GoodGirl
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| PGI2alpha
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A?toxoplasma
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| GoodGirl
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Must add the Q is from wikitestprep.com, I'm not sure if the answer is really correct. That' why I'm posting it here for discussion.
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| grechita12
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A
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| lakshya_0_7
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D......in immuno supressed its gonna be reactivation of the toxo that he must have got in the past, cat faeces would cause primary infection which is less likely here.....i think there is a similar q in the kaplan q bank or UW
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| new_n_lost
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Well this question is rather confusing. Cos it can be reactivation and it can be a new infection. There is no mention of AIDS or anything so it cant be said that this is a REactivation of a previous infection or new one. But from the presence of only one ring lesion as far as i can see. This is could be a new infection. If there are multiple lesions then this is definitely reactivation.
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| lakshya_0_7
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well the CD-4 count is 85...so he is immunosupressed...no doubt about that....and i see definitely more than one ring enhancing lesion...
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| Tiff
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I think it's D. Goodgirl, was the answer A? Because that doesn't seem correct. Toxoplasmosis doesn't really cross the corpus collosum. I think this is a lymphoma probably cause by EBV. Most have EBV dormant and in a immunocompromised person a reinfection will manifest to lymphoma in the brain. So I go with D.
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| hero
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CNS toxoplasmosis results from infection by the intracellular parasite Toxoplasma gondii. It is usually due to reactivation of old CNS lesions or to hematogenous spread of a previously acquired infection.
Occasionally, it results from primary infection. CNS disease occurs during advanced HIV infection when CD4+ counts are less than 200 cells/µL.
http://www.emedicine.com/neuro/TOPIC452.HTM
ans is A actually.
Edited by hero on 04/26/08 - 03:48 PM
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| hero
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Tiff wrote:
I think this is a lymphoma probably cause by EBV. Most have EBV dormant and in a immunocompromised person a reinfection will manifest to lymphoma in the brain. So I go with D.
Lymphoma is a solitary mass
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| Tiff
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hero wrote:
Lymphoma is a solitary mass
Your right. Good point. But Toxo still has the same effect in an immunocompromised person since most people have been infected and when you're immunocompromised reinfection would cause the brain lesions. It has to be due to reinfection. Still sticking with D.
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| Tiff
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lakshya_0_7 wrote:
D......in immuno supressed its gonna be reactivation of the toxo that he must have got in the past, cat faeces would cause primary infection which is less likely here.....i think there is a similar q in the kaplan q bank or UW
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| hero
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lakshya_0_7 wrote:
D......in immuno supressed its gonna be reactivation of the toxo that he must have got in the past, cat faeces would cause primary infection which is less likely here.....i think there is a similar q in the kaplan q bank or UW
reactivation vs reinfection (option D) - quite a difference..
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| Tiff
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hero wrote:
reactivation vs reinfection (option D) - quite a difference..
 Not sure about that. in this case it can be either reinfection or reactivation. Also this isn't a primary infection which I think makes A unlikely. That's just what I think.
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| GoodGirl
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As I mentioned earlier this Q is from wiketestprep , and I think they made a mistake by putting wrong word ''reinfection'' instead a proper one '' reactivation''. So that's why I wanted to post it here.
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| Tiff
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Like I said before, reinfection as well as reactivation can both occur. It's not a mistake.
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| new_n_lost
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Well guys i have only one question how have you all arrived at this conclusion that this is a old infection which got life. Cant it be a new infection. And i always thought there is a difference with reactivation and re-infection.
Any comments.
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| hero
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new_n_lost wrote:
...And i always thought there is a difference with reactivation and re-infection...
Correct. That is basics. 
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| Tiff
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hero wrote: Correct. That is basics.
Please understand that I'm not saying that reactivation and reinfection are the same thing. Very much aware they are different. A lot of things are pretty basic and anyone would agree that the basics are essential right? However people's idea of the basics differ from one another. What I'm saying here is that they both can happen. Reinfection or reactivation. I hope I'm helping here. Just trying to explain how I know it. Here is an excerpt I just found to emphasize my point...
"Toxoplasmosis is another common infection seen in the AIDS population. Some articles report that 3-70% of the healthy adults in the United States have been infected. Four types of infection has been described in toxoplasmosis including acute, latent, reactivation, and reinfection. " http://brighamrad.harvard.edu/Cases/jpnm/hcache/1...
"Staying on antibiotics will suppress the regrowth and reinfection of the toxoplasmosis parasite. " http://www.essortment.com/all/toxoplasmosis_revu....
Reactivation may happen more frequently than reinfection, but it doesn't negate the fact that reinfection does indeed occur. This can happen in pregnant women, people with AIDS and other immunosupressed people.
Please, any disputes/arguments are welcome. Here to learn and share. 
