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中枢神经系统弓形虫病:临床表现随免疫反应而异。

Toxoplasmosis of the central nervous system: Manifestations vary with immune responses.

机构信息

Department of Pathology and Molecular Medicine, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.

Neuroradiology Division, Department of Radiology, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada.

出版信息

J Neurol Sci. 2021 Jan 15;420:117223. doi: 10.1016/j.jns.2020.117223. Epub 2020 Nov 9.

Abstract

Toxoplasmosis is an opportunistic infection caused by Toxoplasma gondii (TG), which affects one third of the global human population and commonly involves the central nervous system (CNS)/brain despite the so-called CNS immune privilege. Symptomatic clinical disease of TG infection is much more commonly associated with immunodeficiency; clinicopathological manifestations of CNS toxoplasmosis are linked to individual immune responses including the CNS infiltration of T-cells that are thought to prevent the disease. In patients with autoimmune diseases, immune status is complicated mainly byimmunosuppressant and/or immunomodulatory treatment but typically accompanied by infiltration of T-cells that supposedly fight against toxoplasmosis. In this article, we review characteristics of CNS toxoplasmosis comparatively in immunocompromised patients, immunocompetent patients, and patients with coexisting autoimmune diseases, as well as CNS immune responses to toxoplasmosis with a representative case to demonstrate brain lesions at different stages. In addition to general understanding of CNS toxoplasmosis, our review reveals that clinical manifestations of CNS toxoplasmosis are commonly nonspecific, and incidental pathological findings of TG infection are relatively common in immunocompetent patients and patients with autoimmune diseases (compared to immunocompromised patients); CNS immune responses such as T-cell infiltrates vary in acute and chronic lesions of brain toxoplasmosis.

摘要

弓形虫病是一种由刚地弓形虫(TG)引起的机会性感染,影响全球三分之一的人口,尽管存在所谓的中枢神经系统(CNS)/大脑免疫特权,但通常涉及中枢神经系统(CNS)/大脑。TG 感染的症状性临床疾病与免疫缺陷更为相关;CNS 弓形虫病的临床病理表现与个体免疫反应有关,包括被认为可预防疾病的 T 细胞向 CNS 的浸润。在自身免疫性疾病患者中,免疫状态主要因免疫抑制剂和/或免疫调节剂治疗而变得复杂,但通常伴有 T 细胞浸润,据推测这些 T 细胞可对抗弓形虫病。在本文中,我们综述了免疫功能低下、免疫功能正常和合并自身免疫性疾病患者的 CNS 弓形虫病的特点,以及弓形虫病的 CNS 免疫反应,并通过一个代表性病例来展示不同阶段的脑部病变。除了对 CNS 弓形虫病的一般认识外,我们的综述还揭示了 CNS 弓形虫病的临床表现通常是非特异性的,免疫功能正常的患者和自身免疫性疾病患者(与免疫功能低下的患者相比)中,偶然发现的 TG 感染的病理发现相对常见;CNS 免疫反应,如急性和慢性脑弓形虫病中的 T 细胞浸润,存在差异。

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