Toxoplasmosis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body temperature, body weight, body height; further:
  • Inspection (viewing).
    • Skin, mucous membranes, and sclerae (white part of the eye) [postnatal infection: maculopapular exanthema (blotchy rash with formation of papules (vesicles/nodules))]
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture?
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels?
      • Scars? Hernias (fractures)?
  • Inspection and palpation of lymph node stations.
  • [postnatal infection: lymphadenopathy (lymph node enlargement), usually in the head and neck region]
  • Auscultation (listening) of the heart [due topossible secondary disease: myocarditis (inflammation of the heart muscle)]
  • Examination of the lungs (due topossible sequelae):
    • Auscultation (listening) of the lungs.
    • Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
    • Voice fremitus (checking the transmission of low frequencies; the patient is asked to pronounce the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (for example, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion,). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
  • Abdominal examination [splenomegaly (splenomegaly)?]
    • Percussion (tapping) of the abdomen.
      • Meteorism (flatulence): hypersonoric tapping sound.
      • Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
      • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
    • Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
• Ophthalmological examination [due topossible secondary diseases:
  • Chorioretinitis (inflammation of the choroid (choroid) with retinal (retina) involvement).
  • Iritis (inflammation of the iris in the eye).
  • Cataract (“cataract”; clouding of the lens of the eye).
  • Optic atrophy (reduction in vision due to degeneration of the optic nerve)]
• Gynecological examination in existing pregnancy [risk of miscarriage (miscarriage); premature birth]Note: If the mother becomes infected shortly before the end of pregnancy, the child is usually born asymptomatic, but later develops symptoms of toxoplasmosis infection and should be examined as a precaution.
• Neurological examination [due tosymptoms (especially in immunosuppressed):
  • Encephalitis (inflammation of the brain) with mental changes, seizures, headache, or paralysis.
  • Pneumonia (inflammation of the lungs) with dyspnea (shortness of breath) and fever]

  [due todifferential diagnosis (especially in immunosuppressed): brain abscess (encapsulated collection of pus in the brain)][due topossible sequelae:

  • Encephalitis (inflammation of the brain).
  • Epilepsy
  • Mental retardation
  • Cerebral atrophy (decrease in the mass of the cerebrum).
  • Hydrocephalus (hydrocephalus; pathological expansion of the liquid-filled fluid spaces (cerebral ventricles) of the brain).
  • Intracranial calcifications (calcifications in the brain)]
• Psychiatric examination [wg.Differential diagnosis: AIDS dementia]

Square brackets [ ] indicate possible pathological (pathological) physical findings.