Case Study of Toxoplasmosis Gondii: Complications & Treatment Analysis

This case study examines a 39-year-old woman with a history of caring for cats who presents with vision loss and other symptoms. Initial examinations reveal metamorphopsia and abnormalities in her retina. Further testing uncovers an HIV infection, which weakens her immune system, leading to a dia...Read More

Toxoplasmosis Gondii

Contents
Contents...........................................................................................................................................2
ABSTRACT....................................................................................................................................3
INTRODUCTION...........................................................................................................................4
CASE STUDY.................................................................................................................................4
DISCUSSION................................................................................................................................10
CONCLUSION..............................................................................................................................13
REFERENCES..............................................................................................................................15

ABSTRACT
According to generic study of infection and immunity, it is analysed that immunity show
mechanism which is built with contextual configuration of body which refer as protection and
providing safety from extrinsic pathogen that affect regulation and function of human body. This
research paper covers cat originated disease or predominant infection named Toxoplasmosis
Gondi. The case study well shows information that provide intentional data that is associated
with untreated disease that cause impact due to the harness of immunity. Toxoplasmosis Gondi is
untreated and infections can lead to blindness. But individual have lack of immunity or delay
immune response can show the result of weakened context, then especially with the outcome of
HIV and AIDS, Toxoplasmosis Gondii can lead complication which is related with the seizure
and life-threatening illness such as encephalitis which is serious brain infection and if the
condition is persist for the longer period that may cause fatality of individual. In this research
paper, Toxoplasmosis Gondii shows their presence in patient with presence of AIDS, the
untreated encephalitis from occurrence of Toxoplasmosis Gondii is fatal. This research paper
covers various observations, perspective that is related with the Toxoplasmosis Gondii which
occurs due to the cat infection. The complication, impact and brief discussion is well elaborated
with the analysis of case study.

INTRODUCTION
Toxoplasmosis Gondii is also referring as tok-so-plaz-MOE-sis derive as disease that
outcome from infection with Toxoplasma Gondi parasite which is one of the most common
diseases which occurs due to parasitic presence (Silva and et. al., 2018). Infection occurs by
taking or eating undercooked food majorly meat based, exposure from infected cat faeces or
mother to child transmission during pregnancy (Koelink and et. al., 2020). In this report, the case
study is provided which is about a lady who is 39-year-old woman from Hull, working as an
administrator at the University of Hull (Montazeri and et. al., 2018). It was reported that the
patient adores and cares for cats (Bonacini and et. al., 2020). She provides them with proper care
and support. However, the patient starts to face complication when one of the cats that she takes
care of scratches her hand after which she starts noticing symptoms of related to fatigue, muscle
cramps and vision issue. The right side of her eyes lost their vision and show predominant
blindness (Almeria, and Dubey, 2021). The Toxoplasmosis Gondii may cause the symptoms
which are associated with flu like in some of people but mostly people impacted do not show any
proper sign and symptom that is evaluated as per clinical diagnosis for disease identification. For
infants born to infected and for people with weakened immune system, Toxoplasmosis may
show their impact that led to serious complication among the individual who is suffering from
such kind of disease as a result of infection (Chegeni and et. al., 2019). The symptoms that
related with Toxoplasmosis Gondii is body ache, fatigue and so on if they are persistent for
longer period, it causes various complication which may affect the potential health of individual
that is well evaluated in case study (Kubysheva and et. al., 2020). In this report, the major of
discussion follow case study interpretation where mechanism, trend, medication and information
are well structured that provide evidence-based data (Saad, Hussein, and Ewida, 2018).
CASE STUDY
The patient made an appointment with a local optician to get her eye sight checked and
reported that she was scratched by a cat named Felix because of which she developed a wound
which did not heal for a very long time. Thereafter, she started noticing blindness in her right eye
due to which she was unable to work at the university. Upon consultation with an
ophthalmologist, it was observed that she had metamorphopsia in her right eye, which is a
condition where straight lined appear curved due to visual distortion (Shiadeh and et. al., 2020).

This condition is caused by displacement of retinal layers which is followed by dislocation of
light on the retina (Lapinskas and Ben-Harari, 2019). Later, the optician observed that her retina
was particularly abnormal due to which her case was referred to the Hull Royal Eye Hospital.
The patient consulted Dr King who reported that the patient lost a lot of weight. The vision of
her left eye was found to be normal however, her right appeared abnormal. Upon examination, it
was observed that there was deposition of granulomatous keratic precipitates on the corneal
endothelium but the crystalline lens was clear. Further, reports suggest that these precipitates
deposited as an inverted triangle on the corneal endothelium in the patient’s eyes (Rosenberg and
et. al., 2019). Dr King also revealed that a significant amount of floating cells were observed in
the anterior chamber and anterior vitreous.
Figure 1 Examination of the fundus, a large patch could be observed in inferno nasal in the optic
disc. A number of fibrous bands could be observed emerging from this lesion. However, no
breaks were observed.
The patient reported this symptom as “headlight in a fog” kind of blur. This diagnosis
could not be clearly explained as the patient looked very pale which looked like anaemia, the
patient also reported soreness, erythema and fissuring at the angles of her mouth because of

