Stability of extemporaneous sulfadiazine oral suspensions from commercially available tablets for treatment of congenital toxoplasmosis.

OBJECTIVES: To determine the physicochemical and microbiological stability of sulfadiazine suspensions (100 mg/mL) in simple syrup (A) and sorbitol (B) formulations prepared from commercially available tablets. METHODS: An ultra-performance liquid chromatographic assay was developed and validated to determine the chemical stability of sulfadiazine. Three samples were prepared and stored at 5 and 25 °C and assayed at 0, 7, 14 and 30 days. Physical parameters (appearance, pH, particle size and viscosity) were also monitored. Microbiological examination was performed through the suitable counting method. RESULTS: The formulations presented a sulfadiazine concentration of around 95% at the beginning at both temperatures. There was some variation in pH, viscosity and particle size distribution over time. The samples met the pharmacopoeia criteria of microbiological quality over 30 days, but only sulfadiazine formulated in syrup stored at 25 °C was suitable for use after one week. CONCLUSION: The sulfadiazine suspension in simple syrup was chosen as the most suitable formulation because it demonstrated stability for 14 days at room temperature, providing an alternative liquid dosage form of sulfadiazine for congenital toxoplasmosis treatment.

OBJECTIFS: Déterminer la stabilité physicochimique et microbiologique de suspensions de sulfadiazine (100 mg/mL) dans des formulations de sirop simple (A) et de sorbitol (B) préparées à partir de comprimés disponibles dans le commerce. MÉTHODES: Un test de chromatographie liquide ultra-performante a été développé et validé pour déterminer la stabilité chimique de la sulfadiazine. Trois échantillons ont été préparés et stockés à 5 ºC et à 25 ºC et analysés à 0, 7, 14 et 30 jours. Les paramètres physiques (apparence, pH, granulométrie et viscosité) ont également été contrôlés. Un examen microbiologique a été effectué par la méthode de comptage appropriée. RÉSULTATS: Les formulations présentaient une concentration en sulfadiazine d'environ 95% au début aux deux températures. Il y avait une certaine variation du pH, de la viscosité et de la distribution de la taille des particules au fil du temps. Les échantillons répondaient aux critères de pharmacopée pour la qualité microbiologique aprè 30 jours, mais seule la sulfadiazine formulée dans du sirop conservé à 25 ºC pouvait être utilisée après une semaine. CONCLUSION: La suspension de sulfadiazine dans un sirop simple a été choisie comme la formulation la plus appropriée car elle a démontré une stabilité à 14 jours à température ambiante, fournissant une forme galénique liquide alternative de sulfadiazine pour le traitement de la toxoplasmose congénitale.

Analysis of regulatory T cells and CTLA-4 expression in pregnant women according to seropositivity to Toxoplasma gondii.

Pregnancy is considered a period in which immunomodulation occurs, although it is important for the maintenance of the foetus, could contribute to infections as Toxoplasma gondii. Immune response cells such as regulatory T cells participate in this immunomodulation, and surface molecules such as CTLA-4 develop an immunosuppressive role, could contribute to the establishment of the parasite. This study aimed to evaluate the presence of regulatory T cells and the expression of CTLA-4 in parturient and non-pregnant seropositive and seronegative for anti-T. gondii antibodies. Sixty-two participants were evaluated, 14 parturient with negative serology, 23 parturient with positive serology, 16 non-pregnant women seronegative and 9 non-pregnant women seropositive. Immunophenotyping was performed for characterize TCD4+Foxp3+ cells, T CD4+CD25-Foxp3+, TCD4+CD25highFoxp3+, TCD4+CTLA-4+, TCD4+CD25-CTLA-4+ and TCD4+CD25highCTLA-4+. We observed a lower level of CD4+CD25highFoxp3+ cells from seropositive parturient compared with seropositive non-pregnant cells. Significative levels of CD4+CD25-Foxp3+ cells from seronegative pregnant were observed compared with seropositive pregnant cells. Furthermore, the higher level of CD4+CD25-CTLA-4+ cells populations was detected in seropositive pregnant cells compared with seropositive non-pregnant. Although a significant increase in CTLA-4 cells was observed in pregnant women positive for anti-T. gondii antibodies, this increase did not cause a risk of reactivation of the infection.

