Rare Presentation of Toxoplasma Pneumonitis in the Absence of Neurological Symptoms in an AIDS Patient and Use of Next-Generation Sequencing for Diagnosis
KeywordsDisseminated toxoplasmosis, Toxoplasma pneumonitis, next-generation sequencing, HIV/AIDS
Toxoplasma gondii is a known cause of encephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients. Toxoplasma pneumonitis is a manifestation of extracerebral toxoplasmosis and can be clinically indistinguishable from other opportunistic infections including Pneumocystis jirovecii pneumonia (PJP) and miliary tuberculosis. In this case report, Toxoplasma pneumonitis and disseminated toxoplasmosis was diagnosed using next-generation sequencing (NGS) and polymerase chain reaction (PCR) assessment. NGS can detect microbial cell-free DNA (cfDNA) circulating in the plasma of over 1,000 pathogens. This case is a rare presentation of Toxoplasma pneumonitis in the absence of neurological symptoms and we discuss the use of NGS of microbial cfDNA and PCR tests that may be utilized for the timely diagnosis of such challenging cases.
Mariuz P, Bosler EM, Luft BJ. Toxoplasma pneumonia. Semin Respir Infect 1997;12(1):40–43.
Schnapp LM, Geaghan SM, Campagna A, Fahy J, Steiger D, Ng V, et al. Toxoplasma gondii pneumonitis in patients infected with the human immunodeficiency virus. Arch Intern Med 1992;152(5):1073–1077.
Bergin C, Murphy M, Lyons D, Gaffney E, Mulcahy FM. Toxoplasma pneumonitis: fatal presentation of disseminated toxoplasmosis in a patient with AIDS. Eur Respir J 1992;5(8):1018–1020.
Oksenhendler E, Cadranel J, Sarfati C, Katlama C, Datry A, Marche C, et al. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome. Am J Med 1990;88(5N):18N–21N.
Murat JB, Hidalgo HF, Brenier-Pinchart MP, Pelloux H. Human toxoplasmosis: which biological diagnostic tests are best suited to which clinical situations? Expert Rev Anti Infect Ther 2013;11(9):943–956.
Hong DK, Blauwkamp TA, Kertesz M, Bercovici S, Truong C, Banaei N. Liquid biopsy for infectious diseases: sequencing of cell-free plasma to detect pathogen DNA in patients with invasive fungal disease. Diagn Microbiol Infect Dis 2018; 92(3):210–213.
Hu Z, Weng X, Xu C, Lin Y, Cheng C, Wei H, et al. Metagenomic next-generation sequencing as a diagnostic tool for toxoplasmic encephalitis. Ann Clin Microbiol Antimicrob 2018;17:45.
Issue: LATEST ONLINE (view)