Iranian Journal of Otorhinolaryngology

Iranian Journal of Otorhinolaryngology

Toxoplasma Lymphadenopathy: A Comparative Diagnostic Assessment of Clinical, Serological and Histopathological Findings

Document Type : Original

Authors
Samah Abbas Hammadi 1
Abbas Jaafar Khaleel Al-Anbari 2
Bassam Maddah Al-Alosi 3
1 Otolaryngologist, College of Medicine, Al-Nahrain University, Iraq.
2 Consultant Cardiovascular and Thoracic Surgery, College of Medicine, Al-Nahrain University, Baghdad, Iraq.
3 College of Medicine, University of Anbar, Iraq.
10.22038/ijorl.2023.64479.3205
Abstract
Introduction:
Toxoplasma Gondii (TG) is a zoonotic protozoan with extensive symptomatology. Toxoplasmic lymphadenopathy is considered an affirmative sign and is proved by a biopsy of the enlarged nodule. This study was conducted to compare the clinical, serological, and histopathological findings for the diagnosis of toxoplasmic lymphadenopathy.
 Materials and Methods:
This study involved biopsy examinations from twelve cases with TG lymphadenopathy. ELISA serological tests were performed for TG specific IgM and IgG immunoglobulins. PCR was done to ratify the results obtained by ELISA.
 Results:
The ages of the patients ranged from 15 to 48 years (mean=27.8). Most of the cases are male n=8(66.7%), while female n=4(33.3%). The asthenia was not only the most frequent clinical presentation (83.3%), but it also last longer. All cases had a positive biopsy. Eight (67.7%) cases revealed seropositivity. Two of them had positive PCR in those who were positive IgM, suggesting that the infection was acute. Six (50%) cases revealed positive IgG tests, while those with negative serology were 4(33.3%). The site of lymph nodes involvement had been assessed and mostly cervical (91.6%).
 Conclusion:
The histopathological results yielded 100% positive findings, thus biopsy was very important in the diagnosis and differential diagnosis of lymph nodes enlargement. The chronic phase of toxoplasmosis does not show the protozoa in the blood causing an absent DNA band for amplification of the PCR cycles, which could explain the lack of bands particular for TG. A negative serological test does not exclude toxoplasmic lymphadenitis, especially in immune-compromised patients.
Keywords
Biopsy
ELISA
Toxoplasma Gondii
Lymphadenopathy
Real-time PCR
Serology
Lymph node
Subjects
  1. Elmore SA, Jones JL, Conrad PA, Patton S, Lindsay DS, Dubey JP. Toxoplasma gondii: epidemiology, feline clinical aspects, and prevention. Trends in Parasitology. 2010;26(4):
    190-6.
  2. Gazzinelli RT, Denkers EY, Sher A. Host resistance to Toxoplasma gondii: model for studying the selective induction of cell-mediated immunity by intracellular parasites. Infectious agents and disease. 1993;2(3):139-49.
  3. Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clinical microbiology reviews. 2012;25(2):264-96.
  4. Ivanova K, Glatz K, Zippelius A, Nicolas G, Itin P. Acute Toxoplasmosis Mimicking Melanoma Metastases: Review of Conditions Causing False-Positive Results on <sup>18</sup>F-FDG PET/CT. Dermatology. 2012;225(4):349-53.
  5. Hadi U, Rameh C. Intraglandular toxoplasmosis of the parotid gland pre- or postoperative diagnosis? Am J Otolaryngol. 2007;28(3):201-4.
  6. Von Arx DP. Cervicofacial toxoplasmosis. Br J Oral Maxillofac Surg. 1988;26(1):70-7.
  7. Camacho AE, Goodman ML, Eavey RD. Pathologic correlation of the unknown solid parotid mass in children. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1989; 101(5): 566-71.
  8. Appel BN, Mendelow H, Pasqual HN. Acquired toxoplasma lymphadenitis. Oral Surg Oral Med Oral Pathol. 1979;47(6):529-32.
  9. Attias M, Teixeira DE, Benchimol M, Vommaro RC, Crepaldi PH, De Souza W. The life-cycle of Toxoplasma gondii reviewed using animations. Parasites & Vectors. 2020;13(1):588.
  10. Li J, Zhao J, Yang X, Wen Y, Huang L, Ma D, et al. One severe case of congenital toxoplasmosis in China with good response to azithromycin. BMC Infectious Diseases. 2021;21(1):920.
  11. Karel Hurt PK, David Stejskal, Michal Zikan, Martina Mojhova, Jakub Rakovic. Toxoplasmosis impact on prematurity and low birth weight. PLoS ONE. 2022;17(1):e0262593.
  12. McCabe RE, Brooks RG, Dorfman RF, Remington JS. Clinical spectrum in 107 cases of toxoplasmic lymphadenopathy. Rev Infect Dis. 1987;9(4):754-74.
  13. Zhou Y, Liu Y, Wen Y. Primary Toxoplasma gondii infection-associated with hemophagocytic syndrome in a man with HIV infection: a case report. BMC Infectious Diseases. 2022;22(1):35.
  14. JK B. Toxoplasmosis. Br Med J. 1973;2:475-78.
  15. Hameda Abd Al-Mahdi Ghazi RAMA-T, and Hayder Abdul-Amir Makki Al-Hindy. Immunophenotypic characterization of malignant lymphoma in Iraqi patients using immunohistochemical CD-marker study. Sys Rev Pharm. 2020;11(11):412-7.
  16. Marium Mohammed Burhan AMM, Hameda Abdull Al-Mahdi Ghazi, Hayder Abdul Amir Makki Al-Hindy. The Value of Immunohistochemical Expression of Estrogen Receptor And Progesterone Receptor Receptors In The Prognosis of Iraqi Women With Breast Carcinoma. Sys Rev Pharm 2020;11(12):1969-74.
  17. Hayder AA. Al-Hindy MJM, Hayder O. Hashim BCG Vaccine in Preventing COVID-19 Epidemic Had to be Reviewed: Correlation does not Imply causation. Australian Journal of Basic and Applied Sciences. 2020;14(11):58-63.
  18. Mazin J Mousa HA-AMA-H, Hayder Sabeeh Al Saffar. The Value of Using Tagman Real-time PCR, Phenol-Auramine Stain and Ziehl-Neelsen Stain in The Diagnosis of Pulmonary Tuberculosis in Fine-Needle Aspiration Material. International Journal of Pharmaceutical Quality Assurance 2019;10(2):
    330-3.
  19. Toxoplasmosis WHOMoIo, World Health O. Toxoplasmosis : report of a WHO meeting of investigators [meeting held in Geneva from 25 to 29 November 1968]. Geneva: World Health Organization; 1969.
  20. Sumi Y, Kaneda T, Nagasaka T. Toxoplasmosis of the preauricular and cervical lymph nodes: Report of a case. Journal of Oral and Maxillofacial Surgery. 1987;45(11):978-9.
  21. Durlach RA, Kaufer F, Carral L, Hirt J. Toxoplasmic lymphadenitis--clinical and serologic profile. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2003; 9(7):625-31.
  22. Jones TC, Kean BH, Kimball AC. Acquired toxoplasmosis. N Y State J Med. 1969;69(16):
    2237-42.
  23. Montoya JG, Remington JS. Studies on the serodiagnosis of toxoplasmic lymphadenitis. Clin Infect Dis. 1995;20(4):781-9.
  24. Moran WJ, Tom DW, King GD, Silverman ML. Toxoplasmosis lymphadenitis occurring in a parotid gland. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 1986; 94(2): 237-40.
  25. Iddawela W, Ehambaram, K. and Bandara, D. Diagnosis of Toxoplasmic Lymphadenopathy: Comparison of serology and histology. Sri Lankan Journal of Infectious Diseases. 2015;5(1):02–6.
  26. Dupouy-Camet J, de Souza SL, Maslo C, Paugam A, Saimot AG, Benarous R, et al. Detection of Toxoplasma gondii in venous blood from AIDS patients by polymerase chain reaction. J Clin Microbiol. 1993;31(7):1866-9.
  27. Hohlfeld P, Daffos F, Costa JM, Thulliez P, Forestier F, Vidaud M. Prenatal diagnosis of congenital toxoplasmosis with a polymerase-chain-