which other tests were requested by Dr King such as chest X-ray, abdominal sonography and
age-related neoplastic workup (mammography and pap smear) to detect the presence of other
infections in her body (Piccolo and et. al., 2019). The doctor also referred the patient to Dr Linda
Anderson at the Infection Research Group at Castle Hill Hospital for urgent tests for
immunology and a complete blood count analysis. The immunology report of the patient is
mentioned in Figure 2.
Figure 2 Complete blood count of the patient as conducted by Dr Linda Anderson
Imaging studies did not reveal anything abnormal or fatal however, the immunological
tests, CBC in specific revealed some issues that seemed severe (Graham, Fong, Naqvi, and Lu,
2021). The findings of immunological tests as told by Dr Linda revealed that the patient was
HIV positive in serology tests which was confirmed with the help of a viral genome replicate
count in her blood, to which she responded that she has had multiple sexual partners in the last 5
years. Her immune system weakened as a result of HIV/AIDS, therefore there is a high chance of
developing encephalitis (Omidian, Ganjkarimi, Asgari and Hatam, 2021). All these aspects and
symptoms faced by the patient suggested presence of a disease which developed patient in a
progressive form. According to the knowledge of doctor, these serological and immunological
tests diagnosed the patient with Toxoplasmosis, caused by Toxoplasma Gondii. Some of the
symptoms of presence of Toxoplasma gondii are inflammation of the lungs, heart muscle and
persistent fever with lymph glands around the neck (Brennan and et. al., 2020).

Figure 3 Flow cytometric analysis of the patient's blood T cells (left) compared to a healthy
donor (right)
Figure 4 Flow cytometric analysis of CD4 T cells in patient (bottom) vs a healthy donor (top).
Intracellular cytokine staining was used to measure TNFa and IFNg by Dr Linda

Following this week, the patient starts feeling worse as the symptoms worsen. As
mentioned in the report, the patient mentions weakness particularly, in left side of the body. The
reports of immunological tests as revealed by Dr King stated that the patient was HIV positive,
to which the patient admitted to have multiple sexual partners over a span of five years. The
confirmation of being HIV was diagnosed with the help of a viral genome replicate count,
221577 230210, 200001 copies/ml (Márquez-Nogueras and et. al., 2021). In addition, the
symptoms mentioned confused state of mind, to which Dr King requested an MRI scan of
patient’s brain. The MRI scan of the patient is given in figure 5.
Figure 5 Ring enhancing lesions observed in the patient's brain from different views in MRI scan
The results from the MRI scan led Dr King to conclude the presence of a bug in her brain
which explains utter state of confusion (Mandelbrot and et. al., 2018). This bug is supposedly
very common in HIV patients causing confusion. This diagnosis was followed by an
immunological test conducted by Dr Linda on that particular part of the brain. This result of the
test is given in figure 6.

Figure 6 the lesioned part showing some tissue damage along with presence of a bug according
to immunohistochemistry conducted by Dr Linda which showed the same bits of Anti-SAG1
monoclonal antibody
Therefore, she was immediately put on highly active antiretroviral therapy, which included
HAART; zidovudine, lamivudine and nevirapine (Yücesan and et. al., 2019). The frequencies of
doses prescribed to the patient were as follows:
 Trimethoprim 160gm, 3 times a day.
 Sulfamethoxazole 800gm, 3 times a day.
 Azithromycin 250 gm daily.
This presentation was followed for over 4 months after which a blood test was performed to
check the progress as shown in figure 7. It was observed that the visual acuity in her right eye
rose to 20/20 along with substantial decrease in inflammation (Kolören, and Dubey, 2020). Her
retina was found to be completely reattached along with decrease in the yellow sub retinal
exudates that appeared in the perifoveal area of her eye. The condition of her blood cells seemed
to improve along with one-sided muscle weakness that she faced. However, she is still advised to
repeat her medications by Dr King and Dr Linda as she resumes her normal life.
The Toxoplasmosis Gondii is usually transmitted in human occur from eating improper
cooked food and so on. In reference to case study, individual is get infected due to the cat
because the patient starts to face the issue of vision issue as per bruises when she gets from the
cat while providing care. the mechanism well provides the detail configuration where retina
impacted readily due to the infection which is refer as Toxoplasmosis Gondii. Toxoplasmosis
Gondii has been found in kidney bladder and intestine of infected human, there are some of rare
organ transplant recipient is also acquiring the issue of Toxoplasmosis Gondii infection.

