Presentation Of Toxoplasmosis Research Articles

Cerebral Toxoplasmosis and Latent Tuberculosis Infection in HIV Infected Patient

Toxoplasmosis is an opportunistic infection caused by Toxopasma gondii, which affects one third of the global human population and commonly involves the central nervous system (CNS)/brain. The diagnosis of obvious sign of imaging method cerebral toxoplasmosis is commonly reported in several case report, but subclinical sign of imaging is uncommon reported. We reported a case of 28-years-old male with chief complaint headache that worsening since 3 days before admission. He was first recognized as HIV infected patient on hospital admission. CT scan revealed minimal perifocal oedema in left frontal region. Patient was diagnosed as cerebral toxoplasmosis and latent tuberculosis infection in HIV clinical stadium IV. Patient recieved empirical therapy of cerebral toxoplasmosis and symptom relieved after 7 days of treatment. Cerebral toxoplasmosisis typically associated with HIV infected patient that result in the reactivation of Toxoplasma gondii infection. Clinical presentation of CNS toxoplasmosis varies and normal brain CT can be found despited presumptive diagnosis was revealed.

The role of age in ocular toxoplasmosis: clinical signs of immunosenescence and inflammaging.

This study aimed to investigate the association between age, immune response, and clinical presentation of ocular toxoplasmosis (OT). This was a monocentric, retrospective, observational cohort study. A review of the medical records of patients with active OT at the Uveitis Center, Charité Universitätsmedizin, was conducted. Baseline parameters included age at presentation, visual acuity, intraocular pressure (IOP), size and location of active lesions, inflammatory activity, antibody index (AI), and complications of intraocular inflammation. The data were presented as the mean ± standard deviation (SD). The level of significance was set at a p-value of <0.05. Between 1998 and 2019, 290 patients with active OT were diagnosed at our tertiary reference center. The mean age of the participants was 37.7 ± 17.1 years, 53.8% of them were female individuals, and 195 patients (70.9%) showed recurrent disease. Older age was associated with lower baseline visual acuity (p = 0.043), poor visual outcome (p = 0.019), increased inflammatory activity (p < 0.005), and larger retinal lesions (p < 0.005). Older patients presented a lower AI (<35 years: 45.1 ± 82.7, median: 12.1; ≥35 years: 18.6 ± 50.5, median: 5.8; p = 0.046), confirmed by a decrease in AI with increasing age (R2 = 0.045; p = 0.024). Finally, AI was correlated with lesion size (multiple linear regression analysis: p = 0.043). Macular involvement (24.3% of patients) was positively correlated with complications (macular/peripapillary edema and retinal detachment, p < 0.005) and poor visual outcome (p < 0.005) and was negatively correlated with inflammatory activity (p < 0.005). We found a strong and clinically relevant impact of age on the clinical presentation and course of OT. While an unspecific inflammatory response increased with age, the specific, local humoral immune response declined. These findings are well in line with the concept of immunosenescence and inflammaging in uveitis.

Diagnostic dilemma- choroidal granuloma as an atypical rare presentation: A case report

Purpose: To report a rare atypical case of ocular toxoplasmosis presenting as choroidal granuloma in a young adult. Case presentation: A 16-year-old male presented with sudden diminution of vision in the right eye. The visual acuity was 6/12p in the right eye. The anterior segment examination was normal. No relative afferent pupillary defect was present. The fundus examination of the right eye showed grade 1 vitritis, a normal disc with a well circumscribed active choroidal lesion on the posterior pole, inferior to the fovea along with surrounding Subretinal Fluid (SRF) pocket. The Optical Coherence Tomography (OCT) of the right eye showed choroidal elevation with the highest dimension just inferior to the fovea, along with surrounding SRF at the fovea. Fluorescein angiography showed punctate hyperfluorescent leakage points around the lesion. Intervention: Blood hemogram was normal with a raised erythrocyte sedimentation rate. Serological screening was positive for toxoplasmosis (IgM and IgG antibodies). Human Immunodeficiency Virus (HIV) and tuberculosis (QuantiFERON Gold test) were negative. Oral medications spiramycin 500 mg three times a day for 3 weeks along with folic acid once a day was started after paediatrician consult. Result: Follow up at 1 week, the visual acuity improved to 6/9 and the choroidal elevation along with the SRF was resolving on the OCT scan. After 3 weeks of treatment the visual acuity improved to 6/6 and the fundus showed complete resolution of the choroidal granuloma along with the surrounding SRF with no residual chorioretinal scar formation. Conclusions: Our case reports a rare atypical presentation of ocular toxoplasmosis with only one more case available in the literature of ocular toxoplasmosis presenting as a posterior pole choroidal granuloma. Timely intervention lead to complete resolution of the lesion and complete restoration of the visual acuity.

