Fatal Outbreak of Human Toxoplasmosis along the Maroni River: Epidemiological, Clinical, and Parasitological Aspects

Demar, Magalie; Ajzenberg, Daniel; Maubon, Danielle; Djossou, Félix; Panchoe, Dayanand; Punwasi, Widya; Nasser, Valéry; Peneau, C.; Daigre, Jean-Louis; Aznar, Christine; Cottrelle, B.; Terzan, Laurence; Dardé, Marie‐Laure; Carme, Bernard

doi:10.1086/521246

Cited by 274 publications

(176 citation statements)

References 31 publications

(18 reference statements)

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“…This possibility can justify the occurrence of the severe cases of toxoplasmosis and possibly even the cases of re-infection. The severe form of toxoplasmosis in humans, which is associated with atypical virulent strains, has been previously reported in forest areas, on the border of Suriname with 8,12 French Guiana, including accounts of death . This occurrence is also possible in Monte Dourado, especially due to the geographic proximity and similarity between the forests of the Almeirim municipality and of Suriname and French Guiana, which favor the circulation of these strains in both areas.…”

Section: Laboratorial Evaluationmentioning

confidence: 84%

Surto de toxoplasmose humana no Distrito de Monte Dourado, Município de Almeirim, Pará, Brasil

Carmo¹,

Póvoa²,

Monteiro³

et al. 2010

Rev Pan-Amaz Saude

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OBJECTIVE: To report an outbreak of human toxoplasmosis that occurred in the District of Monte Dourado, Municipality of Almeirim, Pará State, Brazil. MATERIALS AND METHODS: After the positive diagnosis of five patients with symptoms suggestive of toxoplasmosis, clinical research and epidemiology were executed in the locality. A total of 186 individuals were evaluated, including symptomatic patients, their relatives and/or close contacts. All subjects underwent epidemiological inquiry, clinical assessment and serology by enzyme-linked immunosorbent assay (ELISA) for detection of anti-Toxoplasma gondii IgG and IgM. RESULTS: A total of 40 individuals presented a serological profile of acute toxoplasmosis. Epidemiological analysis indicated that the cases could be related to infection with oocysts eliminated by cats, whose population density was very high in the surveyed locality. The most likely hypothesis of transmission would be through direct contact with oocysts of the parasite, either by the ingestion of contaminated food or by the inhalation of these forms in the soil. The possibility of water transmission through the local supply system was discarded because the system is inaccessible to cats. Infected individuals were treated at the local health care units. Moreover, local health authorities were instructed to implement measures to control stray cats in order to prevent new cases or outbreaks. CONCLUSION: The outbreak that occurred between February and March 2004 in Monte Dourado was caused by T. gondii. The hypothesis of contamination via oocysts of the parasite is supported by several factors, such as a high population density of cats in the surveyed District, frequent gardening habits and a lack of reports of ingestion of raw or undercooked meat.

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Section: Laboratorial Evaluationmentioning

confidence: 84%

Surto de toxoplasmose humana no Distrito de Monte Dourado, Município de Almeirim, Pará, Brasil

Carmo¹,

Póvoa²,

Monteiro³

et al. 2010

Rev Pan-Amaz Saude

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“…Recently, attention has been focused on the genetic variability among T. gondii isolates from apparently healthy and sick hosts (Howe et al, 1997;Grigg and Sundar, 2009). Severe cases of toxoplasmosis have been reported in immunocompetent patients in association with atypical T. gondii genotypes (Ajzenberg et al, 2004;Demar et al, 2007;Elbez-Rubinstein et al, 2009;Grigg and Sundar, 2009;Vaudaux et al, 2010;Wendte et al, 2010).…”

Section: Genetic Diversity and Epidemiological Significancementioning

confidence: 99%

Genetic characterisation of Toxoplasma gondii in wildlife from North America revealed widespread and high prevalence of the fourth clonal type