 

reaction test on amniotic fluid. N Engl J Med. 1994; 331(11):695-9.

  1. Mandell GL D, Bennett JE. , editor. Toxoplasma Gondii. Principles and Practice of Infectious Diseases. Third ed. New York: NY: Churchill Livingstone; 1990.
  2. Dorfman RF, Remington JS. Value of lymph-node biopsy in the diagnosis of acute acquired toxoplasmosis. N Engl J Med. 1973;289(17):878-81.
  3. Mansoor C Abdulla HKH. Toxoplasmosis and Lymphoma: The Mimickers. Indian Journal of Medical and Paediatric Oncology 2017;38(2):3.
  4. Hoshino T, Yoshioka S, Shinohara S, Matsushita A, Imai Y, Kinugasa M, et al. Clinical Diagnosis of Toxoplasmosis via Histopathological and Antibody Examination of Five Immunocompetent Patients at Kobe City Medical Center General Hospital, 2008 to 2015. Case Reports in Infectious Diseases. 2021; 2021:6611273.
  5. Azaz B, Milhem I, Hasson O, Kirsch G. Acquired toxoplasmosis of a submandibular lymph node in a 13-year-old boy: case report. Pediatr Dent. 1994;16(5):378-80.
  6. Choi WY, Nam HW, Kwak NH, Huh W, Kim YR, Kang MW, et al. Foodborne outbreaks of human toxoplasmosis. J Infect Dis. 1997; 175(5): 1280-2.
  7. Mullens A. "I think we have a problem in Victoria": MDs respond quickly to toxoplasmosis outbreak in BC. Cmaj. 1996;154(11):1721-4.
Iranian Journal of Otorhinolaryngology
Volume 35, Issue 3
May and June 2023
Pages 157-163