Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review

Abstract

Background Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients. Methods A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted. Results 61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases. Conclusion Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment.

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

“…It is an autoimmune disease in which the body’s immune system incorrectly recognizes skin proteins as foreign and thus produces antibodies to attack the foreign protein [ 15 , 16 ]. Trigger factors include medications [ 17 ] such as antibiotics, calcium channel blockers, ACE inhibitors, NSAIDs, salicylates, and interleukins, vaccines such as influenza [ 18 , 19 ], swine flu [ 20 ], tetanus toxoid [ 21 ], and COVID-19 vaccines [ 22 , 23 , 24 ], viral infections such as herpes simplex [ 25 ], hepatitis B and C [ 26 , 27 , 28 ], bacterial infections such as Helicobacter pylori [ 29 ], parasitic infections such as Toxoplasma gondii [ 30 , 31 ], and following organ transplantation [ 32 , 33 ]. Physical factors such as trauma, surgical interventions, thermal or electric burns, ultraviolet exposure, radiotherapy, and photodynamic therapy can also cause PV [ 34 ].…”

The role of age in ocular toxoplasmosis: clinical signs of immunosenescence and inflammaging

“…Virtually all warm-blooded hosts can develop a chronic infection, which explains the high evolutionary success of this global parasite ( 4 ). In human, the vast majority of infections remain asymptomatic throughout life, while congenital infections and infections in immunocompromised hosts may result in severe organ damage ( 5 ). Only a small portion of immunocompetent patients will experience organ damage, which typically affects the eye ( 4 , 6 ).…”

A multimodality therapeutic application on Toxoplasma gondii encephalitis utilizing Spiramycin and ‘de novo’ Ferula asafetida in immunodeficient mice

“…It ensures its existence by sexual reproduction in felines and asexual life in other mammals, including humans. The pathogen evolves mechanisms that make the disease life‐threatening in immunodeficient patients and developing foetuses 1–3 . Infected HIV patients are at high risk of cerebral toxoplasmosis in low‐income countries, despite the introduction of antiretroviral therapy.…”