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Parazitologie

Toxoplasmoza


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Toxoplasmosis. Toxoplasma gondii tachyzoites (Giemsa stain).

Tssue cysts of T gondii.

Toxoplasmosis.

Toxoplasma gondii tachyzoites in cell line.

Mama poate fi asimptomatică. Infectarea precoce, în jurul a 2-3 luni de sarcină, practic când are loc organogeneza, este foarte gravă, putând apărea avort spontan, moartea fătului la naştere sau leziuni importante neurologice şi oftalmologice, hidrocefalie sau microcefalie, calcificări intracraniene şi corioretinita cronică.

Dacă infecţia cu Toxoplasma se produce în cel de-al treilea trimestru de sarcină, copilul se poate naşte viu, dar poate manifesta icter, hepatosplenomegalie, retard psihomotor sau manifestări oculare (strabism, orbire, cataractă) şi hepatice.

Congenital toxoplasmosis

The classic clinical triad of retinochoroiditis, cerebral calcifications, and convulsions defines congenital toxoplasmosis. Other findings include the following:

  1. Hydrocephalus
  2. Microcephaly
  3. Organomegaly
  4. Jaundice
  5. Rash
  6. Fever
  7. Psychomotor retardation

Girl with hydrocephalus due to congenital toxoplasmosis

Intracranial calcifications in congenital toxoplasmosis. (A) Posterior-anterior and (B) lateral views of the skull showing scattered bilateral calcific flecks, nodules and linear streaks in frontal and parietal lobes of an infected infant.

Congenital toxoplasmosis with intracranial hyrocephalus. The grossly dilated lateral ventricles are outlined with air on (A) AP and (B) lateral radiographs after pneumoencephalography. There is spreading of the cranial sutures due to increased intracranial pressure.

Acute toxoplasmosis in immunocompetent persons

Approximately 80-90% of patients are asymptomatic. Symptomatic disease may be characterized as follows:

Patients may have cervical lymphadenopathy with discrete, usually nontender, nodes smaller than 3cm in diameter

Fever, malaise, night sweats, and myalgias have been reported

Patients may have a sore throat

Retroperitoneal and mesenteric lymphadenopathy with abdominal pain may occur

Retinochoroiditis is reported

 

Acute toxoplasmosis in hosts who do not have AIDS but are immunodeficient

The disease in these patients may be newly acquired or a reactivation. It may be characterized as follows:

CNS toxoplasmosis occurs in 50% of patients - Seizure, dysequilibrium, cranial nerve deficits, altered mental status, focal neurologic deficits, headache

Patients may have encephalitis, meningoencephalitis, or mass lesions

Hemiparesis and seizures have been reported

Patients may report visual changes

They may have signs and symptoms similar to those observed in immunocompetent hosts.

Patients may have flulike symptoms and lymphadenopathy

Myocarditis and pneumonitis are reported.

Toxoplasmic pneumonitis can occur - Typical symptoms of a pulmonary infection, mirroring in particular P (carinii) jiroveci, including nonproductive cough, dyspnea, chest discomfort, and fever

 

Clinical manifestations of toxoplasmosis in patients with AIDS

Brain involvement (ie, toxoplasmic encephalitis), with or without focal CNS lesions, is the most common manifestation of toxoplasmosis in individuals with AIDS.

Clinical findings include the following:

  • Altered mental state
  • Seizures
  • Weakness
  • Cranial nerve disturbances
  • Sensory abnormalities
  • Cerebellar signs
  • Meningismus
  • Movement disorders
  • Neuropsychiatric manifestations

The characteristic presentation is usually a subacute onset, with focal neurologic abnormalities in 58-89% of cases. However, in 15-25% of cases, the clinical presentation is more abrupt, with seizures or cerebral hemorrhage.

Toxoplasma gondii Infections (Toxoplasmosis). Infant girl with congenital toxoplasmosis with hepatosplenomegaly.

Ophthalmic toxoplasmosis.

Papillitis secondary to toxoplasmosis, necessitating immediate systemic therapy.

Perimacular scars secondary to toxoplasmosis

Peripapillary scars secondary to toxoplasmosis

Inactive retinochoroidal scar secondary to toxoplasmosis

Ring enhancing mass with extensive perilesional edema in the left parietal region , with mass effect. A case of toxoplasmosis.

Bilateral basal ganglia toxoplasmosis

   MULTIPLE TOXOPLASMOSIS- image shows an extensive area of vasogenic edema in the left pariteal cortex. Contrast enhanced scans show multiple ring enhancing toxoplasma.

Ventriculitis and hydrocephalus: an unusual presentation of toxoplasmosis in an adult with human immunodeficiency virus

Tratamentul toxoplasmozei

Pirimetamina/sulfadiazina, Pirimetamina/sulfadoxina,

Spiramicina, Clindamicina, Azitomicina, Claritromicina

- Atovaquona

- Trimetoprim-Sulfametoxazol

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