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Cerebral Toxoplasmosis
Toxoplasmoses Cerebral

Presentation

These nodules were prominent in the cerebellum, midbrain and medulla and also present in the cortex and thalamus. No coagulative necrosis, necrotizing abscesses, or other opportunistic infections were present. [ncbi.nlm.nih.gov]

Entire Body System

  • Fever

    On day +83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS. [ncbi.nlm.nih.gov]

  • Movement Disorder

    Movement disorders occur in some patients with cerebral toxoplasmosis with HIV-1 infection. Such movement disorders have not been described in patients with cerebral toxoplasmosis without HIV-1 infection. [ncbi.nlm.nih.gov]

  • Epilepsy

    In a patient with AIDS presenting partial epilepsy cerebral toxoplasmosis was diagnosed on the serological and CT evidence. The diagnosis was confirmed by the immediate response to sulfonamide therapy. [ncbi.nlm.nih.gov]

    Although chronic infection with T. gondii has been considered as "latent", recent studies indicated a correlation of the infection with cryptogenic epilepsy and neuropsychiatric disorders such as schizophrenia. [jhu.pure.elsevier.com]

    (from Joynt, Clinical Neurology, 1998, ch27, pp41-3) ICD-10-CM B58.2 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 023 Craniotomy with major device implant or acute complex cns pdx with mcc or chemotherapy implant or epilepsy with neurostimulator [icd10data.com]

  • Fatigue

    In this case report, we describe one patient with past medical history of MS in current treatment with Fingolimod for the last year which presents herself with hemiparesis, fever and fatigue. [ncbi.nlm.nih.gov]

    Six months before admission, the patient coursed with recurrent respiratory infections, persistent cough with shortness of breath, fatigue, weakness, oral white plaques and fever predominantly at night up to 40°C. [omicsonline.org]

    Postnatally acquired human infections typically remain subclinical; if clinical disease does occur, symptoms include fever, lymphadenopathy, headache, myalgia, and fatigue, with eventual recovery, except in the immunocompromised patient in whom fatal [medical-dictionary.thefreedictionary.com]

    Most of the remaining 40 percent experience mild, flu-like symptoms, low-grade fever, and fatigue that resolve without intervention in a few weeks. Once exposed, reinfection does not occur in healthy individuals. [healthofchildren.com]

    In the relatively few cases in which symptoms do develop, the most common symptoms are: Painless swelling of the lymph nodes Headache Malaise (a general sick feeling) Fatigue Low-grade fever In rare cases, patients also have experienced muscle aches, [drugs.com]

  • Swelling

    In the relatively few cases in which symptoms do develop, the most common symptoms are: Painless swelling of the lymph nodes Headache Malaise (a general sick feeling) Fatigue Low-grade fever In rare cases, patients also have experienced muscle aches, [drugs.com]

    Swelling may occur at different times after the initial infection, persist, and recur for various times independently of antiparasitic treatment. [16] It is usually found at single sites in adults, but in children, multiple sites may be more common. [en.wikipedia.org]

Gastrointestinal

  • Vomiting

    There was a history of headache, but no seizures, vomiting or loss of consciousness. She was not known to be hypertensive or diabetic, and she does not drink alcohol nor does she smoke. [karger.com]

    After 1 wk of therapy, patient presented with HA, vomiting and decreased right eye visual acuity. CT, MRI, and LP did not reveal evidence of cerebral toxoplasmosis. Interim therapy included pyrimethamine, sulfadiazine, prednisolone, and folic acid. [hopkinsguides.com]

    The patients presented with features of chronic meningitis with headache, vomiting, and neck stiffness. [annalsofian.org]

Liver, Gall & Pancreas

  • Hepatosplenomegaly

    He was hospitalized in the Intensive Care Unit because of anemia, fever and hepatosplenomegaly. Chest X-ray showed pneumonia and subsequent blood cultures were positive for Candida albicans. [ncbi.nlm.nih.gov]

    Prenatally acquired human infection can result in the presence of abnormalities such as microcephalus or hydrocephalus at birth, the development of jaundice with hepatosplenomegaly or meningoencephalitis in early childhood, or the delayed appearance of [medical-dictionary.thefreedictionary.com]

    Ultrasound, fetal: may detect ventriculomegaly, intracranial calcifications or hepatosplenomegaly. Amniocentesis: test fluid using T. gondii PCR. [hopkinsguides.com]

  • Jaundice

    In adults, if the infection continues for an extended period of time, chronic toxoplasmosis can cause an inflammation of the eyes called retinochoroiditis, which can lead to blindness, severe yellowing of the skin and whites of the eyes ( jaundice ), [medical-dictionary.thefreedictionary.com]

