Toxoplasmosis

Toxoplasmosis is an infection caused by a tiny parasite called Toxoplasma gondii (T. gondii). This parasite hides in cysts within the body, potentially causing problems later. While most healthy people fight off the initial infection without even noticing, toxoplasmosis can be serious for pregnant women and those with weakened immune systems.

How You Get Infected?

Toxoplasmosis can be contracted through various means, including:

• Contact with Cat Feces: Cleaning a cat’s litter box or handling anything that has been in contact with infected cat feces can expose you to the parasite.
• Gardening: Accidental ingestion of parasites can occur if you touch your mouth after gardening.
• Contaminated Water: Drinking water containing parasites is another possible route of transmission.
• Consumption of Undercooked Meat: Eating raw or undercooked meat, particularly lamb, pork, or venison, can introduce the parasite into your body.
• Contaminated Utensils: Using utensils that have been in contact with raw meat can lead to ingestion of parasites.
• Unwashed Fruits and Vegetables: Consuming unwashed fruits or vegetables may also expose you to toxoplasmosis.
• Organ Donation or Blood Transfusion: Being an organ donor or undergoing a blood transfusion can also pose a risk of exposure to the parasite.

Who’s Most at Risk?

• Pregnant Women: If a pregnant woman contracts toxoplasmosis, it can be passed to the fetus through the placenta, potentially leading to serious complications. This transmission increases the chances of miscarriage, stillbirth, or serious health issues for the baby. Potential complications for infants born with toxoplasmosis include vision impairments, blindness, developmental delays, and learning difficulties.
• People with Weakened Immune Systems: Individuals with HIV/AIDS, undergoing cancer treatment, or taking immune-suppressing medications have a higher risk of complications from toxoplasmosis. Individuals with weakened immune systems due to conditions like HIV, cancer, or immune-suppressing medications struggle to fend off infections like T. gondii. This compromised immunity leaves them vulnerable to severe complications from toxoplasmosis, which can be life-threatening if left untreated. Even if a person has had toxoplasmosis in the past and the parasite lies dormant in their body, a weakened immune system can reactivate the infection, leading to illness.

Without proper treatment, toxoplasmosis can inflict organ damage in immunocompromised individuals, potentially resulting in fatal outcomes.Without proper treatment, toxoplasmosis can inflict organ damage in immunocompromised individuals, potentially resulting in fatal outcomes.

Symptoms

The symptoms in humans vary depending on the activity of the parasite, whether it’s a new infection, a reactivation, or present at birth.

Ocular Toxoplasmosis Symptoms:

This occurs when T. gondii infects one or both eyes. Symptoms include:

• Eye pain.
• Blurred vision.
• Blindness.

Acute Toxoplasmosis Symptoms:

This is the body’s response to an initial T. gondii infection. Symptoms may include:

• Fever.
• Fatigue.
• Muscle aches.
• Painless, swollen lymph nodes in the neck or armpits.
• Sore throat.
• Enlarged liver and spleen.
• Rarely, there is ocular toxoplasmosis.

Reactivated Toxoplasmosis Symptoms:

This occurs when a previous T. gondii infection reactivates in individuals with weakened immune systems. Symptoms often affect the central nervous system and can include:

• Headaches.
• Confusion.
• Seizures.
• Fever.
• Facial paralysis.
• Vision changes.
• Numbness.
• Weakness or loss of motor skills.
• Toxoplasmic encephalitis.
• Coma.

Congenital Toxoplasmosis Symptoms:

This is when the infection is passed from a pregnant person to the fetus. Symptoms in newborns may include:

• Jaundice (yellowish skin and eyes).
• Rash.
• Enlarged liver and spleen.
• Vision problems, eye pain, or sensitivity to light.
• Calcium deposits in the brain.
• Hydrocephalus (fluid on the brain).
• Microcephaly (small head size).
• Seizures.
• Delays in motor skill development.
• Learning delays or differences.
• Ocular toxoplasmosis.

These symptoms can vary in severity, and not all individuals will experience them. It’s important to seek medical attention if you suspect you have toxoplasmosis, especially if you’re pregnant or have a weakened immune system.

