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Section 3. Summaries of Infectious Diseases

Toxoplasma gondii Infections

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Infants with congenital infection are asymptomatic at birth in 70% to 90% of cases, although visual impairment, learning disabilities, or mental retardation will become apparent in a large proportion of children several months to years later. Signs of congenital toxoplasmosis at birth can include a maculopapular rash, generalized lymphadenopathy, hepatomegaly, splenomegaly, jaundice, and thrombocytopenia. As a consequence of intrauterine meningoencephalitis, cerebrospinal fluid (CSF) abnormalities, hydrocephalus, microcephaly, chorioretinitis, seizures, and deafness can develop. Some of the severely affected infants die in utero or within a few days of birth. Cerebral calcifications may be demonstrated by radiography, ultrasonography, or computed tomography of the head.

Toxoplasma gondii infection acquired after birth usually is asymptomatic. When symptoms develop, they are nonspecific and include malaise, fever, sore throat, and myalgia. Lymphadenopathy, frequently cervical, is the most common sign. Occasionally, patients may have a mononucleosis-like illness associated with a macular rash and hepatosplenomegaly. The clinical course usually is benign and self-limited. Myocarditis, pericarditis, and pneumonitis are rare complications.

Isolated ocular toxoplasmosis most commonly results from congenital infection but also occurs in a small percentage of people with acquired infection. Characteristic retinal infiltrates develop in up to 85% of young adults after congenital infection. Acute ocular involvement manifests as blurred vision. Ocular disease can become reactivated years after the initial infection in healthy and immunocompromised people.

In chronically infected immunodeficient patients, including people with human immunodeficiency virus (HIV) infection, reactivated infection can result in encephalitis, pneumonitis, or less commonly, systemic toxoplasmosis. Rarely, infants who are born to HIV-infected mothers or mothers who are immunocompromised for other reasons who have chronic infection with T gondii may have acquired congenital toxoplasmosis in utero . . . [Go to Full Text]

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This topic has been referenced by these articles:

• Wallon, M., Kodjikian, L., Binquet, C., Garweg, J., Fleury, J., Quantin, C., Peyron, F. (2004). Long-Term Ocular Prognosis in 327 Children With Congenital Toxoplasmosis. Pediatrics 113: 1567-1572 [Abstract] [Full Version]  
• Roizen, N., Kasza, K., Karrison, T., Mets, M., Noble, A. G., Boyer, K., Swisher, C., Meier, P., Remington, J., Jalbrzikowski, J., McLeod, R., other members of the Toxoplasmosis Study Group, (2006). Impact of Visual Impairment on Measures of Cognitive Function for Children With Congenital Toxoplasmosis: Implications for Compensatory Intervention Strategies. Pediatrics 118: e379-e390 [Abstract] [Full Version]  

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