Toxoplasmosis history and symptoms: Difference between revisions
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==Overview== | ==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 | 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|lymphadenopath]]<nowiki/>y 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. [[Immunocompromised|Immunodeficient]] patients often have central nervous system (CNS) disease but may have retinochoroiditis, or [[pneumonitis]]. In patients with [[AIDS]], [[Encephalitis|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== | ==History and Symptoms== | ||
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==== Acute toxoplasmosis in immunocompetent==== | ==== Acute toxoplasmosis in immunocompetent==== | ||
Rarely, a patient with a fully functioning [[immune system]] may develop symptoms from toxoplasmosis. Symptoms are often [[influenza]]-like: | Rarely, a patient with a fully functioning [[immune system]] may develop symptoms from toxoplasmosis. Symptoms are often [[influenza]]-like: | ||
*Cervical lymphadenopathy | *Cervical [[lymphadenopathy]] | ||
*Sore throat | *[[Sore throat]] | ||
*Muscle aches and pains that last for a month or more | *[[Muscle aches]] and [[pains]] that last for a month or more | ||
*Fever, malaise, night sweats | *[[Fever]], [[malaise]], [[night sweats]] | ||
====Acute toxoplasmosis in hosts who do not have AIDS but are immunodeficient==== | ====Acute toxoplasmosis in hosts who do not have AIDS but are immunodeficient==== | ||
CNS is involved 50% of patients infected by toxoplasmosis and symptoms include | CNS is involved 50% of patients infected by toxoplasmosis and symptoms include | ||
*Seizure | *[[Seizure]] | ||
*Dysequilibrium | *Dysequilibrium | ||
*Cranial nerve deficits | *Cranial nerve deficits | ||
*Altered mental status | *[[Altered mental status]] | ||
*Focal neurologic deficits | *Focal neurologic deficits | ||
*Headache | *[[Headache]] | ||
*Encephalitis, meningoencephalitis, or mass lesions | *[[Encephalitis]], [[meningoencephalitis]], or mass lesions | ||
*Hemiparesis | *[[Hemiparesis]] | ||
* | *[[Seizures]] | ||
*Flulike symptoms and lymphadenopathy | *Flulike symptoms and [[lymphadenopathy]] | ||
====Clinical manifestations of toxoplasmosis in patients with AIDS==== | ====Clinical manifestations of toxoplasmosis in patients with AIDS==== | ||
Clinical manifestations of toxoplasmosis in patients with AIDS include the following: | Clinical manifestations of toxoplasmosis in patients with AIDS include the following: | ||
*Altered mental state | *[[Altered mental state]] | ||
*Seizures | *[[Seizure|Seizures]] | ||
*Weakness | *[[Weakness]] | ||
*Cranial nerve disturbances | *Cranial nerve disturbances | ||
*Sensory abnormalities | *Sensory abnormalities | ||
*Cerebellar signs | *Cerebellar signs | ||
*Meningismus | *Meningismus | ||
*Movement disorders | *[[Movement disorders]] | ||
*Neuropsychiatric manifestations | *Neuropsychiatric manifestations | ||
*Pulmonary toxoplasmosis occurs mainly in patients with advanced AIDS (mean CD4+ count of 40 cells/µL ±75 standard deviation) | *Pulmonary toxoplasmosis occurs mainly in patients with advanced AIDS (mean CD4+ count of 40 cells/µL ±75 standard deviation) | ||
**Prolonged febrile illness | **Prolonged febrile illness | ||
**Cough and dyspnea | **[[Cough]] and [[dyspnea]] | ||
Uncommon manifestations of toxoplasmosis in patients with AIDS include the following: | Uncommon manifestations of toxoplasmosis in patients with AIDS include the following: | ||
*Panhypopituitarism and diabetes insipidus | *[[Panhypopituitarism]] and [[diabetes insipidus]] | ||
*Acute respiratory failure and hemodynamic abnormalities similar to septic shock | *Acute respiratory failure and hemodynamic abnormalities similar to [[septic shock]] | ||
*Syndrome of inappropriate antidiuretic hormone secretion and possibly orchitis | *[[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) | *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 | *Acute [[hepatic failure]] | ||
*Musculoskeletal involvement | *Musculoskeletal involvement | ||
*Parkinsonism | *[[Parkinsonism]] | ||
*Focal dystonia | *Focal [[dystonia]] | ||
*Rubral tremor | *Rubral tremor | ||
*Hemichorea-hemiballismus | *Hemichorea-hemiballismus | ||
====Ocular toxoplasmosis==== | ====Ocular toxoplasmosis==== | ||
*Blurred vision | *[[Blurred vision]] | ||
*Scotoma | *[[Scotoma]] | ||
*Photophobia | *[[Photophobia]] | ||
*Floaters | *[[Floaters]] | ||
*Red eye | *[[Red eye]] | ||
*Metamorphopsia | *[[Metamorphopsia]] | ||
==== Congenital toxoplasmosis ==== | ==== Congenital toxoplasmosis ==== | ||
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*The incidence and severity of congenital toxoplasmosis vary with the trimester during which infection was acquired. | *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. | *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. | *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> | *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> | 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> | ||
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*[[Skin rash]] | *[[Skin rash]] | ||
*[[Fever]] | *[[Fever]] | ||
'''Infection later in the pregnancy''' | '''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. | *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]]. | *[[Loss of vision]] is a common symptom and is seen in 95% of infants due to [[chorioretinitis]].<ref>http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm</ref> | ||
http://www.dpd.cdc.gov/dpdx/HTML/Toxoplasmosis.htm</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
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[[Category:Parasitic diseases]] | [[Category:Parasitic diseases]] | ||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
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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.Closing
</ref>missing for<ref>tag[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