Question

Case Study #11

History and Physical Examination:

A 24-year-old female with a history of AIDS presents for evaluation of left-sided weakness. She has also experienced headaches and seizures and others have observed an alteration in her mental status. Her medical history is notable only for an episode of Pneumocystis jiroveci pneumonia, primary syphilis treated with penicillin 5 years ago and occasional thrush. She takes zidovudine and monthly-aerosolized pentamidine for Pneumocystis prophylaxis. An urgent CT scan of the head shows two 1 cm lesions in the right basal ganglia with enhancement seen with intravenous contrast media. Laboratory data: CD4 cell count 50 cells/μL (reference 600 – 1500/μL) RPR positive 1:2 dilution Toxoplasmosis gondii IgG positive Toxoplasmosis gondii IgM negative

Questions:

1.What is the most likely cause of the lesions in the brain?

2. Is this a newly acquired infection? Why or why not?

3. What is the difficulty in using serologic techniques to diagnose infectious disease in this type of patient?

4. Should pregnant women be tested for this microorganism and why?

5. What prenatal serology is currently recommended relative to Toxoplasma past or current infection?

6. What test is performed on the newborn to aid in the diagnosis of congenital toxoplasmosis? 7. What 3 ways can a person become infected?

Answer 1

QUESTION NUMBER 1

INFECTION WITH TOXOPLASMA GONDII IS THE CAUSE OF THE BRAIN LESION.IT IS AN OPPERTUNISTIC INFECTION CAUSED BY TOXOPLASMA GONDII .TYPICALLY AFFECT PATIENTS WITH HIV,IT IS THE MOST COMMON CAUSE OF CEREBRAL ABSCESS.TYPICALLY CERBRAL TOXOPLASMOSIS APPERES AS HYPO DENSE LESIONS PREDOMINANTLY IN THE BASAL GANGLIA.SO IN ABOUVE CASE CAUSE OF BRAIN LESION IS TOXOPLASMA GONDII INFECTION.

QUESTION NUMBER 2

IT IS NOT A NEWLY AQUIRED INFECTION.BECAUSE IN THE DATA IT IS GIVEN THAT TOXOPLASMA IG M NEGATIVE.THAT MEANS IT IS NOT AN ACUTE INFECTION.IG M IS THE INDICATOR OF AN ACUTE INFECTION.HERE POSTIVE PARAMETER IS IG G.THAT REPRESENT IT IS A CHRONIC INFECTION THAT MEANS PERSISTING FOR LONG TIME AND FOR A POSITIVE IG G PATIENT HAS BEEN INFECTED FOR ATLEAST 3 TO 5 MONTHS.

Question number 3.

In patients with HIV or immunosuppression it is quite difficult to do serologival tests.because serological testing fir infectious disease aims at 2 things.one identifying the microbial agent that causes infection and second thing identify the infectious agent by measuring the patients immune responce to the potential agent.In the cause of above mentioned cases or likely cases there is chances of multiple infections from various agents due immunosuppression .it is difficult to identify the exact infection and agent because immune response in that case is a poly clonal one.that is againist multiple organism.the second thing in immunocompramised patienys the immune response is low and not much specific so that identifying exact pathogen is difficult.

Question number 4

It is safe to test the preganant women for toxoplasma.because toxoplasma infection having the capability of vertical transmission and causes serious damages to the newnorn.toxoplasma ibfection of the newborn causes congenital toxoplasmosis with serious brain damages and even cause death of the baby.so serological test for antibodies againist toxoplasma can be done to identify recent or current ibfection and help to reduce the risk for baby.

Question number 5

Antibodies for toxoplasma is tested in serological diagnosis.ig M and Ig G.ig M indicate the acute infection or the current one and other for chronic one.specific ig M and Ig G for toxoplasma is the most commonrecommonded serological testing for past or current infection.

Question number 6

The newborn also tested for toxoplasma antibodies.thats is IgG and Ig M.these helping in identifying recent or past infection.inthe period of gestation amniotic fluid is used for testing.but in case of new born serological testing for specific antibodies are used.

Question number 7

Avoid drinking untreated water.

Wash hands with soap and water after gardening or contact with soil or sand.

Proper cooking of meat, non vegetarian foods.