Therefore, the long term of chronic effect of the infection which provide the result when the cyst
is used to spread on the brain and muscle. The cyst which is present in the body as long the
person live can also rupture and cause the severe illness that include damage to the brain eyes
and organ (Yücesan and et. al., 2019).
Figure 7 Flow cytometric analysis conducted by Dr Linda after therapy. The effect of T cells on
peripheral blood mononuclear cells.
DISCUSSION
The microorganism Toxoplasmosis Gondii causes the toxoplasmosis. In addition, it is well
describing that the parasite infects wild and domestic animals that include birds, cats and sheep
and so on which provide information that is related with causes of Toxoplasmosis Gondii. Cats
are referring as the most common source of Toxoplasmosis Gondii that is well transmitted to the
other animals and people. In the context to the case study, it is well related with the person who
is taking care of cat and it all started with the bruises that she used to get from the at while taking
care. there are three form of Toxoplasmosis Gondii that are tachyzoite, which is refer as instant
reproduction form, the brachyzoite which is refer as slower reproduction form that they are
contained in tissue cyst and also a sporozoite which may have contained in oocyst (Yücesan and
et. al., 2019). In context with cat, the Toxoplasmosis Gondii which may infect the lining of the
small intestine which may reproduce asexually. After the few days that of rapid reproduction the
cell transform into the sexual from, combine and show to become enclosed which is based on
cyst called an oocyst. Therefore, the oocyst which may also comprise of sporozoite form of the

Toxoplasmosis Gondii that refer as the part of parasite. The oocyst which is founded in both wild
and domestic cat but not in any other animals and birds. Therefore, cats become infected by
ingesting food which is well contaminated with preference to oocyst from faces or with the tissue
cyst that is zoitocyst from flesh of infected animals which may create consequence people. The
Toxoplasmosis Gondii is parasite which may create complication with the vision where the
parasite gets attached with retina and blur the vision. In addition, the case study is well related
with cat related infection which is happen due to the bite or attached with cat for the longer
period (Yücesan and et. al., 2019).
The diagnostic reports suggest the presence of toxoplasmosis, which is a single celled
parasitic protozoan which is caused by Toxoplasma gondii. According to this case study, cats
which the patient took care of were the carriers of this parasitic protozoan. The contraction of the
parasite enabled some symptoms such as swollen lymph glands and muscle aches which lasted
for a month or so (Karakavuk and et. al., 2018). With time, these symptoms got severe as the
patient reported noticing blurred vision in her left eye which was followed by complete blindness
in bright light. This is because toxoplasmosis infection affects the retina. This is called as ocular
toxoplasmosis. Clinical findings suggest that characteristically, the eye appears fluffy with white
and yellow fundus lesions that overlay cells of vitreous chamber of the eyes (Mirzaalizadeh and
et. al., 2018). There was a decrease in the number of lymphocytes as the lymph nodes were
attacked by this parasite, leading to persistent weakness. This weakening of the immune system
makes the body prone to diseases and infections. One of the most severe and crucial
manifestation of toxoplasmosis is encephalitis, which usually occurs in patients with AIDS (Fux
and et. al., 2020). According to knowledge of the doctors, toxoplasmosis affects the functioning
of central nervous system and mostly commonly causes mass brain lesions in HIV patients
(Strang and et. al., 2020).
Toxoplasmosis is extremely common in patients with acquired immunodeficiency
syndrome. In patients with AIDS, the parasite can reactivate itself and cause infection in the
body. This usually occurs when the concentration of CD4 cells is less than 100 cells/ micron
(Ocular Toxoplasmosis after Exposure to Wild, 2021). CD4 cells are basically white blood cells
that play a crucial role in the immune system by helping fight off infections in the body. When a
patient comes in contact with HIV, the virus attacks and destroys T cells in the body (Shuralev
and et. al., 2018). This makes the body vulnerable to infections of various sorts. The patient