Could Toxomplasma gondii infection be dangerous? - Systematic review

Introduction: Toxoplasma gondii is an intracellular protozoan commonly found in humans in the form of three main forms: tachyzoite, tissue cyst and oocyst. The definitive host is the Felidae family, and one of the intermediate hosts is humans. The most common routes of infection are ingestion of raw or undercooked meat, water and food contaminated with oocysts. Among the forms of infection, we distinguish between the acquired form and the much more dangerous congenital form. Aim of the study: The objective of the study was to rewiev the literature describing the dangerous impact of Toxoplasma gondii infection on human.Methods and materials: : We reviewed the literature available in the PubMed database, using the key words: "toxoplasma gondii"; "congenital toxoplasmosis"; "pregnacy".Results: T. gondii infection is particularly dangerous in pregnant women, due to the high risk of vertical transmission of the infection to the developing fetus. The clinical presentation of congenital toxoplasmosis depends on the gestational age at which the infection occurred. Pathognomonic signs of congenital toxoplasmosis include Sabin-Pinkerton Triad, which includes inflammation of the retina and choroid of the eye, dilatation of the brain's ventricular system and intracranial calcifications. Available pharmacotherapy works on tachyzoites present in the initial phase of acquired infection, congenital infection and reactivated infection in immunodeficient patients, available drugs do not work on tissue cysts.Conclusion: The consequences of Toxoplasma gondii infection are particularly dangerous for the fetus, so pregnant women should pay special attention to hand hygiene and thorough washing of the food they eat. For this reason, it is extremely important to educate pregnant women about health issues and draw attention to the possible consequences of T.gondii infection.

BI02 Disseminated toxoplasmosis presenting as panniculitis in an immunocompromised patient

Abstract Inflammatory dermatoses and inflammatory reaction patterns to underlying systemic disease are relatively uncommon in immunosuppressed organ transplant recipients (OTRs) and infection should always be suspected as a possible cause. We present an OTR with biopsy-proven panniculitis resulting from disseminated toxoplasmosis, only identified after extensive histological analysis. A 45-year-old Nigerian woman who was profoundly immunocompromised through a combination of a kidney transplant 12 months earlier, hyposplenism due to sickle cell anaemia and a CD4+ count 74 × 106 cells L–1 (&amp;gt; 455 × 106 L–1) presented with a 3-month history of &amp;gt; 20 painful, red–purple and hyperpigmented subcutaneous nodules and plaques up to 2 cm in diameter limited to her legs, associated with fatigue and weight loss. She only had childhood contact with cats. There was no lymphoedema or lymphadenopathy, and she was HIV negative. Urgent skin biopsy excluded Kaposi sarcoma and demonstrated a lobular, necrotizing panniculitis, a mixed inflammatory cell infiltrate and evidence of vasculitis. The cause was unclear; cultures for mycobacterial, fungal and bacterial infections were negative. However, on rereview of histology, within areas of inflammation and necrosis in the subcutaneous fat, there were a few scattered structures (10–30 μm in diameter) consisting of small basophilic periodic acid–Schiff-positive ‘dots’ within bright eosinophilic cytoplasm, raising the possibility of toxoplasmosis. Toxoplasma immuno­staining was positive. Further tertiary review of histology and immunostaining by the Hospital for Tropical Diseases agreed that there was no other causative organism and the panniculitis and vasculitis were consistent with active toxoplasmosis. The diagnosis of toxoplasma reactivation was supported by positive toxoplasma IgG on pretransplant bloods. Magnetic resonance imaging of the head was consistent with cerebral toxoplasmosis. She received treatment with clindamycin, pyrimethamine and folinic acid and, thereafter, long-term cotrimoxazole prophylaxis. Cutaneous toxoplasmosis is rare, with only three reported cases over the last 10 years. Historically, a wide spectrum of clinical morphologies has been described, including maculopapular rashes, nodules, ulcers, dermatomyositis and even mimicry of varicella and graft-versus-host disease. Most cases affect immunocompromised patients. In our patient, this was the result of reactivation of latent infection, which is more common in West Africa, coinciding with profound immunosuppression. In our case, a diagnosis was only made after extensive histological review. Given the varied morphologies of clinical presentations, it is possible that this condition may be easily missed, with potentially serious consequences. In summary, we highlight the importance of maintaining a high index of suspicion for infection and the need for careful clinicopathological correlation in OTRs presenting with apparently atypical inflammatory skin lesions.

