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Toxoplasma gondii and the Compromised Host: Antibody Response in the Absence of Clinical Manifestations of Disease

Toxoplasma gondii and the Compromised Host: Antibody Response in the Absence of Clinical... Abstract • Toxoplasmosis is a well-described opportunistic infection in immunocompromised hosts. Meningoencephalitis, myocarditis, and pneumonitis are the most frequent clinical manifestations of disease. Because of difficulties both with isolation of the organism and with its identification in tissue, most laboratories rely on serological techniques for diagnosis of acute disease. The most widely available and commonly employed serological method is the indirect fluorescent antibody test (IFA). We recently encountered an immunocompromised patient with an undefined hematologic malignant neoplasm who had an IFA titer greater than 1:100,000 without clinical evidence of active toxoplasmosis. Although his dye test titer and direct agglutination titer were also elevated, he had negative double-sandwich—IgM enzyme-linked immunosorbent assay titers. Immunoperoxidase staining of the tissues failed to demonstrate trophozoites. This case demonstrates that elevated toxoplasma IFA titers may occur in patients at high risk for opportunistic infection but who do not manifest overt clinical toxoplasmosis. (Arch Intern Med 1983;143:1235-1237) References 1. Vietzke WM, Gelderman AH, Grimley PM, et al: Toxoplasmosis complicating malignancy: Experience at the National Cancer Institute. Cancer 1968;21:816-827.Crossref 2. Carey RM, Kimball AC, Armstrong D, et al: Toxoplasmosis: Clinical experiences in a cancer hospital. Am J Med 1973;54:30-38.Crossref 3. Remington JS, Anderson SE Jr: Diagnosis and treatment of pneumocystosis and toxoplasmosis in the immunosuppressed host. Transplant Proc 1973;5:1263-1270. 4. Remington JS: Toxoplasmosis in the adult. Bull NY Acad Med 1974;50:211-227. 5. Ruskin J, Remington JS: Toxoplasmosis in the compromised host. Ann Intern Med 1976;84:193-199.Crossref 6. Frenkel JK, Nelson BM, Arias-Stella J: Immunosuppression and toxoplasmic encephalitis: Clinical and experimental aspects. Hum Pathol 1975;6:97-111.Crossref 7. Townsend JJ, Wolinsky JS, Baringer JR, et al: Acquired toxoplasmosis: A neglected cause of treatable nervous system disease. Arch Neurol 1975;32:335-343.Crossref 8. Best T, Finlayson M: Two forms of encephalitis in opportunistic toxoplasmosis. Arch Pathol Lab Med 1979;103:693-696. 9. Theologides A, Kennedy BJ: Toxoplasmic myocarditis and pericarditis. Am J Med 1969;47:169-174.Crossref 10. Krick JA, Remington JS: Toxoplasmosis in the adult: An overview. N Engl J Med 1978;298:550-553.Crossref 11. Ludlam GB, Beattie CP: Pulmonary toxoplasmosis? Lancet 1963;2: 1136-1138.Crossref 12. Anderson SE, Remington JS: The diagnosis of toxoplasmosis. South Med J 1975;68:1433-1443.Crossref 13. Lunde MN: Laboratory methods in the diagnosis of toxoplasmosis. Health Lab Sci 1973;10:319-328. 14. Welch PC, Masur H, Jones TC, et al: Serologic diagnosis of acute lymphadenopathic toxoplasmosis. J Infect Dis 1980;142:256-264.Crossref 15. Naot Y, Remington JS: An enzyme-linked immunosorbent assay for detection of IgM antibodies to Toxoplasma gondii: Use for diagnosis of acute acquired toxoplasmosis. J Infect Dis 1980;142:757-766.Crossref 16. Desmonts G, Remington JS: Direct agglutination test for diagnosis of toxoplasma infection: Method for increasing sensitivity and specificity. J Clin Microbiol 1980;11:562-568. 17. Conley FK, Jenkins KA, Remington JS: Toxoplasma gondii infection of the central nervous system: Use of the peroxidase-antiperoxidase method to demonstrate toxoplasma in formalin-fixed paraffin-embedded tissue sections. Hum Pathol 1981;12:690-698.Crossref 18. Feldman HA, Miller LT: Serologic study of toxoplasmosis prevalence. Am J Hygiene 1956;64:320-335. 19. Walton BC, Benchoff BM, Brooks WH: Comparison of the indirect fluorescent antibody test and methylene blue dye test for detection of antibodies to Toxoplasma gondii. Am J Trop Med Hyg 1966;15:149-152. 20. Luft BJ, Naot Y, Araujo F, et al: Clinical spectrum and serodiagnosis of Toxoplasma gondii infection in immunosuppressed patients, abstracted. Clin Res 1982;30:519A. 21. Araujo FG, Barnett EV, Gentry LO, et al: False-positive antitoxoplasma fluorescent-antibody tests in patients with antinuclear antibodies. Appl Environ Microbiol 1971;22:270-275. 22. Vogel CL, Lunde MN: Toxoplasma serology in patients with malignant diseases of the reticuloendothelial system. Cancer 1969;23:614-618.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Toxoplasma gondii and the Compromised Host: Antibody Response in the Absence of Clinical Manifestations of Disease

