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I am a licensed healthcare professional and wish to proceed to the Healthcare Professionals section of this site. What Is Toxoplasmosis? Toxoplasmic Encephalitis Toxoplasmic encephalitis is a serious brain disease. Ocular Toxoplasmosis Toxoplasmosis can result in serious eye infections and is the most common infection of the retina.
Congenital Toxoplasmosis During maternity, T. Human beings can be infected with T. Toxoplasmosis can present with varied signs and symptoms, of which asymptomatic lymphadenopathy is the most common. We present the case of a patient presenting with generalized lymphadenopathy diagnosed as having acute toxoplasmosis. As there are already many examples in the literature detailing the history of toxoplasmosis, this case report is intended to reinforce the clinician's knowledge of the disease and its presentation, especially given its prevalence and the potential consequences of infection.
A year-old previously healthy man, a student by occupation and a non-smoker not on any medications, presented to his primary care physician with a history of swollen glands for a 'couple of months'. On further review it was found that for one month prior to presentation, our patient had noticed multiple enlarged cervical, occipital, and right inguinal lymph nodes. No constitutional symptoms were reported. He had not travelled recently, nor had he had any recent contact with sick people or any occupational exposure.
On physical examination, our patient was afebrile with normal vital signs. Enlarged, non-tender, freely mobile bilateral cervical and occipital lymph nodes were palpable and measured up to 4cm. His right inguinal lymph nodes were similarly enlarged. The left palatine tonsil was slightly erythematous and enlarged. A monospot test was negative for Epstein-Barr virus infection.
Given these findings, the primary care physician prescribed a course of antibiotics for a possible infectious etiology consisting of a three-day course of azithromycin followed by amoxicillin-clavulanate one week later due to persistent symptoms. Initial investigative tests showed normal blood counts and serum electrolytes.
Our patient returned to the clinic for re-evaluation. With the exception of the enlarged lymph nodes, he remained otherwise clinically asymptomatic. On physical examination, the lymph nodes appeared unchanged, and there were no newly involved nodal chains. Upon Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) thorough investigation, our patient indicated that approximately once month ago he ate raw kibbe, a Middle Eastern dish that consists of spiced uncooked beef or lamb with grains.
Additional laboratory studies were ordered and are listed in Table 1. Our patient was diagnosed with acute toxoplasmosis and counseled regarding dietary habits and risk factors. No specific treatment was administered, and close follow-up was planned to ensure resolution of the lymphadenopathy. Infection of humans with T.
Contact with this obligate intracellular protozoan occurs through direct ingestion of food or water contaminated with Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) feces containing oocysts, ingestion of tissue cysts in uncooked meat, transplacental infection of the fetus, white blood cell transfusion or organ transplantation.
Our patient was probably exposed to T. Clinical presentation of T. In the majority of patients who are immunocompetent, both adult and pediatric, primary infection is usually asymptomatic.
The lymph nodes are usually discreet, non-tender, and do not suppurate. Differential diagnoses include Epstein-Barr virus and other mononucleosis-like illnesses including cytomegalovirus and HIV with acute retroviral syndrome. Though not as common, hematological malignancies, cat scratch disease, leishmaniasis and syphilis can also cause lymphadenopathy.
Very infrequently immunocompetent hosts might also suffer from myocarditis, polymyositis, pneumonitis, hepatitis, or encephalitis. After the acute phase, almost all patients will remain chronically infected with tissue cysts that are dormant and cause no clinical symptoms. In contrast, toxoplasmosis in patients who are immunocompromised can be a life-threatening infection.
In this population, toxoplasmosis almost always occurs as a result of reactivation of chronic disease and most typically affects the central nervous system. Toxoplasmic encephalitis has a varied clinical presentation, ranging from an acute confusional state with or without focal neurological deficits evolving over days to a subacute gradual process evolving over weeks.
Adriana Lopez, M. Vance J. Dietz, M. Marianna Wilson, M. Thomas R. Navin, M. Jeffrey L. Jones, M. Scope of the Problem : Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Acute infections in pregnant women can be transmitted to the fetus and cause severe illness e. An estimatedcases of congenital toxoplasmosis occur each year in the United States.
Etiologic Factors : Toxoplasma can be transmitted to humans by three principal routes: a ingestion of raw or inadequately cooked infected meat; b ingestion of oocysts, an environmentally resistant form of the organism that cats pass in their feces, with exposure of humans occurring through exposure to cat litter or soil e.
Recommendations for Prevention : Toxoplasma infection can be prevented in large part by a cooking meat to a safe temperature i. Research Agenda : Priorities for research were discussed at a national workshop sponsored by CDC in September and include a improving estimates of the burden of toxoplasmosis, b improving diagnostic tests to determine when a person becomes infected with Toxoplasmaand c determining the applicability of national screening programs.
Conclusion : Many cases of congenital toxoplasmosis can be prevented. Specific measures can be taken by women and their health-care providers to decrease the risk for infection during pregnancy and prevent severe illness in newborn infants.
Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. Although these infections are usually either asymptomatic or associated with self-limited symptoms e. In addition, infections in pregnant women can cause serious health problems in the fetus if the parasites are transmitted i. Although congenital toxoplasmosis is not a nationally reportable disease and Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) national data are available regarding its occurrence, extrapolation from regional studies indicates that an estimatedcases occur in the United States each year.
Inthe U. Department of Health and Human Services, the U. The project aims to reduce the incidence of foodborne illness by enhancing surveillance, improving risk assessment, developing new research methods, and furthering food-safety education. Because congenital toxoplasmosis poses a substantial public health problem, CDC has developed prevention recommendations to reduce the risk for congenital infections. Approximately 30 international and national experts in toxoplasmosis participated, representing universities, practitioner associations, research institutions, health-care centers, and other federal agencies.
Specific objectives of NWTPCT included defining approaches for reducing the prevalence of congenital toxoplasmosis, determining the data needed to evaluate and implement these strategies, and identifying critical research and prevention efforts for the future. This report summarizes the recommendations from this workshop and the activities that have been undertaken by CDC in response to these recommendations.
The most reliable information about the burden of toxoplasmosis in the general population is derived Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) serosurveys, which determine the percentage of persons with elevated levels of Toxoplasma -specific IgG antibodies. Since the s, rates of infection with Toxoplasma in the United States appear to be declining.
In the s, a study of U. Ina second study of military recruits indicated a seroprevalence of 9. Similar downward trends have been observed in France and Sweden 7,8. The survey design was a cluster sample of U. Of 5, women of childbearing age i. No recent U. Although serosurveys of the general population help define temporal trends in Toxoplasma seropositivity rates and can be used to estimate the number of women of childbearing age who are at risk for acquiring Toxoplasma infections and potentially transmitting it to their fetuses, serosurveys are less helpful in estimating the number of cases of congenital toxoplasmosis.
Three prospective studies provide useful information regarding the number of congenital toxoplasmosis cases in the United States. Two prospective studies in the s both reported rates of congenital toxoplasmosis of approximately 10 per 10, live births. In one study in the early s, 7, consecutive live births at a hospital in Birmingham, Alabama, were screened for Toxoplasma infection; of these, 10 13 per 10, live births were seropositive 9.
In a study of acute Toxoplasma infection in 4, pregnant women in New York duringsix 0. Of the 23 infants born to these 23 women, three had congenital toxoplasmosis, representing an infection rate of 7 per 10, live births in the study population.
More recent data regarding the rate of congenital toxoplasmosis are available from the New England Regional Newborn Screening Program All infants born in the catchment area of this program are tested for evidence of congenital toxoplasmosis; infected infants undergo clinical evaluation and treatment for 1 year. Duringofinfants who underwent serologic testing, 52 were infected, representing an infection rate of approximately 1 per 10, live births.
Whether the rates of congenital infection in these three studies are representative of the entire U. However, if these rates i. Limited data are available to assist in estimating the portion of the disease burden of toxoplasmosis attributable to meat consumption. A recent study compared results from a cross-sectional seroprevalence study of Seventh Day Adventists, a religious group that follows a diet containing no meat, with serologic results from a control group of volunteers who were not Seventh Day Adventists Thus, approximately one half of Toxoplasma exposure might be caused by eating contaminated meat.
Because this study was originally designed to evaluate the possible association between eating shellfish and Vibrio and Norwalk virus infections, important questions regarding toxoplasmosis i. Pork has been implicated by some authorities as the meat most commonly associated with foodborne toxoplasmosis In some areas, market pigs from small producers have had higher rates of Toxoplasma infections than pigs from larger producers 15 ; however, overall rates appear to be declining over time Ina large survey in Illinois documented that 3.
Toxoplasma infection has also been identified in other meats, but their contribution to the burden of disease is believed to be small Although Toxoplasma infections are associated either with eating contaminated meat or with ingesting oocysts passed in the feces of cats, no laboratory test exists that can determine the origin of a Toxoplasma infection in a specific person and whether it was associated with foodborne, catborne, or soilborne transmission.
Epidemiologic studies of the transmission of toxoplasmosis have been hindered by an inability to determine the origin of isolated infections. Diagnosis and Treatment Acute toxoplasmosis is rarely diagnosed by detecting the parasite in body fluids, tissue, or secretions; the most common method of diagnosis is based on antibody detection.
The presence of elevated levels of Toxoplasma -specific IgG antibodies indicates infection has occurred at some point but does not distinguish between an infection acquired recently and one acquired in the distant past.
The presence of a high Toxoplasma -specific IgM antibody titer combined with a high IgG titer probably indicates an acute infection within the previous 3 months. A low-to-medium IgM titer and a high IgG titer might indicate an acute infection months previously, but IgM antibodies have been detected as long as 18 months after initial infection Determining when Toxoplasma infection occurred in a pregnant woman is particularly important because infection before conception poses no substantial risk for transmission of infection to the fetus; however, infection after conception does pose such risk.
