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Chinmoy Sahu

This document provides an overview of Toxoplasmosis, including its history, morphology, lifecycle, transmission, pathophysiology, clinical manifestations, diagnosis, treatment, and prevention. Some key points are: - Toxoplasmosis is caused by the protozoan Toxoplasma gondii, which was first discovered and named in 1908 after being isolated from the tissues of a rodent in Africa. - It has both active replicating forms (tachyzoites) and dormant tissue cyst forms (bradyzoites) that can reactivate. Transmission occurs via ingestion of infected tissues or contaminated food, water, or soil. - In immunocompetent individuals

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TOXOPLASMOSIS
HISTORY MORPHOLOGY LIFECYCLE TRANSMISSION PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT PREVENTION
SIR HENRY NICOLLE TOXOPLASMOSIS GONDII DISCOVERED AND NAMED BY CHARLES JULES HENRY NICOLLE (1866-1936) AND MONCEAUX IN 1908. AN INTRACELLULAR PARASITE WAS ISOLATED FROM THE LIVER AND SPLEEN OF A WILD AFRICAN RODENT CTENODACTYLUS GONDII. A YEAR LATER THEY CALLED IT TOXOPLASMA GONDII BECAUSE OF ITS ARCHED SHAPE (TOXON: ARCH) AND BECAUSE OF THE COMMON NAME IN WHICH IT WAS FOUND, THE GONDII.
TOXOPLASMOSIS CLASSIFICATION KINGDOM PHYLUM CLASS FAMILY GENDER SPECIES PROTISTA APICOMPLEXA SPOROZOA SARCYSTIDAE TOXOPLASMA GONDII
1908 1923 Janku Chorioretinitis 1939 Wolff and Col Congenital meningoencephalitis 1948 Sabin and Feldman Reaction Serological 1949 Frenkel Hypersensitivity test 1970 renkel & hutchison True Form of Transmission
MORPHOLOGY ASEXUAL FORMS TACHYZOITE BRADYZOITE (TISSUE CYST) SEXUAL FORM OOCYST
TACHYZOITES ACTIVELY M U LT I P LY I N G F O R M CRESCENT SHAPE SEEN IN ACUTE INFECTION INFECT ALL THE NUCLEATED M A M M A L I A N CELLS INSIDE THE HOST CELL, THE TACHYZOITES ARE S U R RO U N DE D BY A VACUOLE - ASEXUAL M U LT I P L I C AT I O N OCCURS - ROSETTES
BRADYZOITES RESTING STAGE OF THE PARASITE SEEN IN C H RO N I C INFECTIONS MOST C O M M O N SITE IS MUSCLES A N D BRAIN INSIDE THE CYST - SLOWLY M U LT I P LY I N G TROPHOZOITES ARE CALLED AS BRADYZOITES
OOCYST SEXUAL F O R M OF THE PARASITE F O U N D O N LY IN CATS A N D FELINES
LIFE CYCLE
TRANSMISSION INGESTION OF SPO RU LA TED O O C YSTS FRO M C O N TA M IN A TED SOIL, F O O D OR WATER INGESTION OF TISSUE CYST C O N TA I N I N G BRADYZOITES F RO M U N D E RC O O K E D MEAT BY BL O O D TRA N SFU SIO N , N EED LE STIC K IN JU RIES, O RG A N TRANSPL ANTATION TRANSPLACENTRAL TRANSMISSION LABORATORY ACCIDENTS ( TACHYZOITES IN BLOOD)
The Tachyzoites arereproduced Dissemination Following route lymphatic/ hematogenous Penetrates the intestinal wall PATHOPHYSIOLOGY