Rare presentation of bilateral congenital toxoplasmosis in newborns

Rare presentation of bilateral congenital toxoplasmosis in newborns

A case of ocular toxoplasmosis presenting with neuroretinitis

A case of ocular toxoplasmosis presenting with neuroretinitis

Optic perineuritis as an initial presentation of ocular toxoplasmosis: a case report.

Optic perineuritis as an initial presentation of ocular toxoplasmosis: a case report.

Punctate Inner Retinal Toxoplasmosis: Case Series and Review of Literature

ABSTRACT Purpose To describe clinical and multimodal imaging characteristics of punctate inner retinal toxoplasmosis (PIRT) as an atypical presentation of ocular toxoplasmosis (OT). Methods Retrospective review of OT cases with PIRT lesions and review of the literature. We describe five cases (6 eyes). Results PIRT lesions were seen adjacent to active/healed toxoplasma retinochoroiditis. The appearance of PIRT was creamy yellowish-white, inner retinal, punctate, and sub-centimetric lesions. The depth of these lesions on optical coherence tomography was till the outer plexiform layer. Co-existing punctate outer retinal toxoplasmosis (PORT) was found in three eyes and recurrent retinochoroiditis in three. The fate of PIRT was resolution with minimal retinal thinning or progression to a full-thickness retinochoroiditis. Conclusion PIRT was noted in association with typical toxoplasma retinochoroiditis and PORT lesions, and had equal chances of resolution or progression to full-thickness lesions.

One severe case of congenital toxoplasmosis in China with good response to azithromycin

BackgroundMost infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly.Case presentationA male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference.ConclusionsTimely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.

Toxoplasmosis presenting as isolated cervical lymphadenopathy-A rare case

Lymphadenopathy is not uncommon in toxoplasmosis. Its rare in an immunocompetent patient. We present a case of toxoplasmosis in an asymptomatic lady with isolated cervical lymph node. The diagnosis was confirmed by excision biopsy of lymph node and serology

Macular pucker, an atypical clinical presentation of ocular toxoplasmosis: a case report

BackgroundOcular toxoplasmosis caused by Toxoplasma gondii is an infectious disease which is widely distributed around the world and can present with various clinic manifestations. We are here reporting an unusual case presented with epiretinal membrane (ERM), i.e., macular pucker.Case presentationA 16-year old male patient visited our outpatient clinic complaining of decreased vision for about 8 years in his left eye. The best-corrected visual acuity (BCVA) was 20/20 OD and 20/400 OS. There was sensory exotropia in his left eye. No inflammatory cells or flare were found in his anterior chamber or vitreous cavity OU. An ERM involving his left macular area was found on his dilated fundus exam, which was confirmed by Optical Coherence Tomography (OCT). The ERM was found to involve his left macular area with his foveal ellipsoid zone absent. The right eye was found to be within normal limit.After a thorough discussion with the patient and his parents about treatment options and surgical benefits, risks and alternatives, we performed vitrectomy, peeled off the ERM and collected the vitreous sample for parasite testing during the procedure. Patient’s blood also was drawn for serological testing. Vitreous sample analysis and serological tests confirmed ocular toxoplasmosis OS as his final diagnosis. Unfortunately, the BCVA of this patient was not improved after the surgery, but the exotropia disappeared.ConclusionERM is an unusual clinical presentation of ocular toxoplasmosis. We may add Toxoplasma gondii infection as a differential diagnosis when encountering ERM cases.

Spinal Cord Involvement and Brain Hemorrhage as an Atypical Presentation of Toxoplasmosis in a Patient with HIV

Spinal Cord Involvement and Brain Hemorrhage as an Atypical Presentation of Toxoplasmosis in a Patient with HIV

Unusual presentation of toxoplasmosis with gastro‐intestinal involvement in HLA non‐identical stem cell transplantation

Toxoplasmosis is a life-threatening infection in allogenic stem cell recipients usually involving the brain or retina and more rarely lungs or bone marrow. Digestive involvement has only been reported in AIDS patient. We report about a 38-year-old man who received a haploidentical allograft for acute myeloid leukemia and developed an unusual digestive presentation with severe protein-losing enteropathy following grade III acute digestive GvHD treated with steroids and ruxolitinib. Diagnosis was brought up because of concomitant brain involvement. Digestive symptoms fully recovered after treatment with sulfamethoxazole-trimethoprim. Digestive toxoplasmosis could be considered as a differential diagnosis or complication of severe digestive GvHD.