Diagnosis of toxoplasmosis

To diagnose this condition, healthcare providers typically perform various tests and examinations, including:

1. Physical Examination and Symptom Assessment: Your healthcare provider will conduct a physical exam and inquire about your symptoms to evaluate potential signs of toxoplasmosis.
2. Blood Tests: Blood tests are commonly used to diagnose toxoplasmosis. A sample of blood is drawn from a vein, which is then analyzed in a lab to detect antibodies to T. gondii. Additionally, the blood may be examined for parts of the parasite’s DNA.
3. Biopsy: In rare cases, doctors may perform a biopsy. They will take a small tissue sample and send it to a lab to check for signs of T. gondii infection.
4. Imaging (CT scan or MRI): If toxoplasmosis in the brain is suspected, imaging tests such as a CT scan or MRI may be conducted. These scans provide detailed images of the brain, allowing healthcare providers to identify any abnormalities associated with toxoplasmosis.
5. Lumbar Puncture (Spinal Tap): A lumbar puncture may be performed if there is suspicion of toxoplasmosis affecting the brain or spinal cord. During this procedure, a needle is inserted into the lower back to collect cerebrospinal fluid, which is then examined for signs of T. gondii.
6. Amniocentesis: For pregnant individuals diagnosed with toxoplasmosis, amniocentesis may be recommended. This procedure involves using a needle to collect cells from the amniotic fluid surrounding the fetus, which are then tested for signs of T. gondii infection.
7. Ultrasound: In cases of pregnancy-related toxoplasmosis, an ultrasound may be performed. While it cannot directly diagnose toxoplasmosis, ultrasound imaging can detect changes in the fetus’s brain that may indicate infection.

Treatment Approach

• For Healthy Individuals: Most people with a healthy immune system don’t require treatment for toxoplasmosis.
• For HIV/AIDS patients, antibiotics like sulfadiazine, in combination with pyrimethamine, may be prescribed.
• For pregnant women:
  • Unaffected Baby: Spiramycin may be prescribed to prevent transmission to the baby.
  • Affected Baby: Sulfadiazine and pyrimethamine may be recommended after the 16th week of pregnancy, with close monitoring for complications.

Who Requires Treatment:

• Toxoplasmosis is generally not treated in individuals without symptoms or those with an intact immune system.
• Treatment is effective only when the parasites are actively reproducing, and it cannot eliminate the cysts formed by the parasite in the body.

Duration and Response to Treatment

• Treatment duration typically ranges from two to six weeks, but you will notice improvement within a few days.
• Brain injuries resulting from the parasite may take three weeks to six months to fully resolve.
• Continuous treatment may be necessary even if symptoms improve to ensure complete eradication of the active parasites.
• Pregnant individuals diagnosed with toxoplasmosis may need to continue medication throughout the pregnancy, while treatment for congenital toxoplasmosis can extend up to a year.
• Individuals with weakened immune systems may require indefinite treatment.

Monitoring and adherence to the prescribed treatment regimen are crucial to effectively managing toxoplasmosis and preventing complications, especially in vulnerable populations such as pregnant individuals and those with compromised immune systems.

Toxoplasmosis Complications

• Individuals with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy, are at higher risk of severe complications.
• Potential complications include seizures, encephalitis, hearing loss, blindness, and mental disabilities.
• Untreated cases in AIDS patients or those with encephalitis can be fatal.

Prevention Measures

• General Measures:
  • Wear gloves and practice thorough handwashing after outdoor activities or gardening.
  • Cover sandboxes to prevent cat access.
  • Maintain hygiene by cleaning surfaces and utensils after handling raw meat, washing fruits and vegetables, and treating water.
• For cat owners:
  • Keep cats indoors to prevent exposure to the parasite.
  • Discourage cats from accessing food preparation areas.
  • Feed cats only commercial cat food to avoid raw meat.
  • Avoid contact with stray cats or kittens.
  • Clean litter boxes daily (non-pregnant, healthy individuals only), wear gloves, and practice thorough handwashing.

Toxoplasmosis Outlook

• Healthy adults generally experience no complications from toxoplasmosis.
• Pregnant women and individuals with compromised immune systems require special attention.
• AIDS patients who have recovered from toxoplasmosis are at risk of recurrence and should continue medication until their immune system strengthens.
• Early treatment during pregnancy reduces the risk of transmission to the baby by 60%.

Seeking medical attention

• Monitor symptoms closely and contact a healthcare provider if they persist or worsen.
• For infants diagnosed with congenital toxoplasmosis, follow up with a pediatrician as per recommendations.

When to Consult a Healthcare Provider

• Pregnant individuals or those planning pregnancy should discuss preventive measures with their provider.
• Contact a healthcare provider promptly if symptoms of toxoplasmosis arise, particularly for individuals with compromised immune systems.

Sources:

• Cleveland Clinic
• FamilyDoctor.org: “Toxoplasmosis.”
• Mayo Clinic: “Diseases and Conditions: Toxoplasmosis,” “Tests and Diagnosis,” “Treatments and Drugs.”