Oesophageal and gastric toxoplasmosis: rare presentation of an emerging zoonotic disease

Abstract

Background: Toxoplasmosis a Zoonotic disease caused by Toxoplasma gondii. Toxoplasma gondii (T. gondii) is a protozoan parasite that infects most species of warm blooded animals including humans. It is an obligate intracellular parasite with a worldwide distribution. Sporozoites exist in oocysts and are found in the gut walls of definitive hosts the cat family (Felidae). Cats become infected with T.gondii by carnivorism or indigestion of oocysts.

Humans can become infected by any of the 4 routes; Eating undercooked meat of animals harbouring tissue cysts, Consuming food or water contaminated with cat feaces or by contaminated environmental samples (such as fecal contaminated soil or changing the litter box of a pet (cat), Blood transfusion or organ transplantation, Transplacentally (from mother to fetus), Accidental inoculation of tachyzoites.

Ocular Toxoplasmosis, a major cause of Chorioretinitis , may be as a result of congenital toxoplasmosis or acquired infection. Congenitally infected patients can remain asymptomatic until the second or third decades of life. Congenital Toxoplasmosis is subclinical in about 75% of infected newborn.

Case Study: E.K a 62 year old lady presented with a 3 months history of odynophagia that progressed to dysphagia. She had dyspepsia that was non-responsive to proton pump inhibitors. She gave history of slight weight loss due to inadequate food intake, because of the odynophagia, dysphagia and dyspepsia. She was in good general condition a febrile (Temp 37.1⁰ C), not pale, no jaundice, no significant lymphadenopathy, nor oedema.

Results: Recent findings have suggested an association between T. gondii infection and various Neurologic diseases or Psychiatric Syndromes such as Schistozophrenia, Alzheimer’s disease and Suicide. 10% to 20% of patients with acute infection may develop cervical lymphadenopathy or flulike illness.

Recommendations: Many of these aspects of disease may be delayed or prevented if treatment of toxoplasmosis is initiated antenatally and in the first 1 – 2 months after delivery.

Diagnosis and treatment must be different for each clinical category. In general, diagnosis accomplished using serology and histology. Isolation of the parasite can be difficult.

Cconclusion: This being the first case in our literature, highliting the fact that; though rare oesophageal and gastric Toxoplasma infection can occur, leading to dysphagia and dyspepsia, Carnivorism of cats makes it difficult to keep them free of disease.

Immunodeficiency patients often have Central Nervous System (CNS) disease but may have Pericarditis or Pneumonitis. Toxoplasmosis in immunodeficiency syndrome patients may be due to reactivation of chronic infection or acquired. Toxoplasmosis in patients being treated with immunosuppressive drugs may also be due to newly acquired or reactivated latent infection.