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→Clinical Signs
Symptoms of toxoplasmosis in people with a weakened immune system depend on the site of infection. Toxoplasmosis of the brain (encephalitis) produces symptoms such as weakness on one side of the body, trouble speaking, headache, confusion, seizures, and coma. Acute disseminated toxoplasmosis can cause a rash, high fever, chills, trouble breathing, and fatigue. In some people, infection causes inflammation of the liver (hepatitis), lungs (pneumonitis), or heart (myocarditis). The affected organ may stop functioning adequately (called organ failure). These types of toxoplasmosis can be life threatening.
Symptoms of toxoplasmosis in people with a weakened immune system depend on the site of infection. Toxoplasmosis of the brain (encephalitis) produces symptoms such as weakness on one side of the body, trouble speaking, headache, confusion, seizures, and coma. Acute disseminated toxoplasmosis can cause a rash, high fever, chills, trouble breathing, and fatigue. In some people, infection causes inflammation of the liver (hepatitis), lungs (pneumonitis), or heart (myocarditis). The affected organ may stop functioning adequately (called organ failure). These types of toxoplasmosis can be life threatening.
Acute toxoplasmosis: Acute infection is usually asymptomatic, but 10 to 20% of patients develop bilateral, nontender cervical or axillary lymphadenopathy. A few of these also have a mild flu-like syndrome of fever, malaise, myalgia, hepatosplenomegaly, and less commonly, pharyngitis, which may mimic infectious mononucleosis. Atypical lymphocytosis, mild anemia, leukopenia, and slightly elevated liver enzymes are common. The syndrome may persist for weeks but is almost always self-limited.
CNS toxoplasmosis: Most patients with AIDS or other immunocompromised patients who develop toxoplasmosis due to reactivation present with ring-enhancing intracranial mass lesions or encephalitis. These patients typically have headache, altered mental status, seizures, coma, fever, and sometime focal neurologic deficits, such as motor or sensory loss, cranial nerve palsies, visual abnormalities, and focal seizures.
Congenital toxoplasmosis: This type results from a primary, often asymptomatic infection acquired by the mother during pregnancy. Women infected before conception ordinarily do not transmit toxoplasmosis to the fetus unless the infection is reactivated during pregnancy by immunosuppression. Spontaneous abortion and stillbirth may occur. The percentage of surviving fetuses born with toxoplasmosis depends on when maternal infection is acquired; it increases from 15% during the 1st trimester to 30% during the 2nd to 60% during the 3rd.
Disease in neonates may be severe, particularly if acquired early in pregnancy; symptoms include jaundice, rash, hepatosplenomegaly, and the characteristic tetrad of abnormalities: bilateral retinochoroiditis, cerebral calcifications, hydrocephalus or microcephaly, and psychomotor retardation. Prognosis is poor. Many children with less severe infections and most infants born to mothers infected during the 3rd trimester appear healthy at birth but are at high risk of seizures, intellectual disability, retinochoroiditis, or other symptoms developing months or even years later.
Ocular toxoplasmosis: This type usually results from congenital infection that is reactivated, often during the teens and 20s, but rarely, it occurs with acquired infections. Focal necrotizing retinitis and a secondary granulomatous inflammation of the choroid occur and may cause ocular pain, blurred vision, and sometimes blindness. Relapses are common.
Disseminated infection and non-CNS involvement: Disease outside the eye and CNS is much less common and occurs primarily in severely immunocompromised patients. They may present with pneumonitis, myocarditis, polymyositis, diffuse maculopapular rash, high fevers, chills, and prostration. In toxoplasmic pneumonitis, diffuse interstitial infiltrates may progress rapidly to consolidation and cause respiratory failure, whereas endarteritis may lead to infarction of small lung segments. Myocarditis, in which conduction defects are common but often asymptomatic, may rapidly lead to heart failure. Untreated disseminated infections are usually fatal