Toxoplasmosis-associated IRIS involving the CNS: a case report with longitudinal analysis of T cell subsets

Background: HIV-infected patients may present an unforeseen clinical worsening after initiating antiretroviral therapy known as immune reconstitution inflammatory syndrome (IRIS). This syndrome is characterized by a heightened inflammatory response toward infectious or non-infectious triggers, and it may affect different organs. Diagnosis of IRIS involving the central nervous system (CNS-IRIS) is challenging due to heterogeneous manifestations, absence of biomarkers to identify this condition, risk of long-term sequelae and high mortality. Hence, a deeper knowledge of CNS-IRIS pathogenesis is needed. Case presentation: A 37-year-old man was diagnosed with AIDS and cerebral toxoplasmosis. Anti-toxoplasma treatment was initiated immediately, followed by active antiretroviral therapy (HAART) 1 month later. At 2 months of HAART, he presented with progressive hyposensitivity of the right lower limb associated with brain and dorsal spinal cord lesions, compatible with paradoxical toxoplasmosis-associated CNS-IRIS, a condition with very few reported cases. A stereotactic biopsy was planned but was postponed based on its inherent risks. Patient showed clinical improvement with no requirement of corticosteroid therapy. Routine laboratorial analysis was complemented with longitudinal evaluation of blood T cell subsets at 0, 1, 2, 3 and 6 months upon HAART initiation. A control group composed by 9 HIV-infected patients from the same hospital but with no IRIS was analysed for comparison. The CNS-IRIS patient showed lower percentage of memory CD4(+) T cells and higher percentage of activated CD4(+) T cells at HAART initiation. The percentage of memory CD4(+) T cells drastically increased at 1 month after HAART initiation and became higher in comparison to the control group until clinical recovery onset; the percentage of memory CD8(+) T cells was consistently lower throughout follow-up. Interestingly, the percentage of regulatory T cells (Treg) on the CNS-IRIS patient reached a minimum around 1 month before symptoms onset. Conclusion: Although both stereotactic biopsies and steroid therapy might be of use in CNS-IRIS cases and should be considered for these patients, they might be unnecessary to achieve clinical improvement as shown in this case. Immunological characterization of more CNS-IRIS cases is essential to shed some light on the pathogenesis of this condition.Portuguese Foundation for Science and Technology (FCT; PIC/IC/83313/2007) and co-financed by the Portuguese North Regional Operational Program (ON.2 - O Novo Norte) under the National Strategic Reference Framework (QREN) through the European Regional Development Fund (FEDER). A FCT fellowship was attributed to RRS (PD/BD/106047/2015; Inter-University Doctoral Program in Ageing and Chronic Disease) and to CN [SFRH/BPD/65380/2009; Programa Operacional Potencial Humano (POPH) through the Fundo Social Europeu (FSE)]info:eu-repo/semantics/publishedVersio

Physiological energetics of juvenile clams Ruditapes decussatus in a high CO2 coastal ocean

Effects of coastal ocean acidification, other than calcification, were tested on juvenile clams Ruditapes decussatus during a controlled CO2 perturbation experiment. The carbonate chemistry of natural (control) seawater was manipulated by injecting CO2 to attain 2 reduced pH levels (-0.4 and -0.7 pH units) as compared with the control seawater. After 87 d of exposure, we found that the acidification conditions tested in this experiment significantly reduced the clearance, ingestion and respiration rates, and increased the ammonia excretion rate of R. decussatus seeds. Reduced ingestion combined with increased excretion is generally associated with a reduced energy input, which will likely contribute to a slower growth of the clams in a future high CO2 coastal ocean. These results emphasize the need for management policies to mitigate the adverse effects of global change on aquaculture, which is an economically relevant activity in most coastal areas worldwide.Regional Ministry of Innovation and Industry of the Galician Government [08MDS018402PR]; Italian Ministry for Environment, Land and Sea; Foundation for Science and Technology of Portugal [ERA-CIRCLE/0004/2007]; European Commissio

Tolerance of juvenile Mytilus galloprovincialis to experimental seawater acidification

Coastal ocean acidification is expected to interfere with the physiology of marine bivalves. In this work, the effects of acidification on the physiology of juvenile mussels Mytilus galloprovincialis were tested by means of controlled CO2 perturbation experiments. The carbonate chemistry of natural (control) seawater was manipulated by injecting CO2 to attain 2 reduced pH levels: -0.3 and -0.6 pH units as compared with the control seawater. After 78 d of exposure, we found that the absorption efficiency and ammonium excretion rate of juveniles were inversely related to pH. Significant differences among treatments were not observed in clearance, ingestion and respiration rates. Coherently, the maximal scope for growth and tissue dry weight were observed in mussels exposed to the pH reduction Delta pH = -0.6, suggesting that M. galloprovincialis could be tolerant to CO2 acidification, at least in the highly alkaline coastal waters of Ria Formosa (SW Portugal).Regional Ministry of Innovation and Industry of the Galician Government [08MDS 018402PR]; Italian Ministry for Environment, Land and Sea; Foundation for Science and Technology of Portugal [ERA-CIRCLE/0004/2007]; European Commissio

Contrasting Physiological Responses of Two Populations of the Razor Clam Tagelus dombeii with Different Histories of Exposure to Paralytic Shellfish Poisoning (PSP)

This study describes the physiological performance of two populations of the razor clam Tagelus dombeii from two geographic areas with different histories of exposure to paralytic shellfish poisoning (PSP) linked to the toxic dinoflagellate Alexandrium catenella. Clams from Melinka-Aysen, which are frequently exposed to PSP, were not affected by the presence of toxins in the diet. However, clams from Corral-Valdivia, which have never been exposed to PSP, exhibited significantly reduced filtration activity and absorption, affecting the energy allocated to scope for growth (SFG). Ammonia excretion and oxygen uptake were not affected significantly by the presence of A. catenella in the diet. Measurements of energy acquisition and expenditure were performed during a 12-day intoxication period. According to three-way repeated measure ANOVAs, the origin of the clams had a highly significant effect on all physiological variables, and the interaction between diet and origin was significant for the clearance and absorption rates and for the scope for growth. The scope for growth index showed similar positive values for both the toxic and non-toxic individuals from the Melinka-Aysen population. However, it was significantly reduced in individuals from Corral-Valdivia when exposed to the diet containing A. catenella. The absence of differences between the physiological response of the toxic and non-toxic clams from Melinka-Aysen may be related to the frequent presence of A. catenella in the environment, indicating that this bivalve does not suffer negative consequences from PSP. By contrast, A. catenella has a negative effect on the physiological performance, primarily on the energy gained from the environment, on T. dombeii from Corral-Valdivia. This study supports the hypothesis that the history of PSP exposure plays an important role in the physiological performance and fitness of filter feeding bivalves