Toxoplasmosis differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Toxoplasmosis]] | |||
{{CMG}} ; {{AE}} {{ADG}} | {{CMG}} ; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
Toxoplasmosis manifests as a painless [[lymphadenopathy]] in an [[immunocompetent]] individual. In patients with [[HIV AIDS|AIDS]] and other [[immunocompromised]] conditions, it mainly involves [[brain]] and presents with [[fever]] and focal neurological symptoms. The major differential diagnosis of focal CNS lesions in patients with [[AIDS]] is CNS [[lymphoma]], which manifests as multiple enhancing lesions in 40% of cases. Other differentials in the diagnosis of [[toxoplasmosis]] include [[brain abscess]], [[Cytomegalovirus infection|cytomegalovirus]], [[herpes simplex]], [[histoplasmosis]], [[infectious mononucleosis]], [[listeria monocytogenes infection]] (Listeriosis), [[lymphoblastic lymphoma]], metastatic cancer with unknown primary site.<ref name="pmid27383150">{{cite journal |vauthors=Ellis R, Letendre SL |title=Update and New Directions in Therapeutics for Neurological Complications of HIV Infections |journal=Neurotherapeutics |volume=13 |issue=3 |pages=471–6 |year=2016 |pmid=27383150 |doi=10.1007/s13311-016-0454-2 |url=}}</ref><ref name="pmid23221843">{{cite journal |vauthors=Kranick SM, Nath A |title=Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy |journal=Continuum (Minneap Minn) |volume=18 |issue=6 Infectious Disease |pages=1319–37 |year=2012 |pmid=23221843 |pmc=3760534 |doi=10.1212/01.CON.0000423849.24900.ec |url=}}</ref><ref name="pmid26171483">{{cite journal |vauthors=Evzelman MA, Snimschikova IA, Koroleva LY, Kamchatnov PR |title=[Neurological disorders associated with HIV-infection] |language=Russian |journal=Zh Nevrol Psikhiatr Im S S Korsakova |volume=115 |issue=3 |pages=89–93 |year=2015 |pmid=26171483 |doi= |url=}}</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
[[Toxoplasmosis]] manifests as a painless [[lymphadenopathy]] in an [[immunocompetent]] individual. In patients with [[HIV AIDS|AIDS]] and other [[immunocompromised]] conditions, it mainly involves [[brain]] and presents with [[fever]] and focal neurological symptoms. The major differential diagnosis of focal CNS lesions in patients with [[AIDS]] is CNS [[lymphoma]], which manifests as multiple enhancing lesions in 40% of cases. Other differentials in the diagnosis of toxoplasmosis include [[brain abscess]], [[Cytomegalovirus infection|cytomegalovirus]], [[herpes simplex]], [[histoplasmosis]], [[infectious mononucleosis]], [[listeria monocytogenes infection]] (Listeriosis), [[lymphoblastic lymphoma]], metastatic cancer with unknown primary site.<ref name="pmid27383150">{{cite journal |vauthors=Ellis R, Letendre SL |title=Update and New Directions in Therapeutics for Neurological Complications of HIV Infections |journal=Neurotherapeutics |volume=13 |issue=3 |pages=471–6 |year=2016 |pmid=27383150 |doi=10.1007/s13311-016-0454-2 |url=}}</ref><ref name="pmid23221843">{{cite journal |vauthors=Kranick SM, Nath A |title=Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy |journal=Continuum (Minneap Minn) |volume=18 |issue=6 Infectious Disease |pages=1319–37 |year=2012 |pmid=23221843 |pmc=3760534 |doi=10.1212/01.CON.0000423849.24900.ec |url=}}</ref><ref name="pmid26171483">{{cite journal |vauthors=Evzelman MA, Snimschikova IA, Koroleva LY, Kamchatnov PR |title=[Neurological disorders associated with HIV-infection] |language=Russian |journal=Zh Nevrol Psikhiatr Im S S Korsakova |volume=115 |issue=3 |pages=89–93 |year=2015 |pmid=26171483 |doi= |url=}}</ref> | |||
{| class="wikitable" | {| class="wikitable" | ||
!Disease | !Disease | ||
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!Differentiating tests | !Differentiating tests | ||
|- | |- | ||
|CNS lymphoma | |[[Lymphoma|CNS lymphoma]] | ||
| | | | ||
* Immunocompetent individual | * [[Immunocompetent]] individual | ||
* Focal symptoms indicative of a mass lesion | * Focal symptoms indicative of a mass lesion | ||
* Seizure | * [[Seizure]] | ||
| | | | ||
*Single solitary ring enhacning lesion on CT or MRI | |||
|- | |- | ||
| | |Disseminated tuberculosis | ||
| | | | ||
* Prior history of residence in an endemic area. | * Prior history of residence in an endemic area. | ||
