Toxoplasma gondii

Sexual reproduction is completed in the cat. Humans become infected by ingesting oocysts from cat feces or incompletely cooked pork or lamb. Virtually any cell can be infected. Tachyzoites can spread from cell to cell. T-cell immunity is required. In healthy adults, the primary infections is usually subclinical or marked by mild fever and lymph adenopathy.

Photo courtesy of University of Rochester.

• CSF in patients can be normal or show mild elevation of protein or WBCs.
• With HIV disease, CNS infection is almost always reactivation.
• Treatment is for 6 weeks with Fansidar or clindamycin (if allergic to sulfa).
• Followed by either lower doses of above drugs or dapsone 200 mg/d for prevention of recurrence.

In Kenya, most HIV is diagnosed by the presence of opportunistic infections.

• Thrush and TB (suggestive)
• Cryptococcal meningitis and toxoplasmosis (essentially diagnostic of HIV)

The next patient is brought by the police.