PATHOGENESIS FORMATION OF TACHYZOITES MULTIPLY AND DISSEMINATION LYMPHATIC TISSUE-FOLLICULAR HYPERPLASIA SKELETAL MUSCLE MYOCARDIUM-FOCAL NECROSIS (MUSCLE CYSTS) RETINA ,CHOROID-GRANULOMATOUS LESION LUNGS-INTERSTITIAL PNEUMONIA CNS NECROSIS AND MICROGLIAL NODULES OTHER ORGANS-PANCREATITIS,GLOMERULONEPHRITIS
IN IMMUNOCOMPETENT INDIVIDUALS,IMMUNE MECHANISMS LIKE MACROPHAGES,CD8+ CELLS,NK CELLS,INTERFERON GAMMA,IL-2,12 KILL OR INHIBIT THE REPLICATION IMMUNOGLOBULINS A,M,G DEVELOP TISSUE CYSTS BECOME ACTIVE WITHIN 7 DAYS AND REACTIVATION OCCURS
ACUTE OR CHRONIC THE RAPIDLY MULTIPLYING CRESCENTRIC CELL (TACHYZOITES ) INITIATE THE ACUTE STAGE OF DISEASE IN FUTHER DEVELOPMENT THEY PENETRATE NEW CELLS ESPECIALLY EYE AND BRAIN. FURTHER DEVELOPMENT SLOWS DOWN IN THESE ORGANS CALLED AS BRADYZOITES TO FORM A QUIESCENT TISSUE CYSTS THE EVENT LEAD TO CHRONIC STAGE OF DISEASE
CLINICAL MANIFESTATIONS FEATURES IN I M M U N O C O M P E T E N T INDIVIDUAL FEATURES IN IMMUNODEFICIENT INDIVIDUAL CO N G E N I TA L TOXOPLASMOSIS OCULAR TOXOPLASMOSIS
IMMUNOCOMPETENT ACUTE STAGE-ASYMPTOMATIC SYMPTOMATIC HEADACHE,FATIGUE MALAISE FEVER CERVICAL LYMPHADENOPATHY SUBOCCIPITAL,SUPRACLAVICULAR,INGUIN AL,MEDIASTINAL(DISCRETE,MULTIPLE,VARI ABLE IN CONSISTENCY)
IMMUNOCOMPROMISED ACUTE INFECTION OR REACTIVATION OF BRADYZOITES DEADLIEST-TOXOPLASMIC ENCEPHALITIS EITHER FOCAL DYSFUNCTION TO NON FOCAL MENINGOENCEPHALITIS DUE TO VASCULITIS,EDEMA AND HEMORRHAGE ALTERED MENTATION(75%),SEIZURES(33%), FOCAL NEUROLOGICAL SIGNS(60%), HEADACHE(56%), FEVER(50%) BRAINSTEM-CRANIAL NERVE PALSY,DYSMETRIA,ATAXIA BASAL GANGLIA-HYDROCEPHALUS,CHOREIFORM MOVEMENTS, CHOREOATHETOSIS DD-CRYPTOCOCCAL MENINGITIS,HSE,TM,CNS LYMPHOMA LUNG-ARDS,HEMOPTYSIS,DIC
OCULAR TOXOPLASMOSIS BLURRED VISION,SCOTOMA,PHOTOPHOBIA MACULAR INVOLVEMENT-LOSS OF CENTRAL VISION, NYSTAGMUS SECONDARY TO POOR FIXATION EOM- CONVERGENCE-STRABISMUS FLARE UPS OF CHORIORETINITIS-DESTROY RETINAL TISSUEGLAUCOMA CONGENITAL LESIONS-MASSIVE CHORIORETINAL DEGENERATION WITH EXTENSIVE FIBROSIS IN PATIENTS WITH AIDS,DIFFUSE RETINAL NECROSIS- FREE TACHYZOITES+CYSTS CONTAINING BRADYZOITES
CONGENITAL TOXOPLASMOSIS
OCCURS DURING FIRST TIME IN PREGNANCY INFECTION OF PLACENTA-HEMATOGENOUS INFECTION OF FETUS AS GESTATION INCREASES-RATE OF TRANSMISSION INCREASES BUT SEVERITY DECREASES INFECTED CHILDREN INITIALLY ASYMPTOMATIC,PERSISTENCE OF T.GONDII- REACTIVATION-MOST FREQUENTLY CHORIORETINITIS CHORIORETINITIS,STRABISMUS,BLINDNESS,EPILEPSY,ANEMIA,JAUNDICE,RASH MICROCEPHALY,INTRACRANIAL CALCIFICATION,HYDROCEPHALUS,PNEUMONITIS TRIMESTER FIRST SECOND THIRD Trasmission rate 10-25% 30-54% 60-65%
DIAGNOSIS DIRECT MICROSCOPY DETECTION OF TACHYZOITES IN B LO O D A N D TISSUE CYST IN TISSUE BIOPSY STAINING METHODS: o GIEMSA o PAS o SILVER STAINS o IMMUNOPEROXIDASE STAIN
