What are the other Names for this Condition? (Also known as/Synonyms)

• Enlarged Lymph Nodes due to Toxoplasmosis
• Piringer-Kuchinka Lymphadenopathy
• Toxoplasmosis Lymphadenitis

What is Toxoplasmosis Lymphadenopathy? (Definition/Background Information)

• Toxoplasmosis Lymphadenopathy is the inflammation and enlargement of lymph nodes (usually in the neck) due to underlying Toxoplasmosis, which is caused by Toxoplasma gondii (a protozoa; common microorganism)
• Toxoplasmosis is generally caused by consuming meat that is contaminated by the parasite. The contamination can occur even during the cooking or preparation stage. Cat feces are also a possible source of this protozoan parasite and an accidental ingestion can cause Toxoplasmosis
• This infection normally does not affect an individual with healthy immune system. However, pregnant women and those with various immunodeficiencies may be severely affected. In such individuals, complications can arise, which can lead to life-threatening situations
• Treatment measures of Toxoplasmosis Lymphadenopathy include treating the underlying infection through prescription oral medications, controlling associated symptoms (such as fever and body pain), and taking plenty of rest
• The prognosis of Toxoplasmosis Lymphadenopathy generally depends upon the severity of the underlying signs and symptoms due to the protozoan infection. Although, it is also dependent upon the health status of an individual. In many individuals, the prognosis is excellent

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.

Who gets Toxoplasmosis Lymphadenopathy? (Age and Sex Distribution)

• Toxoplasmosis Lymphadenopathy occurs due to underlying Toxoplasmosis, which can affect individuals of all ages, both genders (males and females), and all racial and ethnic groups
• Toxoplasmosis is very common in parts of Europe, North and South America, Asia, and Africa - regions with hot-humid climate. A majority of the human population carry this parasite in a latent state, within their body

What are the Risk Factors for Toxoplasmosis Lymphadenopathy? (Predisposing Factors)

The main risk factor for Toxoplasmosis Lymphadenopathy is the underlying Toxoplasmosis infection. The risk factors of Toxoplasmosis include:

• Consuming meat (beef, lamb, pork, and venison) that is partially-cooked, or cooked improperly (without maintaining proper hygienic standards, like using contaminated vessels, knives)
• Inadvertently touching one’s face, mouth, while handling contaminated raw meat; not following safe meat preparation procedures
• Eating raw vegetables and fruits, without washing or cleaning them
• Drinking untreated water from a stream or a well, or from any such source that is contaminated
• Direct exposure to cat feces, or to soil contaminated by the feces
• Living in crowded neighborhoods and/or travelling to areas with poor sanitation facilities
• Eating food that is mass-prepared (using contaminated meat) without proper quality control
• Individuals with weak immunity constitution (caused by factors like AIDS/HIV, cancer, organ transplant, diabetes, and so on) are easily infected
• A newborn baby is at risk to develop severe Toxoplasmosis, if the mother is ‘recently’ infected by the microorganism
• Individuals working at high-risk zones, such as meat processing/packing plants, pet stores, zoos, and veterinary hospitals, are prone to Toxoplasmosis Infection to a higher degree
• Individuals with weak immune systems are prone to developing severe symptoms
• Young women have a high risk of Toxoplasmosis Lymphadenopathy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Toxoplasmosis Lymphadenopathy? (Etiology)

Toxoplasmosis Lymphadenopathy is caused by Toxoplasma gondii, which is a common protozoa generally found in infected meat. The infection due to T. gondii may be transmitted by:

• Consuming undercooked or improperly cooked meat
• Handling raw meat
• Unclean water
• Handling cat feces; infected garden soils (with cat feces)
• Eating raw fruits and vegetables without cleaning or washing them
• Congenital transmission of the infection from an infected mother to the infant child
• Rarely, through blood transfusion or during an organ transplant

What are the Signs and Symptoms of Toxoplasmosis Lymphadenopathy?