Role of Imaging in a Case of Toxoplasmosis Presenting as Generalized Lymphadenopathy.

Toxoplasmosis is caused by Toxoplasma gondii an obligate protozoan intracellular parasite. The disease has variable prevalence globally and is usually asymptomatic. Pregnant and immunocompromised people are at risk of getting infected. Enlarged lymph nodes are the most frequently observed clinical form of Toxoplasma in humans, mostly affecting posterior cervical nodes. Other organs usually affected are the brain and eyes. We present a case of toxoplasmosis with generalized lymphadenopathy mimicking metastasis in a lady with a previous history of operated pancreatic neoplasm.

#100: Disseminated Toxoplasmosis Presenting as Persistent Fevers in a Hematopoietic Stem Cell Transplant Recipient

Abstract Background Toxoplasma reactivation is a known concern in hematopoietic stem cell transplant (HSCT) patients with high mortality of approximately 40% and up to 100% if left untreated. The risk is highest when patients are most immunocompromised and presentation can vary from isolated fever to disseminated disease with CNS toxoplasmosis, pneumonitis, and myocarditis. Case The patient is a 10-year-old male with acute promyelocytic leukemia (APML) CNS1 status post-chemotherapy, secondary acute myeloid leukemia (AML), now status post 10/10 matched unrelated donor hematopoietic stem cell transplant (HSCT). He initially developed fever and neutropenia during conditioning chemotherapy with resolved fever prior to stem cell transplant. His transplant course was complicated by grade IV mucositis on day +4 with improvement on day +11. On day +19 he developed new fevers (Tmax 40.5oC) with a negative initial workup. He continued to have persistent fevers on broad-spectrum empiric therapy with meropenem and liposomal amphotericin B and also complained of daily headaches and abdominal pain, with worsening diffuse body pain. On day +26 the Pediatric Infectious Diseases team was consulted as a CT Chest demonstrated small scattered ground glass nodules in the right lung with minimal bibasilar atelectasis and small pleural effusions. Upon chart review, he was noted to be Toxoplasma IgG positive prior to transplant. Further infectious diseases studies were sent to evaluate for fungal etiologies, including a Toxoplasma PCR blood, and given persistent fever, he was empirically started on trimethoprim–sulfamethoxazole (TMP-SMX) by the primary team. Shortly after the initiation of TMP-SMX he became afebrile and testing confirmed Toxoplasma reactivation with positive PCR studies from the blood, cerebrospinal fluid (CSF), bronchoalveolar lavage (BAL), and bone marrow. He was treated with pyrimethamine, sulfadiazine, and folinic acid and developed sulfa crystalluria, requiring alteration of his therapy. He received multiple treatment regimens and continued on maintenance therapy without further complications. Conclusion This case highlights the importance of serial surveillance or empiric prophylaxis for Toxoplasma reactivation in HSCT recipients known to have prior infection. There is high associated mortality and patients may present with isolated fever or severe disseminated disease with multi-organ involvement. Toxoplasma disease requires the presence of organ involvement as demonstrated in our patient and treatment is typically 6 weeks at higher doses followed by maintenance therapy. The definite treatment course varies by clinical response and multiple options are available if toxicities occur.

Toxoplasmosis and Cerebral Toxoplasmosis in HIV/AIDS Patients in Kariadi Hospital, Semarang

Background: Toxoplasmosis is an infection caused by Toxoplasma gondii which affects the central nervous system resulting to a fatal situation in HIV patients especially at the advanced stage. Cerebral toxoplasmosis (CT) is the clinical presentation of toxoplasmosis in individuals with HIV/AIDS. The study was carried to describe the prevalence of toxoplasmosis and cerebral toxoplasmosis in HIV/AIDS patients attending the hospital setting used in the study.Methods: Patients medical records were checked and analyzed for demographic characteristics as well as to determine the results of toxoplasma IgG tests for HIV/AIDS patients as well as those who had cerebral toxoplasmosis. The study was a descriptive study.Results: Out of the 158 HIV/AIDS patients tested, 129 (81.6%) were positive for T. gondii. A 62.0% prevalence rate was recorded for the male subjects while 19.6% prevalence rate was recorded for the female subjects although there was no significant difference (X2=0.58, P &gt; 0.05). 69.3% of the total population studied had cerebral toxoplasmosis with a prevalence rate of 74.3% and 25.3%) in male and female respectively. A higher prevalence was recorded from the age group &gt;30years without significant difference (X2=0.74, P &gt; 0.05).Conclusion: More research is required to know the exact prevalence of the parasite in this group of individuals since not all the patients were tested.

