RESUMO
Cerebral toxoplasmosis is one of the leading causes of neurologic diseases with high mortality rates in patients with HIV infection. Invasion was difficult to diagnose for a number of objective reasons. The objective of the investigation was to determine the clinical sensitivity of different laboratory techniques as both a single study and their various combinations to verify the diagnosis of cerebral toxoplasmosis in HIV-infected patients. Blood and cerebrospinal fluid were tested in 51 patients with Stage 4B HIV infection (AIDS) with the verified diagnosis of cerebral toxoplasmosis. Separate determination of specific antibodies of IgG, IgM, IgA and toxoplasma DNA in the blood and cerebrospinal fluid was shown to have an insufficient clinical sensitivity (37.3-68.6%). The benefits of various combinations of immunological and molecular biological assays enhancing the diagnostic efficiency up to 76.5-96.1% are demonstrated.
Assuntos
Anticorpos Antiprotozoários/sangue , Encéfalo/patologia , DNA de Protozoário/sangue , Infecções por HIV/patologia , HIV , Toxoplasma/isolamento & purificação , Toxoplasmose Cerebral/diagnóstico , Adulto , Anticorpos Antiprotozoários/líquido cefalorraquidiano , Encéfalo/parasitologia , Encéfalo/virologia , Coinfecção , DNA de Protozoário/líquido cefalorraquidiano , Progressão da Doença , Feminino , Infecções por HIV/sangue , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/virologia , Humanos , Imunoensaio , Imunoglobulina A/sangue , Imunoglobulina A/líquido cefalorraquidiano , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina M/sangue , Imunoglobulina M/líquido cefalorraquidiano , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Toxoplasma/imunologia , Toxoplasmose Cerebral/sangue , Toxoplasmose Cerebral/líquido cefalorraquidiano , Toxoplasmose Cerebral/parasitologiaRESUMO
Contemporary representation of toxoplasmosis reactivation criteria in HIV infection is generalized. Significance of the issue is justified: toxoplasmosis is a leading neurological pathology in AIDS with a high lethality percentage due to complexity of clinical confirmation and difficulties of laboratory confirmation of the start of reactivation. Clinical, instrumental, immunologic, molecular genetic invasion reactivation criteria are discussed in the article and analysis of their effectiveness is performed; their most feasible combinations are justified. Further system analysis of the cerebral toxoplasmosis reactivation criteria specified in the article in combination with search of new pathogen dissemination markers will allow to obtain important information that has both fundamental interest and important practical significance.
Assuntos
Anticorpos Antiprotozoários/sangue , Infecções por HIV/virologia , RNA de Protozoário/sangue , Toxoplasma/patogenicidade , Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/parasitologia , Anticorpos Antiprotozoários/imunologia , Biomarcadores/análise , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/patologia , Coinfecção , HIV/fisiologia , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imageamento por Ressonância Magnética , Recidiva , Toxoplasma/fisiologia , Toxoplasmose Cerebral/sangue , Toxoplasmose Cerebral/imunologiaAssuntos
DNA de Protozoário/sangue , Interações Hospedeiro-Parasita , Toxoplasma/fisiologia , Toxoplasmose Animal/imunologia , Administração Oral , Animais , Antígenos CD/genética , Antígenos CD/imunologia , Linfócitos B/imunologia , Linfócitos B/patologia , Movimento Celular , Citocinas/sangue , Citocinas/imunologia , Células Dendríticas/imunologia , Células Dendríticas/patologia , Citometria de Fluxo , Predisposição Genética para Doença , Imunofenotipagem , Injeções Intraperitoneais , Macrófagos/imunologia , Macrófagos/patologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Transgênicos , Neutrófilos/imunologia , Neutrófilos/patologia , Taxa de Sobrevida , Linfócitos T/imunologia , Linfócitos T/patologia , Toxoplasma/patogenicidade , Toxoplasmose Animal/genética , Toxoplasmose Animal/mortalidade , Toxoplasmose Animal/patologiaRESUMO
AIM: Comparative assessment of effectiveness of serologic methods for toxoplasmosis diagnostics in patients with HIV-infection. MATERIALS AND METHODS: Sera and CSF samples from 166 patients with AIDS stage IIIB were tested for antibodies to Toxoplasma gondii by indirect immunofluorescence, ELISA and immunoblotting. Results of serological tests were compared with clinical, pathological data as well as with results of MRI and PCR. RESULTS: Clinical value of IgG detection in blood and CSF by ELISA was shown--high level of antibodies marked reactivation of the invasion. IgG antibodies in CSF were detected only if high levels of IgG were present in the blood. Detection of antigenic determinants with molecular mass 18 - 20 and 65 - 70 kDa in immunoblotting was proposed as a criterion of cerebral toxoplasmosis reactivation. CONCLUSION: Complex laboratory serologic tests along with data obtained by MRI, PCR and microscopy of T. gondii cysts enhances the effectiveness of toxoplasmosis diagnostics. Knowledge of toxoplasmosis reactivation criteria in patients with AIDS will allow to develop the optimal protocol of toxoplasmosis diagnostics and substantiate measures for its prevention.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Anticorpos Antiprotozoários/análise , Infecções por HIV/complicações , Toxoplasmose/diagnóstico , Toxoplasmose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adulto , Idoso , Anticorpos Antiprotozoários/sangue , Anticorpos Antiprotozoários/líquido cefalorraquidiano , Antígenos de Protozoários/análise , Antígenos de Protozoários/imunologia , Western Blotting/métodos , Epitopos/análise , Epitopos/imunologia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina G/análise , Imunoglobulina G/sangue , Imunoglobulina G/líquido cefalorraquidiano , Pessoa de Meia-Idade , Federação Russa/epidemiologia , Toxoplasma/isolamento & purificação , Toxoplasmose/complicações , Toxoplasmose Cerebral/diagnósticoAssuntos
Antígenos de Protozoários/imunologia , Vacinas Protozoárias/imunologia , Toxoplasma/imunologia , Toxoplasmose/prevenção & controle , Vacinação , Adjuvantes Imunológicos/administração & dosagem , Administração Oral , Animais , Anticorpos Antiprotozoários/sangue , Especificidade de Anticorpos , Antígenos de Protozoários/administração & dosagem , Células Cultivadas , Citotoxinas/análise , Citotoxinas/genética , Ácido Hialurônico/administração & dosagem , Macrófagos/imunologia , Camundongos , Camundongos Endogâmicos DBA , Mucosa Bucal , Vacinas Protozoárias/administração & dosagem , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Baço/imunologia , Toxoplasmose/sangue , Toxoplasmose/imunologiaRESUMO
A new approach for the evaluation of oxidizability of proteins and lipids in the same sample of blood plasma was proposed. We tested a method for evaluation of metal-catalyzed oxidation of fibrinogen by the formation of bityrosine cross-links during oxidation detected by the increase in fluorescence at 415 nm. A correlation was revealed between parameters of oxidizability estimated by this marker and carbonyl derivatives (dinitrophenylhydrazine method). Oxidizability of total proteins from whole plasma was compared with oxidizability of plasma lipids (marker malonic dialdehyde). Study of these parameters in patients with coronary heart disease showed that the proposed experimental approach allows us to divide the sample into several subgroups differing in the resistance to oxidative stress. These data can be used for diagnostic and prognostic purposes.