It is a brain disease caused by the Toxoplasma gondii parasite. The seropositivity rate for Toxoplasma in China is 5.84%. Cerebral toxoplasmosis is the leading cause of death in toxoplasmosis.

bubble_chart Diagnosis

1. Medical History and Symptoms:

Since the blood-brain barrier can prevent antibodies from entering the central nervous system, approximately 50% of toxoplasmosis patients may also suffer from cerebral toxoplasmosis. Based on the route of infection, toxoplasmosis can be classified into congenital and acquired forms.

1. Acquired cerebral toxoplasmosis: The incubation period ranges from 3 days to 2 years. It can manifest as either a primary brain disease or part of systemic toxoplasmosis, commonly seen in immunocompromised individuals. Clinical presentations may include meningitis, diffuse encephalopathy, epileptic seizures, intracranial space-occupying lesions, or psychiatric abnormalities.

2. Congenital cerebral toxoplasmosis: Infection in pregnant women often leads to late abortion, premature labor, or stillbirth. Surviving infants may exhibit developmental abnormalities such as hydrocephalus, microcephaly, or intellectual disabilities.

Some toxoplasmosis patients may experience fever, myalgia, lack of strength, and lymphadenopathy with hepatosplenomegaly. Conditions like chorioretinitis, iridocyclitis, or retinitis may also occur.

2. Physical Examination Findings:

1. Patients with increased intracranial pressure may present with headache, nausea, vomiting, and papilledema. 2. Those with parenchymal brain damage may exhibit hemiplegia, aphasia, etc.

3. Diagnostic Tests:

1. Lumbar puncture and cerebrospinal fluid (CSF) analysis: Elevated white blood cell count, predominantly lymphocytes, accompanied by increased eosinophils and protein levels.

3. Head CT scans may reveal single or multiple isodense or hypodense lesions.

4. Definitive diagnosis is confirmed by identifying toxoplasma trophozoites in CSF, lymph nodes, or brain biopsy specimens.

4. Differential Diagnosis:

Sometimes, differentiation is required from subcutaneous nodular disease, cryptococcal meningitis, or herpes encephalitis.

bubble_chart Treatment Measures

1. Sulfadiazine, 1.0g 4 times/d, orally or intramuscularly. Sulfisoxazole, 1-2.0g 4 times/d, combined with trimethoprim (TMP) to enhance efficacy.

2. Pyrimethamine, adult daily dose is 50mg (1mg/kg for children) taken in divided doses, treatment course 1 month.

3. Other treatments: For those complicated with choroid membrane optic neuritis, add prednisone or dexamethasone. For immunocompromised patients, add levamisole or transfer factor. For epilepsy attacks, increased intracranial pressure, and paralysis, provide corresponding treatments (refer to other chapters).