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| Tiff
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new_n_lost wrote:
Well guys i have only one question how have you all arrived at this conclusion that this is a old infection which got life. Cant it be a new infection. And i always thought there is a difference with reactivation and re-infection.
Any comments.
It could most certainly be a new infection. However the likelihood of having been infected increases with age since it's pretty common. Very few immunocompetent people will show symptoms. Immunosuppressed people on the other hand, will show symptoms, sometimes severe.
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| new_n_lost
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ok that Harvard article is saying the same thing as I am Reactivation and Re-infection are different entities. But my question is that how can you predict that this is a a re-infection. If this is a re-infection then the parasite must RE ENTER the patient. So if its gonna re-enter the patient then it must have a route. So if there is a route to it, then what is that route. The normal route of transmission is thru cat feces (oral) or placental.
"In immunocompetent hosts, cysts that contain the live T gondii organisms cause no harm; most patients remain asymptomatic but seropositive. However, if the immune system of the host declines, the cysts may reactivate, causing disseminated infection that manifests as encephalitis, myocarditis, or chorioretinitis. In immunocompromised patients, T gondii infection is potentially fatal. Seronegative patients can be infected via the usual oral route or via organ transplantation. More commonly, infection results from reactivation of latent tissue cysts..................." http://www.emedicine.com/radio/TOPIC703.HTM
My question is that if this is Re infection the parasite, did the parasite re-enter the host if so then how. thats the only thing confusing me .
Thanks.
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| Tiff
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There are several strains of toxoplasmosis. Reinfection would likely be due to ingesting oocysts of a different strain. Here is an interesting pdf link. It's a quick read - 2 pages. http://jcm.asm.org/cgi/reprint/35/5/1276.pdf
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| new_n_lost
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Tiff wrote:There are several strains of toxoplasmosis. Reinfection would likely be due to ingesting oocysts of a different strain. Here is an interesting pdf link. It's a quick read - 2 pages. http://jcm.asm.org/cgi/reprint/35/5/1276.pdf
You mean that the host was Reinfected by a second strain.... So how did that different strain get into the host is my question. Whether its teh same strain or different strain, re-infection implies that organism got in the host again. right or am i missing something here. And i do know what re-infection means, this article has illustrated the same that a patient can be re-infected which i guess we all know. But only my question which still remains unanswered, As per the question indicates and the given answer is RE-INFECTION. My question is how did this re-infection occur and have they given any form of indication that this is a re-infection ??
Cos if they say its re-infection then how did the parasite enter the host., Which should be the choice A but to say that this is a re-infection is a bit far off base. By their own reason if the primary infection never went away then why cant it be re-activation. What indications have they given to predict that this is Re-infection.
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| Tiff
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new_n_lost wrote:Tiff wrote:There are several strains of toxoplasmosis. Reinfection would likely be due to ingesting oocysts of a different strain. Here is an interesting pdf link. It's a quick read - 2 pages. http://jcm.asm.org/cgi/reprint/35/5/1276.pdf You mean that the host was Reinfected by a second strain.... So how did that different strain get into the host is my question. Whether its teh same strain or different strain, re-infection implies that organism got in the host again. right or am i missing something here. And i do know what re-infection means, this article has illustrated the same that a patient can be re-infected which i guess we all know. But only my question which still remains unanswered, As per the question indicates and the given answer is RE-INFECTION. My question is how did this re-infection occur and have they given any form of indication that this is a re-infection ?? Cos if they say its re-infection then how did the parasite enter the host., Which should be the choice A but to say that this is a re-infection is a bit far off base. By their own reason if the primary infection never went away then why cant it be re-activation. What indications have they given to predict that this is Re-infection.
I think I answered that. The person most likely ingested oocysts of a different toxoplasmosis strain like from his cat or his neighbors cat or from some undercooked or contaminated food. For example, from the article... "the mother was immune but was probably infected through contacts with kittens during pregnancy." In this case the mother had IgG to toxoplasmosis, but got reinfected by ingesting oocysts when she had contact with a cat later on in the pregnancy (& subsequently passing it on to her baby) - which is why IgM was found later.
The question doesn't really give any indication that he was reinfected. My take is that they are looking for the best answer. Cat feces isn't the only source of toxoplasmosis so i think, not the best answer. But as I read the question and answer choices again, I can see how it's a mean question. But illness occurs by infection or reinfection by ingesting oocysts despite where it came from. Hope I answered your question.
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| new_n_lost
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The question doesn't really give any indication that he was reinfected. My take is that they are looking for the best answer. << but if they arent telling u this is re-infection so how can we assume that RE-infection is teh answer.
But illness occurs by infection or reinfection by ingesting oocysts despite where it came from. << i think there are asking that in the question. Hence we are having this discussion.
The question is poorly worded and if the word Re-infection is replaced by Re-activation then it might make a lot more sense. Anyhow enough time spent.
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