toxoplasmosis

Toxoplasmosis 

Definition

Toxoplasmosis is an infectious disease caused by the one-celled protozoan parasite Toxoplasma gondii. Although most individuals do not experience any symptoms, the disease can be very serious, and even fatal, in individuals with weakened immune systems.

Description

Toxoplasmosis is caused by a one-celled protozoan parasite known as Toxoplasm a gondii. Cats, the primary carriers of the organism, become infected by eating rodents and birds infected with the organism. Once ingested, the organism reproduces in the intestines of cats, producing millions of eggs known as oocysts, which are excreted in cat feces daily for approximately two weeks. In the United States, it is estimated that approximately 30% of cats have been infected by T. gondii. Oocysts are not capable of producing infection until approximately 24 hours after being excreted, but they remain infective in water or moist soil for approximately one year. When cattle, sheep, or other livestock forage through areas with contaminated cat feces, these animals become carriers of the disease. Fruits and vegetables can also become contaminated when irrigated with untreated water that has been contaminated with cat feces. In humans and other animals, the organisms produce thick-walled, dormant structures called cysts in the muscle and other tissues of the body.

Most humans contract toxoplasmosis by eating cyst-contaminated raw or undercooked meat, vegetables, or milk products. Humans can also become infected when they come into contact with the T. gondii eggs while cleaning a cat's litterbox, gardening, or playing in a sandbox, for instance. Once infected, an individual is immune to reinfection. The incubation period or period between infection and the start of the disease ranges from several days to months.

Anyone can be infected by T. gondii, but usually only those individuals with weakened immune systems (immunocompromised) develop symptoms of the disease. For them, toxoplasmosis can be severe, debilitating, and fatal. Immunocompromised individuals at risk include those with AIDS, cancer, or other chronic illnesses.

There is no person-to-person transmission, except from an infected mother to her child in the womb. Approximately six out of 1,000 women contract toxoplasmosis during pregnancy. Nearly half of these maternal infections are passed on to the fetus. Known as congenital toxoplasmosis, this form of the disease is acquired at birth by approximately 3,300 infants in the United States every year. The risk of fetal infection is estimated to be between one in 1,000 to one in 10,000. In children born with toxoplasmosis, symptoms may be severe and quickly fatal, or may not appear until several months or even years after birth.

Causes and symptoms

Healthy individuals do not usually display symptoms. When symptoms do occur, they are usually mild, resembling infectious mononucleosis, and include the following:

• enlarged lymph nodes
• muscle pains
• intermittent fever
• general sick feeling

The distinction is made between acquired toxoplasmosis, in which an individual becomes infected, and neonatal congenital toxoplasmosis, in which a fetus is born with the infection because the mother became infected during pregnancy. If a fetus becomes infected early in pregnancy, the disease can cause the fetus to spontaneously abort, be stillborn. If full-term, the infant may die in infancy or suffer from central nervous system lesions. If the mother becomes infected in the last three months of pregnancy, however, the prognosis is good and the baby may not even display any symptoms.

In adults, if the infection continues for an extended period of time, chronic toxoplasmosis can cause an inflammation of the eyes called retinochoroiditis, which can lead to blindness, severe yellowing of the skin and whites of the eyes (jaundice), easy bruising, and convulsions.

Adults with weakened immune systems have a high risk of developing cerebral toxoplasmosis, including inflammation of the brain (encephalitis), one-sided weakness or numbness, mood and personality changes, vision disturbances, muscle spasms, and severe headaches. If untreated, cerebral toxoplasmosis can lead to coma and death. This form of encephalitis is the second most common AIDS-related nervous system infection that takes advantage of a person's weakened immune system (opportunistic infection).

Diagnosis

A diagnosis of toxoplasmosis is made based on clinical signs and supporting laboratory results, including visualization of the protozoa in body tissue or isolation in animals and blood tests. Laboratory tests for toxoplasmosis are designed to detect increased amounts of a protein or antibody produced in response to infection with the toxoplasmosis organism. Antibody levels can be elevated for years, however, without active disease.