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References (24)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350060167025
Publisher site
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Abstract

Abstract • Toxoplasmosis is a well-described opportunistic infection in immunocompromised hosts. Meningoencephalitis, myocarditis, and pneumonitis are the most frequent clinical manifestations of disease. Because of difficulties both with isolation of the organism and with its identification in tissue, most laboratories rely on serological techniques for diagnosis of acute disease. The most widely available and commonly employed serological method is the indirect fluorescent antibody test (IFA). We recently encountered an immunocompromised patient with an undefined hematologic malignant neoplasm who had an IFA titer greater than 1:100,000 without clinical evidence of active toxoplasmosis. Although his dye test titer and direct agglutination titer were also elevated, he had negative double-sandwich—IgM enzyme-linked immunosorbent assay titers. Immunoperoxidase staining of the tissues failed to demonstrate trophozoites. This case demonstrates that elevated toxoplasma IFA titers may occur in patients at high risk for opportunistic infection but who do not manifest overt clinical toxoplasmosis. (Arch Intern Med 1983;143:1235-1237) References 1. Vietzke WM, Gelderman AH, Grimley PM, et al: Toxoplasmosis complicating malignancy: Experience at the National Cancer Institute. Cancer 1968;21:816-827.Crossref 2. Carey RM, Kimball AC, Armstrong D, et al: Toxoplasmosis: Clinical experiences in a cancer hospital. Am J Med 1973;54:30-38.Crossref 3. Remington JS, Anderson SE Jr: Diagnosis and treatment of pneumocystosis and toxoplasmosis in the immunosuppressed host. Transplant Proc 1973;5:1263-1270. 4. Remington JS: Toxoplasmosis in the adult. Bull NY Acad Med 1974;50:211-227. 5. Ruskin J, Remington JS: Toxoplasmosis in the compromised host. Ann Intern Med 1976;84:193-199.Crossref 6. Frenkel JK, Nelson BM, Arias-Stella J: Immunosuppression and toxoplasmic encephalitis: Clinical and experimental aspects. Hum Pathol 1975;6:97-111.Crossref 7. Townsend JJ, Wolinsky JS, Baringer JR, et al: Acquired toxoplasmosis: A neglected cause of treatable nervous system disease. Arch Neurol 1975;32:335-343.Crossref 8. Best T, Finlayson M: Two forms of encephalitis in opportunistic toxoplasmosis. Arch Pathol Lab Med 1979;103:693-696. 9. Theologides A, Kennedy BJ: Toxoplasmic myocarditis and pericarditis. Am J Med 1969;47:169-174.Crossref 10. Krick JA, Remington JS: Toxoplasmosis in the adult: An overview. N Engl J Med 1978;298:550-553.Crossref 11. Ludlam GB, Beattie CP: Pulmonary toxoplasmosis? Lancet 1963;2: 1136-1138.Crossref 12. Anderson SE, Remington JS: The diagnosis of toxoplasmosis. South Med J 1975;68:1433-1443.Crossref 13. Lunde MN: Laboratory methods in the diagnosis of toxoplasmosis. Health Lab Sci 1973;10:319-328. 14. Welch PC, Masur H, Jones TC, et al: Serologic diagnosis of acute lymphadenopathic toxoplasmosis. J Infect Dis 1980;142:256-264.Crossref 15. Naot Y, Remington JS: An enzyme-linked immunosorbent assay for detection of IgM antibodies to Toxoplasma gondii: Use for diagnosis of acute acquired toxoplasmosis. J Infect Dis 1980;142:757-766.Crossref 16. Desmonts G, Remington JS: Direct agglutination test for diagnosis of toxoplasma infection: Method for increasing sensitivity and specificity. J Clin Microbiol 1980;11:562-568. 17. Conley FK, Jenkins KA, Remington JS: Toxoplasma gondii infection of the central nervous system: Use of the peroxidase-antiperoxidase method to demonstrate toxoplasma in formalin-fixed paraffin-embedded tissue sections. Hum Pathol 1981;12:690-698.Crossref 18. Feldman HA, Miller LT: Serologic study of toxoplasmosis prevalence. Am J Hygiene 1956;64:320-335. 19. Walton BC, Benchoff BM, Brooks WH: Comparison of the indirect fluorescent antibody test and methylene blue dye test for detection of antibodies to Toxoplasma gondii. Am J Trop Med Hyg 1966;15:149-152. 20. Luft BJ, Naot Y, Araujo F, et al: Clinical spectrum and serodiagnosis of Toxoplasma gondii infection in immunosuppressed patients, abstracted. Clin Res 1982;30:519A. 21. Araujo FG, Barnett EV, Gentry LO, et al: False-positive antitoxoplasma fluorescent-antibody tests in patients with antinuclear antibodies. Appl Environ Microbiol 1971;22:270-275. 22. Vogel CL, Lunde MN: Toxoplasma serology in patients with malignant diseases of the reticuloendothelial system. Cancer 1969;23:614-618.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Jun 1, 1983

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