SEROLOGY DETECTION OF TOXOPL ASMA ANTIGEN BY ELISA DETECTION OF TOXOPL ASMA ANTIBODY BY o SABIN F E L D M A N DYE TEST o INDIRECT FLUORESCENT ANTIBODY TEST o IGM ELISA o IGG ELISA o IGG AVIDITY TEST
PARALLEL IGG TESTING -4 FOLD RISE IN PAIRED SERA OF 3 WEEKS APART- ACUTE INFECTION IGG LOW AVIDITY-ACUTE INFECTION(<3 MONTHS) HIGH -CHRONIC INFECTION(>3 MONTHS) PRESENCE OF IGA,M,E ACUTE INFECTION OTHER METHODS-DOUBLE SANDWICH IGM ELISA & IGM IMMUNOSORBENT ASSAY
MOLECULAR METHODS POLYMERASE CHAIN REACTION AMPLIFICATION OF B1 GENE DETECTION OF T.GONDII DNA SAMPLES o AMNIOTIC FLUID o PERIPHERAL BLOOD o CSF o URINE o AQUEOUS & VITREOUS FLUID
TREATMENT GOAL-TO ARREST THE REPLICATION OF PARASITE AND PREVENT FURTHER DAMAGE TO ORGANS INVOLVED IMMUNOCOMPETENT IMMUNOCOMPROMISED CONGENITAL
IMMUNOCOMPETENT NOT REQUIRE SPECIFIC THERAPY IF OCULAR+ ,TREATED FOR 1 MONTH PYRIMETHAMINE+SULFADIAZINE/CLINDAMYCIN OR PREDNISONE
IMMUNOCOMPROMISED AIDS PATIENTS SEROPOSITIVE FOR T.GONDII CD4+T LYMPHOCYTE COUNT<100/MCGL(SCREENING AIDS PATIENTS) IF CD4+T LYMPHOCYTE COUNT>200,NO NEED OF PROPHYLAXIS TRIMETHOPRIM-SULFAMETHOXAZOLE NOT TOLERATE-DAPSONE+PYRIMETHAMINE ATOVAQUONE +/_ PYRIMETHAMINE PROPHYLACTIC MONOTHERAPY- DAPSONE,PYRIMETHAMINE,AZITHROMYCIN,CLARITHROMYCIN,AEROSOLIZE D PENTAMIDINE PATIENT+HIV- CD4+T LYMPHOCYTE COUNT>200 FOR ATLEAST 6 MONTHS AFTER ART+ASYMPTOMATIC---DISCONTINUE THE PROPHYLAXIS
CONGENITAL INFECTION NEONATES-ORAL PYRIMETHAMINE(1MG/KG) SULFADIAZINE (100 MG/KG) FOLINIC ACID FOR 1 YEAR PREDNISOLONE(1MG/KG PER DAY)-MAY BE USED PREGNANT-SPIRAMYCIN(IN ACUTE CASE EARLY IN PREGNANCY) PYRI/SULFA/FOLINIC ACID AFTER 18 WEEKS OF PREGNANCY
PREVENTION IS BETTER THAN CURE AVOIDANCE OF HUMAN CONTACT WITH CAT FECES IS HIGHLY IMPORTANT CHANGING OF CAT LITTER AND SAFE DISPOSAL CAN PREVENT TRANSMISSION MEAT SHOULD BE COOKED TO INTERNAL TEMPERATURE OF 74-75DEGREE CELCIUS WASH YOUR HANDS AFTER HANDLING RAW MEAT PROTECT CHILDREN'S PLAY AREAS FROM CAT AND DOG DROPPINGS WASH YOUR HANDS VERY WELL AFTER BEIN G IN CONTACT WITH SOIL POSSIBLY CONTAMINATED BY ANIMAL FECES SCREENING OF IMMUNOCOMPROMISED FOR ANTIBODY TO T.GONDII PREGNANT WOMEN SHOULD AVOID CONTACT WITH KITTENS
REFERENCES PRINCIPLES AND PRACTICES OF INFECTIOUS DISEASES,8TH EDITION- MANDELL,DOUGLAS

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toxoplasma.pptx

  • 2. HISTORY MORPHOLOGY LIFECYCLE TRANSMISSION PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT PREVENTION
  • 3. SIR HENRY NICOLLE TOXOPLASMOSIS GONDII DISCOVERED AND NAMED BY CHARLES JULES HENRY NICOLLE (1866-1936) AND MONCEAUX IN 1908. AN INTRACELLULAR PARASITE WAS ISOLATED FROM THE LIVER AND SPLEEN OF A WILD AFRICAN RODENT CTENODACTYLUS GONDII. A YEAR LATER THEY CALLED IT TOXOPLASMA GONDII BECAUSE OF ITS ARCHED SHAPE (TOXON: ARCH) AND BECAUSE OF THE COMMON NAME IN WHICH IT WAS FOUND, THE GONDII.
