title: Recurrent headaches may be caused by cerebral toxoplasmosis.
abstract: OBJECTIVE
  To establish seroprevalence and provide characteristics of Toxoplasma gondii (TG) infection in children with recurrent headaches.
  
  
  METHODS
  The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG IgM, IgG antibodies and IgG avidity using enzyme immunoassay Platelia Toxo IgM, IgG.
  
  
  RESULTS
  The study showed that 19 children (8 boys, 11 girls; 8-17 years old, mean age 14.36 years) had high serum anti-TG IgG antibody levels (range: 32.2 > 240 UI/mL, mean 120.18 UI/mL; positive value for IgG was ≥ 9 UI/mL). The avidity index (AI) ranged from 0.202 to 0.925 (scale: ≥ 0.5 high AI). The results for IgM antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/mL (mean = 0.191 IU/mL) and all values below 0.8 IU/mL were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal (13 children), occipital (4) and parietal areas (5). Headaches usually had a pulsating (in 7 patients) and squeezing (6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy (5 patients), various infections in 3 children (chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.
  
  
  CONCLUSIONS
  Ten point six seven percent of the studied children had markedly increased serum anti-TG IgG antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Prandota
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Gryglas
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Fuglewicz
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Zesławska-Faleńczyk
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ujma-Czapska
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Szenborn
authors.affiliation: Joseph Prandota, Anna Gryglas, Aleksander Fuglewicz, Agata Żesławska-Faleńczyk, Department of Social Pediatrics, Faculty of Health Sciences, Wroclaw Medical University, 51618 Wroclaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Mierzwa
keywords: Cerebral toxoplasmosis; Children; Chronic Toxoplasma gondii infection; IgG avidity; Recurrent headaches; Seroprevalence of anti-Toxoplasma gondii IgG antibodies