DOI: 10.12890/2024_004938
Toxoplasmosis infection in an HIV-negative patient presenting with clinical and MRI findings similar to those of multiple sclerosis
Authors
nurgalieva.b@kaznmu.kz
Keywords
Toxoplasmosis, central nervous system, MRIAbstract
Toxoplasmosis is a parasitic infection that can present in various clinical forms, ranging from asymptomatic to severe neurological manifestations. The primary sources of infection include undercooked meat, unwashed produce and contact with cat faeces. Toxoplasmosis can lead to encephalitis, particularly in immunocompromised patients, and is often misdiagnosed as other neurological conditions such as multiple sclerosis (MS). We report the case of a 44-year-old male from Almaty, Kazakhstan, who presented with neurological symptoms including headaches, dizziness, diplopia, leg weakness and elevated blood pressure. The patient had a history of consuming undercooked meat, but no prior neurological conditions. Initial magnetic resonance imaging (MRI) revealed demyelinating lesions, leading to a diagnosis of MS. However, high levels of IgG antibodies against Toxoplasma gondii were detected, prompting further testing. A polymerase chain reaction test for toxoplasmosis was negative, but the patient was treated empirically with trimethoprim and sulfamethoxazole for six months. A follow-up MRI showed a significant reduction in brain lesions, and the patient’s symptoms improved.
References
- Hunter CA, Sibley LD. Modulation of innate immunity by Toxoplasma gondii virulence effectors. Nat Rev Microbiol 2012;10:766–778.
- Flegr J, Prandota J, Sovicková M, Israili ZH. Toxoplasmosis – a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries. PLoS One 2014;9:e90203.
- Jones JL, Parise ME, Fiore AE. Neglected parasitic infections in the United States: toxoplasmosis. Am J Trop Med Hyg 2014;90:794–799.
- Centers for Disease Control and Prevention. Parasites – Toxoplasmosis (Toxoplasma infection) epidemiology & risk factors [Internet]. Atlanta: CDC; 2015 [cited 23 September 2023]. Available from: https://www.cdc.gov/parasites/toxoplasmosis/epi.html
- Torgerson PR, Rosenheim K, Tanner I, Ziadinov I, Grimm F, Brunner M, et al. Echinococcosis, toxocarosis and toxoplasmosis screening in a rural community in eastern Kazakhstan. Trop Med Int Health 2009;14:341–348.
- Slifko TR, Smith HV, Rose JB. Emerging parasite zoonoses associated with water and food. Int J Parasitol 2000;30:1379-93.
- Dubey JP, Jones JL. Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 2008;38:1257–1278.
- Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000;30:1217–1258. Erratum in: Int J Parasitol 2001;31:217–220.
- Sullivan WJ Jr, Smith AT, Joyce BR. Understanding mechanisms and the role of differentiation in pathogenesis of Toxoplasma gondii: a review. Mem Inst Oswaldo Cruz 2009;104:155–161.
- Ferguson DJ, Hutchison WM, Pettersen E. Tissue cyst rupture in mice chronically infected with Toxoplasma gondii: an immunocytochemical and ultrastructural study. Parasitol Res 1989;75:599–603.
- Benson JC, Cervantes G, Baron TR, Tyan AE, Flanagan S, Lucato L, et al. Imaging features of neurotoxoplasmosis: a multiparametric approach, with emphasis on susceptibility-weighted imaging. Eur J Radiol Open 2018;5:45–51.
- Lee YY, Bruner JM, Van Tassel P, Libshitz HI. Primary central nervous system lymphoma: CT and pathologic correlation. AJR Am J Roentgenol 1986;147:747-752.
- Chaudhari AB, Singh A, Jindal S, Poon TP. Haemorrhage in cerebral toxoplasmosis. A report on a patient with the acquired immunodeficiency syndrome. S Afr Med J 1989;76:272–274.