  • 5. 1908 1923 Janku Chorioretinitis 1939 Wolff and Col Congenital meningoencephalitis 1948 Sabin and Feldman Reaction Serological 1949 Frenkel Hypersensitivity test 1970 renkel & hutchison True Form of Transmission
  • 6. MORPHOLOGY ASEXUAL FORMS TACHYZOITE BRADYZOITE (TISSUE CYST) SEXUAL FORM OOCYST
  • 7. TACHYZOITES ACTIVELY M U LT I P LY I N G F O R M CRESCENT SHAPE SEEN IN ACUTE INFECTION INFECT ALL THE NUCLEATED M A M M A L I A N CELLS INSIDE THE HOST CELL, THE TACHYZOITES ARE S U R RO U N DE D BY A VACUOLE - ASEXUAL M U LT I P L I C AT I O N OCCURS - ROSETTES
  • 8. BRADYZOITES RESTING STAGE OF THE PARASITE SEEN IN C H RO N I C INFECTIONS MOST C O M M O N SITE IS MUSCLES A N D BRAIN INSIDE THE CYST - SLOWLY M U LT I P LY I N G TROPHOZOITES ARE CALLED AS BRADYZOITES
  • 9. OOCYST SEXUAL F O R M OF THE PARASITE F O U N D O N LY IN CATS A N D FELINES
  • 11. TRANSMISSION INGESTION OF SPO RU LA TED O O C YSTS FRO M C O N TA M IN A TED SOIL, F O O D OR WATER INGESTION OF TISSUE CYST C O N TA I N I N G BRADYZOITES F RO M U N D E RC O O K E D MEAT BY BL O O D TRA N SFU SIO N , N EED LE STIC K IN JU RIES, O RG A N TRANSPL ANTATION TRANSPLACENTRAL TRANSMISSION LABORATORY ACCIDENTS ( TACHYZOITES IN BLOOD)
  • 12. The Tachyzoites arereproduced Dissemination Following route lymphatic/ hematogenous Penetrates the intestinal wall PATHOPHYSIOLOGY
  • 13. PATHOGENESIS FORMATION OF TACHYZOITES MULTIPLY AND DISSEMINATION LYMPHATIC TISSUE-FOLLICULAR HYPERPLASIA SKELETAL MUSCLE MYOCARDIUM-FOCAL NECROSIS (MUSCLE CYSTS) RETINA ,CHOROID-GRANULOMATOUS LESION LUNGS-INTERSTITIAL PNEUMONIA CNS NECROSIS AND MICROGLIAL NODULES OTHER ORGANS-PANCREATITIS,GLOMERULONEPHRITIS
  • 14. IN IMMUNOCOMPETENT INDIVIDUALS,IMMUNE MECHANISMS LIKE MACROPHAGES,CD8+ CELLS,NK CELLS,INTERFERON GAMMA,IL-2,12 KILL OR INHIBIT THE REPLICATION IMMUNOGLOBULINS A,M,G DEVELOP TISSUE CYSTS BECOME ACTIVE WITHIN 7 DAYS AND REACTIVATION OCCURS
  • 15. ACUTE OR CHRONIC THE RAPIDLY MULTIPLYING CRESCENTRIC CELL (TACHYZOITES ) INITIATE THE ACUTE STAGE OF DISEASE IN FUTHER DEVELOPMENT THEY PENETRATE NEW CELLS ESPECIALLY EYE AND BRAIN. FURTHER DEVELOPMENT SLOWS DOWN IN THESE ORGANS CALLED AS BRADYZOITES TO FORM A QUIESCENT TISSUE CYSTS THE EVENT LEAD TO CHRONIC STAGE OF DISEASE
