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{{Toxoplasmosis}} | {{Toxoplasmosis}} | ||
{{CMG}} | {{CMG}} ; {{AE}}{{ADG}} | ||
==Overview== | |||
==History and Symptoms== | ==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 drug]]s may be due to either newly acquired or reactivated latent infection. | 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 drug]]s may be due to either newly acquired or reactivated latent infection. | ||
==== Acute toxoplasmosis ==== | ==== Acute toxoplasmosis ==== | ||
*During [[Acute (medical)|acute]] toxoplasmosis, symptoms are often [[influenza]]-like: | |||
During [[Acute (medical)|acute]] toxoplasmosis, symptoms are often [[influenza]]-like: | **Swollen [[lymph node]]s, | ||
**Muscle aches and pains that last for a month or more. | |||
*Rarely, a patient with a fully functioning [[immune system]] may develop eye damage from toxoplasmosis. | |||
*Young children and [[Immunodeficiency|immunocompromised]] patients, such as those with HIV/AIDS, those taking certain types of [[chemotherapy]], or those who have recently received an [[organ transplant]], may develop severe toxoplasmosis. | |||
*This can cause damage to the brain or the eyes. | |||
*Only a small percentage of infected newborn babies have serious eye or brain damage at birth. | |||
==== Latent toxoplasmosis ==== | ==== Latent toxoplasmosis ==== | ||
*Most patients who become infected with ''[[Toxoplasma gondii]]'' and develop toxoplasmosis do not know it. | |||
Most patients who become infected with ''[[Toxoplasma gondii]]'' and develop toxoplasmosis do not know it. In most immunocompetent patients, the infection enters a '''[[Virus latency|latent]]''' phase, during which only [[bradyzoite]]s are present, forming [[cyst]]s in [[nervous tissue|nervous]] and [[muscle]] tissue. Most infants who are infected while in the womb have no symptoms at birth but may develop symptoms later in life.[http://www.futurepundit.com/archives/001675.html] | *In most immunocompetent patients, the infection enters a '''[[Virus latency|latent]]''' phase, during which only [[bradyzoite]]s are present, forming [[cyst]]s in [[nervous tissue|nervous]] and [[muscle]] tissue. | ||
* Most infants who are infected while in the womb have no symptoms at birth but may develop symptoms later in life.[http://www.futurepundit.com/archives/001675.html] | |||
==== Congenital 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. | *[[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.<ref> | |||
The clinical manifestations in the newborn are dependent on the month of [[gestation]] the infection has occurred - earlier the infection more severe the disease.<br> | |||
'''Infection in early pregnancy''' : Neuro-ocular symptoms are typical presenting features in congenital toxoplasmosis, symptoms include: | |||
*Involvement of the [[CNS]] can present with psycho-motor retardation and [[seizures]].<ref name="pmid14023494">{{cite journal| author=COUVREUR J, DESMONTS G| title=Congenital and maternal toxoplasmosis. A review of 300 congenital cases. | journal=Dev Med Child Neurol | year= 1962 | volume= 4 | issue= | pages= 519-30 | pmid=14023494 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14023494 }} </ref><ref name="pmid4698952">{{cite journal| author=Saxon SA, Knight W, Reynolds DW, Stagno S, Alford CA| title=Intellectual deficits in children born with subclinical congenital toxoplasmosis: a preliminary report. | journal=J Pediatr | year= 1973 | volume= 82 | issue= 5 | pages= 792-7 | pmid=4698952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4698952 }} </ref> | |||
*[[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.<ref name="pmid16098868">{{cite journal| author=Chen KT, Eskild A, Bresnahan M, Stray-Pedersen B, Sher A, Jenum PA| title=Previous maternal infection with Toxoplasma gondii and the risk of fetal death. | journal=Am J Obstet Gynecol | year= 2005 | volume= 193 | issue= 2 | pages= 443-9 | pmid=16098868 | doi=10.1016/j.ajog.2004.12.016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16098868 }} </ref><ref name="HutsonWheeler2015">{{cite journal|last1=Hutson|first1=Samuel L.|last2=Wheeler|first2=Kelsey M.|last3=McLone|first3=David|last4=Frim|first4=David|last5=Penn|first5=Richard|last6=Swisher|first6=Charles N.|last7=Heydemann|first7=Peter T.|last8=Boyer|first8=Kenneth M.|last9=Noble|first9=A. Gwendolyn|last10=Rabiah|first10=Peter|last11=Withers|first11=Shawn|last12=Montoya|first12=Jose G.|last13=Wroblewski|first13=Kristen|last14=Karrison|first14=Theodore|last15=Grigg|first15=Michael E.|last16=McLeod|first16=Rima|title=Patterns of Hydrocephalus Caused by CongenitalToxoplasma gondiiInfection Associate With Parasite Genetics|journal=Clinical Infectious Diseases|volume=61|issue=12|year=2015|pages=1831–1834|issn=1058-4838|doi=10.1093/cid/civ720}}</ref> | |||
*Yellowish discolouration of skin | |||
*Focal neurological deficits and [[learning disabilities]] | |||
*[[Feeding difficulties]] | |||
*[[Hearing impairment|Hearing]] impairment | |||
*[[Skin rash]] | |||
*[[Fever]] | |||
'''Infection later in the pregnancy''': Majority of the infected newborns remain [[asymptomatic]] at birth.<ref name="pmid14023494">{{cite journal| author=COUVREUR J, DESMONTS G| title=Congenital and maternal toxoplasmosis. A review of 300 congenital cases. | journal=Dev Med Child Neurol | year= 1962 | volume= 4 | issue= | pages= 519-30 | pmid=14023494 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14023494 }} </ref> | |||
*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]]. | |||
http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm</ref> | http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm</ref> | ||
==References== | ==References== | ||
Revision as of 15:29, 26 May 2017
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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
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
- During acute toxoplasmosis, symptoms are often influenza-like:
- Swollen lymph nodes,
- Muscle aches and pains that last for a month or more.
- Rarely, a patient with a fully functioning immune system may develop eye damage from toxoplasmosis.
- Young children and immunocompromised patients, such as those with HIV/AIDS, those taking certain types of chemotherapy, or those who have recently received an organ transplant, may develop severe toxoplasmosis.
- This can cause damage to the brain or the eyes.
- Only a small percentage of infected newborn babies have serious eye or brain damage at birth.
Latent toxoplasmosis
- Most patients who become infected with Toxoplasma gondii and develop toxoplasmosis do not know it.
- In most immunocompetent patients, the infection enters a latent phase, during which only bradyzoites are present, forming cysts in nervous and muscle tissue.
- Most infants who are infected while in the womb have no symptoms at birth but may develop symptoms later in life.[3]
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.
http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm</ref>
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.