Immunocompetent adults and children with toxoplasmic lymphadenitis do not require treatment unless symptoms are severe or persistent. Infections acquired by laboratory accident or transfusion of blood products are potentially more severe, and these patients should always be treated. The combination of pyrimethamine, sulfadiazine, and folinic acid for 4-6 weeks is the most commonly used and recommended drug regimen (Box 2).
Toxoplasma Gondii: Clinical Findings
Primary infection in any host often goes unrecognized. In ~ 10% of immunocompetent individuals, it causes a self-limited and nonspecific illness that rarely requires treatment. The most frequently observed clinical manifestation in this setting is lymphadenopathy and fatigue without fever; other manifestations include chorioretinitis, myocarditis, and polymyositis (Box 1). Reinfection occurs but does not appear to result in clinically apparent disease.
Malaria and Babesia
Malaria, a disease of antiquity, was recognized by Hippocrates and described possibly as early as 1700 BC in ancient Chinese texts. Malaria is a global disease that occurs most commonly in the tropics; however, transmission may also occur in temperate zones.
Babesia SPP.
The members of the genera Babesia and Theileria are protozoan parasites. These organisms are of medical, veterinary, and economic importance. Babesia species cause disease in humans and animals.
Non-falciparum Malaria (P Vivax, P Ovale, P Malariae)
Patients with nonfalciparum malaria invariably develop fever and chills that may become cyclic. Initially, patients experience chills, which are followed by fever (Box 1). Patients with malaria often manifest many nonspecific symptoms such as weakness, malaise, headache, and myalgias. As the disease progresses, signs of anemia, such as pale conjunctiva, may be seen.
Falciparum Malaria
Fevers are often continual, with irregular spikes and associated chills and paroxysms. Patients with severe falciparum malaria may disclose central nervous system changes (prostration, convulsions, and impaired consciousness) and develop respiratory distress, abnormal bleeding, and circulatory collapse. Fatigue and malaise are nonspecific symptoms of malaria. These are in part caused by hypoglycemia and anemia.
Pneumocystis Carinii
In 1983, P carinii pneumonia (PCP) was described as the AIDS-defining illness in = 60% of the first 1000 patients diagnosed with AIDS in the United States. Subsequently, the advent of prophylactic measures has reduced the incidence of PCP presenting as the initial diagnosis for AIDS to < 50% of cases. In addition, the hospitalization rate is also declining for patients with AIDS who also have PCP. This decline has presumably been caused by successful use of prophylaxis against the organism.
Extrapulmonary P Carinii Infections
Extrapulmonary P carinii infections occur in < 3% of patients and must be diagnosed with histopathologic samples. Primary prophylaxis for PCP with pentamidine may confer a higher risk for extrapulmonary infection. Symptoms of extrapulmonary involvement are nonspecific, usually consisting of fevers, chills, and sweats.
Dermatophytes
Dermatophytes are molds that infect keratinized tissues including skin, hair, and nails. Whereas 40 dermatophyte species are known to infect humans, only about 15 of these are common causes of disease. These organisms belong to three genera, Microsporum, Trichophyton, and Epidermophyton. Because these fungi have such similar infectivity, morphology, and pathogenicity, they are often categorized according to the clinical syndrome and the preferred anatomic site with which they are associated, such as tinea capitis, tinea pedis, etc.
Fusarium, Penicillium, Paracoccidioides, & Agents of Chromomycosis
Fusarium spp. is an emerging fungal pathogen. Although long recognized as a cause of local infection involving nails, traumatized skin, or the cornea (eg, in contact lens wearers), deep or disseminated infection was not described until the mid 1970s. Despite its worldwide distribution and its frequent recovery from soil and vegetative material, infection is quite rare. Only ~ 100 cases involving invasive disease in immunosuppressed patients have been described in the medical literature.