Toxoplasmosis is a disease that came of age with the AIDS epidemic. And it's now one of our major opportunistic infections in the brain in, in HIV or AIDS in Africa. As it is globally as well. It's of interest that it becomes an opportunistic infection. In other words, it, it, it, it tends to occur where the host immunity is decreased. So, toxoplasmosis was always a bit like that. By that I mean you may, you, you may have been exposed to toxoplasmosis say as a child growing up. It's always existed in the so called animal kingdom. Cats excrete it in their, in their, in their stool. Ungulates are, are, are, are animals ingested, and become the intermediate host, become the host of it. And of course communities that have a tradition of eating meat that's undercooks, undercooked have a higher incidence of, of, of, of toxoplasmosis. And people who, caps may have accidentally become infected, sometimes poultry. You pick it up from the blood and and through wounds. Preparation of undercooked meat. You can accidentally become infected. Now, the antibody rate against tox, toxoplasmosis in a country like France, gets up over 50%. They have a tradition of eating undercooked foods. Come to Africa and it varies across whole countries within countries. Parts of South Africa are endemic for it, and then you go another hundred kilometers and there's very little of it. And this tends to reflect previous exposure. And, and the disease always existed in a primary form. Toxoplasmosis, presented with generalized lymph glands. A debilitating disease, and usually responding to an anti protozoa drug, Pyrimethamine. But, along comes the AIDS epidemic and it reinvents itself, and then becomes one of our major opportunistic infections. And a disease very difficult to diagnose clinically. Because the antibody tests are so ubiquitously positive. They measure IGG. And unless you're able to measure an acute phase antibody like IGM, you may not be able to recognize, an exacerbation of a recent infection. Now, very few places in Africa are able to do IGM titers. So we left then with the antibody teacher not helping us, and it's usually a clinical presentation of the disease that we recognize in HIV disease. That is very specific, it tends to cause a brain abscess. And we recognize that relatively easy because that presents as a focal brain lesion. In more or less in HIV disease and the patient represent with a loss of function in one area of the body for example loss of power in one side or a brain seizure or maybe an alteration in the level of consciousness. It is so common and ubiquitous in HIV disease that we employ a blunderbuss treatment when patients present with these symptoms. We cover all patients for toxoplasmosis by using a combination drug, pyrimethamine, cotrimoxazole, and, and high-dose in a dose of 1920, or 1920 milligrams, three times a day, and we do it for, for a long period. Two to four weeks. And then even use a maintenance therapy of the drug. Until someone becomes immunocompetent. Or has a CD-4 getting back over, up to healthy levels. About 350. That sounds a bit technical. But I'm just highlighting that Toxoplasmosis came of age with the AIDS epidemic. And, if you understand that neurological infections are the second leading cause of death in AIDS, and toxoplasmosis along with cryptococcosis and tuberculosis are the three leading opportunistic infections in the brain, then you realize that toxoplasmosis is a major, major pathogen, in East Afri, in, in Africa sub-Saharan Africa, in the AIDS epidemic, where we have, 25 million cases, or two-thirds of the world's epidemic. And it is a protozoa, and, an, and, unlike some, unlike TB is a bacteria. Bacteria meningitis is bacteria by definition, and cryptococcus is a fungus. So, here's a big organism reactivating in the context of immunosuppression, and causing what we call you know, a leading cause of death in AIDS in Africa. And for the foreseeable future then. We're going to be dealing with toxoplasmosis. It makes little sense to try to event primary rate exposure. That usually occurs in childhood, young adulthood. And it's interesting that the organism replicates inside of you at low rates, and doesn't go away. Remember, we have that which, tuberculosis does it. You don't kill off the organism. It stays inside you. And may reactivate if you become immune suppressed, or you become malnourished. We've always known that, with mal, with, with, with malnutrition. Or you develop another disease that makes but AIDS is the archetypal disease that exposes us. So the concept then of living with infection. And it replicating at lower rates. Protozoa are always unusual. There's one malaria parasite does it called" P. Malaria". Falciparin, either kills you or you kill it. And then the other two malaria parasites, Ovale, and Vivax can also do it, replicate at low rates. And, and survive within your, within your body. So I think this, that that concludes my comments on, on, some of the, more unusual protozoan infections that have come of age with the AIDS epidemic. Thank you.