N° 363 - Évaluation et prise en charge de l'anasarque fœtoplacentaire non immune.

OBJECTIF: Décrire les méthodes actuelles d'évaluation et de prise en charge de l'anasarque fœtoplacentaire non immune en mettant l'accent sur les étiologies traitables ou récurrentes. RéSULTATS: Offrir de meilleurs services de conseil et de prise en charge en cas d'anasarque fœtoplacentaire non immune diagnostiquée en période prénatale. DONNéES: La littérature publiée a été récupérée au moyen de recherches menées dans PubMed, MEDLINE, CINAHL, et la Bibliothèque Cochrane en 2017 à l'aide de mots-clés (« non-immune hydrops fetalis ¼, « fetal hydrops ¼, « fetal therapy ¼, « fetal metabolism ¼). Les articles retenus portaient sur des revues systématiques, des essais cliniques contrôlés, randomisés ou non, des études observationnelles et des études de cas importantes. D'autres publications ont été repérées dans les bibliographies de ces articles. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mis à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2017. Nous avons également tenu compte de la littérature grise (non publiée) trouvée sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes liés aux technologies de la santé, dans des collections de directives cliniques et des registres d'essais cliniques, et obtenue auprès d'associations nationales et internationales de médecins spécialistes. AVANTAGES, INCONVéNIENTS ET COûTS: La présente directive clinique renseigne les lecteurs sur les causes de l'anasarque fœtoplacentaire non immune ainsi que sur son évaluation et sa prise en charge. Elle propose également une approche standardisée d'évaluation et de prise en charge, et met l'accent sur la recherche des conditions traitables en période prénatale et des étiologies génétiques récurrentes. VALEURS: La qualité des données probantes a été évaluée en fonction des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. RECOMMANDATIONS.

The efficacy of herbal medicines against Toxoplasma gondii during the last 3 decades: a systematic review.

The objective of the current study was to systematically review papers discussing the efficacy of medicinal herbs against Toxoplasma gondii. Data were systematically collected from published papers about the efficacy of herbs used against T. gondii globally from 1988 to 2015, from PubMed, Google Scholar, ISI Web of Science, EBSCO, Science Direct, and Scopus. Forty-nine papers were included in the current systematic review reporting the evaluation of medicinal plants against T. gondii globally, both in vitro and in vivo. Sixty-one plants were evaluated. Most of the studies were carried out on Artemisia annua. The second highest number of studies were carried out on Glycyrrhiza glabra extracts. RH and ME49 were the predominant parasite strains used. Additionally, Swiss-Webster and BALB/c mice were the major animal models used. Alcoholic and aqueous extracts were used more than other types of extracts. Natural compounds mentioned here may be developed as novel and more effective therapeutic agents that improve the treatment of toxoplasmosis due to their lower side effects, higher availability, and better cultural acceptance compared with those of the chemical drugs that are currently being used.

[Seroprevalence of toxoplasmosis in pregnant women in Annaba, Algeria]. / Séroprévalence de la toxoplasmose chez les femmes enceintes dans la wilaya d'Annaba, Algérie.

