Clinical symptoms in the immunocompetent individual

The incubation time varies, but is usually between 10 and 14 days depending on the dose, the route of entry of the parasite, and individual factors (Krick and Remington 1978). The primary Toxoplasma infection is not commonly recognized, since the symptoms described are non-specific. Low-grade fever, sore throat, night sweats, myalgia, fatigue, malaise, and a maculopapular rash may occur, as well as, enlargement of the liver and spleen. Initially a lymphadenopathy may occur, often in the cervical region, and the nodes are usually discrete and non-tender and do not suppurate. This condition can clinically be mistaken for mononucleosis or a cytomegalovirus infection. A low number of atypical lymphocytes may be present in the blood.

These nodes usually disappear within a month but can persist for a longer period in some individuals. Enlarged nodes in the abdomen can cause abdominal pain. Retinochoroiditis, usually unilateral, may occur in cases of an acute, acquired infection. Pneumonitis, myocarditis, pericarditis, hepatitis, and central nervous system involvement may occur, but is rare (Sherman and Nozik 1992). Pulmonary toxoplasmosis has been described in immunocompetent patients (Pomeroy and Filice 1992). Shortness of breath and cough are the most common symptoms, together with fever and rales. Lymphadenopathy and hepatosplenomegaly are also common, and chest roentgenographs may show bilateral interstitial infiltrates. Mortality rates tend to be low.

Toxoplasmic myocarditis and polymyositis in an adult with primary toxoplasmosis has been described (Montoya et al. 1997) and it is recommended that a toxoplasmic serological

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profile is performed on patients with myocarditis and/or polymyositis of unknown origin. There are case reports describing recurrent toxoplasmosis in immuno-competent hosts (Norrby and Eilard 1976; Candolfi et al. 1993). Conventional immunological tests proved no abnormalities. In one case Toxoplasma parasitemia was detectable in blood using polymerase chain reaction although immunological parameters, including antibody responses, were normal (O'Connell et al. 1993). This is, however, a rare condition and should be followed, as it might be an early sign of a defect in the immune-defense. Treatment can be given.

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