PROTOZOAL DISEASES 4 TOXOPLASMOSIS Internal Medicine
TOXOPLASMOSIS
• Causative organism: Toxoplasma Gondii
• Congenital Tox.
From infected mother during pregnancy to her fetus.
Acquired Tox.
From the ingestion of cyst excreted in the faces of the infected cats or from eating
undercooked beef (( oöcysts and cysts ))
Pathology
In congenital form
• the parasite widely spread in the CNS, eyes, heart, lung and adrenals.
• If the infant survive, the parasite disappear from most organs except the brain (( CNS ))
and retina.
In acquired form:
• the organism invade the LN, spleen and less commonly; liver and myocardium.
CLINICAL FEATURES:
Congenital Toxoplasmosis:
• The main features are cerebral with hydrocephalus, microcephaly, convulsion, tremor
or paralysis.
• Microphthalmos, nystagmus and choroidoretinitis are common.
• Hepatomegaly, thrombocytopenia and purpura may occurs.
• Severe forms are usually fatal and if the child survive, he will be disabled and blind.
• Mild cases presented with only choroidoretinitis.
Acquired Toxoplasmosis:
• Many of them are asymptomatic.
• In the acute form:
Fever, cough, myalgia, malaise, maculopapular rash and rarely jaundice & myocarditis.
In the chronic form:
• Generalized lymphadenopathy, particularly cervical lymph nodes, may be splenomegaly.
• Some pf them may developed encephalitis, myocarditis, pneumonia, hepatitis and even
choroidoretenitis.
INVESTIGATIONS:
1. in congenital Tox., skull X – ray may shows calcifications.
2. blood film will shows atypical lymphocytosis.
3. serology
• antibodies detected by DYE test.
• Rise in Ig M antibody titer indicate acute infection.
• significant levels of Toxoplasma Ig M – antibody by double sandwich IgM ELISA and Ig M
Immunosorbent agglutination assay ISAGA.
TREATMENT:
• Most of the patients not require treatment.
• Sulphadiazine 2gm/day, Pyrimethamin 25mg/day and folinic acid 15mg/day. For 4
weeks.
• In pregnancy with recent infection, Spiramycin 3gm/day until term.