CEREBRAL

TOXOPLASMOSIS
Fairuza Laily
Janry Sinaga
Firman Budi Simatupang
Magister Kedokteran Tropis
Fakultas Kedokteran Universitas Sumatera Utara

CASE REPORT
A male, 37 yo, came to the RSHAM with altered

consciousness since 3 weeks ago. Personality and

mental status changes has been found. History of
previous seizures occurred 3 months ago. Fever is
found.
CT Scan (04/06/2014) shows multiple intracranial SOL
at the right temporal frontal region.
Differential Diagnose:
Tuberculoma
Primary CNS Malignancy
Opportunistic Infection (Toxoplasmosis)

CASE REPORT
Lab result (29/10/2014):
IgG Toxoplasma: Positive 37.8
IgG Rubella: Positive 14.0
IgG CMV: Positive 162.1
Diagnose: Toxoplasmosis Encephalitis
Patient is given:
Meropenem inj.1 gr/8 jam/IV
Clyndamicyn 3x 600mg
Pirimetamin 1 x75mg

And shows a good progress.

DISCUSSION

Cerebral Toxoplasmosis
Cerebral toxoplasmosis results from infection by the

intracellular parasite Toxoplasma gondii.

It is almost always due to reactivation of old CNS lesions
or to hematogenous spread of a previously acquired
infection.
Cerebral toxoplasmosis mostly occurred in
immunocompromissed patients like AIDS, or malignancy.

The Transmission of
Toxoplasma gondii
Infective stages

Diagnostic stages

The Transmission
to Human

Ingestion of raw or partly cooked meat

Tissue cysts may also be ingested during hand-to-mouth contact
Ingestion of unwashed fruits or vegetables that have been in

contact with contaminated soil containing infected cat feces

Ingestion of contaminated cat feces
Acquiring congenital infection through the placenta

Morphology: Toxoplasma gondii

involved in
invasion

Morphology of Toxoplasma gondii with its pathogen

protein

Infective Stages of Toxoplasma gondii

There are three infectious stages of T. gondii:
1. the tachyzoites (in groups or clones)
2. the bradyzoites (in tissue cysts), and
3. the sporozoites (in oocysts).

tachyzoites

bradyzoites

sporozoites

the tachyzoites
The stage that rapidly multiplied in any cell of the

intermediate host and in nonintestinal epithelial cells

of the definitive host
Tachyzoites can move by gliding, flexing, undulating,
and rotating
Tachyzoites enter host cells by actively penetrating
through the host cell plasmalemma or by
phagocytosis
Tachyzoites multiply asexually within the host cell by
repeated endodyogeny, a specialized form of
reproduction in which two progeny form within the
parent parasite.

Tachyzoites enter host cells

the bradyzoites (tissue cysts)

The organism multiplying slowly within a tissue cyst,

also called cystozoites.

Tissue cysts more prevalent in the neural and muscular
tissues, including the brain, eyes, and skeletal and cardiac
muscles.
Intact tissue cysts probably do not cause any harm and
can persist for the life of the host without causing a host
inflammatory response.

the sporozoites (in oocysts)

Cats shed oocysts after ingesting any of the three

infectious stages of T. gondii, i.e., tachyzoites,

bradyzoites, and sporozoites
Prepatent periods (time to the shedding of oocysts after
initial infection)
3 to 10 days after ingesting tissue cysts
18 days after ingesting oocysts
13 days after ingesting tachyzoites
Each oocyst contains two ellipsoidal sporozoites.

How Toxoplasma gondii causing harm to the host

Anti-apoptotic mechanism
the infected host cells to persist
and replicate more and more

Initiate autophagy of the hosts cells

healthy and uninfected cells

How Toxoplasma gondii invades the host cells

Definitive Diagnosis of Cerebral Toxoplasmosis

Compatible clinical findings
Rising titers of anti-toxoplasma immunoglobulin G (IgG)

antibodies
Identification of one or more mass lesions by CT, MRI, or
other radiographic testing
Detection of T gondii DNA on polymerase chain reaction
(PCR) testing of cerebrospinal fluid (CSF) samples
Lumbar puncture may be contraindicated because of
increased intracranial pressure.

anti-Toxoplasmagondii IgG detection may be unreliable in

immunodeficient individuals false-negative results

Treatment of Cerebral Toxoplasmosis

Standard therapy consists of pyrimethamine, sulfadiazine,

and folinic acid in combination.

Patients allergic to sulfa drugs use Clyndamicyn
Adjunctive steroids to treat cerebral edema

With antibiotic therapy, 74% of patients improve

by day 7, and 91% improve by day 14.

Prevention

Conclusion
Feeling sociable or reckless?
Having recurrent headache?
Feeling depressed?

Toxoplasma
gondii

You might have

Toxoplasmosis
Toxoplasma manipulates the behavior of its
animal host by increasing the concentration of
dopamine and by changing levels of certain
hormones.

THANK YOU