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Toxoplasmosis - Symptoms and causes

Overview

Toxoplasmosis (tok-so-plaz-MOE-sis) is an infection with a parasite called Toxoplasma gondii. People often get the infection from eating undercooked meat. You can also get it from contact with cat feces. The parasite can pass to a baby during pregnancy.

Most people infected with the parasite do not have symptoms. Some people get flu-like symptoms. Serious disease most often affects infants and people with weakened immune systems. Toxoplasmosis during pregnancy may cause miscarriage and birth defects.

Most infections don't need treatment. Drug treatment is used for people with more-serious cases, pregnant people, newborns and people with weakened immune systems. Several steps to prevent toxoplasmosis can lower the risk of infection.

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Symptoms

Most people infected with toxoplasmosis do not have any symptoms. They often don't know they're infected. Some people have flu-like symptoms, including:

  • Fever.
  • Swollen lymph nodes that may last for weeks.
  • Headache.
  • Muscle aches.
  • Skin rash.

Symptoms of eye disease

The toxoplasma parasites may infect tissues of the inner eye. This can occur in people with healthy immune systems. But the disease is more serious in people with weakened immunity. An infection in the eye is called ocular toxoplasmosis. Symptoms may include:

  • Eye pain.
  • Poor vision.
  • Floaters, which are specks that seem to swim in your vision.

Untreated eye disease can cause blindness.

Effect on people with weakened immune systems

People with weakened immune systems are likely to have more-serious disease from toxoplasmosis. A toxoplasmosis infection from earlier in life may become active again. People at risk include those living with HIV/AIDS, people receiving cancer treatment and people with a transplanted organ.

In addition to serious eye disease, toxoplasmosis can cause severe lung or brain disease for a person with weakened immunity. Rarely, the infection can show up in other tissues throughout the body.

Lung infection may cause:

  • Breathing problems.
  • Fever.
  • Cough.

Toxoplasmosis may cause inflammation of the brain, also called encephalitis. Symptoms may include:

  • Confusion.
  • Poor coordination.
  • Muscle weakness.
  • Seizures.
  • Changes in alertness.

Effect on fetus or infant

Toxoplasmosis can pass from the mother to the fetus during a pregnancy. This is called congenital toxoplasmosis.

Infection during the first trimester often causes more-severe disease. It also may result in miscarriage. For some babies with toxoplasmosis, serious disease may be present at birth or appear early in infancy. Medical problems may include:

  • Too much fluid in or around the brain, also called hydrocephalus.
  • Severe eye infection.
  • Irregularities in brain tissues.
  • An enlarged liver or spleen.

Symptoms of severe disease vary. They may include:

  • Problems with mental or motor skills.
  • Blindness or other vision problems.
  • Hearing problems.
  • Seizures.
  • Heart disorders.
  • Yellowing of the skin and whites of the eyes, also called jaundice.
  • Rash.

Most babies with toxoplasmosis do not show symptoms. But problems may show up later in childhood or teenage years. These include:

  • Return of eye infections.
  • Problems with motor skill development.
  • Problems with thinking and learning.
  • Hearing loss.
  • Slowed growth.
  • Early puberty.

When to see a doctor

Talk to your health care provider about a test if you are worried about exposure to the parasite. If you are planning a pregnancy or are pregnant, see your provider if you suspect exposure.

The symptoms of severe toxoplasmosis include blurred vision, confusion and loss of coordination. These need immediate medical care, particularly if you have a weakened immune system.

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Causes

Toxoplasma gondii is a parasite that can infect most animals and birds. It can only go through the entire cycle of reproduction in domestic and wild cats. These are the main hosts for the parasite.

Immature eggs, a middle stage of reproduction, can be in the feces of cats. This immature egg allows for the parasite to make its way through the food chain. It can pass from soil and water to plants, animals and humans. Once the parasite has a new host, the reproduction cycle goes on and causes an infection.

If you're in typical health, your immune system keeps the parasites in check. They stay in your body but are not active. This often gives you lifelong immunity. If you're exposed to the parasite again, your immune system would clear it out.

If your immune system is weakened later in life, parasite reproduction can start again. This causes a new active infection that can lead to serious disease and complications.

People often get a toxoplasma infection one of the following ways:

  • Cat feces with the parasite. Cats that hunt or who are fed raw meat are more likely to carry toxoplasma parasites. You may get infected if you touch your mouth after touching anything that has been in contact with cat feces. This may be gardening or cleaning a litter box.
  • Contaminated food or water. Undercooked beef, lamb, pork, venison, chicken and shellfish are all known carriers of the parasite. Unpasteurized goat milk and untreated drinking water also may be carriers.
  • Unwashed fruits and vegetables. The surface of fruits and vegetables may have the parasite on them.
  • Contaminated kitchen tool. Parasites may be on cutting boards, knives and other utensils that come into contact with raw meat or unwashed fruits and vegetables.
  • Infected organ transplant or transfused blood. Rarely, toxoplasma parasites are passed through an organ transplant or blood transfusion.

Risk factors

The parasite is found throughout the world. Anyone can become infected.

Risks of serious disease from toxoplasmosis include things that prevent the immune system from fighting infections, such as:

  • Infection with HIV/AIDS.
  • Chemotherapy treatment for cancer.
  • High-dose steroids.
  • Drugs that prevent the rejection of transplanted organs.

