Case 5

Dr. med. Uwe Auf der Strasse

Jürgen D., 53 y.

 

This documentation is a bit more extensive, as there were two causes of the disease, a reactivated toxoplasmosis and an infection with Chlamydia pneumophilae, both of which could be treated successfully. For the diagnosis and treatment of chlamydial diseases, please read the "Update July 2020", where a download of the "Additional checklist Chlamydia" can also be obtained.

 

Mr D. works in a demanding and time-consuming  job, but he was able to keep fit through a lot of sport for years, including racing marathons distance on inline skates. There are no significant pre-existing illnesses and so only occasional treatments in the practice were necessary in the recent years.

 

In 2020 he had to undergo a complicated shoulder surgery, after which he did not recover properly. He noticed increasing tiredness, and due to a considerable shortness of breath and reduced performance, Mr. D. could no longer do sports, his muscles showed increased involuntary twitching (= fasciculation), and permanent and profound exhaustion developed. In addition, there were considerable disturbances in the ability to concentrate, which created problems at work.

 

By the end of 2020 Mr. D suffered from a serious infection, a Covid-19 infection was excluded by means of PCR. As a result, however, his health deteriorated further and more symptoms appeared, such as an unclear irritation of the airways with noticeably dry mucous membranes, an unclear burning sensation in the eyes, pain in the soles of the feet, burning sensations in the stomach area and occasional sharp pain in the left chest area. Unclear inflammation of the skin developed which healed poorly.

 

The entire symptoms of the disease showed a fluctuation, so there were occasional “good” days in which the symptoms were less pronounced, but there was no lasting improvement, and overall the intensity of the symptoms increased slowly.

 

4/2021, Mr. D. presented himself to the practice with the symptoms described, due to the severe symptoms, a sick leave was now inevitable. The checklists for Toxoplasmosis and Chlamydia both indicated a high risk, the Toxoplasma IgG was significantly increased at 23.9 IU/ml, while the Toxoplasma IgM was negative. The IgG antibodies for Chlamydia pneumophilae were increased at 47.2, (positive above 12) the IgA antibodies were also increased at 59.4 (positive above 13) and indicated an active disease. The other laboratory values ​​showed normal results.  If Toxoplasma as well as a Chlamydial infection are active at the same time,  it has been proven useful to treat the chlamydial infection  first, please read the "Update July 2020" on diagnosis and treatment of chlamydial diseases for further information.

 

Blood for a Toxoplasma LTT was drawn, then a 20-day treatment for the chlamydia infection was prescribed, consisting of Doxycycline 100mg 2 x 1 and Clarithromycin 500mg 2 x 1. This  treatment resulted in a significant amelioration of the Chlamydia-related symptoms:

Additional Checklist             to be used only together with the  "Checklist Toxoplasmosis"  Chlamydia                                                     www.toxoplasmachronic.com             

Mr / Mrs.   Jürgen D. 

                                             Duration of                                Fluctuation of    

Age:   54  years                  Symptoms  4  months                  Symptoms      yes / no

 

Chlam. Pneumophilae        IgA 59,4 U/ml     IgG  47,2 U/ml    LTT ........ SI

 

Chlam. Trachomatis           IgA ........ U/ml     IgG ........  U/ml    LTT ......... SI

                                             Date ....….... 16.3.2021               Date ............. 7.4.2021 

                                                            

Treatment:                           20  days  Doxycyclin 100 2x1  +  Clarithromycin 500 2x1              

 

Coughing, obstructive            0 1 2 X 4 5 6 7 8  9 10               0 X 2 3 4 5 6 7 8 9 10

bronchitis, Sinusitis

              

Exsiccation of mucous       0 1 2 3 4 5 6 7  8 X 10               0 2 3 4 5 6 7 8 9 10

membranes,  itching

ear canal            

 

Visual disturbance +           0 1 2 3 4 5 X 7 8  9 10               X 1 2 3 4 5 6 7 8 9 10

burning eyes

                 

Pain of soles                       0 1 2 3 4 5 X 7  8  9 10                X 1 2 3 4 5 6 7 8 9 10

and tendons                 

 

Irritation of urinary            X 1 2 3 4 5 6 7 8 9 10                X 1 2 3 4 5 6 7 8 9 10

tract or rectum

Pain of ovaries                          X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

uterus or prostate

Spine pain                           X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10                

Burning stomach                 0 1 2 3 X 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10 

               

Heart stitches                      0 1 2 3  4  X 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

               

Skin inflammation               0 1 2 3 4 5  X 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10               

Toothache                           X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

   

SCORE                                 39                                                2

If more than 2 of the symptoms listed here apply in addition to the symptoms listed on the checklist toxoplasmosis, there is an increased likelihood of an active chlamydial infection and a determination of the chlamydial antibodies is useful.

The significant reduction of symptoms was achieved by a combination of Doxycycline and Clari-thromycin; this is a very reliable combination. Therapy should be continued  for at least 20 days in order to prevent a relapse.

 

However, Chlamydia can also trigger some symptoms that are actually typical of chronically active Toxoplasmosis. It is therefore difficult to distinguish between these two causes of the disease and it is useful to work with both checklists.  If a therapy for the chlamydial infection is prescribed first a significant amelioration of the related symptoms should be noticed already within 10 days, while the symptoms on the Checklist Toxoplasmosis  are only slightly influenced, usually  tiredness and muscle complaints show some improvement.

