Dr. med. Uwe Auf der Strasse
What are the next steps, if I have undiagnosed symptoms that might be caused by chronic active Toxoplasmosis ?
If you suffer from the listed symptoms and other illnesses and deficiencies have been excluded, it can be useful to fill out the Checklist Toxoplasmosis in order to evaluate the risk of a chronic active Toxoplasmosis. This download is free of charge:
How to use the checklist:
The basis is a completed history and pre-examination to exclude other causes of illness. Since the symptoms are so manifold, it is advisable to always work through the complete questionnaire while working on the diagnosis as well as during regular examinations of the healing process. This is necessary, since neither patient nor doctor might otherwise be able to correctly evaluate the progression of the therapy. In case of symptom fluctuations with “good” and “bad” days, I ask the patients to name the symptom intensities on the “bad” days.
It is worth noticing, that during such fluctuations usually several symptoms are affected, so that this results in a general increase or decrease of symptoms. When out of the 6 first named symptoms (the main criteria) more than 3 are inconspicuous and no secondary symptoms occur an active toxoplasmosis is not likely.
A risk for an active toxoplasmosis can be assumed if intensities of at least “5” for Fatigue and for 3 of the next 5 listed symptoms (including “listlessness / exhaustion”),
if Fatigue and 2 of the next 5 symptoms (including “listlessness / exhaustion”) and 2 of the remaining ones are rated positive. In most cases this means that the patient names an intensity level of at least “5”. All patients with an active toxoplasmosis reported an unusual tiredness, which means that the missing of this symptom largely rules out an active toxoplasmosis. The more criteria which apply, the higher the probability for an active toxoplasmosis.
The frequency and significance of the symptoms listed on the checklist decreases from top to bottom. In cases with short disease durations and/or lower disease intensity often only some of the first 8 secondary symptoms such as “morning stiffness” and “joint pains” are seen.
The criterion “exhaustion” has been added to “listlessness” recently, as this is the severe and most important symptom in ME/CFS patients. The criterion “visual disturbances” has a high significance when opthalmological causes have been excluded. The symptom “unsteady gait” / “impaired coordination” is a newer addition as there was still a gap in the description of the clinical picture concerning this symptom-complex.
Since February, 2019 I use, aside from Toxoplasma IgM and IgG, a Toxoplasma LTT (Leucocyte transformation test) for those patients whose results using the Toxoplasma checklist toxo-plasmosis are positive. A validation concerning chronic active toxoplasmosis has not yet been performed, but the experience so far is that in diagnosing chronic active toxoplasmosis the LLT shows a remarkably better sensitivity than the Toxoplasma IgM (see pp. 212 -220).
Please take note, that the LTT shows the reactivity of our immune system against Toxoplasma Gondii, but this reactivity is not necessarily directly linked to the intensitiy of the disease. For this reason the LTT can show an inconspicious result in single cases.
A combination therapy can be prescribed if the checklist indicates a high risk of chronic active toxoplasmosis and if symptoms have significantly decreased during the initial 7-10 days of clindamycin therapy. A positive Toxoplasma LTT confirms the diagnosis, but a negative result does not rule out this diagnosis with absolute certainty. You find more about this on the following page. If a positive Toxoplasma IgM should occur, this would be a reason for therapy as well, however in case of chronic active toxoplasmosis, the IgM is extremely unreliable. Please read chapter 10, which deals with risks and side effects of antibiotics therapy.
If at this point there are many arguments why your symptoms might originate in a chronically active Toxoplasmosis, it is the right time to team up with your doctor. This is an excerpt of the chapter from my book, that deals with this:
16.13 What happens if I have undiagnosed symptoms and I want my doctor to investigate toxoplasmosis?
Of course, your doctor is familiar with toxoplasmosis, but very few doctors are familiar with research which shows that an infection producing symptoms doesn't necessarily result in a positive test result. Even fewer know of the use of the LLT test.
If you are in the unfortunate position of having severe symptoms like those listed on the Checklist Toxoplasmosis and your physician has tried every test and procedure without finding a conclusive diagnosis, then you might wish to bring up the possibility of toxoplasmosis. The response from your physician might be to point out that the relevant test has been performed and has shown no infection. At that point I would recommend to ask your doctor for a Toxoplasma LTT. He might not be familiar with the LTT, but it should not be a big problem to find a lab that is able to perform this test. The Lab will need about 10 to 14 days to deliver the LTT result, and that would be the right time to have another appointment with your physician, bringing your completed checklist with you.
If the Toxoplasma LTT shows a positive result that corresponds to your symptoms on the checklist you have ready for your doctor, he or she might already agree to a therapy.
If the LTT delivers a negative result, your doctor might be in a bit of a quandary. He or she really wants to help you, but the new information that toxoplasma can be active despite negative lab results (even the LTT is not perfect) is difficult to grasp quickly. You might ask him to read the book or this website, every argument is based on basic research in order to convince even sceptic physicians. I have quoted the relevant sources (see "References"), so that your doctor can follow the argumentation.
If your doctor is too busy to read the whole book, copies of the pages 33 – 42, 49 – 60 and 211 – 220 might be sufficient to convince him or her. In this case it might be the right move to start a probatory treatment for 7-10 day using Clindamycine 300 3 x 1. A combination therapy should only be considered if this probatory treatment is successful.
You can help your doctor tremendously by filling out a checklist every week. It is very difficult to monitor the progression of the therapy without meticiously recording the symptoms. This information is extremely valuable to your doctor, as he is the one who is responsible for therapeutical decisions, and he urgently needs information about the development of your symptoms.
In case of questions that extend beyond this website or my book, your doctor or you might contact me directly, I will be happy to answer questions and to work together with him or her.
The Lymphocyte-Tranformation-Test (LTT) has made my work on Toxo-plasmosis easier in the last years. By means of this test, we can detect activity of our immune system´s T-lymphocytes, which react specifically towards certain pathogens, as to Toxoplasma gondii. While the immune system is dealing with certain pathogens, T-lymphocytes become specifically reactive to this pathogen, and the intensity of this reactivity can be measured pathogen-specifically. This is measurable for about 4 weeks, and thus the LTT mirrors the current immune system's acitivity towards the tested pathogen. When a thorough exclusion of other diseases has been performed and the LTT shows a positive result, a chronic active toxoplasmosis is highly probable, but as with other lab methods, if negative a chronic active toxoplasmosis cannot be excluded securely.