BACKGROUND: The aim of the study was to estimate the seroprevalence and risk factors of toxoplasmosis in pregnant women in the department of Annaba, Algeria. METHODS: We performed a cross-sectional study with analytical purposes. The study was collaboration between the laboratory of Parasitology-Mycology, Faculty of Medicine of Annaba and Parasite Biology Department at the Pasteur Institute of Algeria. A total of 1028 pregnant women who underwent prenatal diagnosis/visit were included over a period of 4 years from January 2006 to December 2009. Immunoglobulin G and M were assayed, using the microparticle enzyme method. The avidity test was used to determine the date of contamination according to age of pregnancy. Search for the parasite was made by inoculation of the placenta and cord blood in white mice. The study compared mother-to-child serological profiles using Western Blot (WB) IgG and IgM. Direct (not well-cooked meat) and indirect (presence of cat, gardening) indicators were recorded to search for parasite exposure. RESULTS: Seroprevalence was 47.8 % (95 % CI: 44.8 to 51.0) and the rate of active toxoplasmosis was 1.1 % (95 % CI 0.6 to 1.8). According to their immune status, this was the first serology for 41 % (CI95 %: 38.0-44.0) of women; 12 % (CI95 %: 10.5-14.6) of primiparous women had only one serology test during their entire pregnancy. Major risk factors were consumption of poorly-cooked meat and exposure to cats. CONCLUSION: Toxoplasmosis during pregnancy is a serious issue and an effective prevention program is needed.

[How to handle unexpected biological abnormalities observed in the pre-donation workup for hematopoietic stem cell transplantation: an SFGM-TC report on pre-transplant cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, or syphilis IgM positive serology test]. / Conduite à tenir devant une anomalie biologique découverte lors du bilan pré-don cellules souches hématopoïétiques: sérologie IgM positive pour le cytomégalovirus, le virus d'Epstein-Barr, la toxoplasmose, ou la syphilis.

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of pre-transplant donor's cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, or syphilis IgM positive serology test.

Prevalence of toxoplasmosis in France in 1998: is there a difference between men and women? At what age do children become infected?

BACKGROUND: The only national seroprevalence data currently available on toxoplasmosis in France are from the national perinatal surveys of pregnant women conducted in 1995 and 2003. These surveys are national, exhaustive and cross-sectional studies of all pregnant women who give birth in France during one specified week. These cross-sectional studies, conducted among women of childbearing age (defined as 18 to 45 years), showed a positive correlation between seroprevalence and age, with a significant regional disparity. This study was performed in order to compare the prevalence of toxoplasmosis antibodies in men and women in the 18-45 age group, to confirm regional variations and to estimate the seroprevalence of toxoplasmosis in France for different age groups, particularly among children and among adults aged over 45 years. METHODS: Serum samples from 2060 subjects were available from a national serum bank that was established in 1997 as part of a European study on vaccine preventable diseases. The sera were tested for IgG antibodies in 2008-2009, by ELISA test, at the laboratory of parasitology-mycology, CHU Grenoble. RESULTS: The seroprevalence for the population aged 1-64 years was 55.4%. Seroprevalence did not vary between the sexes, except among those aged over 45 years, where it was higher in men than in women. Toxoplasmosis seroprevalence varied significantly by regions for all ages. It increased with age and we noted a stronger increase in prevalence in adolescents (10-20 years) than in other age groups. CONCLUSION: This study showed that children have limited exposure to Toxoplasma gondii and that seroprevalence in men and women does not differ for the population aged 45 years and under. This study confirms the geographical disparity in prevalence in France that has been found in other studies in women of childbearing age. This disparity cannot be explained by different laboratory techniques, because sera were tested in a single laboratory. The study also raises the possibility of extrapolating seroprevalences from ENP to the general population and thus estimating the seroprevalence in the French population.

Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe, North-east Brazil.

OBJECTIVES: To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. METHODS: Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. RESULTS: Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.4-8.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age. CONCLUSIONS: The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.

[Causes of visual impairment among people living with HIV at the University Hospital of Libreville]. / Causes de deficience visuelle chez les personnes vivant avec le VIH/SIDA au CHU de Libreville.

