Cargando…

Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review

Background: Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening. Methods: We performed a systematic review of severe toxoplasmosis cases in immunocompetent patients to gain insight into the epidemiology, clinical characteristics, radiological...

Descripción completa

Detalles Bibliográficos
Autores principales: Layton, John, Theiopoulou, Danai-Christina, Rutenberg, David, Elshereye, Amro, Zhang, Yumeng, Sinnott, John, Kim, Kami, Montoya, Jose G., Contopoulos-Ioannidis, Despina G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10145896/
https://www.ncbi.nlm.nih.gov/pubmed/37111429
http://dx.doi.org/10.3390/pathogens12040543
_version_ 1785034448193978368
author Layton, John
Theiopoulou, Danai-Christina
Rutenberg, David
Elshereye, Amro
Zhang, Yumeng
Sinnott, John
Kim, Kami
Montoya, Jose G.
Contopoulos-Ioannidis, Despina G.
author_facet Layton, John
Theiopoulou, Danai-Christina
Rutenberg, David
Elshereye, Amro
Zhang, Yumeng
Sinnott, John
Kim, Kami
Montoya, Jose G.
Contopoulos-Ioannidis, Despina G.
author_sort Layton, John
collection PubMed
description Background: Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening. Methods: We performed a systematic review of severe toxoplasmosis cases in immunocompetent patients to gain insight into the epidemiology, clinical characteristics, radiological findings, and outcomes of these cases. We classified severe toxoplasmosis as cases with the symptomatic involvement of target organs (the lungs, central nervous system (CNS), and heart), disseminated disease, prolonged disease (>3 months), or a fatal outcome. Our primary analysis focused on cases published from 1985–2022 to avoid confounding with cases in AIDS patients. Results: We identified 82 pertinent articles (1985–2022) with a total of 117 eligible cases; the top five countries for these cases were French Guiana (20%), France (15%), Colombia (9%), India (9%), and Brazil (7%). Overall, 44% (51/117) of cases had pulmonary involvement, 39% (46/117) CNS, 31% (36/117) cardiac, 24% (28/117) disseminated disease, 2% (2/117) had prolonged disease, and 8% (9/117) of patients died. More than one organ was involved in 26% (31/117) of cases. Eighty-four percent (98/117) of cases occurred in the context of a recent acute primary Toxoplasma infection; for the remaining, the exact timing of infection was unclear. Genotyping data were very sparse. Among those reporting genotyping data, 96% (22/23) were caused by atypical non-type II strains; one case was caused by a type-II strain. Only half of the cases reported risk factors. The most common risk factors were eating raw/undercooked meat or eating game meat (47% (28/60)), drinking untreated water (37% (22/60)), or living in a toxoplasmosis high-prevalence area (38% (23/60)). For the 51 pulmonary cases, the main clinical presentation was pneumonia or pleural effusions in 94% (48/51) and respiratory failure in 47% (24/51). For the 46 CNS cases, the main clinical presentation was encephalitis in 54% (25/46), meningitis in 13% (6/46), focal neurologic findings in 24% (11/46), cranial nerve palsies in 17% (8/46), Guillain–Barre syndrome or Miller Fisher syndrome in 7% (3/46), and Brown–Sequard syndrome in 2% (1/46) of cases; more than one clinical manifestation could also be present. Among the 41 CNS cases reporting the CNS imaging findings, 68% (28/41) had focal supratentorial lesions and 7% (3/41) had focal infratentorial lesions. Brain abscess-like/mass-like lesions were seen in 51% (21/41) of cases. For the 36 cardiac cases, the main clinical presentation was myocarditis in 75% (27/36), pericarditis in 50% (18/36), heart failure and/or cardiogenic shock in 19% (7/36), and cardiac arrhythmias in 22% (8/36); more than one manifestation could also be present. Illness was critical in 49% (44/90) of cases intensive care unit care was needed in 54% (29/54) of cases among those reporting this information, and 9 patients died. Conclusion: The diagnosis of severe toxoplasmosis in immunocompetent hosts can be challenging. Toxoplasmosis should be considered in the differential diagnosis of immunocompetent patients presenting with severe illness of unclear etiology with pulmonary, cardiac, CNS, or multiorgan involvement/failure, or prolonged febrile illness, even in the absence of common exposure risk factors or common manifestations of toxoplasmosis (e.g., fever, mononucleosis-like illness, lymphadenopathy, and chorioretinitis). Fatal outcomes can also rarely occur in immunocompetent patients. Prompt initiation of anti-Toxoplasma treatment can be lifesaving.
format Online
Article
Text
id pubmed-10145896
