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Jose L. Guzman III Toxoplasmosis Fact Sheet: Description/Etiology: Toxoplasmosis is an infection caused by the protozoan parasite caused by Toxoplasma gondii. It can affect most warm blood animals, including humans. Toxoplasmosis can affect the fetus while the mother is pregnant (called congenital Toxoplasmosis) and people who have weakened immune systems. Humans become infected by ingesting uncooked meat with the parasite, touching food, or water contaminated with cat feces. Transmission can also be from transplacental transmission, or via blood transfusion or organ transplantation. The main 2 routes of infection are oral and congenital. The parasite has 3 stages 1) tachyzoites: rapidly multiplying, 2) bradyzoites: slowly multiplying and leading to dormacy, and 3) oocysts:which are excreted by infected cats in their feces. Cats are the only definitive hosts for T. gondii in all 3 stages, and are the main reservoirs of infection. Toxoplasmosis Fact Sheet Pg. 1 Jose L. Guzman III Facts & Figures: Toxoplasmosis is one of the most common causes of human parasitic infections worldwide, with 22.5% of all persons over the age 12 in the US having antibodies to the parasite. Congenital toxoplasmosis (infection transmitted in utero) occurs in 1 in 3000 to 1 in 10,000 live births in the US. Risk Factors: Risk factors for T. gondii infection include eating raw or undercooked pork, mutton, lamb, beef, mince meat products, mince meat products, or wild game meat, cleaning the cat litter box, contact with soil (gardening and yard work), and eating raw or unwashed vegetables or fruits. Clinical Presentation/ Signs & Symptoms: Toxoplasmosis can be categorized in 4 groups. a). acquired in the immunocompetent host (i.e. HIV patient), b). acquired or reactivated in the immunosuppressed host (i.e. chemotherapy patient), c). congenital infection (obtained in utero), and d). ocular toxoplasmosis disease. With congenital infection, the rate of transmission to the fetus and severity of the disease in the baby depends according to when in the pregnancy the woman acquires the infection. Getting toxoplasmosis in Toxoplasmosis Fact Sheet Pg. 2 Jose L. Guzman III the first trimester leads to congenital infection 10-20% of the time, with symptoms including: severe microcephaly (small head), or hydrocephalous (big head), severe chorioretinitis (an inflammation of the choroid ,thin pigmented vascular coat of the eye and retina of the eye.), hearing loss, and mental retardation. Getting toxoplasmosis in the last trimester results in 80-90% congenital infection to the baby, usually asymptomatic at birth. Many of these children will acquire ocular toxoplasmosis disease later. Ocular toxoplasmosis disease is an important cause of chorioretinitis in the US, and can result from congenital or acquired toxoplasmosis infection. These patients can present with unilateral or bilaterally disease. Typical findings of ocular toxoplasmosis disease include white lesions with an overlying and intense vitreal inflammatory reaction. The disease can affect the brain, lung, heart, eyes, or liver. Symptoms in persons with otherwise healthy immune systems: enlarged lymph nodes in the head and neck, headache, mild illness with fever, similar to mononucleosis, muscle pain, and sore throat. Symptoms in immunosuppressed persons: confusion, fever, headache, retinal inflammation that causes blurred vision Toxoplasmosis Fact Sheet Pg. 3 Jose L. Guzman III Diagnosis: Tests to determine infection or to find cysts: include brain biopsy, cranial, CT scan, MRI of head, serologic titers for toxoplasmosis, and patent signs of toxoplasmosis. Treatment: Treatment depends on when the patient obtained the infection. Immunocompetent patients are not treated unless symptomatic. If symptoms are severe, they are treated with medications for 2-4 weeks. Medications to treat the infection include an antimalarial drug and antibiotics. AIDS patients should continue treatment for as long as their immune system is weak to prevent the disease from reactivating. If the patient is pregnant while obtaining infection, she will receive antitoxoplasma treatment with folic acid, for 4 weeks, this will result in less disease to the infant. Hydrocephalous (extremely large head) of infant on ultrasound, has been used as indication for termination of pregnancy. Patients with ocular toxoplasmosis will depend on severity of inflammatory response, proximity of retinal lesions to the optic disk. Chorioretinitis can be self-limiting, or may require treatment with antibiotics for upto 3 weeks. Toxoplasmosis Fact Sheet Pg. 4 Jose L. Guzman III References: Freeman, K., Hooi, K., Andrea, P., et al. (2008). Predictors of retinochorioiditis in children with congenital toxoplasmosis: Europe, prospective study. Downloaded 6/30/09 at http://www.pediatrics.org/cgi/content/full/121/5/31215 McAuley, J. (2008). Toxoplasmosis in children. The Pediatric Infectious Disease Journal, 27: 161-163. McCance, K., Huether, S. Pathophysiology: The Biologic Basis for Disease in Adults and Children, 6th ed. ST. Louis, MO: Mosby, 2006: 579. Montoya, J. & Liesenfeld, O. (2004). Toxoplasmosis. The Lance, 363: 196576. Wallon, M., Kodjikian, L., Binquet, C. et al, (2004). Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics, (113)6:1567-1572. Toxoplasmosis Fact Sheet Pg. 5