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Neurotoxoplasmosis diagnosis for HIV-1 patients by real-time PCR of cerebrospinal fluid.
Braz J Infect Dis 2009; 13(1):18-23BJ

Abstract

Encephalitis caused by Toxoplasma gondii is the most common cause of central nervous system damage in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma may infect any of the brain cells, thus leading to non-specific neurotoxoplasmosis clinical manifestations including focused or non-focused signs and symptoms of central nervous system malfunction. Clinical development ranges from insidious display during weeks to experiencing acute general confusion or ultimately fatal onset. Cerebral toxoplasmosis occurs in advanced stages of immunodeficiency, and the absence of anti-toxoplasmosis antibodies by the immunofluorescence method does not allow us to rule out its diagnosis. As specific therapy begins, diagnosis confirmation is sought through clinical and radiological response. There are few accurate diagnosis methods to confirm such cases. We present a method for T. gondii DNA detection by real time PCR-Multiplex. Fifty-one patients were evaluated; 16 patients had AIDS and a presumptive diagnosis for toxoplasmosis, 23 patients were HIV-positive with further morbidities except neurotoxoplasmosis, and 12 subjects were HIV-negative control patients. Real time PCR-Multiplex was applied to these patients' cephalorachidian liquid with a specific T. gondii genome sequence from the 529bp fragment. This test is usually carried out within four hours. Test sensitivity, specificity, positive predictive value, and negative predictive value were calculated according to applicable tables. Toxoplasma gondii assay by real time Multiplex of cephalorachidian fluid was positive for 11 out of 16 patients with AIDS and a presumptive diagnosis for cerebral toxoplasmosis, while none of the 35 control patients displayed such a result. Therefore, this method allowed us to achieve 68.8% sensitivity, 100% specificity, 100% positive predictive value, and 87.8% negative predictive value. Real time PCR on CSF allowed high specificity and good sensitivity among patients who presumably had cerebral toxoplasmosis. Since this is a low invasive method, it could be included in the diagnosis algorithm of patients with AIDS and central nervous system damage.

Authors+Show Affiliations

Federal University of São Paulo, Brazil. fnogui@globo.com

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19578625

Citation

Nogui, Fábio Luís Nascimento, et al. "Neurotoxoplasmosis Diagnosis for HIV-1 Patients By Real-time PCR of Cerebrospinal Fluid." The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, vol. 13, no. 1, 2009, pp. 18-23.
Nogui FL, Mattas S, Turcato Júnior G, et al. Neurotoxoplasmosis diagnosis for HIV-1 patients by real-time PCR of cerebrospinal fluid. Braz J Infect Dis. 2009;13(1):18-23.
Nogui, F. L., Mattas, S., Turcato Júnior, G., & Lewi, D. S. (2009). Neurotoxoplasmosis diagnosis for HIV-1 patients by real-time PCR of cerebrospinal fluid. The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, 13(1), pp. 18-23.
Nogui FL, et al. Neurotoxoplasmosis Diagnosis for HIV-1 Patients By Real-time PCR of Cerebrospinal Fluid. Braz J Infect Dis. 2009;13(1):18-23. PubMed PMID: 19578625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurotoxoplasmosis diagnosis for HIV-1 patients by real-time PCR of cerebrospinal fluid. AU - Nogui,Fábio Luís Nascimento, AU - Mattas,Sandro, AU - Turcato Júnior,Gilberto, AU - Lewi,David Salomão, PY - 2008/07/19/received PY - 2008/12/07/accepted PY - 2009/7/7/entrez PY - 2009/7/7/pubmed PY - 2009/8/28/medline SP - 18 EP - 23 JF - The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases JO - Braz J Infect Dis VL - 13 IS - 1 N2 - Encephalitis caused by Toxoplasma gondii is the most common cause of central nervous system damage in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma may infect any of the brain cells, thus leading to non-specific neurotoxoplasmosis clinical manifestations including focused or non-focused signs and symptoms of central nervous system malfunction. Clinical development ranges from insidious display during weeks to experiencing acute general confusion or ultimately fatal onset. Cerebral toxoplasmosis occurs in advanced stages of immunodeficiency, and the absence of anti-toxoplasmosis antibodies by the immunofluorescence method does not allow us to rule out its diagnosis. As specific therapy begins, diagnosis confirmation is sought through clinical and radiological response. There are few accurate diagnosis methods to confirm such cases. We present a method for T. gondii DNA detection by real time PCR-Multiplex. Fifty-one patients were evaluated; 16 patients had AIDS and a presumptive diagnosis for toxoplasmosis, 23 patients were HIV-positive with further morbidities except neurotoxoplasmosis, and 12 subjects were HIV-negative control patients. Real time PCR-Multiplex was applied to these patients' cephalorachidian liquid with a specific T. gondii genome sequence from the 529bp fragment. This test is usually carried out within four hours. Test sensitivity, specificity, positive predictive value, and negative predictive value were calculated according to applicable tables. Toxoplasma gondii assay by real time Multiplex of cephalorachidian fluid was positive for 11 out of 16 patients with AIDS and a presumptive diagnosis for cerebral toxoplasmosis, while none of the 35 control patients displayed such a result. Therefore, this method allowed us to achieve 68.8% sensitivity, 100% specificity, 100% positive predictive value, and 87.8% negative predictive value. Real time PCR on CSF allowed high specificity and good sensitivity among patients who presumably had cerebral toxoplasmosis. Since this is a low invasive method, it could be included in the diagnosis algorithm of patients with AIDS and central nervous system damage. SN - 1678-4391 UR - https://www.unboundmedicine.com/medline/citation/19578625/Neurotoxoplasmosis_diagnosis_for_HIV_1_patients_by_real_time_PCR_of_cerebrospinal_fluid_ L2 - http://www.diseaseinfosearch.org/result/9735 DB - PRIME DP - Unbound Medicine ER -