  • 16. CLINICAL MANIFESTATIONS FEATURES IN I M M U N O C O M P E T E N T INDIVIDUAL FEATURES IN IMMUNODEFICIENT INDIVIDUAL CO N G E N I TA L TOXOPLASMOSIS OCULAR TOXOPLASMOSIS
  • 17. IMMUNOCOMPETENT ACUTE STAGE-ASYMPTOMATIC SYMPTOMATIC HEADACHE,FATIGUE MALAISE FEVER CERVICAL LYMPHADENOPATHY SUBOCCIPITAL,SUPRACLAVICULAR,INGUIN AL,MEDIASTINAL(DISCRETE,MULTIPLE,VARI ABLE IN CONSISTENCY)
  • 18. IMMUNOCOMPROMISED ACUTE INFECTION OR REACTIVATION OF BRADYZOITES DEADLIEST-TOXOPLASMIC ENCEPHALITIS EITHER FOCAL DYSFUNCTION TO NON FOCAL MENINGOENCEPHALITIS DUE TO VASCULITIS,EDEMA AND HEMORRHAGE ALTERED MENTATION(75%),SEIZURES(33%), FOCAL NEUROLOGICAL SIGNS(60%), HEADACHE(56%), FEVER(50%) BRAINSTEM-CRANIAL NERVE PALSY,DYSMETRIA,ATAXIA BASAL GANGLIA-HYDROCEPHALUS,CHOREIFORM MOVEMENTS, CHOREOATHETOSIS DD-CRYPTOCOCCAL MENINGITIS,HSE,TM,CNS LYMPHOMA LUNG-ARDS,HEMOPTYSIS,DIC
  • 19. OCULAR TOXOPLASMOSIS BLURRED VISION,SCOTOMA,PHOTOPHOBIA MACULAR INVOLVEMENT-LOSS OF CENTRAL VISION, NYSTAGMUS SECONDARY TO POOR FIXATION EOM- CONVERGENCE-STRABISMUS FLARE UPS OF CHORIORETINITIS-DESTROY RETINAL TISSUEGLAUCOMA CONGENITAL LESIONS-MASSIVE CHORIORETINAL DEGENERATION WITH EXTENSIVE FIBROSIS IN PATIENTS WITH AIDS,DIFFUSE RETINAL NECROSIS- FREE TACHYZOITES+CYSTS CONTAINING BRADYZOITES
  • 21. OCCURS DURING FIRST TIME IN PREGNANCY INFECTION OF PLACENTA-HEMATOGENOUS INFECTION OF FETUS AS GESTATION INCREASES-RATE OF TRANSMISSION INCREASES BUT SEVERITY DECREASES INFECTED CHILDREN INITIALLY ASYMPTOMATIC,PERSISTENCE OF T.GONDII- REACTIVATION-MOST FREQUENTLY CHORIORETINITIS CHORIORETINITIS,STRABISMUS,BLINDNESS,EPILEPSY,ANEMIA,JAUNDICE,RASH MICROCEPHALY,INTRACRANIAL CALCIFICATION,HYDROCEPHALUS,PNEUMONITIS TRIMESTER FIRST SECOND THIRD Trasmission rate 10-25% 30-54% 60-65%
  • 22. DIAGNOSIS DIRECT MICROSCOPY DETECTION OF TACHYZOITES IN B LO O D A N D TISSUE CYST IN TISSUE BIOPSY STAINING METHODS: o GIEMSA o PAS o SILVER STAINS o IMMUNOPEROXIDASE STAIN
  • 23. SEROLOGY DETECTION OF TOXOPL ASMA ANTIGEN BY ELISA DETECTION OF TOXOPL ASMA ANTIBODY BY o SABIN F E L D M A N DYE TEST o INDIRECT FLUORESCENT ANTIBODY TEST o IGM ELISA o IGG ELISA o IGG AVIDITY TEST
