Toxoplasmosis in immunocompetent hosts
- Michael Tolentino, MD
Michael Tolentino, MD
- Director of Clinical Research
- Center for Retina and Macular Disease
- Associate Professor, Ophthalmology
- University of Central Florida
- Eskild Petersen, MD, DMSc, DTM&H
Eskild Petersen, MD, DMSc, DTM&H
- Associate Professor, Consultant
- Specialist of Infectious Diseases and Tropical Medicine
- Department of Infectious Diseases
- Aarhus University Hospital Skejby, Denmark
Toxoplasmosis, an infection with a worldwide distribution, is caused by the intracellular protozoan parasite, Toxoplasma gondii. Immunocompetent persons with primary infection are usually asymptomatic. However, in some immunocompetent hosts, T. gondii infection can present as an acute systemic infection or as ocular disease (eg, posterior uveitis).
After initial infection (even if asymptomatic), latent infection can persist for the life of the host. Immunocompromised individuals (eg, those with HIV/AIDS) can have reactivation of latent infection; such patients typically present with multiple central nervous system abscess-like, round processes with ring enhancement.
Toxoplasmosis in immunocompetent persons will be reviewed here. Toxoplasmosis in HIV-infected individuals, pregnant women, and neonates is discussed separately. (See "Toxoplasmosis and pregnancy" and "Congenital toxoplasmosis: Clinical features and diagnosis" and "Toxoplasmosis in HIV-infected patients".)
Genotypes — There are three main T. gondii genotypes (types I, II, and III), which are prevalent in different geographic areas, and can impact the clinical presentation of T. gondii infection . As an example, in Europe, where genotype II is present, 80 to 90 percent of individuals who become infected are asymptomatic. This is in contrast to South and Central America, where other genotypes are present, and infection is associated with a higher rate and increased severity of disease, such as retinochoroiditis in immunocompetent adults and children with congenital disease [2-4]. A mix of geotype I and II are the most prevalent in North America.
Prevalence — The seroprevalence of T. gondii infection ranges widely depending upon the geographic area. Seroepidemiologic surveys in the United States report that 11 percent of persons aged 6 to 49 are seropositive for T. gondii , whereas the seroprevalence is as high as 78 percent in some areas of Brazil .
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- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguideline s/adult_oi.pdf (Accessed on March 04, 2016).
- ACUTE SYSTEMIC INFECTION
- Clinical manifestations
- - General symptoms
- - Lymphadenopathy
- - Uncommon manifestations
- - Laboratory findings
- Approach to diagnosis
- Differential diagnosis of acute systemic infection
- Treatment of acute infection
- - Whom to treat
- - Choice or regimen
- OCULAR DISEASE
- Clinical manifestations
- Diagnosing ocular disease
- - Indications
- - Antimicrobial therapy for ocular disease
- Preferred regimens
- Alternative regimens
- - Adjunctive glucocorticoids
- - Frequency of follow-up
- - Duration of treatment
- MONITORING FOR ADVERSE DRUG REACTIONS
- SUMMARY AND RECOMMENDATIONS