It has been shown that serologic diagnosis is very sensitive in confirming the diagnosis. It has 100% sensitivity on the first serum specimen tested at a reference laboratory, BAY 73-4506 order if drawn within 3 months of onset of lymphadenopathy.9 This can eliminate the need for further invasive workup. Our series has a male to female ratio of 6.5 : 1, which is likely due to the high proportion of returned male missionary travelers being seen at our center. Travelers occasionally acquire two or more infections concurrently. Comorbidities, likely also resulting from travel, were noted in 50% of the patients and included chronic diarrhea (three), suspected dengue fever (one),
latent tuberculosis acquisition (one), culture positive Salmonella typhi (one), serologic evidence of Chagas disease (one), and carbon monoxide
Wnt inhibitor poisoning during travel (one). While life-threatening toxoplasmosis is generally associated with the immunosuppressed populations, there have been a number of case reports in immunocompetent individuals. Documented complications include disseminated disease,10 bronchiolitis, pneumonitis,11 pneumonia in a pregnant woman,12 fatal myocarditis, pericarditis, simultaneous myocarditis and polymyositis,13 hepatosplenomegaly and hepatitis, diffuse encephalitis,14 encephalitis with quadriparesis and chorioretinitis, and Guillain-Barré syndrome.1,15 Several of these complications were noted in relationship with an atypical strain of Toxoplasma, for example in the well-described community outbreak of multivisceral toxoplasmosis in Patam, a Surinamese village near the French Guianan border. In our series, 2 of 14 (14%) patients required hospital admission—one for febrile illness with concern for endocarditis, and one for unexplained fever and lymphadenopathy. Both were discharged home once the diagnosis of toxoplasmosis was established. Atypical lymphocytes are often seen in patients with acute toxoplasmosis. Atypical lymphocytosis
Endonuclease was noted in 3 of 14 (21%) patients in our series, all of whom presented during the acute phase of symptoms. Clinicians should recognize atypical lymphocytes as a sign of acute toxoplasmosis and if the symptomatology is appropriate, order toxoplasma serologies. In all of our patients where toxoplasmosis was clinically suspected, diagnosis was established by a positive IgM and a positive IgG titer. Ideally, repeat serologic testing with fourfold rise in IgG titers is recommended, but the self-limiting nature of the illness and this retrospective study design precluded this confirmatory testing. Tests for IgM and IgG antibodies should be used for initial evaluation of suspected toxoplasmosis. Acute infection is supported by documented seroconversion of IgM and IgG antibodies or a greater than fourfold rise in IgG antibody titer in sera run in parallel.