TOXOPLASMOSIS

Toxoplasmosis is a zoonotic protozoal disease of humans and animals caused by the coccidian
parasite, Toxoplasma gondii. Infection by T. gondii is widely prevalent in humans, and nearly one-
third of humanity has been exposed to this parasite. Although T. gondii usually causes only mild
disease or asymptomatic infection in immune-competent adults, it can cause devastating disease
in congenitally infected children and in adults and children with depressed immunity. T. gondii
utilizes felids as definitive hosts and has an unusually wide intermediate host range. Many species
of domestic and wild animals, including birds, can be infected. This broad spectrum of
intermediate hosts contributes to T. gondii being one of the most common parasitic infections of
humans and other warm-blooded animals. Serologic surveys indicate that infections are common
in wild pigs and carnivores, including bears, felids, foxes, raccoons, and skunks. Clinical and
subclinical forms of toxoplasmosis have been reported in wild cervids (Cervidae, the deer family),
ungulates, marsupials, monkeys, and marine mammals.

Morphology

T. gondii occurs in 3 forms: • Trophozoite (tachyzoite), Tissue cyst (containing bradyzoites),

Life cycle
The only known definitive hosts for Toxoplasma gondii are members of family Felidae (domestic
cats and their relatives). Unsporulated oocysts are shed in the cat’s feces . Although oocysts are
usually only shed for 1–3 weeks, large numbers may be shed. Oocysts take 1–5 days to sporulate
in the environment and become infective. Intermediate hosts in nature (including birds and
rodents) become infected after ingesting soil, water or plant material contaminated with oocysts .
Oocysts transform into tachyzoites shortly after ingestion. These tachyzoites localize in neural and
muscle tissue and develop into tissue cyst bradyzoites . Cats become infected after consuming
intermediate hosts harboring tissue cysts . Cats may also become infected directly by ingestion of
sporulated oocysts. Animals bred for human consumption and wild game may also become
infected with tissue cysts after ingestion of sporulated oocysts in the environment . Humans can
become infected by any of several routes:

 Eating undercooked meat of animals harboring tissue cysts .

 Consuming food or water contaminated with cat feces or by contaminated environmental

 Blood transfusion or organ transplantation .

In the human host, the parasites form tissue cysts, most commonly in skeletal muscle, myocardium,
brain, and eyes; these cysts may remain throughout the life of the host. Diagnosis is usually
achieved by serology, although tissue cysts may be observed in stained biopsy specimens .
Diagnosis of congenital infections can be achieved by detecting T. gondii DNA in amniotic fluid
using molecular methods such as PCR .

Geographic Distribution
Serologic prevalence data indicate that toxoplasmosis is one of the most common human infections
throughout the world. A high prevalence of infection in France has been related to a preference for
eating raw or undercooked meat, while a high prevalence in Central America has been related to
the frequency of stray cats in a climate favoring survival of oocysts and soil exposure. The overall
seroprevalence in the United States among adolescents and adults, as determined with specimens
collected by the third National Health and Nutrition Examination Survey (NHANES III) between
1988 and 1994, was found to be 22.5%, with a seroprevalence among women of childbearing age
(15 to 44 years) of 15%. In a more recent evaluation using data from NHANES 2009–2010, the
overall age-adjusted T. gondii antibody seroprevalence among persons > 6 years of age was
12.4%, and among women 15–44 years of age was 9.1%.

Clinical Presentation
Acquired infection with Toxoplasma in immunocompetent persons is generally an asymptomatic
infection. However, 10% to 20% of patients with acute infection may develop cervical
lymphadenopathy and/or a flu-like illness. The clinical course is usually benign and self-limited;
symptoms usually resolve within a few weeks to months. In rare cases ocular infection with visual
loss can occur. Immunodeficient patients often have central nervous system (CNS) disease but
may have retinochoroiditis, pneumonitis, or other systemic disease. In patients with AIDS,
toxoplasmic encephalitis is the most common cause of intracerebral mass lesions and is thought to
usually be caused by reactivation of chronic infection. Toxoplasmosis in patients being treated
with immunosuppressive drugs may be due to either newly acquired or reactivated latent infection.

Congenital toxoplasmosis results from an acute primary infection acquired by the mother during
pregnancy. The incidence and severity of congenital toxoplasmosis vary with the trimester during
which infection was acquired. Because treatment of the mother may reduce the incidence of
congenital infection and reduce sequelae in the infant, prompt and accurate diagnosis is
important. Many infants with subclinical infection at birth will subsequently develop signs or
symptoms of congenital toxoplasmosis. Ocular Toxoplasma infection, an important cause of
retinochoroiditis in the United States, can be the result of congenital infection, or infection after
birth. In congenital infection, patients are often asymptomatic until the second or third decade of
life, when lesions develop in the eye.

Treatment
Treatment for toxoplasmosis depends on the patient's symptoms, pregnancy status, and immune
health. Standard therapy combines pyrimethamine and sulfadiazine, paired with leucovorin
(folinic acid) to prevent bone marrow suppression. Most healthy individuals with no symptoms
require no treatment.

Control
It is difficult to control toxoplasmosis because of wide range of animal reservoirs.
Currently, there is no effective vaccine available for humans. The following are ways
Toxoplasmosis can be controlled:
 Freeze meat for several days at sub-zero (0° F) temperatures before cooking to
greatly reduce chance of infection. Freezing does not reliably kill other parasites
that may be found in meat (like certain species of Trichinella) or harmful
bacteria.
 Rinse fruit and vegetables under running water.
 Do not drink unpasteurized goat's milk.
 Do not eat raw or undercooked oysters, mussels, or clams (these may be
contaminated with Toxoplasma that has washed into seawater).

 Wash utensils, cutting boards, and countertops with hot, soapy water after
preparing each food item.
 Teach children the importance of washing hands to prevent infection.
 Wear gloves when gardening or touching soil or sand that cat feces
containing Toxoplasma may have contaminated.
 Wash hands with soap and water any time you touch something, including soil
or sand, that cat feces containing Toxoplasma may have contaminated.
 Avoid drinking untreated water.
 Wear gloves when gardening or when touching any soil or sand that may be contaminated
with cat feces containing Toxoplasma. Wash your hands with soap and water after
gardening or contact with soil or sand.
 Cover outdoor sandboxes.
 Only feed cats canned or dried commercial food or well-cooked table food. Do not feed
cats raw or undercooked meats.
 Change the cat litter box daily. The Toxoplasma parasite does not become infectious until
1 – 5 days after a cat shed it in its feces. By cleaning the litter box every day you remove
the feces before they become infectious
 Proper washing of hands and washing of vegetables and fruits before eating.

 Blood or blood products from seropositive persons should not be given and
screening for T. gondii antibody should be done in all blood banks.