ToxoplasmosisB58.9

Frequently systemic, but mostly benign protozoan infection with Toxoplasma gondii.

ingestion of infectious oocysts or tissue cysts from T. gondii by consumption of infected meat (tissue cysts) or contact with cats (oocysts)

Rarely intrauterine infection, transmission by blood transfusion or organ transplantation.

A reactivation of a latent infection occurs in immunosuppression (AIDS, e.g. organ transplantation, malignancy, patients under immunosuppressive therapy). Most frequent opportunistic CNS infection in AIDS.

Postnatally acquired toxoplasmosis: 1-3 weeks after infection, mild fever, fatigue, headache, muscle and joint pain and occasional diarrhoea occur. Mostly chronic latent course and development of isolated organ cysts. In immunocompetent patients, the infection usually proceeds as an inapparent or harmless mononucleosis-like course (fever, lymphadenopathy, splenomegaly).

The most frequent organ manifestation is cervical lymph node toxoplasmosis (see below lymphadenopathy, dermatopathic).

Other possible extracerebral manifestations are polymyositis, pneumonia, myocarditis, chorioretinitis.

Skin lesions: Acute febrile exanthema and cutaneous nodules (see also toxoplasmosis, exanthematic form).

Congenital toxoplasmosis: infection in the first trimester is often followed by severe damage to the fetus or in the newborn, including necrotizing retinitis, CNS calcifications, hydrocephalus.

CCT/MRT: solitary focus, possibly multiple space-consuming hypodense focus

CSF: lymphocytic pleocytosis and protein elevation, with immunosuppression normal findings also possible.

Sabin-Feldman test, complement fixation reaction, detection of IgM antibodies.

In immunocompetent patients, no treatment is usually necessary, as inapparent courses of disease are often present. Symptomatic therapy may be necessary.

Notice! Seronegative pregnant women and immunocompromised patients should avoid contact with cats and the consumption of raw meat!

In infected pregnant women:

• Infection before the 16th week of pregnancy: Spiramycin (e.g. Selektomycin) 3 times/day 1 g p.o. until the 16th week of pregnancy then change to Pyrimethamine (e.g. Daraprim) 50 mg p.o. (day 1) or 25 mg/day (day 2-28) in combination with sulfadiazine (e.g. sulfadiazine-heyl) 3 times/day 1 g p.o. and 5-10 mg folic acid/day Therapy in 4-week cycles alternating with spiramycin s.o. until birth!
• Infection after the 16th week: 4-week cycles with pyrimethamine/sulfadiazine/folic acid (see above) alternating with spiramycin (see above).

For immunocompromised persons:

• Pyrimethamine initial 100-200 mg p.o. (day 1), from day 2 50-100 mg/day in combination with sulfadiazine 4 times/day 1-2 g p.o. and folic acid 5-15 mg/day for at least 6 weeks.
• Alternatively: monotherapy with Cotrimoxazol (e.g. Eusaprim infusion solution) 4 times/day 2 amp. i.v. initially (day 1), then further 3 times/day 2 amp. i.v. in combination with folic acid 15 mg/day p.o. for 4-6 weeks.

1. Darling ST (1909) Sarcosporidiosis: with report of a case in man. Proc Canal Zone Med Assoc 1: 141-152
2. Jones J et al (2003) Congenital toxoplasmosis. On Fam Physician 67: 2131-2138
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