CNS and extracerebral toxoplasmosis

 Q: Central nervous system (CNS) toxoplasmosis is more common than extracerebral toxoplasmosis?

A) True 

B) False 

 Answer: A

Immuno-compromise state is the biggest risk factor for clinical toxoplasmosis. Interestingly, CNS is the most affected system. Solo extracerebral toxoplasmosis is rare. Toxoplasmosis in lungs, eyes, or as disseminated infection usually occur along with CNS infection.

Another important pearl for clinicians to remember is that fever may not be present in toxoplasmic encephalitis due to immunosuppression. Headache is the most prominent symptom with mental status change or seizure. 

Multiple ring-enhancing lesions on brain imaging is considered a hallmark for the diagnosis.

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References:

1. Belanger F, Derouin F, Grangeot-Keros L, Meyer L. Incidence and risk factors of toxoplasmosis in a cohort of human immunodeficiency virus-infected patients: 1988-1995. HEMOCO and SEROCO Study Groups. Clin Infect Dis 1999; 28:575.

2. Rabaud C, May T, Amiel C, et al. Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey. Medicine (Baltimore) 1994; 73:306.

3. Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 1992; 327:1643.