    Other symptoms in newborns can include: Unusually small body size Strabismus, an eye that wanders or is misaligned, or other eye problems Head size that is unusually large or unusually small Convulsions Jaundice Enlarged lymph nodes Abnormal bruising [drugs.com]

Eyes

  • Visual Impairment

    Pathways and their Functional Deficits 303 Nerve Fiber Bundle Defects 305 1732 Optic Chiasmal Syndromes 307 17331 Hemianopic Reading Disorder 308 17332 Hemianopic Orientation Disorder 310 1734 Cortical Visual Impairment 311 175 Rehabilitation Programs [books.google.com]

Neurologic

  • Headache

    Abstract Headache and/or migraine, a common problem in pediatrics and internal medicine, affect about 5% to 10% children and adolescents, and nearly 30% of middle-aged women. [ncbi.nlm.nih.gov]

    Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures. [karger.com]

  • Seizure

    He had focal seizures for which he was treated as an "epileptic" with herbal preparations. A computerized tomography (CT) head scan revealed the characteristic scan findings in CNS toxoplasmosis. [ncbi.nlm.nih.gov]

    Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures. [karger.com]

    Clinical manifestations include SEIZURES, altered mentation, headache, focal neurologic deficits, and INTRACRANIAL HYPERTENSION. [connects.catalyst.harvard.edu]

  • Confusion

    Alteration of consciousness, Karnofsky score less than 70, psychomotor slowing, hemoglobin less than 12 mg/dL, mental confusion, Glasgow Coma Scale less than 12 were the main predictors of partial clinical response. [ncbi.nlm.nih.gov]

    This can confuse the diagnosis and more particularly can confuse therapy since the background dementia will not clear even if parasitic infection is treated. This case is being presented because of the following facts. 1. [neurologyindia.com]

    Primary CNS Lymphoma (EBV) 30% of all brain lesions in AIDS patients (PML, HIV-associated encephalopathy, and CMV encephalitis usually do not cause mass lesions) History Toxo Headache, confusion, +/- fever; focal weakness, seizures; if advanced, dull [learningradiology.com]

    Make sure the airway is protected, especially in confused or obtunded patients. [cancertherapyadvisor.com]

  • Focal Neurological Deficit

    Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific. [ncbi.nlm.nih.gov]

    Clinical manifestations include SEIZURES, altered mentation, headache, focal neurologic deficits, and INTRACRANIAL HYPERTENSION. [connects.catalyst.harvard.edu]

    Clinical manifestations include SEIZURES, altered mentation, headache, focal neurologic deficits, and INTRACRANIAL HYPERTENSION.(From Joynt, Clinical Neurology, 1998, Ch27, pp41-3) [termsciences.fr]

    Clinical presentation of cerebral toxoplasmosis in these patients includes headache, focal neurological deficits and seizures. [karger.com]

    The clinical presentation of CNS toxoplasmosis ranges from headache and fever without neurological symptoms to coma. Typically, the patient presents subacutely with a combination of focal neurological deficits and a non-focal encephalitic component. [neurologyindia.com]

  • Ataxia

    Cerebral toxoplasmosis or Toxoplasmic encephalitis (TE) in most advance stage HIV infected patients composed of fever, headache, alteration of consciousness with focal neurological signs/symptoms such as include hemiparesis, cranial nerve palsies, and ataxia [clinicaltrials.gov]

    There are very rare reports of neurologic IRIS associated with cerebral toxoplasmosis. 3, 4 A 26-year-old woman with HIV-1 infection for 8 years presented with a 1-month history of ataxia, left-sided weakness, and hyperreflexia. [ajnr.org]

    […] mass lesions) History Toxo Headache, confusion, +/- fever; focal weakness, seizures; if advanced, dull affect Lymphoma All of above and constitutional symptoms (night sweats, weight loss) PML Rapid neurologic decline (hemiplegia, visual field defects, ataxia [learningradiology.com]

    Due the most frequently localization of encephalitis lesions by Toxoplasma are in the corticalsubcortical binding of the cerebral hemispheres and basal ganglia, contralateral hemiparesis is the most common focal sign followed by ataxia, as was reported [omicsonline.org]

    He was apparently doing well on anti retro viral therapy until recently when he began to experience symptoms of ataxia and weakness. Magnetic Resonance Imaging (MRI) of the brain revealed several ring enhancing lesions. [ispub.com]

Workup

An exhaustive diagnostic workup revealed no underlying hematologic disease and no viral infection; a test for autoantibodies had negative results. [jamanetwork.com]

