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Abstract: Toxoplasma gondii is a human-animal commensal disease with two main routes of infection: dietary infection, consumption of undercooked meat, etc., and contact with animals and their feces. The patient mentioned in this paper came to the clinic with fever of unknown origin for 2 weeks, and no significant abnormalities were found based on symptoms and ancillary examinations. After parasitological examination, Toxoplasma gondii was found, and the symptoms gradually improved after anti-infection treatment was given.
Basic information】Female, 56 years old
Type of disease】Toxoplasmosis
Hospital】Beijing Huairou District Hospital of Traditional Chinese Medicine
Date of consultation】April 2022
Treatment plan】Anti-fever treatment (compound acetaminophen tablets) + anti-infection treatment (clindamycin and Synthroid) + antiviral treatment (antiviral oral solution)
Treatment period】Anti-viral treatment for 5 days, anti-Toxoplasma gondii infection treatment for 1 month
Treatment effect] The symptoms of discomfort improved and the body temperature gradually returned to normal
I. Initial consultation
The patient was 56 years old female, with a body temperature of 37.5℃. She complained of recurrent fever for 2 weeks, with body temperature fluctuating around 37.5℃, and her body temperature could return to normal after taking ibuprofen extended-release capsules on her own. The patient had no special symptoms during the fever, only peripheral weakness and loss of appetite. Previous history of hypertension and renal transplantation. The patient was given a screening test for new coronary pneumonia (lung CT, nucleic acid test, coronavirus antibodies, blood analysis). Considering the patient’s long history of onset and previous history of renal transplantation, liver and kidney function and urinalysis were performed. Lung CT, nucleic acid test, coronavirus antibody, liver and kidney function and urinalysis did not show any significant abnormalities; blood analysis suggested that the number of lymphocytes was reduced, and white blood cells and neutrophils were normal; the patient’s clinical symptoms were atypical, and poor resistance existed after renal transplantation, and the patient was considered to have a high possibility of viral infection in combination with symptoms and ancillary tests.
II. Treatment history
The patient was in good mental condition, with no special discomfort, mild fatigue and loss of appetite during fever. The patient was temporarily given antiviral oral solution and compound acetaminophen tablets, which can be taken when the body temperature exceeds 38.5℃, and the patient was asked to take them for 3 days before the follow-up examination to judge the treatment effect. The patient’s fever worsened at the follow-up visit 5 days later, and the body temperature could be as high as 39.1℃. Combining with the patient’s symptoms and the results of auxiliary examinations, the possibility of parasitic infection was considered, so immunological and parasitological examinations were performed. The results of the examination indicated positive microscopic staining of Toxoplasma gondii and positive IgM antibody, and toxoplasmosis infection was considered.
III. Treatment effect
After the patient took the antiviral oral solution in the 3rd week, the symptoms of weakness and loss of appetite did not improve, and the fever was worse than before. After taking anti-Toxoplasma gondii clindamycin and Synthroid in the 4th week, the body temperature was significantly better than before, and the maximum body temperature did not exceed 38.5℃, and the symptoms of malaise and loss of appetite were less than before. The patient’s body temperature returned to normal after 1 month of medication, no obvious malaise and other discomfort, appetite has basically returned to normal, blood analysis has returned to normal, and Toxoplasma gondii microscopy staining is negative.
IV. Notes
We are glad that the patient’s treatment effect is ideal. Toxoplasmosis generally has a long treatment period, and patients need to take drugs regularly for 1-1.5 months to achieve the treatment effect. Patients should not be overly anxious, as toxoplasmosis can usually be cured after active treatment. If the body temperature exceeds 38.5℃, it will aggravate the symptoms of fatigue and loss of appetite, so you can take acetaminophen tablets to reduce fever and improve the symptoms. If you have a poor appetite, you can eat light and easy-to-digest foods such as vegetable porridge and millet porridge. Sleep should be 7 hours a day, and you should be active and avoid overworking.
V. Personal insight
Toxoplasma gondii is usually found in dogs and cats, but it can also be found on raw meat, unwashed vegetables and fruits. In this case, the patient’s immunity was affected after organ transplantation, so he was more likely to be infected with toxoplasmosis. To prevent toxoplasmosis, we need to strengthen our resistance, avoid eating raw meat and seafood, and wash vegetables and fruits thoroughly. Pets such as dogs and cats are generally not recommended for families with elderly, pregnant women, infants and other members with low resistance.