A 52-year-old woman is brought to the emergency department 20 minutes after having a generalized tonic-clonic seizure. Medical history is remarkable for HIV infection. Her medications include dolutegravir, lamivudine, and tenofovir, which she uses inconsistently. She appears lethargic and confused. Neurological examination shows no abnormalities. There is generalized lymphadenopathy. Laboratory studies show a CD4+ count of 89 cells/L (N 500). A CT scan of the head with contrast shows multiple ring-enhancing lesions in the basal ganglia and subcortical white matter. An India ink preparation of cerebrospinal fluid is negative. Which of the following is the most likely route of transmission of the infectious agent causing this patient's current condition?

Question

A 52-year-old woman is brought to the emergency department 20 minutes after having a generalized tonic-clonic seizure. Medical history is remarkable for HIV infection. Her medications include dolutegravir, lamivudine, and tenofovir, which she uses inconsistently. She appears lethargic and confused. Neurological examination shows no abnormalities. There is generalized lymphadenopathy. Laboratory studies show a CD4+ count of 89 cells/L (N > 500). A CT scan of the head with contrast shows multiple ring-enhancing lesions in the basal ganglia and subcortical white matter. An India ink preparation of cerebrospinal fluid is negative. Which of the following is the most likely route of transmission of the infectious agent causing this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Toxoplasma gondii is an intracellular parasite that is typically transmitted to humans after accidental ingestion of contaminated cat feces (eg, cat handling, litter box).  Most initial cases are asymptomatic.  However, the organism establishes a latent infection that can reactivate in the setting of severe immunocompromise, particularly advanced AIDS.  Patients usually develop encephalitis with multiple ring-enhancing lesions.

A 52-Year-Old Woman Is Brought to the Emergency Department 20