Advertisement

Infection

, Volume 44, Issue 2, pp 259–262 | Cite as

Recurrent seizures during acute acquired toxoplasmosis in an immunocompetent traveller returning from Africa

  • Anna Beltrame
  • Sergio Venturini
  • Giovanni Crichiutti
  • Valeria Meroni
  • Dora Buonfrate
  • Matteo Bassetti
Case Report

Abstract

Introduction

We report an unusual case of acute acquired toxoplasmosis (AAT) presenting as lymphadenopathy and recurrent seizures in an immunocompetent 15-year-old boy.

Materials and methods

The patient reported an 18-day vacation to Africa (Ethiopia), 39 days prior to the first seizure. Electroencephalogram (EEG) showed sporadic single-spike or sharp-wave paroxysms and the magnetic resonance imaging (RMI) of the brain was negative. The serology for T. gondii was compatible with an acute infection defined as positive for both toxoplasma-specific IgG and IgM and a low avidity (6 %), confirmed by a reference laboratory. The patient reported other two episodes of seizures, occurring 7 days apart. He was treated with pyrimethamine plus sulfadiazine and leucovorin for 4 weeks, with an improvement of lymphadenitis and normalization of EEG. After 5 months, new seizures were reported and a diagnosis of epilepsy was done. Toxoplasma polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and blood were negative. A treatment with valproic acid was started, obtaining control of the neurological disease.

Conclusion

Awareness of this neurologic manifestation by clinicians is required, also in immunocompetent patients. The relationship between toxoplasmosis and recurrent seizure needs to be investigated by new studies.

Keywords

Toxoplasma gondii Acute acquired toxoplasmosis Seizure Immunocompetent Travel 

Notes

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Montoya JG, Liensenfeld O. Toxoplasmosis. Lancet. 2004;363:1965–76.CrossRefPubMedGoogle Scholar
  2. 2.
    Galli-Tsinopoulou A, Kyrgios I, Giannopoulou EZ, Gourgoulia S, Maggana I, Katechaki E, et al. Acquired Toxoplasmosis accompanied by facial nerve palsy in an immunocompetent 5-year-old child. J Child Neur. 2010;25:1525–8.CrossRefGoogle Scholar
  3. 3.
    Neves Ede S, Kropf A, Bueno WF, Bonna IC, Curi AL, Amendoeira, et al. Disseminated toxoplasmosis: an atypical presentation in an immunocompetent patient. Trop Doct. 2011;41:59-60.Google Scholar
  4. 4.
    Undseth O, Gerlyng P, Goplen AK, Holetr E, Von der Lippe E, Dunlop O. Primary toxoplasmosis with critical illness and multi-organ failure in an immunocompetent young man. Scand J Infect Dis. 2014;46:58–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Demar M, Hommel D, Djossou F, Peneau C, Boukhari R, Louvel D, et al. Acute toxoplasmosis in immunocompetent patients hospitalized in an intensive care unit in French Guiana. Clin Microbiol Infect. 2012;18:E221–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Carme B, Demar M, Ajzenberg D. Darde’ML. Severe acquired toxoplasmosis caused by wild cycle of Toxoplasma gondii, French Guiana. Emerg Infect Dis. 2009;15:656–8.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sepulveda-Arias J, Gomez-Marin JE, Bobic B, Naranjo-Galvis CA, Djurkovic-Djakovic O. Toxoplasmosis as a travel risk. Travel Med Infect Dis. 2014;1–10.Google Scholar
  8. 8.
    Pomares C, Ajzenberg D, Bornard L, Bernardin G, Hasseine L, Darde ML, et al. Toxoplasmosis and horse meat. France. Emerg Infect Dis. 2011;17:1327–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Sobanski V, Ajzenberg D, Delhaes L, Bautin N, Just N. Severe toxoplasmosis in immunocompetent hosts: be aware of atypical strains. Am J Respir Crit Care Med. 2013;187:1143–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Dardé ML. Toxoplasma gondii, new genotypes and virulence. Parasite. 2008;15:366–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Stommel EW, Seguin R, Thadani V, Schwartzman JD, Gilbert K, Ryan KA, et al. Cryptogenic epilepsy: an infectious etiology? Epilepsia. 2001;42:436–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Ngoungou EB, Bhalla D, Nzoghe A, Dardé ML, Preux PM. Toxoplasmosis and epilepsy—systemic review and meta-analysis. PLoS Negl Trop Dis. 2015;19:e0003525.CrossRefGoogle Scholar
  13. 13.
    Feustel SM, Meissner M, Liesenfeld O. Toxoplasma gondii and the blood-brain barrier. Virulence. 2012;3:182–92.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Velmurugan GV, Dubey JB, Su C. Genotyping studies of Toxoplasma gondii isolated from Africa revealed that the archetypal clonal lineages predominate as in North America and Europe. Vet Parasitol. 2008;155:314–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Mercier A, Devillard S, Ngoubangoye B, Bonnabau H, Banuls AL, Durant P, et al. Additional haplogroups of Toxoplasma gondii out of Africa: population structure and mouse-virulence of strains from Gabon. PLoS Negl Trop Dis. 2010;4:e876.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Maubon D, Ajzenberg D, Brenier-Pinchart MP, Dardé ML, Pelloux H. What are the respective host and parasite contributions to toxoplasmosis? Trends Parasitol. 2008;24:299–303.CrossRefPubMedGoogle Scholar
  17. 17.
    Sullivan WJ Jr, Jeffers V. Mechanisms of Toxoplasma gondii persistence and latency. FEMS Microbiol Rev. 2012;36:717–33.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Centre for Tropical DiseasesSacro Cuore HospitalNegrarItaly
  2. 2.Clinic of Infectious DiseasesAzienda Ospedaliero-Universitaria di UdineUdineItaly
  3. 3.Department of PaediatricsAzienda Ospedaliero-Universitaria di UdineUdineItaly
  4. 4.Department of Internal Medicine and Therapeutics, Microbiology and Virology Department Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly

Personalised recommendations