 

In the second treatment step, the same revolving therapy was prescribed for the treatment of Toxoplasmosis as in cases 1, 3 and 4: Daraprim 25 mg 2 x 1 and calcium folinate 6.35 mg 1 x 1 were taken continuously.  Cotrim forte 2 x 1 was added first, after 5 days this was changed to Clarithromycin 500 2 x 1, after a further 5 days this was changed to Clindamycin 300 mg 3 x 1, then the scheme was repeated again.   This is the result:

Checklist                                                       www.toxoplasmachronic.com 

Toxoplasmosis        Mr / Mrs   Jürgen D. 

 

                                             Duration of                                Fluctuation

Age:  53  years                   symptoms  1 year                              of symptoms   yes/no

 

Toxoplasma                        IgG 23,9 IU/ml                          IgM  0   AU/ml

 

LTT 45,6 SI                          Date ….......... 7.4.2021               Date ........... 21.5.2021                

Treatment:                          revolving therapy                   revolving therapy                               

Fatigue                                0 1 2 3 4 5 6 7 X 9 10               0 1 X 3 4 5 6 7 8 9 10

               

Muscular pain                     0 1 2 3 4 5 6 7 X 9 10               X 1   2  3 4 5 6 7 8 9 10

                

Concentration disorder     0 1 2 3 4 5 6 7 X 9 10               0 1 X 3 4 5 6 7 8 9 10

                 

Sweating                             0 1 2 3 4 5 6 7 X 9 10               X 2 3 4 5 6 7 8 9 10

                 

Dispnoea                             0 1 2 3 4 5 6 X 8 9 10               0 X 2 3 4 5 6 7 8 9 10

 

Listlessness                         0 1 2 3 4 5 6 7  8  9  X                0 1 X 3 4 5 6 7 8 9 10

Exhaustion .............................................................................................................................

Irritability                             0 1 2 3 4 5 6 7  8  9  X                   X 2 3 4 5 6 7 8 9 10

               

Visual disturbance             X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

               

Dizzyness                           X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

               

Depressive moods              0 1 2 3 4 5 6 7  8 X10                X 2 3 4 5 6 7 8 9 10

               

Anxieties                             0 1 2 3 4 5 6 7  8 X10               X 2 3 4 5 6 7 8 9 10

Morning stiffness               X 1 2 3 4 5 6 7 8  9 10              X1 2 3 4 5 6 7 8 9 10

Wassereinlagerung              X  1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

Oedema                                0 1 2 3 4 5 6 7  8  9  X               0 1 X 3 4 5 6 7 8 9 10

Insecure gait                       X 1 2 3 4 5 6 7 8 9 10               1 2 3 4 5 6 7 8 9 10

impaired coordination ….....................................................................................................

 

Pressure in the                  0 1 2 3 4 X 6 7 8 9 10                1 2 3 4 5 6 7 8 9 10

upper abdomen

 

Headaches                          0 1 2 3 4 X 6 7 8 9 10             0 X 2 3 4 5 6 7 8 9 10

Joint aches                         X 1 2 3 4 5 6 7 8 9 10               X 1 2 3 4 5 6 7 8 9 10

Swelling of lymph nodes       X 1 2 3 4 5 6 7 8 9 10                X 1 2 3 4 5 6 7 8 9 10

    

SCORE                                  97                                               12

After 30 days of revolving therapy, treatment was continued for 8 weeks on 2 days per week to prevent a relapse, after that the therapy was terminated. Details on relapse prevention can be found under "Therapy".

 

Comment: Toxoplasma IgG is increased at 23.9 IU/ml, which means that Mr. D. is a Toxoplasma carrier. The course of the disease suggests that a continuously high workload in combination with surgery weakened Mr D. to a point that a reactivation of Toxoplasmosis took place approximately one year ago. As in other patients the Toxoplasma IgM were not increased. Nevertheless, the significantly elevated LTT of 45.6 SI (norm up to 3) indicated Toxoplasma activity. After an infection at the end of 2020, additional symptoms that are typically related to Chlamydia pneumophilae appeared, these symptoms had been present for about 4 months,  the corresponding  Chlamydia IgG and IgA values ​​were both clearly positive, indicating Chlamydial activity.

 

Whether the infection at the end of 2020 was an initial Chlamydial infection or if it induced a reactivation of Chlamydia cannot be answered, but as a consequence chlamydial activity added to a already pre-existing Toxoplasma activity. It can be assumed that this resulted in a considerable combined burden of the immune system, which made it apparently impossible to control both Toxoplasma and Chlamydia effectively, and this resulted in increasing symptoms.

Due to the relatively short duration of the illness of only one year, some typical symptoms of Toxoplasmosis such as visual disturbance, morning stiffness, joint pain and impaired coordination were not present in this case, there was also still a fluctuation of symptoms with "good" days on which the symptoms were less pronounced, these are good prerequisites for a treatment. If such a disease is not treated it can be expected, that more symptoms develop and increase over years. Then the course of the disease becomes more uniform, i.e. the "good" days become more and more rare and with increasing disease intensity they finally disappear completely.     After the treatment, Mr D's health is restored, he is able to work again and is also doing sports again.