Meisheri Y V, Mehta S, Patel U
Department of Medicine, Seth G.S. Medical College, Parel, Bombay, India.
J Postgrad Med. 1997 Oct-Dec;43(4):93-7.
Two hundred and seventy nine sera (age group 13-50 years) were tested for antitoxoplasma IgG/IgM antibodies by ELISA techniques; the diagnostic titer for positive test is 10 iu/ml or > 1:100. Sera were obtained from (i) 165 (100 men/65 women) healthy adult voluntary blood donors (HIV, HBsAg, VDRL negative); (ii) 89 consecutive HIV/AIDS patients (82 men/7 women); and (iii) 25 patients (HIV negative: 12 men/13 women) treated for cerebral Tuberculoma or Neurocysticercosis during this study from January 1996-June 1997. The overall seroprevalence was 30.9% (51/165) in the immunocompetent adult (group i) 34% (34/100) men and 26.2% (17/65) in women [range: 10-899 iu/ml; (mean: 376.8)]. In HIV infected hosts the seroprevalence [range: 21-340 iu/ml; (mean; 180)] was 67.8% (56/82 men, 04/07 women). The seroprevalence was 20.5% (8/39), 32.8% (22/67), 34.8% (16/46) and 38.4% (5/13) in the 2nd, 3rd, 4th and 5th decades respectively in healthy adults. In HIV/AIDS patients, 69% (29/42) in the 3rd and 70.6% (24/34) in 4th decade were seropositive. The risk of cerebral Toxoplasmosis (encephalitis-02, granuloma-24) was 43.3% (26/60, mean 250 iu/ml). The seroprevalence was 28% in group iii (range 12-80 iu/ml, mean 21 iu/ml). Anti-toxo IgM was negative in all. Primary Toxoplasma infection appears to be subclinical and prevalent throughout life. T. gondii has emerged as an important opportunistic infection in HIV/AIDS patients in Bombay. Recrudescence of cerebral toxoplasmosis (CTOX) is observed with low IgG response during mid-late stage of the disease, as seen in our patients (mean IgG 250 iu/ml, CD4+ = 283/cmm (range 43-504 in 5 patients). Primary prophylaxis for CTOX seems rationale and can be targeted to asymptomatic HIV/AIDS population at risk who are seropositive for T. gondii (mean IgG 111.5 iu/ml in our study). The very high predictive value of a negative test for TOX remains the best serological parameter for excluding acute episode of TOX.
采用酶联免疫吸附测定（ELISA）技术对279份血清（年龄在13至50岁之间）进行抗弓形虫IgG/IgM抗体检测；阳性检测的诊断滴度为10 iu/ml或>1:100。血清取自：（i）165名（100名男性/65名女性）健康成年自愿献血者（HIV、乙肝表面抗原、性病研究实验室反应素检测均为阴性）；（ii）89名连续的HIV/AIDS患者（82名男性/7名女性）；以及（iii）在1996年1月至1997年6月本研究期间因脑结核瘤或神经囊尾蚴病接受治疗的25名患者（HIV阴性：12名男性/13名女性）。免疫功能正常的成年人（第一组）总体血清阳性率为30.9%（51/165），男性为34%（34/100），女性为26.2%（17/65）[范围：10 - 899 iu/ml；（平均值：376.8）]。在HIV感染宿主中，血清阳性率[范围：21 - 340 iu/ml；（平均值：180）]为67.8%（56/82名男性，4/7名女性）。健康成年人在第二、第三、第四和第五个十年的血清阳性率分别为20.5%（8/39）、32.8%（22/67）、34.8%（16/46）和38.4%（5/13）。在HIV/AIDS患者中，第三个十年的血清阳性率为69%（29/42），第四个十年的血清阳性率为70.6%（24/34）。脑弓形虫病（脑炎 - 2例，肉芽肿 - 24例）的风险为43.3%（26/60，平均值250 iu/ml）。第三组的血清阳性率为28%（范围12 - 80 iu/ml，平均值21 iu/ml）。所有样本的抗弓形虫IgM均为阴性。原发性弓形虫感染似乎为亚临床感染且终生普遍存在。在孟买，弓形虫已成为HIV/AIDS患者重要的机会性感染。在疾病的中晚期，如我们的患者所见（平均IgG 250 iu/ml，CD4 + = 283/立方毫米（5名患者范围为43 - 504）），脑弓形虫病（CTOX）复发时IgG反应较低。对CTOX进行一级预防似乎合理，可针对无症状的、弓形虫血清阳性的HIV/AIDS高危人群（在我们的研究中平均IgG为111.5 iu/ml）。弓形虫检测阴性的极高预测价值仍然是排除弓形虫急性发作的最佳血清学参数。
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