  • 24. PARALLEL IGG TESTING -4 FOLD RISE IN PAIRED SERA OF 3 WEEKS APART- ACUTE INFECTION IGG LOW AVIDITY-ACUTE INFECTION(<3 MONTHS) HIGH -CHRONIC INFECTION(>3 MONTHS) PRESENCE OF IGA,M,E ACUTE INFECTION OTHER METHODS-DOUBLE SANDWICH IGM ELISA & IGM IMMUNOSORBENT ASSAY
  • 25. MOLECULAR METHODS POLYMERASE CHAIN REACTION AMPLIFICATION OF B1 GENE DETECTION OF T.GONDII DNA SAMPLES o AMNIOTIC FLUID o PERIPHERAL BLOOD o CSF o URINE o AQUEOUS & VITREOUS FLUID
  • 26. TREATMENT GOAL-TO ARREST THE REPLICATION OF PARASITE AND PREVENT FURTHER DAMAGE TO ORGANS INVOLVED IMMUNOCOMPETENT IMMUNOCOMPROMISED CONGENITAL
  • 27. IMMUNOCOMPETENT NOT REQUIRE SPECIFIC THERAPY IF OCULAR+ ,TREATED FOR 1 MONTH PYRIMETHAMINE+SULFADIAZINE/CLINDAMYCIN OR PREDNISONE
  • 28. IMMUNOCOMPROMISED AIDS PATIENTS SEROPOSITIVE FOR T.GONDII CD4+T LYMPHOCYTE COUNT<100/MCGL(SCREENING AIDS PATIENTS) IF CD4+T LYMPHOCYTE COUNT>200,NO NEED OF PROPHYLAXIS TRIMETHOPRIM-SULFAMETHOXAZOLE NOT TOLERATE-DAPSONE+PYRIMETHAMINE ATOVAQUONE +/_ PYRIMETHAMINE PROPHYLACTIC MONOTHERAPY- DAPSONE,PYRIMETHAMINE,AZITHROMYCIN,CLARITHROMYCIN,AEROSOLIZE D PENTAMIDINE PATIENT+HIV- CD4+T LYMPHOCYTE COUNT>200 FOR ATLEAST 6 MONTHS AFTER ART+ASYMPTOMATIC---DISCONTINUE THE PROPHYLAXIS
  • 29. CONGENITAL INFECTION NEONATES-ORAL PYRIMETHAMINE(1MG/KG) SULFADIAZINE (100 MG/KG) FOLINIC ACID FOR 1 YEAR PREDNISOLONE(1MG/KG PER DAY)-MAY BE USED PREGNANT-SPIRAMYCIN(IN ACUTE CASE EARLY IN PREGNANCY) PYRI/SULFA/FOLINIC ACID AFTER 18 WEEKS OF PREGNANCY
  • 30. PREVENTION IS BETTER THAN CURE AVOIDANCE OF HUMAN CONTACT WITH CAT FECES IS HIGHLY IMPORTANT CHANGING OF CAT LITTER AND SAFE DISPOSAL CAN PREVENT TRANSMISSION MEAT SHOULD BE COOKED TO INTERNAL TEMPERATURE OF 74-75DEGREE CELCIUS WASH YOUR HANDS AFTER HANDLING RAW MEAT PROTECT CHILDREN'S PLAY AREAS FROM CAT AND DOG DROPPINGS WASH YOUR HANDS VERY WELL AFTER BEIN G IN CONTACT WITH SOIL POSSIBLY CONTAMINATED BY ANIMAL FECES SCREENING OF IMMUNOCOMPROMISED FOR ANTIBODY TO T.GONDII PREGNANT WOMEN SHOULD AVOID CONTACT WITH KITTENS
  • 31. REFERENCES PRINCIPLES AND PRACTICES OF INFECTIOUS DISEASES,8TH EDITION- MANDELL,DOUGLAS