The signs and symptoms of Toxoplasmosis Lymphadenopathy may include:

• Lymphadenopathy or enlarged lymph nodes; the presence of enlargement of localized lymph nodes is seen
• The enlarged lymph nodes can usually measure between 0.5-3.0 cm in size
• Commonly the lymph nodes of the head and neck region are involved. However, other lymph nodes of the body can also be affected
• The swollen lymph nodes can be painless or painful upon touch (palpation)
• The skin over the enlarged lymph nodes is usually intact and not affected; no ulceration is noted, unlike some bacterial infection such as actinomyces infection or tuberculosis
• In some, mild symptoms, such as fever and body aches, are see; while, in a majority, no signs and symptoms with respect to the enlarged lymph nodes are observed
• Rarely, enlargement of lymph nodes all over the body (generalized lymphadenopathy) may be seen. In such individuals, enlarged liver and spleen (hepatosplenomegaly) is also observed

The associated signs and symptoms of underlying Toxoplasmosis depend upon the health condition of the individual affected and the severity of the infection. The onset of signs and symptoms may occur within 10-14 days after being infected. These are categorized as:

• Normal, healthy individuals (including most newborn babies) usually do not exhibit any signs of the infection, but act as a carrier of the protozoa. This condition is referred to as latent Toxoplasmosis. If any signs and symptoms are exhibited, they are mild and these may include:
  • Fever
  • Headaches, body aches
  • Enlarged lymph nodes; in children longstanding lymph node enlargements may occur
  • Sore throat (sometimes)
• In case of acute Toxoplasmosis, some individuals may have flu-like symptoms, with muscle aches and body aches, swollen lymph nodes, which subside after 1-2 months
• Infrequently, itchy eruptions on the skin with formation of nodules or lesions are observed

Individuals with weak immune systems may be severely affected and suffer damage to the eyes, brain, lungs, and other vital organs. In such cases, either the parasite (which the individual carried) gets reactivated due to favorable conditions, or a recent infection might have occurred. The signs and symptoms of Toxoplasmosis in such cases may include:

• Reduced vision or blurred vision, vision impairment, sensitivity to light, eye pain, redness of the eyes
• Anxiety, confusion, lack of coherent (focused) behavior, even seizures
• Fever and headaches

How is Toxoplasmosis Lymphadenopathy Diagnosed?

The diagnosis of Toxoplasmosis Lymphadenopathy can be difficult, since many parts of the body including the CNS may be involved. The healthcare provider may perform the following exams and tests to aid in the diagnosis:

• Complete physical examination and evaluation of medical history
• Blood samples are examined, to detect the presence of the microorganism causing Toxoplasmosis infection. Some of these tests include:
  • Polymerase chain reaction test (PCR test for Toxoplasmosis)
  • ELISA test for Toxoplasmosis
  • Sabin-Feldman dye test for Toxoplasmosis
• Inoculating the potentially infected tissue into the belly of mice (Intraperitoneal inoculation) will reveal the presence of Toxoplasma organisms in less than a week. This procedure is considered to be a highly-reliable method for diagnosis of the condition
• Eye examination using a slit-lamp
• CT scan of head
• MRI scan of the brain
• Biopsy of the brain: The biopsy is examined under a microscope by the pathologist, to arrive at a definitive diagnosis. A biopsy is performed, if Toxoplasmosis causes a brain infection

In majority of the cases, a lymph node biopsy is not performed for Toxoplasmosis Lymphadenopathy. However, if the signs and symptoms persist despite suitable treatment, then a biopsy may be undertaken to rule-out other causes of swollen glands (such as a lymphoma).

In case of a lymph node biopsy, the following information may be noted:

• Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
• The lymph node biopsy may be performed through any of the following procedures:
  • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
  • Lymph node core biopsy of the enlarged lymph node
  • Lymph node open biopsy of the enlarged lymph node

A differential diagnosis may be performed to exclude other conditions before arriving at a diagnosis such as:

• Sarcoidosis lymphadenopathy
• Dermatopathic lymphadenopathy
• Systemic lupus erythematosus lymphadenopathy
• HIV lymphadenopathy
• Rosai-Dorfman disease

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Toxoplasmosis Lymphadenopathy?