Toxoplasmosis chorioretinitis mimicking acute retinal necrosis associated with local corticosteroid

BackgroundThe cases discussed highlight the atypical presentation and diagnostic dilemmas of toxoplasmosis with fulminant retinal necrosis and the potentially devastating visual outcomes of toxoplasma chorioretinitis following local corticosteroid exposure.Case presentationWe report a series of three patients who presented with toxoplasmosis mimicking severe acute retinal necrosis. Patients were between 59 and 77 years old and had been exposed to local corticosteroids preceding our evaluation. All patients demonstrated diffuse retinal whitening with severe vision loss on presentation. Polymerase chain reaction testing (PCR) was diagnostic in two patients, and histopathologic examination of a vitrectomy specimen was diagnostic in one patient. All cases of retinitis resolved with anti-parasitic medication; however, visual acuity failed to improve in all patients due to disease severity and presentation.ConclusionsLocal corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, particularly following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected.

Toxoplasmosis Outbreak Associated With Toxoplasma gondii-Contaminated Venison-High Attack Rate, Unusual Clinical Presentation, and Atypical Genotype.

During 2017, in response to a physician's report, the Wisconsin Department of Health Services, Division of Public Health, began investigating an outbreak of febrile illness among attendees of a retreat where never frozen, intentionally undercooked, locally harvested venison was served. Preliminary testing tentatively identified the illness as toxoplasmosis. Confirmatory human serology panels and testing of the venison to confirm and categorize the presence and type of Toxoplasma gondii were completed by French and American national reference laboratories. All 12 retreat attendees were interviewed; medical records were reviewed. All attendees were male; median age was 51 years (range: 22-75). After a median incubation period of 7 days, 9 (82%) of 11 exposed persons experienced illness lasting a median of 12 days. All 9 sought outpatient healthcare for symptoms including fever, chills, sweats, and headache (100%) and ocular disturbances (33%). Testing confirmed the illness as toxoplasmosis and venison as the infection source. Multiple laboratory results were atypical for toxoplasmosis, including transaminitis (86%), lymphocytopenia (88%), thrombocytopenia (38%), and leukopenia (63%). One exposed but asymptomatic person was seronegative; the other had immunity from prior infection. The T. gondii strain was identified as closely related to an atypical genotype (haplogroup 12, polymerase chain reaction restriction fragment length polymorphism genotype 5) common in North American wildlife but with previously uncharacterized human clinical manifestations. The T. gondii strain contaminating the venison might explain the unusual clinical presentations. In North America, clinicians and venison consumers should be aware of risk for severe or unusual presentations of acute toxoplasmosis after consuming undercooked game meat.

Characterization of Fetal Brain Damage in Early Abortions of Ovine Toxoplasmosis.

There is an unacknowledged clinical presentation of ovine toxoplasmosis characterized by early abortions and lesions of fetal leukoencephalomalacia. To investigate the pathogenesis of this condition, the extent and distribution of leukomalacia and the variations in the cell populations associated with it were characterized in 32 fetal brains from 2 previously published experimental studies of Toxoplasma gondii infection in pregnant sheep. Immunohistochemical labeling of βAPP allowed for the detection of leukomalacia in 100/110 (91%) studied samples. There was no clear influence of the challenge dose or the area of the brain (frontal lobe, corpus callosum, midbrain, and cerebellum). In tissues with leukomalacia, there was loss of oligodendrocytes and increased number of astrocytes and microglia both in the areas of necrosis but also in the surrounding area. These findings were similar to those described in ovine experimental models (inflammation syndrome and hypoxic models) of periventricular leukomalacia in humans. Thus, a fetal inflammatory syndrome may be involved in the pathogenesis of early abortion in ovine toxoplasmosis. However, further studies are needed to determine the pathogenesis of this clinical presentation because placental thrombosis and resulting hypoxia could also be responsible for the leukomalacia.