Toxoplasmosis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Acquired infection with Toxoplasma in immunocompetent persons is generally an asymptomatic infection. However, 10% to 20% of patients with acute infection may develop cervical lymphadenopathy and/or a flu-like illness. The clinical course is usually benign and self-limited; symptoms usually resolve within a few months to a year. Immunodeficient patients often have central nervous system (CNS) disease but may have retinochoroiditis, or pneumonitis. In patients with AIDS, toxoplasmic encephalitis is the most common cause of intracerebral mass lesions and is thought to be caused by reactivation of chronic infection. Toxoplasmosis in patients being treated with immunosuppressive drugs may be due to either newly acquired or reactivated latent infection.
History and Symptoms
Acquired infection with Toxoplasma in immunocompetent persons is generally an asymptomatic infection. However, 10% to 20% of patients with acute infection may develop cervical lymphadenopathy and/or a flu-like illness. The clinical course is usually benign and self-limited; symptoms usually resolve within a few months to a year. Immunodeficient patients often have central nervous system (CNS) disease but may have retinochoroiditis, or pneumonitis. In patients with AIDS, toxoplasmic encephalitis is the most common cause of intracerebral mass lesions and is thought to be caused by reactivation of chronic infection. Toxoplasmosis in patients being treated with immunosuppressive drugs may be due to either newly acquired or reactivated latent infection.
Acute toxoplasmosis in immunocompetent
Rarely, a patient with a fully functioning immune system may develop symptoms from toxoplasmosis. Symptoms are often influenza-like:
- Cervical lymphadenopathy
- Sore throat
- Muscle aches and pains that last for a month or more
- Fever, malaise, night sweats
Acute toxoplasmosis in hosts who do not have AIDS but are immunodeficient
CNS is involved 50% of patients infected by toxoplasmosis and symptoms include
- Seizure
- Dysequilibrium
- Cranial nerve deficits
- Altered mental status
- Focal neurologic deficits
- Headache
- Encephalitis, meningoencephalitis, or mass lesions
- Hemiparesis
- Seizures
- Flulike symptoms and lymphadenopathy
Clinical manifestations of toxoplasmosis in patients with AIDS
Clinical manifestations of toxoplasmosis in patients with AIDS include the following:
- Altered mental state
- Seizures
- Weakness
- Cranial nerve disturbances
- Sensory abnormalities
- Cerebellar signs
- Meningismus
- Movement disorders
- Neuropsychiatric manifestations
- Pulmonary toxoplasmosis occurs mainly in patients with advanced AIDS (mean CD4+ count of 40 cells/µL ±75 standard deviation)
Uncommon manifestations of toxoplasmosis in patients with AIDS include the following:
- Panhypopituitarism and diabetes insipidus
- Acute respiratory failure and hemodynamic abnormalities similar to septic shock
- Syndrome of inappropriate antidiuretic hormone secretion and possibly orchitis
- Gastrointestinal system invasion of T gondii may result in abdominal pain, diarrhea, and/or ascites (due to involvement of the stomach, peritoneum, or pancreas)
- Acute hepatic failure
- Musculoskeletal involvement
- Parkinsonism
- Focal dystonia
- Rubral tremor
- Hemichorea-hemiballismus
Ocular toxoplasmosis
Congenital toxoplasmosis
- Congenital toxoplasmosis results from an acute primary infection acquired by the mother during pregnancy.
- The incidence and severity of congenital toxoplasmosis vary with the trimester during which infection was acquired.
- Because treatment of the mother may reduce the incidence of congenital infection and reduce sequelae in the infant, prompt and accurate diagnosis is important.
- Most infants with subclinical infection at birth will subsequently develop signs or symptoms of congenital toxoplasmosis unless the infection is treated.
- Ocular Toxoplasma infection, an important cause of retinochoroiditis in the United States, can be the result of congenital infection, or infection after birth.
- In congenital infection, patients are often asymptomatic until the second or third decade of life, when lesions develop in the eye.[1]
- Chorioretinitis presents with impaired vision.
- Obstruction in the ventricles results in accumulation of CSF, causing enlargement of the head and increased intracranial pressure symptoms such as vomiting, headache, confusion and double vision.[2][3]
- Yellowish discolouration of skin
- Focal neurological deficits and learning disabilities
- Feeding difficulties
- Hearing impairment
- Skin rash
- Fever
Infection later in the pregnancy
- Majority of the infected newborns remain asymptomatic at birth.[4]
- Children develop psycho-motor retardation and chorioretinitis later in life.
- Loss of vision is a common symptom and is seen in 95% of infants due to chorioretinitis.[5]
References
- ↑ Saxon SA, Knight W, Reynolds DW, Stagno S, Alford CA (1973). "Intellectual deficits in children born with subclinical congenital toxoplasmosis: a preliminary report". J Pediatr. 82 (5): 792–7. PMID 4698952.
- ↑ Chen KT, Eskild A, Bresnahan M, Stray-Pedersen B, Sher A, Jenum PA (2005). "Previous maternal infection with Toxoplasma gondii and the risk of fetal death". Am J Obstet Gynecol. 193 (2): 443–9. doi:10.1016/j.ajog.2004.12.016. PMID 16098868.
- ↑ Hutson, Samuel L.; Wheeler, Kelsey M.; McLone, David; Frim, David; Penn, Richard; Swisher, Charles N.; Heydemann, Peter T.; Boyer, Kenneth M.; Noble, A. Gwendolyn; Rabiah, Peter; Withers, Shawn; Montoya, Jose G.; Wroblewski, Kristen; Karrison, Theodore; Grigg, Michael E.; McLeod, Rima (2015). "Patterns of Hydrocephalus Caused by CongenitalToxoplasma gondiiInfection Associate With Parasite Genetics". Clinical Infectious Diseases. 61 (12): 1831–1834. doi:10.1093/cid/civ720. ISSN 1058-4838.
- ↑ COUVREUR J, DESMONTS G (1962). "Congenital and maternal toxoplasmosis. A review of 300 congenital cases". Dev Med Child Neurol. 4: 519–30. PMID 14023494.
- ↑ http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm