitoria frente a taquizoitos de T. gonddi, con una CI50 de 21,2 ± 3,0 µM, la cual fue similar (p> 0,05) a la obtenida con la sulfadiazina (CI50= 23,3 ± 3,6 µM) y mayor (p< 0,05) que el atazanavir (CI50= 2,8 ± 0,7 µM) y la pirimetamina (CI50= 1,2 ± 0,2 µM). Sin embargo, mostró un valor de CC50 (105,9 ± 10,0 µM) superior (p< 0,05) con respecto a los fármacos de referencia (atazanavir (CC50= 25,0 ± 0,5 µM), sulfadiazina (CC50= 25,2 ± 3,2 µM) y pirimetamina (CC50= 4,4 ± 1,2 µM). En conclusión, este trabajo describe por primera vez la actividad in vitro del tipranavir sobre taquizoitos de T. gondii.

The introduction of highly efficient antiretroviral therapy has brought about a decrease in the frequency of neurotoxoplasmosis among people with HIV. It was demonstrated experimentally that protease inhibitor antiretrovirals may also have a direct action against the parasite, in this case Toxoplasma gondii. The purpose of the study was to evaluate the antitoxoplasma activity in vitro of tipranavir, a third-generation protease inhibitor antiretroviral. To achieve this aim, determination was made of the growth inhibition caused by tipranavir in Toxoplasma gondii intracellular tachyzoites, as well as its cytotoxicity against macrophages living in the peritoneum of OF-1 mice. Additionally, evaluation was conducted of atazanavir, sulfadiazine and pyrimethamine as reference drugs. Tipranavir displayed inhibitory activity against T. gondii tachyzoites, with a IC50 of 21.2 ± 3,0 µM, similar (p> 0.05) to the one obtained with sulfadiazine (IC50= 23.3 ± 3.6 µM) and higher (p< 0.05) than atazanavir (IC50= 2.8 ± 0.7 µM) and pyrimethamine (IC50= 1.2 ± 0.2 µM). However, its CC50 value (105.9 ± 10.0 µM) was higher (p< 0.05) than that of the reference drugs atazanavir (CC50= 25.0 ± 0.5 µM), sulfadiazine (CC50= 25.2 ± 3.2 µM) and pyrimethamine (CC50= 4.4 ± 1.2 µM). This is the first time a description is provided of the in vitro activity of tipranavir against T. gondii tachyzoites.

Conventional polymerase chain reaction for the diagnosis of neurotoxoplasmosis: comparison of three sets of primers for the B1 gene using CSF samples.

Polymerase chain reaction (PCR) has made a significant improvement in the diagnosis of toxoplasmic encephalitis (TE). Nevertheless, a wide variety of targets and primers has been used in different assays, and few comparative studies had been carried out. The aim of the present study was to compare the efficiency of 3 conventional PCR methods by using 3 sets of primers targeting the repetitive B1 gene in the diagnosis of TE. Diagnostic sensitivity and specificity of PCR and nested-PCR protocols were assessed for 207 (nested-PCR/T1-T4), 200 (nested-PCR/S1-AS1), and 206 (PCR/B22-B23) cerebrospinal fluid (CSF) samples, including AIDS and HIV-negative patients. The diagnostic sensitivity of PCR and nested-PCR assays was 50.85%, 68.97%, and 72.41% for T1-T4, S1-AS1, and B22-B23, respectively. The diagnostic specificity was high for all the assays showing values between 95% and 97%. In general, the best results were obtained for the B22-B23 set of primers, suggesting their usefulness compared with 2 nested-PCR protocols and showing that this simple and rapid strategy may be the preferred one for the diagnosis of TE in AIDS patients.

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.

Comparison of four DNA extraction methods from cerebrospinal fluid for the detection of Toxoplasma gondii by polymerase chain reaction in AIDS patients.

BACKGROUND: Toxoplasmosis is a serious and often life-threatening disease in immunodeficient patients. Polymerase chain reaction (PCR) assays allow a rapid diagnosis of Toxoplasma infection by direct detection of the parasite's DNA. To perform a sensitive, specific, and reliable PCR-based diagnostic test, the availability of pure DNA lacking PCR inhibitors as well as a rapid and easy-to-perform DNA extraction protocol are essential. The aim of the present study was to compare four DNA extraction methods for the detection of T. gondii on cerebrospinal fluid (CSF) using the PCR technology. MATERIAL/METHODS: Four DNA extraction methods (boiling, lysis + centrifugation, the miniMAG commercial system, and phenol-chloroform) were compared with respect to the time of completion, the manual labor involved, and PCR analytical sensitivity for the detection of T. gondii in CSF. The optimal DNA extraction method for the detection of the parasite was evaluated in CSF from 43 AIDS patients using the nest-PCR B1 assay. RESULTS: According to the time required for completion, labor, and PCR analytical sensitivity, the lysis + centrifugation protocol proved to be a simple, efficient, and economical in-house procedure to recover the T. gondii DNA present in the CSF. The diagnostic sensitivity of nest-PCR, according to Centers for Disease Control and Prevention (CDC) criteria, was 86.3% and the diagnostic specificity was 100%. CONCLUSIONS: We report a simple, rapid, reproducible, and economical in-house method for T. gondii DNA extraction from CSF. This method is recommended for diagnostic PCR of Toxoplasmic encephalitis (TE) in places with economical shortage.

Primoinfección por Toxoplasma gondii durante el embarazo / Frist infection with Toxoplasma gondii during pregnancy

Congenital toxoplasmosis is a consequence of a first infection during pregnancy. A descriptive study was carried out in a sample of 181 pregnant women. This sample was representative of a universe integrated by pregnant women from 3 policlinics of La Lisa municipality, Havana City, booked from March to September 2004, with the aim of identifying those with acute or recent toxoplasmosis infection. As well, the follow-up and control of seronegative pregnant women was also conducted. The sample size was determined through a simple, randomized sampling. The serological method of Indirect Immunofluorescence (IFI) was used to detect the IgG and IgM anti-Toxoplasma antibodies, and the molecular method of the Polymerase Chain Reaction (PCR) to confirm infection in blood or amniotic fluid. One of the patients of this study, who was at her 18th week of gestation with acute infection and probable congenital transmission, showed seroconversion with IgG antibody titters of 1/256 and 1/2048 in her first and second sera, respectively. The result of the IgM detection was of 1/32. These findings demonstrate a 44,2% of seroprevalence of T. gondii infection in a pregnant women population

Toxoplasma gondii antigenuria in patients with acquired immune deficiency syndrome

A longitudinal study was performed with sera and urine of patients with acquired immune deficiency syndrome (AIDS), taken before, during and after clinically Toxoplasma infection. The tested patients were followed for an average of two years. The titres of the specific IgG and IgM antibodies were measured by an indirect fluorescent antibody test (IFAT), and the appearance of circulating antigens of T. gondii was determined in 36 urine samples of 13 patients with neurotoxoplasmosis by means of the coagglutination test. The presence of T. gondii antigens in the urine of AIDS patients by this test was correlated with the immunoblot technique, with clinical symptoms and also with pathological findings. Our results indicate that the detection of T. gondii antigens in the urine of AIDS patients can be regarded as a rapid and efficient method for the diagnosis of acute toxoplasmosis.