Serum

  • Cytopenia

    Adverse reactions include rash, cytopenias, LFT abnormalities and hyperkalemia. Atovaquone Alternate therapy for TE, may replace sulfadiazine in combination with pyrimethamine. Pyrimethamine/sulfadiazine Preferred therapy for TE. [hopkinsguides.com]

Microbiology

  • Toxoplasma Gondii

    The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). [ncbi.nlm.nih.gov]

    Tenter AM, Heckeroth AR, Weiss LM: Toxoplasma gondii: from animals to humans. Int J Parasitol 2000, 30 :1217–1258. PubMed CrossRef Google Scholar 2. [link.springer.com]

    Population biology of Toxoplasma gondii and its relevance to human infection: do different strains cause different disease? Curr Opin Microbiol. 2002; 5 (4): 438-442[ DOI ] 2. Dubey JP. The history of Toxoplasma gondii--the first 100 years. [jjmicrobiol.com]

    Life cycle of Toxoplasma gondii. [medical-dictionary.thefreedictionary.com]

Treatment

CT, 15 patients (3 blood samples collected one day before Toxoplasma gondii treatment; 7 and 15days during the treatment). P/CT, 5 patients (one blood sample collected at least, one year after the treatment). [ncbi.nlm.nih.gov]

Prognosis

In this study, we aimed to characterize the prognosis of patients with HIV infection with severe forms of cerebral toxoplasmosis and to investigate the effects of adjunctive steroids on outcomes. [ncbi.nlm.nih.gov]

Prognosis The prognosis is poor when congenital toxoplasmosis is acquired during the first three months of pregnancy. [medical-dictionary.thefreedictionary.com]

Etiology

For determining etiology, advanced neuroimaging techniques, serological and molecular biological tests have been evolved with varying sensitivities/specificities. [ncbi.nlm.nih.gov]

274 1541 Myohistological Investigations 275 155 Treatment 276 1552 Symptomatic Treatment 277 156 Differential Diagnosis 278 1563 Congenital Fibrosis of the Extraocular Muscles 279 Treatment of Specific Types of Nystagmus 283 161 Introduction 284 16211 Etiology [books.google.com]

However, in many patients, the etiology of subacute meningitis cannot be established [1], [3]. [journals.plos.org]

Epidemiology

Full Text Dear Editor, Highly active antiretroviral therapy (HAART) significantly reduced the cerebral toxoplasmosis incidence in HIV-infected patients from high-income countries. 1 However, there is scarce epidemiological information about this neurological [bjid.org.br]

This chapter presents a review of the biology of this infection including the life cycle, transmission, epidemiology, parasite strains, and the host immune response. [books.google.com]

Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev. 2012; 25 (2): 264-96[ DOI ][ PubMed ] 4. Nissapatorn V, Lee C, Quek KF, Leong CL, Mahmud R, Abdullah KA. Toxoplasmosis in HIV/AIDS patients: a current situation. [archcid.com]

Am J Epidemiol 154:357–65 Article CAS PubMed Google Scholar Jeannel D, Niel G, Costagliola D, et al (1988) Epidemiology of toxoplasmosis among pregnant women in the Paris area. [link.springer.com]

Epidemiology and trend of neurological diseases associated to HIV/AIDS. Experience of Mexican patients 1995-2009. Clin Neurol Neurosurg. 2013 Jan 28. [Medline]. Jones JL, Roberts JM. [emedicine.medscape.com]

Pathophysiology

Currently suggested pathophysiological mechanisms of the disease are mostly derived from stroke cases. Although rare, cerebral toxoplasmosis may strengthen the pathophysiologic mechanism of disease. [ncbi.nlm.nih.gov]

Pathophysiology CNS toxoplasmosis results from infection by the intracellular parasite Toxoplasma gondii. [emedicine.medscape.com]

Prevention

No case of cerebral toxoplasmosis was noted in patients receiving co-trimoxazole in prevention. Presumptive treatment of cerebral toxoplasmosis with co-trimoxazole was effective in all patients with a significant clinical improvement in 83.3%. [ncbi.nlm.nih.gov]

To evaluate the effectiveness of pyrimethamine (given with leucovorin calcium versus placebo (an inactive substance) for the primary prophylaxis (prevention) of cerebral toxoplasmosis in HIV-infected patients. [clinicaltrials.gov]

IFNγ can activate microglia, astrocytes, and brain microvascular endothelial cells to prevent tachyzoite growth by using different mechanisms depending on the cell types. [jhu.pure.elsevier.com]

A.. 2001 ; Preventing opportunistic infections after hematopoietic stem cell transplantation: the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society for Blood and Marrow Transplantation Practice Guidelines [jmmcr.microbiologyresearch.org]

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