Delayed Cerebral Toxoplasmosis in a Kidney Transplant Patient: a Case Report

Cerebral toxoplasmosis is often life-threatening in an immunocompromised patient due to delayed diagnosis and treatment. Several differential diagnoses could be possible only with preoperative brain images of cerebral toxoplasmosis which show multiple rim-enhancing lesions. Due to the rarity of cerebral toxoplasmosis cases in Korea, the diagnosis and treatment are often delayed. This paper concerns a male patient whose cerebral toxoplasmosis was activated 21 years post kidney transplantation. Brain open biopsy was decided to make an exact diagnosis. Cerebral toxoplasmosis was confirmed by immunohistochemistry and PCR analyses of the tissue samples. Although cerebral toxoplasmosis was under control with medication, the patient did not recover clinically and died due to sepsis and recurrent gastrointestinal bleeding.     

Toxoplasmosis in Sheep

The epidemiology of toxoplasmosis in sheep was studied during a period of 31/2 to 6 years in 4 flocks in which abortions from the infection previously had occurred. The epidemiological pattern indicated that a heavy contamination of the environment may persist for about 2 years. Even in flocks with an apparently normal reproductive performance, toxoplasmosis may cause barrenness, abortion or delivery of dead lambs in 1–2 % of the breeding ewes. The prevalence of infected sheep increased with the age. The incidence of infection was significantly lower in 6–12 months old lambs than in mature ewes. The incidence of infection was higher on lowland pastures than on mountain pastures in not populated areas. On lowland pastures the incidence of infection was lower during the summer than during the winter. kw|Keywords|k]toxoplasma infection; k]epidemiology; k]sheep {fn1|This work was supported by grants from the Norwegian Research Council for Science and for the Humanities.}     

Toxoplasmosis in Sheep

The presence of Toxoplasma gondii in the diaphragm was correlated with the dye test titres in 174 sheep. In 94 of these the presence of the parasite was also correlated with the haemoglobin (Hb) type. T. gondii was recovered from 3 % of the sheep with titres < 1/16, compared with 30 % of those with titres 1/16 and 70 % of those with titres ≥ 1/32. The results indicate that the distinction between serologically positive and negative individuals at a final serum dilution of 1/16 is justified. Some evidence was found that the parasite is easier to recover from dye test positive mature sheep than from dye test positive lambs. Of the 174 sheep, 143 were examined at random among 186 sheep culled or cast for age during a 4-year period from 1 flock in which the prevalence of Toxoplasma antibodies was representative for flocks in the southern Norway, and T. gondii was recovered from 53 (37 %) of these. It was concluded that 10—15 % of the lamb carcases and 25—37 % of the carcases from mature sheep in this country have T. gondii in their muscles detectable by the peptic digestion technique. A possible genetical influence on the infection was indicated by the higher frequency of recoveries of T. gondii from sheep with Hb type B than from sheep with the Hb types A or AB, but the number of individuals with Hb type B was too small to demonstrate statistically significant differences. The epidemiological importance of infected sheep carcases is discussed.     

Ovine Toxoplasmosis in Sweden

Sera from 155 ewes representing 21 different sheep flocks from the central parts of Sweden were examined for the presence of antibodies to Toxoplasma gondii by the indirect fluorescent-antibody test. Seropositive animals were found in 14 flocks, which corresponded to 55 % of the tested sera. Animals from the same flock were with few exceptions either all positive or all negative. Some ewes with a history of abortion a few months before blood sampling showed high titers indicating causative correlation with toxoplasmosis. These are the first verified cases of ovine toxoplasmal abortions in Sweden.