What is the presentation of toxoplasmosis in immunocompromised patients?

Updated: Mar 08, 2019
  • Author: Murat Hökelek, MD, PhD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Although toxoplasmosis in immunocompromised patients may manifest as retinochoroiditis, reactivation disease in these individuals is typically in the CNS, with brain involvement being common.

Toxoplasmic encephalitis and brain abscess present most commonly as headache, but focal neurologic deficits and seizures are as common. With significant disease, patients may also demonstrate the signs and symptoms of elevated intracranial pressure. Cerebral toxoplasmosis is generally identified on computed tomography (CT) scan as multiple ring-enhancing lesions; however, solitary lesions may be seen, and negative CT or magnetic resonance imaging (MRI) scans should not rule out the diagnosis of CNS toxoplasmosis. [21]

Aside from CNS toxoplasmosis, other conditions commonly identified in immunocompromised patients include toxoplasmic pneumonitis, myocarditis, and disseminated toxoplasmosis. Toxoplasmic pneumonitis typically presents with symptoms typical for an infectious pulmonary process, including fever, dyspnea, and cough. Chest radiography is often nonspecific, but findings may have an appearance similar to that of Pneumocystis (carinii) jiroveci pneumonia. Diagnosis is established via bronchoalveolar lavage. Most patients with extra-CNS manifestations of toxoplasmosis will also be noted to have CNS lesions when appropriate radiographic studies have been performed. [22]


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