INTRODUCTION: Few data exist on the issue of visual impairment (VI) in people living with HIV (PLHIV). OBJECTIVE: To identify the causes of visual impairment among people living with HIV (PLHIV) at the University Hospital of Libreville. POPULATION AND METHODS: This was an observational study of 737 people living with HIV (PLHIV). The parameters studied were age (year), gender, CD4 count, age of infection, use of antiretroviral therapy as well as visual acuity from far and near (CMI-11) and cause of VI. RESULTS: Out of a population of 737 PLHIV, 75 (101 eyes) had VI, representing a hospital prevalence of 10.2% (n = 75/737). VI was bilateral for 34.7% (n = 26/75) of them. The main aetiology were refractive disorders (47.5%). Uveitis affected 16.8% of the number of eyes, of which 12.9% were of toxoplasmic origin. Other causes were cataracts (11.9%) and cytomegalovirus retinitis (10.9%). Two patients experienced early macular degeneration and two others with macular ischemia. Bilateral macular hemorrhage and occlusion of the central artery of the retina were also observed. CONCLUSION: One in 10 PLHIV is visually impaired. In half of the cases, the pathologies that provide this handicap, are opportunistic disease with ocular toxoplasmosis in the foreground. Routine screening may improve visual prognosis.

INTRODUCTION: Peu de données existent sur la question de la déficience visuelle (DV) chez les personnes vivant avec le VIH (PVVIH). OBJECTIF: Recenser les causes d'insuffisance visuelle chez les personnes vivant avec le VIH (PVVIH) au centre hospitalier universitaire de Libreville. POPULATION ET MÉTHODES: Il s'agissait d'une étude observationnelle réalisée auprès de 737 personnes vivant avec le VIH (PVVIH). Les paramètres étudiés étaient l'âge (année), le sexe, le taux de CD4, l'ancienneté de l'infection, la prise du traitement antirétroviral ainsi que l'acuité visuelle de loin et de près (CMI-11) et la cause de la DV. RÉSULTATS: Sur un effectif de 737 PVVIH, 75 (101 yeux) ont présenté une DV, soit une prévalence hospitalière de 10,2% (n = 75/737). La DV était bilatérale pour 34,7% (n = 26/75) d'entre eux. Les principales étiologies étaient les troubles de la réfraction (47,5%). Les uvéites affectaient16,8% de l'effectif d'yeux dont 12,9% étaient d'origine toxoplasmique. Les autres causes étaient la cataracte (11,9%) et la rétinite à CMV (10,9%). Deux patients ont présenté une dégénérescence maculaire précoce et deux autres une ischémie maculaire. Une hémorragie maculaire bilatérale et une occlusion de l'artère centrale de la rétine étaient également observées. CONCLUSION: Une PVVIH sur 10 est déficiente visuelle. Dans la moitié des cas, les pathologies pourvoyeuses de ce handicap sont les affections opportunistes avec au premier plan la toxoplasmose oculaire. Un dépistage systématique pourrait améliorer le pronostic visuel.

[Cerebral toxoplasmosis in the infectious diseases department of the CHU du Point G in people living with HIV]. / La toxoplasmose cerebrale dans le service de maladies infectieuses du CHU du Point G chez les personnes vivant avec le VIH.

Toxoplasmosis is defined as a cosmopolitan protozoan disease caused by an obligate intracellular coccidia, Toxoplasma gondii. The advent of HIV infection has made cerebral toxoplasmosis one of the most widespread neurological opportunistic infections. METHOD: We conducted a descriptive cross-sectional study with retrospective review of files of cerebral toxoplasmosis on HIV infected patients who had been hospitalized in the infectious diseases department of Point G University Hospital between January 1st, 2014 and September 30th, 2019. RESULTS: During the study period, the frequency of cerebral toxoplasmosis was 10.1% and in 46.4% of the patients, the diagnosis led to the discovery of HIV co-infection. The clinical features were characterized by fever, headaches, and motor deficit at 86.6%, 84.5% and 69.1% respectively. Roundel image on computed tomography was most represented and was found in 24.4% of patients. Anti-toxoplasma treatment based on trimethoprim /sulfamethoxazole (TMP/SMX) associated with folinic acid was initiated in 78 patients out of 90, but 19 patients had a contraindication or adverse effects to this combination and were treated with clindamycin. HAART was initiated in 31 patients out of 45 (68.9%) newly diagnosed. The overall prognosis was limited with a mortality rate of 42%. CONCLUSION: The prevalence of cerebral toxoplasmosis was high in our study, 10.1%. To reduce this prevalence, chemoprophylaxis should be initiated in all HIV-infected patients with a CD4 count below 200 cells/mm3.