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-101458962023-04-29 Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review Layton, John Theiopoulou, Danai-Christina Rutenberg, David Elshereye, Amro Zhang, Yumeng Sinnott, John Kim, Kami Montoya, Jose G. Contopoulos-Ioannidis, Despina G. Pathogens Systematic Review Background: Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening. Methods: We performed a systematic review of severe toxoplasmosis cases in immunocompetent patients to gain insight into the epidemiology, clinical characteristics, radiological findings, and outcomes of these cases. We classified severe toxoplasmosis as cases with the symptomatic involvement of target organs (the lungs, central nervous system (CNS), and heart), disseminated disease, prolonged disease (>3 months), or a fatal outcome. Our primary analysis focused on cases published from 1985–2022 to avoid confounding with cases in AIDS patients. Results: We identified 82 pertinent articles (1985–2022) with a total of 117 eligible cases; the top five countries for these cases were French Guiana (20%), France (15%), Colombia (9%), India (9%), and Brazil (7%). Overall, 44% (51/117) of cases had pulmonary involvement, 39% (46/117) CNS, 31% (36/117) cardiac, 24% (28/117) disseminated disease, 2% (2/117) had prolonged disease, and 8% (9/117) of patients died. More than one organ was involved in 26% (31/117) of cases. Eighty-four percent (98/117) of cases occurred in the context of a recent acute primary Toxoplasma infection; for the remaining, the exact timing of infection was unclear. Genotyping data were very sparse. Among those reporting genotyping data, 96% (22/23) were caused by atypical non-type II strains; one case was caused by a type-II strain. Only half of the cases reported risk factors. The most common risk factors were eating raw/undercooked meat or eating game meat (47% (28/60)), drinking untreated water (37% (22/60)), or living in a toxoplasmosis high-prevalence area (38% (23/60)). For the 51 pulmonary cases, the main clinical presentation was pneumonia or pleural effusions in 94% (48/51) and respiratory failure in 47% (24/51). For the 46 CNS cases, the main clinical presentation was encephalitis in 54% (25/46), meningitis in 13% (6/46), focal neurologic findings in 24% (11/46), cranial nerve palsies in 17% (8/46), Guillain–Barre syndrome or Miller Fisher syndrome in 7% (3/46), and Brown–Sequard syndrome in 2% (1/46) of cases; more than one clinical manifestation could also be present. Among the 41 CNS cases reporting the CNS imaging findings, 68% (28/41) had focal supratentorial lesions and 7% (3/41) had focal infratentorial lesions. Brain abscess-like/mass-like lesions were seen in 51% (21/41) of cases. For the 36 cardiac cases, the main clinical presentation was myocarditis in 75% (27/36), pericarditis in 50% (18/36), heart failure and/or cardiogenic shock in 19% (7/36), and cardiac arrhythmias in 22% (8/36); more than one manifestation could also be present. Illness was critical in 49% (44/90) of cases intensive care unit care was needed in 54% (29/54) of cases among those reporting this information, and 9 patients died. Conclusion: The diagnosis of severe toxoplasmosis in immunocompetent hosts can be challenging. Toxoplasmosis should be considered in the differential diagnosis of immunocompetent patients presenting with severe illness of unclear etiology with pulmonary, cardiac, CNS, or multiorgan involvement/failure, or prolonged febrile illness, even in the absence of common exposure risk factors or common manifestations of toxoplasmosis (e.g., fever, mononucleosis-like illness, lymphadenopathy, and chorioretinitis). Fatal outcomes can also rarely occur in immunocompetent patients. Prompt initiation of anti-Toxoplasma treatment can be lifesaving. MDPI 2023-03-31 /pmc/articles/PMC10145896/ /pubmed/37111429 http://dx.doi.org/10.3390/pathogens12040543 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Layton, John
Theiopoulou, Danai-Christina
Rutenberg, David
Elshereye, Amro
Zhang, Yumeng
Sinnott, John
Kim, Kami
Montoya, Jose G.
Contopoulos-Ioannidis, Despina G.
Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title_full Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title_fullStr Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title_full_unstemmed Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title_short Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review
title_sort clinical spectrum, radiological findings, and outcomes of severe toxoplasmosis in immunocompetent hosts: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10145896/
https://www.ncbi.nlm.nih.gov/pubmed/37111429
http://dx.doi.org/10.3390/pathogens12040543
work_keys_str_mv AT laytonjohn clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT theiopouloudanaichristina clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT rutenbergdavid clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT elshereyeamro clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT zhangyumeng clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT sinnottjohn clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT kimkami clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT montoyajoseg clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview
AT contopoulosioannidisdespinag clinicalspectrumradiologicalfindingsandoutcomesofseveretoxoplasmosisinimmunocompetenthostsasystematicreview