 Infection with the protozoan Toxoplasma gondii , an obligate

intracellular parasite

 The infection produces a wide range of clinical syndromes in humans

 Discovered in 1908 by Nicolle and Manceaux – Ctenodactylus gondii

 3 major genotypes of T. gondii – Type I, Type II and Type III

 Uncommonly causes clinically significant disease

 At risk individuals include fetuses, newborns, and immunologically

impaired patients.

 Congenital toxoplasmosis is usually a subclinical infection- affects

those with defects of T cell mediated immunity
 Toxoplasma gondii has 2 distinct life cycles- sexual and asexual

 Toxoplasma gondii : Tachyzoites vs Bradyzoites

 Host cell receptor consisting of lamini, lectin and SAG1

 Invasion is significantly faster than phagocytosis. During invasion the

host cell seemingly appears normal

 Tachyzoites proliferate and produces necrotic foci

 Cysts are formed in the tissue as early as 7 days after infection

 A consequence of latent infection and reactivation

 CD4 counts less than 200 cells/uL- reactivates T gondii cysts

 CD4 counts of less than 100 cells/uL- clinical disease becomes more
likely

 Reactivation disease is typically in the CNS with brain involvement

being common

IMMUNOCOMPETENT PERSONS
 80-90% are asymptomatic
 Cervical Lympadenopathy
 Fever, malaise, night sweats and
myalgias
 May have sore throat
 Retroperitoneal and Mesenteric
Lympadenopathy
 Retinochoroiditis
IMMUNODEFICIENT PERSONS
(WITHOUT AIDS)
 CNS involvement in 50% patients
 Encephalitis, meningoencephalitis
 Seizure, disequilibrium,cranial nerve
deficits, altered mental status,
headache
 Flulike symptoms and
lymphadenopathy
 Myocarditis and Pneumonitis
TOXOPLASMOSIS IN PERSONS WITH AIDS

 Usually a subacute onset with focal

neurological abnormalities in 58-89%
of cases
 Pulmonary toxoplasmosis- CD4 count
of 40cells/uL
 Brain Abscess
 Cat Scratch Disease
 Cytomegalovirus
 Herpes Simplex
 Epstein-Barr Virus
 Leprosy
 Lymphoblastic Lymphoma
 Metastatic Cancer with unknown primary site
 Direct Detection

 Molecular Diagnosis and Polymerase Chain Reaction (PCR)

 Indirect- ELISA
 Most Healthy persons don’t require treatment
 Pyrimethamine
 Sulfadiazine

 Persons with HIV/AIDS

 Pyrimethamine and Sulfadiazine taken with Folinic Acid

 Pregnant Women and Babies

 Spiramycin
 Pyrimethamine and Sulfadiazine and Folinic Acid
 Immunocompetent patients have an excellent prognosis, and
lymphadenopathy and other symptoms generally resolve within weeks
of infection

 Toxoplasmosis in immunodeficient patients often relapses if treatment

is stopped. Suppressive therapy and immune reconstitution
significantly reduce the risk of recurrent infection.
1. "Toxoplasmosis: Background, Etiology and Pathophysiology,
Epidemiology." Sickle Cell Anemia Differential Diagnoses. June 04,
2018. Accessed September 17, 2018.
https://emedicine.medscape.com/article/229969-overview#a7.

2. "Toxoplasmosis." Mayo Clinic. October 03, 2017. Accessed September

17, 2018. https://www.mayoclinic.org/diseases-
conditions/toxoplasmosis/symptoms-causes/syc-20356249.

3. "Toxoplasmosis." Wikipedia. September 16, 2018. Accessed

September 17, 2018. https://en.wikipedia.org/wiki/Toxoplasmosis.
 Yancheva, Nina, Nina Tsvetkova, Irina Marinova, Ivaylo Elenkov, Tatyana
Tchervenyakova, Maria Nikolova, and Ivaylo Aleksiev. "A Report of Two
Cases with Different Clinical Presentation of Cerebral Toxoplasmosis in
HIV-Infected Bulgarian Patients." Journal of AIDS & Clinical Research08,
no. 03 (2017). doi:10.4172/2155-6113.1000673.