INTRODUCTION: La toxoplasmose est une protozoose cosmopolite due à Toxoplasmagondii. Avec l'avènement du VIH, la toxoplasmose cérébrale est une des infections opportunistes neurologiques les plus répandues. MÉTHODE: Nous avons mené une étude transversaledescriptive à collecte rétrospective portant sur des cas de toxoplasmoses cérébrales sur terrain d'immunodépression aux VIH ayant séjourné en hospitalisation dans le service des maladies infectieuses du CHU de Point G du 1er janvier 2014 au 30 septembre 2019. RÉSULTATS: La prévalence de la toxoplasmose cérébrale était de 10,1%. Chez 46,4% des patients, le diagnostic de toxoplasmose cérébrale avait permis la découverte d'une coïnfection à VIH. Le tableau clinique était dominé par la fièvre, les céphalées et le déficit moteur soit respectivement 86,6%, 84,5% et 69,1%. L'image en cocarde à la tomodensitométrie a été retrouvée chez 24,4% des patients. Le traitement anti-toxoplasmique à base de triméthoprime/sulfaméthoxazole (TMP/ SMX) associée à l'acide folinique a été conduit chez 78 patients sur 90. Dix-neuf patients avaient une contre-indication ou des effets indésirables à l'association TMP/ SMX et ont été traités par la clindamycine. Le traitement ARV a été initié chez trente-un patients sur 45 nouvellement dépistés soit 68,9%. Le pronostic chez nos patients était réservé et marqué par une mortalité de 42%. CONCLUSION: La prévalence de la toxoplasmose cérébrale était élevée dans notre étude soit 10,1%. Pour diminuer cette prévalence, la chimio-prophylaxie doit être instaurée chez tous les patients infectés par le VIH et ayant un taux de CD4 inférieur à 200 cellules/mm3.

Treatment of a full-thickness macular hole and retinal detachment secondary to toxoplasma chorioretinitis that developed shortly after COVID-19: A case report.

Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.

[Management of ocular toxoplasmosis in France: Results of a modified Delphi study]. / Prise en charge de la toxoplasmose oculaire en France : résultats d'une étude Delphi modifiée.

OBJECTIVE: To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study. MATERIALS AND METHODS: Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %. RESULTS: The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci. CONCLUSION: This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

[Intravitreal clindamycin injection in toxoplasma retinochoroiditis: About 9 cases in the ophthalmology department of the CHU de Bordeaux]. / Injection intravitréenne de clindamycine dans le traitement des rétinochoroïdites toxoplasmiques : à propos de 9 cas dans le service d'ophtalmologie du CHU de Bordeaux.

INTRODUCTION: Toxoplasma retinochoroiditis (TRC) is the main cause of posterior uveitis in immunocompetent patients. Several studies have shown safety and efficacy of treatment with intravitreal clindamycin injection in patients with contraindications, inadequate response or side effects with classic oral therapy. The goal of this study is to describe anatomic and functional results of local treatment with intravitreal clindamycin injection. MATERIALS AND METHODS: We performed an observational, retrospective, single-center study in the ophthalmology service of Bordeaux university medical center between December 2017 and January 2020 on management of toxoplasma retinochoroiditis by intravitreal clindamycin injection. We analyzed the efficacy of this treatment on improvement in visual acuity, decrease in size of the retinal lesion and decrease in macular thickness. RESULTS: A total of 10 eyes of 9 patients were injected. Only a single injection was required in 9 of the 10 cases. Injections demonstrated improvement in the 3 study criteria; visual acuity went from a mean of 1 LogMAR (1.07±0.77) pre-injection to 0.4 LogMAR (0.43±0.53) at 6 months, lesion size decreased by 51%, and macular thickness decreased by 78µm over the follow-up period. CONCLUSION: Intravitreal clindamycin injections are safe and effective for the treatment of TRC. They offer an alternative in patients with allergies, side effects or inadequate response to classic oral therapy.