Some commercial IgM tests have had problems with specificity, resulting in unacceptably high rates of false-positive test results. InFDA and CDC conducted extensive evaluations of the six most commonly used commercial IgM kits in the United States to determine the extent of the problem with the specificity of these kits. Sensitivity and specificity rates for these six kits ranged from As a result of these findings, in FDA distributed an advisory to physicians in the United States highlighting these test limitations.
The agency provided a guide for interpreting test results and issued a recommendation to laboratory personnel and physicians advising them to be aware of the problems associated with the test kits before making decisions about the clinical management of their patients.
In addition, IgM-positive results should be confirmed by a Toxoplasma reference laboratory Treatment of toxoplasmosis in immunocompetent persons other than pregnant women is generally not indicated unless symptoms are severe or persistent In immunocompromised persons, treatment usually consists of pyrimethamine and sulfadiazine.
Depending on gestational age and whether the fetus is known to be infected, pregnant women have been treated with the antibiotic spiramycin or with sulfadiazine alone or the combination of pyrimethamine and sulfadiazine. Members of the family Felidae including domestic and feral cats are the definitive hosts of Toxoplasma.
During acute infections, cats excrete unsporulated i. Under favorable conditions i. They do not survive in arid, cool climates and can be destroyed by heating 17,19,20,23, Toxoplasmosis can be transmitted to humans by three principal routes. First, humans can eat raw or inadequately cooked infected meat or eat uncooked foods that have come in contact with contaminated meat.
Second, humans can inadvertently Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) oocysts that cats have passed in their feces, either in a cat litter box or outdoors in soil e. Third, a woman can transmit the infection to her unborn fetus. Women infected with Toxoplasma before conception, with rare exceptions, do not transmit the infection to their fetuses.
Women infected with Toxoplasma after conception i. Maternal infections early in pregnancy are less likely to be transmitted to the fetus than infections later in pregnancy, but early fetal infections, when they do occur, are more likely than later infections to be severe An estimated one half of untreated maternal infections are transmitted to the fetus.
The classic triad of signs suggestive of congenital toxoplasmosis include chorioretinitis, intracranial calcifications, and hydrocephalus. However, most infants infected in utero are born with no obvious signs of toxoplasmosis on routine examination, but many develop learning and visual disabilities later in life 26, If untreated, congenital toxoplasmosis can be associated with severe and even fatal disease The severity of Toxoplasma infections is correlated with the immune status of the infected person.
Toxoplasmosis in immunocompetent adolescents or adults is generally mild or unapparent. Mild infections can result in lymphadenopathy, fever, fatigue, and malaise, all of which usually resolve within weeks to months without specific treatment. However, infection in immunocompromised persons can be severe.
Immunosuppression caused by AIDS or therapies for malignancies, transplants, or lymphoproliferative disorders can result in reactivation of preexisting latent Toxoplasma infections. Reactivation most often involves the central nervous system, and symptoms can include meningoencephalitis or symptoms of a mass lesion. A food thermometer should be used to measure the internal temperature of cooked meat to ensure that meat is cooked all the way through. Beef, lamb, and veal roasts and steaks should be cooked to at least F, and pork, ground meat, and wild game should be cooked to F before eating.
Whole poultry should be cooked to F in the thigh to ensure doneness. Fruits and vegetables should be peeled or thoroughly washed before eating. Cutting boards, dishes, counters, utensils, and hands should always be washed with hot soapy water after they have contacted raw meat, poultry, seafood, or unwashed fruits or vegetables. Pregnant women should wear gloves when gardening and during any contact with soil or sand because cat waste might be in soil or sand.
After gardening or contact with soil or sand, wash hands thoroughly. Pregnant women should avoid changing cat litter if possible. If no one else is available to change the cat litter, use gloves, then wash hands thoroughly. Change the litter box daily because Toxoplasma oocysts require Danke (Toxoplasma) - Sperrzone - No Fun No Future (Cassette) days to become infectious.
Pregnant women should be encouraged to keep their cats inside and not adopt or handle stray cats. Cats should be fed only canned or dried commercial food or well-cooked table food, not raw or undercooked meats. Health education for women of childbearing age should include information about meat-related and soilborne toxoplasmosis prevention.
Health-care providers should educate pregnant women at their first prenatal visit about food hygiene and prevention of exposure to cat feces. Health-care providers who care for pregnant women should be educated about two potential problems associated with Toxoplasma serology tests. First, no assay exists that can determine precisely when initial Toxoplasma infection occurred. Second, in populations with a low incidence of Toxoplasma infection, such as in the United States, a substantial proportion of the positive IgM test results will probably be false positive.
The government and the meat industry should continue efforts to reduce Toxoplasma in meat. These issues included the need to improve estimates of the burden of toxoplasmosis and immunodiagnostics for the disease and to determine the applicability of national toxoplasmosis screening for newborns.
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