Forms of Postnatal Toxoplasma Infection

■ Primary infection in immunocompetent persons. This is the most frequent form without clinical manifestations, recognizable by the specific serum antibodies. The infection can persist for the life of the host, and it may exacerbate in response to immunosuppression. Subacute cervical lymphadenitis occurs in about 1 % of infected persons.

■ Primary infection during pregnancy. This may cause prenatal infection of the fetus and thus become a significant threat (see prenatal toxoplasmosis p. 513).

■ Primary infection in immunosuppressed persons. In cases of immune deficiency (with significant disturbance of CD4+ and CD8+ cell functions) or immunosuppressant therapies (e.g., in organ transplantations) the infection gives rise to febrile generalized illness with maculopapulous exanthema, generalized lymphadenitis, necrotizing interstitial pneumonia, hepatosple-nomegaly, mycocarditis, meningoencephalitis, eye damage, and other manifestations. There is a high rate of lethality if left untreated.

■ Reactivation toxoplasmosis in cases of immune deficiency. Local and generalized reactivation of a Toxoplasma infection originating from tissue cysts. Cerebral manifestations are the most frequent (up to 40% of patients in full-blown AIDS stage), for example, with multiple coagulative necroses, small-focus hemorrhages, and surrounding edema. Other organ systems are affected more rarely (in about 15% of cases), e.g., myocardium and lungs.

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