[Toxoplasmosis in pregnancy: Practical Management]. / Toxoplasmose pendant la grossesse : proposition actuelle de prise en charge pratique.

The burden of congenital toxoplasmosis has become small in France today, in particular as a result of timely therapy for pregnant women, fetuses and newborns. Thus, the French screening and prevention program has been evaluated and recently confirmed despite a decline over time in the incidence of toxoplasmosis. Serological diagnosis of maternal seroconversion is usually simple but can be difficult when the first trimester test shows the presence of IgM, requiring referral to an expert laboratory. Woman with confirmed seroconversion should be referred quickly to an expert center, which will decide with her on treatment and antenatal diagnosis. Although the level of proof is moderate, there is a body of evidence in favor of active prophylactic prenatal treatment started as early as possible (ideally within 3 weeks of seroconversion) to reduce the risk of maternal-fetal transmission, as well as symptoms in children. The recommended therapies to prevent maternal-fetal transmission are: (1) spiramycin in case of maternal infection before 14 gestational weeks; (2) pyrimethamine and sulfadiazine (P-S) with folinic acid in case of maternal infection at 14 WG or more. Amniocentesis is recommended to guide prenatal and neonatal care. If fetal infection is diagnosed by PCR on amniotic fluid, therapy with P-S should be initiated as early as possible or continued in order reduce the risk of damage to the brain or eyes. Further research is required to validate new approaches to preventing congenital toxoplasmosis.

[Toxoplasmosis and behavioural changes (French translation of the article)]. / Toxoplasmose et modifications du comportement humain.

Nearly one-third of the planet's population is affected by T. gondii infection. In ophthalmology, toxoplasmosis is even considered to be the most common cause of posterior uveitis of infectious origin. Humans are only an intermediate host, and T. gondii needs to infect cats for its sexual reproduction. All the elements increasing the risk of predation by the definitive host are then favourable to the parasite. Numerous experimental animal model studies have shown that T. gondii infection is associated with predatory risk behaviours such as an attraction of infected mice to cat urine. Infection with the parasite is associated with a demethylation of the promoters of certain genes in the cerebral amygdala of the intermediate hosts, modifying dopaminergic circuits associated with fear. Similarly, T. gondii has been linked to behavioural changes in humans. Toxoplasma infection is classically associated with the frequency of schizophrenia, suicide attempts or "road rage." A more recent study shows that toxoplasma infection prevalence was a consistent, positive predictor of entrepreneurial activity. Fear of failure would be less important in infected individuals, who are more willing than others to start their own business. These elements shed interesting light on behaviours and their possible relationship with toxoplasmosis, which is generally considered benign in adults.

Toxoplasmosis, cryptosporidiosis, and isosporiasis in HIV-negative immunocompromised patients: A single-centre study, Ottawa, Ontario, Canada.

Background: Historically, patients with HIV have been at the highest risk of infection with opportunistic protozoans such as Toxoplasma, Cryptosporidium, and Isospora. Among patients with HIV who are compliant with antiretroviral therapy, the likelihood of acquiring an opportunistic infection is low. The risk of infection is harder to mitigate in the growing number of HIV-negative immunodeficient patients, such as people with hematological malignancies or those who are post-transplantation. Methods: We conducted a retrospective case series of patients with documented Toxoplasma infections between 2008 and 2017 and with Cryptosporidium and Isospora infections between 2014 and 2017 at the Ottawa Hospital. Results: During the study period, there were 10 confirmed cases of toxoplasmosis, 20 cases of cryptosporidiosis, and 2 cases of isosporiasis. Cryptosporidiosis (95%) and toxoplasmosis (60%) occurred more frequently among HIV-negative patients, whereas isosporiasis cases were limited to HIV-positive patients. Among patients with cryptosporidiosis, the most common underlying cause of immunosuppression in HIV-negative individuals was solid organ transplantation (15.79%), followed by diabetes (10.53%), end-stage renal disease (5.26%), and hematologic malignancy (5.26%). Seventy percent of patients had no known cause of immunosuppression. The most common underlying condition associated with toxoplasmosis was hematological malignancy (50%), followed by solid organ transplantation (33.33%), and solid tumours (16.66%). Conclusions: This study's results suggest that Cryptosporidium infections are more common among immunocompetent patients in Ottawa, whereas Toxoplasma infections are more common among HIV-negative patients with acquired immunodeficiencies. As the demographics of immunocompromised individuals continue to evolve, screening for protozoal infections in high-risk populations may become clinically important.

