TOXOPLASMOSIS

General Information

DEFINITION--A protozoan infection found in humans and many species of mammals and birds. There are several types that occur in humans: congenital toxoplasmosis (passed from infected mother to her unborn child); ocular toxoplasmosis (also called retinochoroiditis, which usually results from congenital toxoplasmosis, but symptoms may not occur until ages 20-40); acute toxoplasmosis in a basically healthy individual; acute toxoplasmosis in an immunocompromised individual (person with AIDS, cancer or on immunosuppressant drugs).

BODY PARTS INVOLVED--Nerves, heart, gastrointestinal, skin.

SEX OR AGE MOST AFFECTED--Both sexes: all ages.

SIGNS & SYMPTOMS

• No symptoms usually (80-90% of patients).
• Fever; tiredness; swollen lymph glands.
• Muscle aches; sore throat; rash (sometimes).
• Retinitis (inflammation of the retina).

CAUSES--

The protozoan, Toxoplasma gondii, usually transmitted by:

• Eating undercooked meats from infected animals.
• Cats that harbor the germ can excrete it in their stools; humans who handle cat litter (or fail to wash their hands after handling it) may become infected. Children who eat soil contaminated with feces can become infected.
• Blood transfusion.
• An infected pregnant woman can transmit it to her unborn child (often with severe effects).

RISK INCREASES WITH

• Immunosuppression due to illness or drugs.
• Contact with cats.
• Improper food preparation.

HOW TO PREVENT

• Avoid eating raw or undercooked meats, unpasteurized milk, uncooked eggs. Use proper techniques for preparation and storage of meat products. Wash hands carefully after handling raw meats.
• A pregnant woman should have laboratory blood test early in pregnancy to determine if she has antibodies to toxoplasmosis (about 55% of the U.S. population have them, which means they were infected at some time). She should be tested again at 16-18 weeks of pregnancy to determine if she has acquired an infection, and if so, may consider a therapeutic abortion.
• Immunocompromised persons and pregnant women should avoid contact with cat feces.
• Protect children's play area, including sand boxes, from cat and dog feces.
• Change cat litter boxes daily.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Laboratory studies to detect the infection.

> Pregnant female--

Your doctor will discuss treatments, risks and outcomes.

• Immunocompromised patient--Treatment is with medication.
• Newborns with infection are treated with medications (with or without symptoms as the germs can multiply after birth).

> For pregnant female--

When infection occurs early in pregnancy: miscarriage, stillbirth, various chronic disorders (seizures) and birth defects (blindness, deafness) in the newborn (some may not be apparent for years). An infection later in pregnancy usually has no ill effects.

• For immunocompromised patient--Lung and heart damage, brain inflammation, recurrence.
• For non-immunocompromised patient (basically healthy)--Rarely, may develop lung or brain inflammation. Younger children (under 5) may develop eye inflammation.

PROBABLE OUTCOME--The majority of infected persons have no symptoms and those with mild symptoms recover spontaneously with no aftereffects.

How To Treat

GENERAL MEASURES--

• Follow instructions in How to Prevent.
• If you are prescribed drugs, your doctor will do frequent blood tests to monitor side effects.

MEDICATION--Your doctor may prescribe:

• Pyrimethamine, sulfadiazine or trisulfapyrimidines for 3-4 weeks.
• Folinic acid to reduce the side effects of pyrimethamine.
• Corticosteroids for inflammation.

ACTIVITY--Level of activity will be determined by severity of symptoms.

DIET--No special diet.

Call Your Doctor If

• Symptoms worsen or don't improve after diagnosis and treatment.
• New, unexplained symptoms develop.