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A Rare case of a 33-year-old male with CNS toxoplasmosis / Irvin Allen O. Punsalan.

Contributor(s): Language: english Publication details: Fairview, Quezon City: Department of Internal Medicine, FEU-NRMF, 2020.Description: (in folder) with CD (soft copy)Content type:
  • text
Media type:
  • unmediated
Carrier type:
  • volume
LOC classification:
  • MED 2020 0008
Summary: Abstract: This is a case of a 33-year-old male presenting with a 4-week history of generalized body weakness, with seizures episodes described as tonic clonic, associated with vomiting, headache and undocumented fever. Neurological examination revealed GCS 15 but slow response, shallow left nasolabial fold and tongue deviated to the left. There were no noted signs of meningeal irritation such as Babinski, Brudzinski, Nuchal rigidity, and Kernig's. IgG Antibody to Toxoplasma gondii revealed 2678 IU/mL (≥8 = positive). IgM Antibody to Toxoplasma gondii revealed 0.06 IU/mL (<0.55 = negative). On Cranial MRI with contrast, multiple enhancing mass lesions with perilesional edema were noted, to consider infectious vs oncologic process. The patient was initially treated conservatively with Paracetamol 500mg every 4 hours for temp ≥37.8 °C, Pantoprazole 40mg was also given intravenously and Metoclopramide 10 mg intravenously every 8 hours as needed for nausea and vomiting. On the 3rd hospital day,serological testing for Toxoplasmosis revealed IgG Antibody of 2678 (334x↑). Hence, Cotrimoxazole 800/160mg/tab was started. Acute toxoplasmosis in immunocompromised patients with AIDS is detrimental if left untreated. Such patients who are seropositive for Toxoplasma gondii with a CD4+ T lymphocyte count of <1000/µl warrants prophylaxis against TE while those who are seronegative and are not receiving PcP prophylaxis are advised to be retested for Toxoplasma IgG antibody if the CD4+ T cell count is <100/µl. Prophylaxis for TE can be discontinued if patients have responded to cART, and their CD4+ T Lymphocyte count is >200/µl for at least 3 months. Patients who have completed initial therapy for TE, remain asymptomatic, with evidence of restored immune function, and are currently receiving maintenance therapy, have lower risk for relapse. Counseling of all HIV-infected patients with regards to Toxoplasma infection should be done. Proper cooking of meat products and avoiding contaminated materials can reduce incidences of primary infection with Toxoplasma.
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Abstract: This is a case of a 33-year-old male presenting with a 4-week history of generalized body weakness, with seizures episodes described as tonic clonic, associated with vomiting, headache and undocumented fever. Neurological examination revealed GCS 15 but slow response, shallow left nasolabial fold and tongue deviated to the left. There were no noted signs of meningeal irritation such as Babinski, Brudzinski, Nuchal rigidity, and Kernig's. IgG Antibody to Toxoplasma gondii revealed 2678 IU/mL (≥8 = positive). IgM Antibody to Toxoplasma gondii revealed 0.06 IU/mL (<0.55 = negative). On Cranial MRI with contrast, multiple enhancing mass lesions with perilesional edema were noted, to consider infectious vs oncologic process. The patient was initially treated conservatively with Paracetamol 500mg every 4 hours for temp ≥37.8 °C, Pantoprazole 40mg was also given intravenously and Metoclopramide 10 mg intravenously every 8 hours as needed for nausea and vomiting. On the 3rd hospital day,serological testing for Toxoplasmosis revealed IgG Antibody of 2678 (334x↑). Hence, Cotrimoxazole 800/160mg/tab was started. Acute toxoplasmosis in immunocompromised patients with AIDS is detrimental if left untreated. Such patients who are seropositive for Toxoplasma gondii with a CD4+ T lymphocyte count of <1000/µl warrants prophylaxis against TE while those who are seronegative and are not receiving PcP prophylaxis are advised to be retested for Toxoplasma IgG antibody if the CD4+ T cell count is <100/µl. Prophylaxis for TE can be discontinued if patients have responded to cART, and their CD4+ T Lymphocyte count is >200/µl for at least 3 months. Patients who have completed initial therapy for TE, remain asymptomatic, with evidence of restored immune function, and are currently receiving maintenance therapy, have lower risk for relapse. Counseling of all HIV-infected patients with regards to Toxoplasma infection should be done. Proper cooking of meat products and avoiding contaminated materials can reduce incidences of primary infection with Toxoplasma.

Research - Department of Medicine

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