Treatment

Most individuals who contract toxoplasmosis do not require treatment because their immune systems are able to control the disease. Symptoms are not usually present. Mild symptoms may be relieved by taking over-the-counter medications, such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). Sore throat lozenges and rest may also ease the symptoms.

Although the treatment of women infected with toxoplasmosis during pregnancy is controversial, most physicians feel that treatment is justified. Transmission of toxoplasmosis from the mother to the fetus may be prevented if the mother takes the antibiotic spiramycin. Later in a pregnancy, if the fetus has contracted the disease, treatment with the antibiotic pyrimethamine (Daraprim, Fansidar) or sulfonamides may be effective. Babies born with toxoplasmosis who show symptoms of the disease may be treated with pyrimethamine, the sulfa drug sulfadiazine (Microsulfon), and folinic acid (an active form of folic acid).

AIDS patients who have not been infected may be given a drug called TMP/SMX (Bactrim or Septra) to prevent toxoplasmosis infection. To treat cases of toxoplasmosis in immunocompromised AIDS patients, a combination of pyrimethamine and a sulfa-based drug, either sulfadiazine or clindamycin (Cleocin), have been used together and can be effective in treating this disease. Other antibiotic combinations and dosing schedules are still being investigated. Physicians have reported success in alleviating symptoms by using trimethoprim-sulfamethoxazole (Proloprim or Trimpex) or dapsone (DDS) plus pyrimethamine. These drugs can produce side effects, such as allergic reaction, itching, rashes;, and nausea and patients must be monitored closely.

Key terms

Cyst — The thick-walled dormant form of many organisms.

Immunocompromised — A state in which the immune system is suppressed or not functioning properly.

Oocyst — The egg form of the toxoplasmosis organism.

Protozoan — A single-celled, usually microscopic, organism.

Prognosis

The prognosis is poor when congenital toxoplasmosis is acquired during the first three months of pregnancy. Afflicted children die in infancy or suffer damage to their central nervous systems that can result in physical and mental retardation. Infection later in pregnancy usually results in only mild symptoms, if any. The prognosis for acquired toxoplasmosis in adults with strong immune systems is excellent. The disease often disappears by itself after several weeks. However, the prognosis for immuniodeficient patients is not as positive. These patients often relapse when treatment is stopped. The disease can be fatal to all immunocompromised patients, especially AIDS patients, and particularly if not treated. As a result, immunocompromised patients are typically placed on anti-toxoplasmosis drugs for the rest of their lives.

Prevention

There are no drugs that can eliminate T. gondii cysts in animal or human tissues. Humans can reduce their risks of developing toxoplasmosis by practicing the following:

• freezing (to 10.4°F/−12°C) and cooking foods to an internal temperature of 152°F/67°C will kill the cyst
• practicing sanitary kitchen techniques, such as washing utensils and cutting boards that come into contact with raw meat
• keeping pregnant women and children away from household cats and cat litter
• disposing of cat feces daily, because the oocysts do not become infective until after 24 hours
• helping cats to remain free of infection by feeding them dry, canned, or boiled food and by discouraging hunting and scavenging
• washing hands after outdoor activities involving soil contact and wearing gloves when gardening

Resources

Periodicals

Rose, I. "Morphology and Diagnostics of Human Toxoplasmosis." General & Diagnostic Pathology 142 (June 1997): 257-70.

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toxoplasmosis /tox·o·plas·mo·sis/ (-plaz-mo´sis) an acute or chronic, widespread disease of animals and humans caused by Toxoplasma gondii and transmitted by oocysts in the feces of cats. Most human infections are asymptomatic; when symptoms occur, they range from a mild, self-limited disease resembling mononucleosis to a disseminated, fulminating disease that may damage the brain, eyes, muscles, liver, and lungs. Severe manifestations are seen principally in immunocompromised patients and in fetuses infected transplacentally as a result of maternal infection. Chorioretinitis may be associated with all forms, but it is usually a late sequel of congenital disease.