Historique: Par le passé, les patients atteints du VIH présentaient le plus fort risque d'infection par des protozoaires opportunistes comme le Toxoplasma, le Cryptosporidium et l'Isospora. Chez les patients atteints du VIH qui adhèrent à la thérapie antivirale, la probabilité de contracter une infection opportuniste est faible. Le risque d'infection est toutefois plus difficile à contrôler auprès du nombre croissant de patients immunodéprimés non atteints du VIH, tels que ceux qui souffrent d'un cancer hématologique ou qui ont subi une transplantation. Méthodologie: Les chercheurs ont réalisé une étude auprès d'une série de patients rétrospectifs atteints d'une infection démontrée par le Toxoplasma entre 2008 et 2017 ainsi que d'une infection par le Cryptosporidium et l'Isospora entre 2014 et 2017 à l'Hôpital d'Ottawa. Résultats: Pendant la période de l'étude, dix cas confirmés de toxoplasmose, 20 cas de cryptosporidiose et deux cas d'isosporose ont été recensés. La cryptosporidiose (95 %) et la toxoplasmose (60 %) étaient plus fréquentes chez les patients non atteints du VIH, mais les cas d'isosporose étaient limités aux patients atteints du VIH. Chez les patients atteints de la cryptosporidiose, la transplantation d'un organe plein (15,79 %) était la cause principale d'immunodépression chez les patients non atteints du VIH, suivie du diabète (10,53 %), de l'insuffisance rénale terminale (5,26 %) et du cancer hématologique (5,26 %). Toutefois, 70 % des patients ne présentaient aucune cause connue d'immunodépression. Le cancer hématologique (50 %) était l'affection la plus associée à la toxoplasmose, suivi de la transplantation d'un organe plein (33,33 %) et des tumeurs solides (16,66 %). Conclusions: Selon les résultats de la présente étude, les infections à Cryptosporidium sont plus courantes chez les patients immunocompétents d'Ottawa, mais celles à Toxoplasma le sont davantage chez les patients qui ne sont pas atteints du VIH, mais qui ont une immunodéficience acquise. Devant l'évolution de la démographie des patients immunodéprimés, le dépistage des infections protozoaires peut devenir important sur le plan clinique dans les populations à haut risque.

[Epidemiology and clinical pattern of ocular toxoplasmosis in Kinshasa]. / Profil clinique et épidémiologique de la toxoplasmose oculaire à Kinshasa.

PURPOSE: To determine the epidemiology and clinical pattern of Congolese patients with ocular toxoplasmosis. PATIENTS AND METHODS: A retrospective study was conducted on records of patients with ocular toxoplasmosis examined in the Teaching Hospital of Kinshasa (DR Congo) from 2010 to 2012. Each patient underwent a complete ophthalmic examination. Sociodemographic data, clinical symptoms and signs, visual outcome, modality of treatment and type of complications were studied. RESULTS: Thirty-five cases of ocular toxoplasmosis were diagnosed out of 18,144 patients, giving a frequency of 0.2 %. Eighteen men (51.4 %) were affected, with a sex ratio of 1.05. The mean age of the patients was 40.9±20 years (range: 10-72 years). The mean time until consultation was 10 months (range: 2 days-84 months). Ocular involvement was unilateral for 65.7 % of patients. Decreased visual acuity (77.1 %) and pain (7.1 %) were the main ocular complains. Chorioretinal lesions involved the central retina in 26 patients (74.3 %). Five patients (14.2 %) developed recurrences during follow-up. Complications affected 17 patients (48.6 %), with macular scarring (34.3 %) and cataract (17.1 %) being the most common. At the first consultation, 61.7 % of the affected eyes had visual impairment (VA<0.3). Visual impairment was associated with macular lesions (P<0.001, OR=3 [1.4-6.1]) and age greater than 45 years (P=0.002, OR=11 [2.2-53.6]). CONCLUSION: In our context, complications are common with ocular toxoplasmosis,s and they lead to visual impairment in the majority of patients.

