Toxoplasmosis

Depending on their environment and eating habits, up to 70% of people in the United States are infected with Toxoplasma gondii - making toxoplasmosis one of the most common infectious diseases. Occurring worldwide, it's less common in cold or hot, arid climates and at high elevations.

The disease usually causes localized infection. However, it may produce significant generalized infection, especially in immunodeficient patients, such as neonates, acquired immunodeficiency syndrome (AIDS) patients, patients who recently had an organ transplant, those with lymphoma, and those receiving immunosuppressant therapy.

Once infected, the patient may carry the organism for life. Reactivation of the acute infection can occur. Congenital toxoplasmosis, characterized by lesions in the central nervous system (CNS), may result in stillbirth or serious birth defects.

Causes

Human infection results from ingestion of the parasites cysts in raw or undercooked meat, ingestion of oocysts on contaminated vegetables or other foods, following careless handling of cat litter, or from soil by soil-eating children. It can also be transmitted during pregnancy via the placenta.

Symptoms and Signs

Their immune system keeps the parasite from causing illness. However, in people who have a weak immune system, toxoplasmosis can cause serious medical problems, such as damage to your eyes and brain. Your immune system can become weak for a number of reasons. Human immunodeficiency virus (HIV) infection leading to acquired immunodeficiency syndrome (AIDS) can weaken the immune system. So can some kinds of cancer chemotherapy or medicines that are taken after an organ transplant.

Diagnostic tests

Isolation of T. gondii in mice after their inoculation with specimens of body fluids, blood, and tissue, or T. gondii antibodies in such specimens, confirms toxoplasmosis.

Treatment

Most effective during the acute stage, treatment consists of drug therapy with sulfonamides and pyrimethamine for 4 to 6 weeks. The patient also may receive folinic acid to control pyrimethamine's adverse effects.

These drugs act synergistically against the traphozoites but don't eliminate already developed tissue cysts. For this reason, and because they don't alleviate the underlying immune system defect in AIDS, an AIDS patient needs toxoplasmosis treatment for life.

An AIDS patient who can't tolerate sulfonamides may receive clindamycin instead. This drug also is the primary treatment in ocular toxoplasmosis.

Prevention

• Make sure your physician checks your blood for toxoplasma antibodies (depending on results, this may need to be repeated several times during your pregnancy).
• Don't allow your cat to go outside your home where it may come into contact with Toxoplasma.
• Have another family member change the cat litter box and then disinfect it with boiling water for five minutes.

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