* Chronic cough, weight loss, hemoptysis | * Chronic [[cough]], [[weight loss]], [[hemoptysis]] | ||
| | | | ||
* PCR of CSF for tuberculosis | * [[PCR]] of [[CSF]] for [[tuberculosis]] | ||
* Mycobacterial culture of CSF | * Mycobacterial culture of CSF | ||
* Brain biopsy for acid-fast bacilli staining | * Brain biopsy for [[acid-fast bacilli]] staining | ||
* Culture and acid stain positive for acid-fast bacilli | * Culture and acid stain positive for [[acid-fast bacilli]] | ||
* CXR shows cavitations. | * CXR shows cavitations. | ||
|- | |- | ||
|Aspergillosis | |[[Aspergillosis]] | ||
| | | | ||
* Pulmonary lesions in addition to CNS lesions. | * Pulmonary lesions in addition to CNS lesions. | ||
* Symptoms may include cough, chest pain, and hemoptysis. | * Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]. | ||
| | | | ||
*CSF fungal culture, galactomannan. | *CSF fungal culture, galactomannan. | ||
|- | |- | ||
|Cryptococcosis | |[[Cryptococcosis]] | ||
| | | | ||
*Symptoms include cough, chest pain, and hemoptysis | *Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]] | ||
| | | | ||
*Cryptococcal antigen from CSF and serum | *[[Cryptococcal antigen]] from [[CSF]] and serum | ||
*CSF fungal culture | *CSF fungal culture | ||
|- | |- | ||
| | |[[Chagas disease]] | ||
| | | | ||
*History of residence in Central and South America | *History of residence in Central and South America | ||
*Acute infection is rarely symptomatic, | *Acute infection is rarely symptomatic, | ||
*Encephalitis or focal brain lesions | *[[Encephalitis]] or focal brain lesions | ||
*Myocarditis | *[[Myocarditis]] | ||
*Chronic infections in immunocompromised patients develops into encephalitis with necrotic brain lesions causing mass effect. | *Chronic infections in [[immunocompromised]] patients develops into [[encephalitis]] with necrotic brain lesions causing mass effect. | ||
| | | | ||
*Trypanosoma cruzi in blood, tissue or CSF, PCR of tissue or body fluids, serologic tests. | *Trypanosoma cruzi in blood, tissue or CSF, PCR of tissue or body fluids, serologic tests. | ||
|- | |- | ||
|CMV infection | |[[Cytomegalovirus infection|CMV infection]] | ||
| | | | ||
*Most common CNS opportunistic infection in AIDS patients | *Most common CNS opportunistic infection in AIDS patients | ||
*Presents with encephalitis, retinitis, progressive myelitis or polyradiculitis. | *Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]]. | ||
*In disseminated disease, it involves both liver and renal organs. | *In disseminated disease, it involves both [[liver]] and [[renal organs]]. | ||
| | | | ||
*Brain CT/MRI/biopsy: location of lesions are usually near the brain stem or periventricular areas. | *Brain CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or [[periventricular]] areas. | ||
*PCR of CSF with detectable virus is diagnostic. | *[[PCR]] of CSF with detectable virus is diagnostic. | ||
*Brain biopsy with + staining for CMV or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions. | *Brain biopsy with + staining for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions. | ||
|- | |- | ||
|HSV infection | |[[HSV|HSV infection]] | ||
| | | | ||
*Seizures, headache, confusion and/or urinary retention can be seen in disseminated disease, which usually affects only immunocompromised or acute infections *In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal. | *[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in disseminated disease, which usually affects only [[immunocompromised]] or acute infections | ||
*In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal. | |||
*Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease. | *Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease. | ||
| | | | ||
*Brain CT/MRI/biopsy: location of lesions is usually the medial temporal lobe or the orbital surface of the frontal lobe. | *Brain CT/MRI/biopsy: location of lesions is usually the medial [[temporal lobe]] or the orbital surface of the [[frontal lobe]]. | ||
*PCR of CSF with detectable virus is diagnostic. | *[[PCR]] of [[CSF]] with detectable virus is diagnostic. | ||
|- | |- | ||
| | |Varicella Zoster infection | ||
| | | | ||
*Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits, and seizures. | *Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits, and seizures. | ||
*Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs, and stroke. | *Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs, and stroke. | ||
*Disseminated varicella zoster virus can occur in adults during primary infection, presenting with pneumonitis and/or hepatitis. | *Disseminated [[varicella zoster virus]] can occur in adults during primary infection, presenting with [[pneumonitis]] and/or [[hepatitis]]. | ||
*Disease is a vasculopathy, with hemorrhage and stroke. | *Disease is a [[vasculopathy]], with [[hemorrhage]] and [[stroke]]. | ||
| | | | ||
*PCR of CSF with detectable virus is diagnostic. | *[[PCR]] of [[CSF]] with detectable virus is diagnostic. | ||
|- | |- | ||
| | |[[Brain abscess]] | ||
| | | | ||
*Associated with sinusitis (abutting the sinuses) or with bacteremia. | *Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]. | ||
*Signs and symptoms includes fever and necrotizing brain lesions with mass effect | *Signs and symptoms includes [[fever]] and necrotizing brain lesions with mass effect | ||
| | | | ||
*CSF culture or culture of brain abscess. | *CSF culture or culture of brain abscess. | ||
|- | |- | ||
|Progressive multifocal leukoencephalopathy | |[[Progressive multifocal leukoencephalopathy]] | ||
| | | | ||
*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms. | *Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms. | ||
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*PCR of CSF for JC virus. | *PCR of CSF for JC virus. | ||
*Biopsy reveals white matter lesions and not well-circumscribed lesions. | *Biopsy reveals white matter lesions and not well-circumscribed lesions. | ||
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Latest revision as of 00:27, 30 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Toxoplasmosis manifests as a painless lymphadenopathy in an immunocompetent individual. In patients with AIDS and other immunocompromised conditions, it mainly involves brain and presents with fever and focal neurological symptoms. The major differential diagnosis of focal CNS lesions in patients with AIDS is CNS lymphoma, which manifests as multiple enhancing lesions in 40% of cases. Other differentials in the diagnosis of toxoplasmosis include brain abscess, cytomegalovirus, herpes simplex, histoplasmosis, infectious mononucleosis, listeria monocytogenes infection (Listeriosis), lymphoblastic lymphoma, metastatic cancer with unknown primary site.[1][2][3]
Differential Diagnosis
Toxoplasmosis manifests as a painless lymphadenopathy in an immunocompetent individual. In patients with AIDS and other immunocompromised conditions, it mainly involves brain and presents with fever and focal neurological symptoms. The major differential diagnosis of focal CNS lesions in patients with AIDS is CNS lymphoma, which manifests as multiple enhancing lesions in 40% of cases. Other differentials in the diagnosis of toxoplasmosis include brain abscess, cytomegalovirus, herpes simplex, histoplasmosis, infectious mononucleosis, listeria monocytogenes infection (Listeriosis), lymphoblastic lymphoma, metastatic cancer with unknown primary site.[1][2][3]
| Disease | Differentiating signs and symptoms | Differentiating tests |
|---|---|---|
| CNS lymphoma |
|
|
| Disseminated tuberculosis |
|
|
| Aspergillosis |
|
|
| Cryptococcosis |
|
|
| Chagas disease |
|
|
| CMV infection |
|
|
| HSV infection |
|
|
| Varicella Zoster infection |
|
|
| Brain abscess |
|
|
| Progressive multifocal leukoencephalopathy |
|
|
References
- ↑ 1.0 1.1 Ellis R, Letendre SL (2016). "Update and New Directions in Therapeutics for Neurological Complications of HIV Infections". Neurotherapeutics. 13 (3): 471–6. doi:10.1007/s13311-016-0454-2. PMID 27383150.
- ↑ 2.0 2.1 Kranick SM, Nath A (2012). "Neurologic complications of HIV-1 infection and its treatment in the era of antiretroviral therapy". Continuum (Minneap Minn). 18 (6 Infectious Disease): 1319–37. doi:10.1212/01.CON.0000423849.24900.ec. PMC 3760534. PMID 23221843.
- ↑ 3.0 3.1 Evzelman MA, Snimschikova IA, Koroleva LY, Kamchatnov PR (2015). "[Neurological disorders associated with HIV-infection]". Zh Nevrol Psikhiatr Im S S Korsakova (in Russian). 115 (3): 89–93. PMID 26171483.