[Seroprevalence of Toxoplasmosis among Pregnant Women in Benin: Meta-Analysis and Meta-Regression]. / Séroprévalence de la toxoplasmose chez les femmes enceintes au Bénin : méta-analyse et métarégression.

To assess the seroprevalence of toxoplasmosis among pregnant women in Benin, we conducted a meta-analysis using the PRISMA criteria. Al research published between 1990 and 2018 on toxoplasmosis among pregnant women Benin were eligible. A total of five databases were investigated, and the extracted data were subjected to a meta-analysis under R 3.1 using both random effect model and fixed effect model. The overall prevalence of toxoplasma-specific IgG among pregnant women was 47% (CI 95%: 40-53) and that of specific IgM was 2% (CI 95%: 1-3). The infection rate in urban areas (52%) was significantly higher than in rural areas (33%). The two main risk factors identified by the various eligible studies were the age of the pregnant women and the consumption of raw vegetables. We show that toxoplasmosis is endemic in pregnant women in Benin, implying that primary prevention measures must be put in place by the competent authorities to control this infection.

Afin d'évaluer le niveau de l'infection toxoplasmique chez les femmes enceintes au Bénin, nous avons effectué une méta-analyse selon le protocole PRISMA. Étaient éligibles tous les articles de recherche publiés entre 1990 et 2018 sur la toxoplasmose chez les femmes enceintes en consultation prénatale au Bénin. Au total, cinq bases de données ont été consultées, puis les données extraites ont été soumises à une méta-analyse sous R 3.1 selon les modèles à effet aléatoire et à effet fixe. La séroprévalence de la toxoplasmose chez la femme enceinte était de 47 % (IC 95 % : 40­53) pour les IgG et de 2 % (IC 95 % : 1­3) pour les IgM spécifiques. Le taux d'infection en milieu urbain (52 %) était significativement plus élevé qu'en milieu rural (33 %). Deux principaux facteurs de risque associés à la toxoplasmose ont été identifiés par les différentes études éligibles : l'âge des gestantes et la consommation de crudités. Nous montrons ainsi que la toxoplasmose est endémique chez les femmes enceintes au Bénin, impliquant que des mesures de prévention primaire soient mises en place par les autorités compétentes pour contrôler cette infection.

Study of brainstem auditory evoked potentials in early diagnosis of congenital toxoplasmosis.

INTRODUCTION: Congenital toxoplasmosis is an infectious disease with high prevalence in tropical countries. It is characterized by neurological, ophthalmological and auditory sequelae. OBJECTIVE: The aim of this study was to evaluate and describe the brainstem auditory evoked potential in infants aged 1-3 months diagnosed with congenital toxoplasmosis and to compare them with infants of the same age group without the infection. METHODS: This is an observational, analytical and cross-sectional study in which brainstem auditory evoked potential was investigated in infants with congenital toxoplasmosis. The following audiological exams were performed: transient-evoked otoacoustic emissions, clinical and automatic brainstem auditory evoked potential. RESULTS: 100 children participated in the study, but the final sample consisted of 76 children. Of the 37 children with toxoplasmosis included in the study, 28 completed the neurological imaging evaluation, and of these, 3 (10.7%) showed an altered neurological examination. At the brainstem auditory evoked potential assessment, two children without toxoplasmosis and 10 children with congenital toxoplasmosis had results suggestive of alterations in the brainstem auditory pathway maturation. CONCLUSION: 10 (27%) children were identified with a possible unilateral alteration in the electrophysiological assessment. There was a 5-fold higher risk for a child between 1 and 3 months of age with toxoplasmosis to have an altered brainstem auditory evoked potential compared to a child of the same age range without the infection.