contracted the infection through ingestion of infective oocysts from feline litter. This was
followed by invasion of the parasite to the intestinal epithelium (Nishimura and et. al., 2019).
The depletion of CD4 cells follows depletion of cytokines along with impaired T lymphocyte
activity that leads to development of infection. Cerebral toxoplasmosis is one major complication
of infection caused by T. gondii. The infection caused development of lesions in the cerebral
column of the patient's brain along with tissue damage. Muscle weakness observed by the patient
in the left side of her body when analysed reported the presence of a bug that caused lesions in
the left side of brain (Foroutan and et. al., 2019).
The contraction of infection is less harmful than reactivation as it is followed by severe
symptoms such as focal brain lesions and sometimes even death (Valenzuela-Moreno and et. al.,
2019). HIV infected patients are at a high risk of developing encephalitis, which causes
abnormality in the brain by development of brain lesions. This infection is contracted through
consumption of contaminated food or water which contains oocyts excreted by cats. The
ingestion these oocyts by the patient led to the development of tachyzoites entering the nucleated
cells of host (Mandelbrot, 2020). These tachyzoits are invasive in nature and cause cell death.
They are transported to other parts of the body through circulatory system. Tachyzoits are
transformed in tissue cysts. However, these cysts are dormant in nature (Salant and et. al., 2021)..
The various sites of cysts formation in the body are brain, skeletal and cardiac muscles. If these
cysts enter the body of an immunocompromised person, they are instantly activated and
transform themselves into tachyzoites (Crouch and et. al., 2019). These agents lead to formation
of infections in the body and can cause disease of the central nervous system by dropping the
CD4 cell count to less than 200 cells/ microliter, which occurred in this case. The infection then
disseminated throughout the whole body leading to development of necrotic focus which is
usually surrounded by inflammation. This causes the infection to last throughout the entire life of
the host organism (Triana and et. al., 2018).
Both the type 1 interferon (IFN), which is also used as IFN-α and also show the tumour
necrosis factor where alpha (TNF-alpha) that has been implicated which is based on pathogensis
based on pathogenesis of sarcoidosis. The corelation is well investigated that used to provide the
serum level of these cytokine in the large multi-ancestral sarcoidosis population that is help to
determine correlation between the cytokine level and show the disease phenotype. The correlaton
which is well related with the TNFa and IFNg.

Clinical manifestations with HIV infection in this patient were accompanied by
encephalitis, chorioretinitis (de Paula and et. al., 2022). Some of the common sites of infections
were ocular. Cerebral toxoplasmosis had a definitive diagnosis based on radiological findings,
molecular studies and blood tests. Serological diagnoses were based on the identification of high
IgG in the body which indicated the presence of an infection as an inflammatory response of the
immune system. T. gondii affected the brain along with the retina causing broad spectrum of
clinical diseases (Multimodal Imaging in Ocular Toxoplasmosis, 2021). Toxoplasmosis in AIDS
patients marks the activation of chronic infection. The diagnosis of toxoplasmosis was done by
serologic and histocytologic examination. The diagnostic measures helped in detection of
antibodies to T. gondii. The brain lesions, also called human cerebral toxoplasmosis, observed in
the patient's brain were diagnosed an MRI scan. Upon confirmation of diagnosis, the physician
provided the patient with an appropriate treatment plan. Pharmacological intervention techniques
for treatment of toxoplasmosis include HAART antiviral therapy regime (Ogunmiloro, 2019).
This includes a combination therapy of trimethoprim, sulfamethoxazole and azithromycin. The
risk of ongoing opportunistic infection can be prevented by use of HAART therapy. This
treatment method has significantly helped reduce death rates in humans over a period of time.
The rate of the infection is reduced after a period of time and the patient's condition significantly
improves (Yangand and et. al., 2019). As observed in the patient where, her vision was restored
along with visual acuity rising up to 20/20. The inflammation in her eyes reduces with time as
yellow sub retinal hard exudates disappeared over Peri-foveal area. Retinal attachment and clear
vision were acknowledged (Ramanan and et. al., 2020). The muscle weakness observed in the
left-hand side of her body improved. A blood test performed after a course of four months of
continuous anti-retroviral therapy revealed that the levels of her CD4 blood cells improved
substantially.
CONCLUSION
The patient was experiencing severe complications due to infective parasitic protozoan
species which is found to be Toxoplasmosis gondii which lead the patient to develop severe
infections. She was showing severe symptoms of predominant blindness along with numbness in
the left part of her body. The immunological and serological tests revealed that she was HIV
positive which made her immune deficient, as her CD4 cell count dropped to 200 cells/micro
litres. Her retina was detached along with emergence of multiple fibrous bands in her optic disc.

There was a white patch surrounding fundus which causes problems in vision. The condition of
the patient worsened with time probably as a result of development of multiple ring enhancing
lesions in her brain. MRI scan of her brain confirmed the presence of a big in her brain that was
causing serious tissue damage. After receiving proper medical care in the form of antiviral
regimen, the condition of the patient significantly improved overtime.

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Online
Multimodal Imaging in Ocular Toxoplasmosis, 2021 [Online] Available through
<https://www.tandfonline.com/doi/abs/10.1080/09273948.2020.1737142 >
Ocular Toxoplasmosis after Exposure to Wild, 2021 [Online] Available through:
<https://www.tandfonline.com/doi/abs/10.1080/09273948.2020.1854316 >