== A 55year-old female with pulmonary toxoplasmosis.Axial view of CT scan displays bilateral ground-glass opacities, interlobular and peribronchovascular clean thickening and small bilateral pleural effusion. == Number 2. and pleural effusion (66%). All the individuals improved their symptoms after treatment, and total resolution of tomographic findings were found in the followup. == Summary == These instances provide a unique description of the demonstration and development of pulmonary tomographic manifestations of toxoplasmosis in immunocompetent individuals.Toxoplasmapneumonia manifests with fever, dyspnea and a non-productive cough that may result in respiratory failure. In animal models, changes were described as interstitial pneumonitis with focal infiltrates of neutrophils that can finally evolve into a pattern of diffuse alveolar damage with focal necrosis. The tomographic findings are characterized as floor glass opacities, clean septal and designated peribronchovascular thickening; and may mimic pulmonary congestion, lymphangitis, atypical pneumonia and pneumocystosis. This is the largest series of CT findings of acute toxoplasmosis in immunocompetent hosts, and the diagnosis should be considered as individuals that present with acute respiratory failure in the context of a subacute febrile illness with bilateral and diffuse interstitial infiltrates with designated peribronchovascular thickening. If promptly treated, pulmonary toxoplasmosis can result in total medical and radiological recovery in immunocompetent hosts. Keywords:Pulmonary toxoplasmosis, Chest, Toxoplasmosis == Background == Toxoplasma gondiiis probably one of the most common human being zoonosis, infecting Lobeline hydrochloride approximately one-third of the worlds human population [1]. Although rare in Europe and in the USA, the seroprevalence for this obligate intracellular protozoan can reach 79% in males and 63% in females in Brazil [2]. Toxoplasmosis is generally benign and often goes unnoticed in healthy hosts; however, non-specific flu-like symptoms, hepatomegaly and diffuse lymphadenopathy may be associated with main contamination [2]. In adults, contamination can result from the ingestion of undercooked or natural meat containing tissue cysts or from the consumption of water or food contaminated by oocysts that are excreted in the feces of infected cats [3,4]. Rarely, the parasite is also transmitted by blood transfusion or organ transplantation [5,6]. Pulmonary involvement in acute toxoplasmosis has been explained in immunosuppressed patients [46], but is usually rare in immunocompetent subjects [7,8] Herein, we describe chest computed tomography (CT) findings in three immunocompetent patients with confirmed acuteT. gondiiinfection and review the current literature. == Case presentation == From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis with considerable lung involvement. Two of the patients were female, and one was male; the patients were 38, 56 and 36 years old, respectively. All three patients similarly presented to the emergency department with a two-week febrile illness and progressive dyspnea during the few days before admission without previous respiratory symptoms. The physical examinations revealed crackles in all patients and low oxygen saturation (SpO2) values, ranging from 82% to 86%. One patient had splenomegaly. Regarding their medical history, two of the patients experienced Type 2 diabetes, one of whom experienced undergone bariatric surgery the year prior. The third individual was previously healthy. Laboratory test results were normal with the exception of lymphocytosis with atypical lymphocytes (in two Lobeline hydrochloride patients), slight changes in liver enzymes and high inflammatory markers. The clinical and laboratory findings are summarized in Table1. One individual was Lobeline hydrochloride transferred from another hospital, where she was submitted to a lung biopsy and pleural Lobeline hydrochloride drainage; regrettably, we did not have access to these results. == Table 1. == Clinical and laboratory findings of patients with acute pulmonary toxoplasmosis *C-reactive protein. **Aspartate aminotransferase. ***Alanine aminotransferase. Rabbit Polyclonal to Collagen I alpha2 (Cleaved-Gly1102) The diagnosis of toxoplasmosis was made from serology (positive for IgM antibodies and low IgG avidity). In our institutions, real-time polymerase chain reaction-based assay to detect DNA ofT.gondiiis not available; therefore, serologic (IgM, IgG and IgG avidity) screening is our routine diagnosis method. All patients were investigated for immunodeficiency disorders (main immunodeficiencies, hematological and non-hematological malignancies, and immunoglobulinopathies) and the use of immunosuppressive drugs. Regarding infectious differential diagnosis, all three patients had negative blood and urine cultures. Serology was performed for HIV, viral hepatitis (A, B and C), Epstein-Barr and cytomegalovirus in each one of the pacients and the results were unfavorable. The lung biopsy culture, when performed, was unfavorable for all those microorganisms. Serology forMycoplasma pneumoniaeandChlamydia pneumoniawas performed in one of the patients; however, result was unfavorable. All patients underwent a chest CT scan, and the following CT abnormalities were found: bilateral easy septal and peribronchovascular thickening (100%), ground-glass opacities (100%) (Figures1and2), atelectasis (33%) and random nodules varying in size from 5 m to 2.5 cm (33%)..