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tox·o·plas·mo·sis (tks-plz-mss)

n. pl. tox·o·plas·mo·ses (-msz)

An infectious disease caused by the protozoan Toxoplasma gondii. The congenital form, resulting from parasites in the infected mother being transmitted to the fetus, is characterized by lesions of the central nervous system that can cause blindness and brain damage. Acquired toxoplasmosis is characterized by fever, swollen lymph nodes, and lesions in the liver, heart, lungs, and brain.

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toxoplasmosis

[tok′sōplazmō′sis]

Etymology: Gk, toxikon + plasma + osis, condition

a common infection with the protozoan intracellular parasite Toxoplasma gondii. The congenital form is characterized by liver and brain involvement with cerebral calcification, convulsions, blindness, microcephaly or hydrocephaly, and mental retardation. The acquired form is characterized by rash, lymphadenopathy, fever, malaise, central nervous system disorders, myocarditis, and pneumonitis.

observations Cats acquire the organism by eating infected birds and mice. Cysts of the organism are transmitted from cat feces to humans or by human ingestion of inadequately cooked meat containing the cysts. Transplacental transmission occurs only during acute infection of the mother, but the disease is very serious in the fetus and in those with human immunodeficiency virus or other immunosuppressive conditions or impaired immune system. Diagnosis is made by demonstrating rising antibody titers or by immunofluorescent antibody tests. Infection confers immunity.

interventions Combinations of sulfonamides with pyrimethamine are recommended as treatment, possibly reducing the severity of the illness in the fetus.

nursing considerations All meat should be heated to at least 140° F (60° C) throughout to kill this parasite. Pregnant women who are not immune are advised not to handle cats, cat feces, or litter boxes.

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toxoplasmosis (tok´sōplazmō´sis),

n a disease caused by protozoa in the bloodstream and body tissues.

Toxoplasmosis.

toxoplasmosis, neonatal,

n an infection passed to the fetus during pregnancy via the placenta that can cause mental retardation, blindness, or an abnormally small head. See Toxoplasma gondii.

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toxoplasmosis

a contagious disease of all species caused by the sporozoan parasite Toxoplasma gondii. The principal manifestation in animals is as abortion in ewes. It is also a cause of sporadic cases of pneumonia, central nervous system disease, and less often retinochoroiditis, and hepatitis in dogs and cats. Clinical signs include fever, malaise, lymphadenitis, abortion, fetal malformation. Major importance as a zoonosis from bradyzoites in meat.

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toxoplasmosis 

An infectious disease caused by the protozoan Toxoplasma gondii. It occurs either as a congenital or as an acquired type. The congenital type is characterized by bilateral retinochoroiditis in which the fovea is frequently destroyed, resulting in loss of central vision, hydrocephalus, convulsions and encephalomyelitis. The acquired type varies in severity and so does the ocular involvement, the more common lesion being a nonspecific intraocular inflammation involving either the anterior or posterior segment of the eye.

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toxoplasmosis

Infectious disease An infection by Toxoplasma gondii which is either 1. Congenital–acquired transplacentally, often with major neurologic residua or 2. Acquired Epidemiology Ingestion of inadequately cooked meats with T gondii-filled cysts, or due to exposure to feces of infected cats, which are the definitive hosts Clinical In immunocompetent Pts, infection is benign with transient lymphadenopathy–80% of primary infections are asymptomatic; in immunocompromised Pts, T gondii infection may be accompanied by necrotizing encephalitis, myocarditis, pneumonitis, with CNS involvement in ≥ 50% Treatment Clindamycin, pyrimethamine; in AIDS, azithromycin. See Congenital toxoplasmosis.