Dubey

Velmurugan

Rajendran

et al. 2011

International Journal for Parasitology

162

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a b s t r a c tLittle is known of the genetic diversity of Toxoplasma gondii circulating in wildlife. In the present study wild animals, from the USA were examined for T. gondii infection. Tissues of naturally exposed animals were bioassayed in mice for isolation of viable parasites. Viable T. gondii was isolated from 31 animals including, to our knowledge for the first time, from a bald eagle (Haliaeetus leucocephalus), five gray wolves (Canis lupus), a woodrat (Neotoma micropus), and five Arctic foxes (Alopex lagopus). Additionally, 66 T. gondii isolates obtained previously, but not genetically characterised, were revived in mice. Toxoplasma gondii DNA isolated from these 97 samples (31 + 66) was characterised using 11 PCR-restriction fragment length polymorphism (RFLP) markers (SAG1, 5 0 -and 3 0 -SAG2, alt.SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico). A total of 95 isolates were successfully genotyped. In addition to clonal Types II, and III, 12 different genotypes were found. These genotype data were combined with 74 T. gondii isolates previously characterised from wildlife from North America and a composite data set of 169 isolates comprised 22 genotypes, including clonal Types II, III and 20 atypical genotypes. Phylogenetic network analysis showed limited diversity with dominance of a recently designated fourth clonal type (Type 12) in North America, followed by the Type II and III lineages. These three major lineages together accounted for 85% of strains in North America. The Type 12 lineage includes previously identified Type A and X strains from sea otters. This study revealed that the Type 12 lineage accounts for 46.7% (79/169) of isolates and is dominant in wildlife of North America. No clonal Type I strain was identified among these wildlife isolates. These results suggest that T. gondii strains in wildlife from North America have limited diversity, with the occurrence of only a few major clonal types. Ó

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“…Although these reports strongly support the idea of a higher virulence of some atypical strains in humans, the role of the inoculum and of the host genetic background should not be forgotten. Interestingly, in an outbreak due to a single atypical strain (Demar et al, 2007), some patients died or were seriously ill whereas other patients presented only with mild symptoms.…”

Section: Genotypes and Expression Of Toxoplasma Virulence In Humansmentioning

confidence: 99%

Toxoplasma gondii, “new” genotypes and virulence

Dardé¹

2008

Parasite

149

113

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Summary :Toxoplasma gondii has been described as a parasite with a low genetic diversity and a clonal population structure. The three main clonal lineages designated as type I, II or III largely predominate in Europe and North America. But strains not related to these main lineages circulate, notably, in other continents. They possess a shuffled combination of alleles that typify the three clonal types and unique polymorphisms detected by multilocus analysis. The population structure of Toxoplasma in these continents is also characterized by a higher genetic diversity associated with a lower linkage desequilibrium suggesting a role for genetic exchange. Due to their genomic diversity, it is difficult to draw global conclusions about their virulence. However, most of them are virulent in mice at isolation. Several reports also suggest a higher pathogenicity in humans and an association with ocular toxoplasmosis or severe cases of acquired toxoplasmosis in immunocompetent patients. T he three main types respond to the criteria for a clonal population structure of Toxoplasma (isolation of identical multilocus genotypes over large geographic areas and at interval of several years, and a strong linkage disequilibrium) (Tibayrenc et al., 1991). This simple clonal structure is accompanied by a low genetic divergence between the three main lineages (only ≈ 2 % divergence at the DNA sequence level between lineages). A large majority (84 %) of the of the single nucleotide polymorphisms (SNPs) identified among the three types are type I and II SNPs, type III polymorphisms (only 16 %) being located mainly on chromosome IV (Boyle et al., 2006). The assymetrical distribution of SNPs on chromosomes indicates that types I and III are second and first generation offspring, respectively, of a cross between a type II strain and one of two ancestral strains. The limited genetic diversity within each of these lineages and the low divergence between lineages strongly suggest that these three clonal lineages have expanded as the dominant strains relatively recently, from a common ancestor 10,000 years ago (Su et al., 2003).

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Fatal Outbreak of Human Toxoplasmosis along the Maroni River: Epidemiological, Clinical, and Parasitological Aspects

Cited by 274 publications

References 31 publications

Surto de toxoplasmose humana no Distrito de Monte Dourado, Município de Almeirim, Pará, Brasil

Surto de toxoplasmose humana no Distrito de Monte Dourado, Município de Almeirim, Pará, Brasil

Genetic characterisation of Toxoplasma gondii in wildlife from North America revealed widespread and high prevalence of the fourth clonal type

Toxoplasma gondii, “new” genotypes and virulence

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