Toxoplasmosis Symptoms and Manifestations

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Questions and Answers

What is a common neurological manifestation of toxoplasmosis in immunocompetent patients?

Gastrointestinal symptoms

Fever and malaise

Abnormal reflexes (correct)

Cutaneous rash

What is the primary source of toxoplasmosis in stem cell transplant recipients?

Contact with infected individuals

Contaminated food and water

Reactivation of latent infection (correct)

Acute primary infection acquired directly from the transplanted organ

What is the significance of testing for Toxoplasma-specific IgG antibodies in potential transplant recipients?

To diagnose acute toxoplasmosis

To determine the severity of the disease

To identify the source of infection

To determine the antibody status of the recipient (correct)

What is a characteristic of the immunological response in individuals with reactivation of toxoplasmosis?

No increase in IgG antibody levels and no IgM response Signup and view all the answers

What is a common cutaneous manifestation of toxoplasmosis?

Macular and papular rash on the palms and soles Signup and view all the answers

What is the prognosis of toxoplasma encephalitis (TE) in AIDS patients if left untreated?

Fatal Signup and view all the answers

What percentage of AIDS patients with TE may not have detectable IgG antibodies to T. gondii?

5% Signup and view all the answers

What is a common neurological symptom of toxoplasmosis in AIDS patients?

Seizures Signup and view all the answers

What is a possible time frame for congenital CNS involvement symptoms to appear?

Several years later Signup and view all the answers

Why can reinfection of the mother during pregnancy occur?

Due to contact with large numbers of infective cysts and/or oocysts Signup and view all the answers

What is ocular toxoplasmosis typically seen in?

Immunocompetent patients due to an earlier congenital infection Signup and view all the answers

What is the typical pattern of chorioretinitis in patients with congenitally acquired infection?

Bilateral Signup and view all the answers

What is the definitive diagnosis method for Toxoplasma infections?

Identification of tachyzoites in tissue sections Signup and view all the answers

What is the purpose of molecular tests in Toxoplasma detection?

To detect T.gondii in deparaffinized ocular tissue sections, cerebrospinal fluid, blood, and bronchoalveolar fluid Signup and view all the answers

What happens to tachyzoites after they enter muscle and brain cells?

They are transformed into bradyzoites Signup and view all the answers

What is the Sabin-Feldman dye test used for?

To detect and quantitate specific antibodies to T.gondii at low levels Signup and view all the answers

What is the primary site of involvement in immunocompromised patients?

Central nervous system Signup and view all the answers

What is the Giemsa stain used for in Toxoplasma diagnosis?

To stain the cytoplasm pale blue and the nucleus red Signup and view all the answers

What is a common complication of toxoplasmosis in AIDS patients?

Meningoencephalitis Signup and view all the answers

What is the primary mode of transmission of toxoplasmosis in transplant recipients?

Organ transplantation Signup and view all the answers

What is the characteristic skin lesion of cutaneous toxoplasmosis?

Maculopapular rash Signup and view all the answers

What is the typical incubation period of toxoplasmosis after ingestion of contaminated food?

2-3 weeks Signup and view all the answers

What is the primary immunological response to toxoplasmosis?

Cell-mediated immune response Signup and view all the answers

What is a common symptom of ocular toxoplasmosis?

Iridocyclitis Signup and view all the answers

Study Notes

Toxoplasmosis

More than 50% of toxoplasmosis patients show altered mental state, motor impairment, seizures, abnormal reflexes, and other neurologic sequelae.

Organ Involvement

Lung is the next most common organ involved, often manifesting as interstitial pneumonitis.
Gastrointestinal tract, liver, and heart may also be involved.
Cutaneous toxoplasmosis presents as a prominent macular and papular rash on the palms and soles.

Disease Acquired in Immunocompetent Patients

Disease severity depends on previous exposure to T.gondii by the donor and recipient, the type of organ transplanted, and the level of immunosuppression of the patient.
Disease can be due to reactivation of a latent infection or an acute primary infection acquired directly from the transplanted organ.
Stem cell transplant recipients are particularly susceptible to severe toxoplasmosis, primarily due to reactivation of a previously acquired latent infection.
All potential transplant recipients should be tested for Toxoplasma-specific immunoglobulin G (IgG) antibodies to determine their antibody status.

AIDS Patients

Fever and malaise usually precede the first neurologic symptoms; headache, confusion, seizures, or other focal signs strongly suggest the diagnosis of toxoplasmosis.
Toxoplasma encephalitis (TE) is reported as a life-threatening infection among AIDS patients.
This condition is fatal if untreated.
Most AIDS patients with TE have detectable IgG antibodies to T.gondii; however, 5% may not have antibody in their serum.
Psychiatric manifestations of toxoplasmosis may occur.
Symptoms of congenital CNS involvement may not appear until several years later.
Congenital transmission can occur even if the mother is immune, although this is rare; reinfection of the mother during pregnancy is possible.

Ocular Infections

Ocular infections, also known as ocular toxoplasmosis, are seen in immunocompetent patients due to an earlier congenital infection.
Patients may be asymptomatic until the second or third decade; at that point, cysts may rupture, with lesions then developing in the eye.
Chorioretinitis is usually bilateral in patients with congenitally acquired infection and is generally unilateral in patients with recently acquired infection.

Diagnosis

Sample: Tissue biopsy, spleen aspiration, bone marrow aspiration or lymph node aspiration, CSF, and blood.
Acute Toxoplasma infections may be diagnosed by detection of parasites (tachyzoites) in blood, lymph node punctures, in fluid or in biopsies of tissues.
Identification of tachyzoites in tissue sections is the definitive diagnosis method.
Serologic tests: For the determination of the age of an infection.
Molecular tests to detect T.gondii in deparaffinized ocular tissue sections, cerebrospinal fluid, blood, and bronchoalveolar fluid.

Pathogenesis

In most cases, toxoplasmosis is mostly not noted, since the symptoms are unspecific and of low grade.
T.gondii infections may become harmful, reaching the status of a severe disease.
Pathogenesis involves four main categories: disease acquired or reactivated in immunosuppressed or immunodeficient patients, disease acquired in immunocompetent patients, congenital disease, and ocular disease.

Acquired Postnatal Infection

Infection is acquired by ingestion of sporulated oocysts excreted by cats or by ingestion of undercooked raw meat of infected vertebrates.
After an incubation period of about 2-3 weeks, the following symptoms can be observed:
- Swellings of lymph nodes (adenitis)
- Infections of the eyes (iridocyclitis, chorioretinitis)
- Infections of the brain (meningoencephalitis)
- Infection of visceral organs (e.g., leading to intestinal pneumonia, hepatitis, myocarditis, enterocolitis, myositis, oedema of the skin)

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Description

This quiz covers the symptoms and manifestations of toxoplasmosis, including altered mental state, motor impairment, seizures, and respiratory and gastrointestinal complications.