Jordan Leroy1, Sandrine Houzé2, Marie-Laure Dardé3, Hélène Yéra4, Benjamin Rossi5, Laurence Delhaes6, Frédéric Gabriel6, Paul Loubet7, Anne-Sophie Deleplancque1, Eric Senneville8, Faïza Ajana8, Boualem Sendid9, Denis Malvy10. 1. CHU Lille, Parasitology Mycology Department, Univ. Lille, Inserm, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France. 2. Laboratoire de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France. 3. Inserm UMR_S 1094, Neuroépidémiologie Tropicale, Laboratoire de Parasitologie-Mycologie, Faculté de Médecine, Université de Limoges, Limoges, 87025, France; Centre National de Référence Toxoplasmose/Toxoplasma Biological Resource Center, CHU Limoges, 87042, Limoges, France. 4. Department of Parasitology-Mycology, Faculty of Medicine, Université Paris Descartes, Hôpitaux Universitaire Paris Centre, Assistance Publique Hôpitaux de Paris, CHU Cochin, Paris, France. 5. Department of Internal Medicine, Beaujon Hospital, Hôpitaux Universitaires Paris Nord Val de Seine, APHP, Clichy, France. 6. Department of Parasitology and Mycology, Bordeaux Hospital University Center, Bordeaux, France. 7. IAME, UMR 1137, Inserm, Paris Diderot University, Sorbonne Paris Cité, AP-HP, Bichat-Claude Bernard Hospital, Infectious Diseases Department, Paris, France. 8. Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France. 9. CHU Lille, Parasitology Mycology Department, Univ. Lille, Inserm, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France. Electronic address: boualem.sendid@chru-lille.fr. 10. Department for Infectious and Tropical Diseases, University Hospital Centre of Bordeaux, Inserm 1219, University of Bordeaux, Bordeaux, France.
Abstract
BACKGROUND: Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii. In immunocompetent patients the infection is usually benign. However, cases of severe and even lethal primo-infections are regularly reported in South America. In contrast, data from tropical Africa are fragmentary. METHODS: Data for French cases of severe toxoplasmosis acquired between 2013 and 2018, in tropical Africa and among immunocompetent patients were collected retrospectively in 2018. RESULTS: Four male patients with a mean age of 34-years were identified. All infections originated in West or Central Africa. The clinical presentations were heterogeneous: two patients had severe disseminated toxoplasmosis, of which one presented with chorioretinitis associated with myositis and the other with febrile pneumopathy; one patient presented with post-infectious acute cerebellar ataxia and the final case had general symptoms and skin manifestations. The diagnosis of acute toxoplasmosis was confirmed by serology in four patients. Molecular diagnosis confirmed T. gondii infection in three patients with Africa 1 as the dominant genotype. The infection was cured with anti-infective treatment in all four patients. Ocular sequelae were reported in the two patients with chorioretinitis. CONCLUSIONS: Imported cases of severe toxoplasmosis in immunocompetent patients are rare in France. However, this aetiology should be evoked rapidly in a patient with a severe infectious syndrome who has recently visited or originated from tropical Africa.
BACKGROUND:Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii. In immunocompetent patients the infection is usually benign. However, cases of severe and even lethal primo-infections are regularly reported in South America. In contrast, data from tropical Africa are fragmentary. METHODS: Data for French cases of severe toxoplasmosis acquired between 2013 and 2018, in tropical Africa and among immunocompetent patients were collected retrospectively in 2018. RESULTS: Four male patients with a mean age of 34-years were identified. All infections originated in West or Central Africa. The clinical presentations were heterogeneous: two patients had severe disseminated toxoplasmosis, of which one presented with chorioretinitis associated with myositis and the other with febrile pneumopathy; one patient presented with post-infectious acute cerebellar ataxia and the final case had general symptoms and skin manifestations. The diagnosis of acute toxoplasmosis was confirmed by serology in four patients. Molecular diagnosis confirmed T. gondii infection in three patients with Africa 1 as the dominant genotype. The infection was cured with anti-infective treatment in all four patients. Ocular sequelae were reported in the two patients with chorioretinitis. CONCLUSIONS: Imported cases of severe toxoplasmosis in immunocompetent patients are rare in France. However, this aetiology should be evoked rapidly in a patient with a severe infectious syndrome who has recently visited or originated from tropical Africa.