Complications of Toxoplasmosis causing Lymphadenopathy may include:

• The Toxoplasma is retained in the body even after recovery. This may get reactivated, when conditions are favorable and the infection can recur
• Toxoplasmosis can affect the brain and cause certain behavioral changes
• Side effects of treatment medication
• Individuals with weak immune systems can be ‘severely-to-fatally’ affected with the infection spreading all over the body
• In pregnant women, the fetus may be infected via the placenta and develop growth abnormalities and mental disorders. Owing to this, miscarriage, stillbirth, or death of the infant following its birth may take place

How is Toxoplasmosis Lymphadenopathy Treated?

Most cases of Toxoplasmosis Lymphadenopathy are self-limiting, meaning that a healthy individual usually recovers from the condition in a few weeks. In such cases, no treatment is usually required.

• The swelling of the lymph nodes may last for a few days in some individuals; while in others, it may remain for a year
• In many, the enlarged lymph nodes get better spontaneously on its own, without any treatment, within a month’s time

The underlying Toxoplasmosis infection may be treated symptomatically by the physician, as required.

• Pregnant women and infants require medication and sometimes extensive treatment
• Prolonged treatment with antibiotics and even antimalarial drugs may be required for those who are immunocompromised and are infected with the Toxoplasmosis parasite

How can Toxoplasmosis Lymphadenopathy be Prevented?

The preventative measures for Toxoplasmosis Lymphadenopathy includes taking proper precautions to prevent transmission of the harmful protozoa via food and water. Pregnant women have a high-risk of Toxoplasmosis infection being transmitted to their babies; hence, they must be particularly careful.

Some preventative measures for the underlying Toxoplasmosis infection include:

• Avoid undercooked food (mainly meat) and contaminated water; always drink water that is clean and from a reliable source
• Follow basic rules while cooking and consuming food, such as:
  • Carefully washing food items (like meat and vegetables)
  • Washing food vessels, cutting boards, etc. before use
  • Cooking meat to the required temperatures, to kill any microorganism
  • Keeping food items covered, stored properly
  • Washing hands before eating, or immediately after handling raw meat
• Sample tasting of meat, while it is being cooked (or while still undercooked), is to be avoided
• Fruits and vegetables have to be washed and cleaned well, particularly if they are to be consumed raw
• Be extremely careful while handling cat feces, or while cleaning cat litter boxes (use hand gloves). Also, ensure that the litter boxes are cleaned regularly
• Train children to understand the importance of washing their hands, especially after playing in the mud, after playing outdoors
• Garden soil may be contaminated with Toxoplasma found in cat feces - ensure that you wash your hands thoroughly with soap and water after being in contact with the soil (due to activities, such as gardening or backyard cleaning)
• If you belong to any of the high-risk groups, such as working at a vet clinic, a pet store, or having a weak immune system; then, do ensure that you take adequate safety precautions while handling cats (or other pets), also avoid touching or playing with stray cats

All these factors contribute in preventing Toxoplasmosis infection and consequently, Toxoplasmosis Lymphadenopathy.

What is the Prognosis of Toxoplasmosis Lymphadenopathy? (Outcomes/Resolutions)

The prognosis of Toxoplasmosis Lymphadenopathy is based on the severity of the underlying Toxoplasmosis infection.

• A healthy individual usually recovers from Toxoplasmosis within a few days, despite no treatment being given; the prognosis, in such cases, is excellent
• Prompt treatment of the infection is necessary, if the infection affects newborn babies, very young infants, or pregnant women. If treatment is delayed in such cases, the prognosis of Toxoplasmosis infection is guarded
• High mortality rates are generally associated with untreated cases of Toxoplasmosis infection, in individuals with poor immunity

Additional and Relevant Useful Information for Toxoplasmosis Lymphadenopathy:

• It is observed that in case of unexplained enlarged lymph nodes occurring in adults, the probable cause in 1 in 5 individuals is believed to be Toxoplasmosis infection
• In the US, Toxoplasma is one of the most common parasite infecting humans; 50% of Americans have antibodies indicative of a chronic asymptomatic condition
• The prevention and treatment of Toxoplasmosis can be accomplished to a good extent through mass-education. This should include providing information on proper hygiene, maintaining good food preparation practices, and observing certain preventive measures (mentioned above)