Prevention

Certain precautions can help prevent toxoplasmosis:

  • Wear gloves when you garden or handle soil. Wear gloves when you work outdoors. Wash your hands with soap and water afterward.
  • Don't eat raw or undercooked meat. Use a meat thermometer to make sure meat is cooked enough. Cook whole meats and fish to at least 145 F (63 C) and let rest for at least three minutes. Cook ground meat to at least 160 F (71 C). Cook whole and ground poultry to at least 165 F (74 C).
  • Don't eat raw shellfish. Do not eat raw clams, mussels or oysters, particularly during pregnancy.
  • Wash kitchen utensils thoroughly. Wash cutting boards, knives and other utensils with soapy water after contact with raw meats or unwashed fruits and vegetables. Wash your hands thoroughly before and after preparing foods.
  • Wash all fruits and vegetables. Wash fresh fruits and vegetables before eating, peeling or cooking.
  • Don't drink unpasteurized goat milk. Avoid unpasteurized goat milk or products made from the milk.
  • Don't drink untreated water. During pregnancy, do not drink untreated water.
  • Cover children's sandboxes. Cover sandboxes to prevent outdoor cats from using them as litter boxes.

For cat lovers

If you're pregnant or otherwise at risk of toxoplasmosis, take these steps to protect yourself:

  • Help your cat stay healthy. Keep your cat indoors. Feed it dry or canned cat food, not raw or undercooked meat.
  • Avoid stray cats or kittens. Avoid stray cats, especially kittens. Do not get a new cat when you're pregnant.
  • Have someone else clean the litter box. Clean the box daily, if possible. If someone else can't clean it, wear gloves and a face mask to change the litter. Then wash your hands well.

By Mayo Clinic Staff

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Pregnancy and toxoplasmosis | The Humane Society of the United States

To help keep you and your baby safe, follow our tips for avoiding exposure to toxoplasmosis

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If pregnant, you can transmit toxoplasmosis, a rare parasitic disease, to your unborn baby and a toxoplasmosis infection can lead to miscarriage or cause malformed babies. Since toxoplasmosis can be transmitted via contact with cat feces, cat owners are told to lower their risk by putting their cats outside or even giving their cats away. But neither is necessary, as this is a myth!

The CDC says your cat isn't the greatest threat

It's unlikely that your cat will give you toxoplasmosis. In fact, according to the Centers for Disease Control and Prevention, "people are more likely to get [toxoplasmosis] from eating raw meat or from gardening." 

How do cats get toxoplasmosis?

Cats can get toxoplasmosis from eating contaminated raw meat, birds, mice or soil. But cats aren't the only animals who can transmit it, they're just the only species to shed the infectious stage in their feces. Humans can contract toxoplasmosis from the infected, undercooked meat of other animals too.

Understanding the disease can make you feel safer

An understanding of the life cycle of Toxoplasma gondii (T. gondii) and the role that cats play in disease transmission can allay fears of cats' role in the disease.

T. gondii is a protozoan organism that can infect all mammals, who serve as intermediate hosts. Once a cat has been infected with toxoplasmosis, they typically acquire immunity and can only rarely get re-infected. So, normally, it is only during a cat's first exposure to T. gondii that they'll excrete potentially infectious oocysts (reproducing microorganisms). In addition, oocysts are not immediately infective, requiring an incubation period of one to five days.

How do humans get toxoplasmosis?

Humans most commonly contract the disease from the consumption of undercooked meat, which contains T. gondii within tissue cysts. A less common method of acquisition is through direct ingestion of infective oocysts. Finally, transplacental transmission of the disease to an unborn child can occur if a primary infection is contracted during pregnancy.

The likelihood of contracting toxoplasmosis

Because it's difficult for cats to transmit toxoplasmosis directly to their caregivers, a pregnant person is generally unlikely to contract the disease from their pet cat.

Several factors keep the chance of such transmission low:

  • Only cats who ingest tissue cysts get infected. Within the feline population, this would be limited to outdoor cats who hunt and eat rodents, as well as cats who are fed raw meat by their owners.
  • Typically a cat only excretes oocystsis when they are first exposed to T. gondii and this goes on for only two weeks. An outdoor hunting cat is often exposed to the disease as a kitten and is therefore less likely to transmit the infection as they age.
  • Because oocysts only become infective after one to five days, exposure to the disease is unlikely as long as you clean the cat's litter box daily.
  • Since oocysts are transmitted by ingestion, in order to contract toxoplasmosis, the person would have to make contact with contaminated feces in the litter box and then, without washing their hands, touch their mouth or otherwise transmit the contaminated fecal matter to their digestive system.

Take steps to protect yourself against toxoplasmosis

Even though it is unlikely that you will contract toxoplasmosis from your cat, it's good to be as careful as possible. The following recommendations will help cat owners expecting a child to reduce their risk of contracting toxoplasmosis.

  • Avoid undercooked meat.
  • Wash all uncooked vegetables thoroughly.
  • Wash all cutting boards and utensils that might have come in contact with meat before using them.
  • Wear gloves when gardening or working in soil for other reasons. If you don't wear gloves, wash your hands thoroughly afterward.
  • Ask your spouse, friends or neighbors to help out with litter box duties while you're pregnant.
  • If you don't have help to keep the litter box clean, wear rubber gloves when changing the litter and thoroughly wash your hands afterward.
  • Have your cat's litter changed on a daily basis.
  • Keep your cat indoors.

A final thought

Sensible precautions will protect you from toxoplasmosis during your pregnancy and getting rid of your cat would be an unnecessary cruelty to both of you. If you're concerned about your well-being, it's far better for you to enjoy your cat's love and companionship throughout your pregnancy and following the birth of a child.

Toxoplasmosis and pregnancy

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In some grandmother's tales, there are those that tell about the nine lives of cats, as well as the impossibility of pregnant women to communicate with representatives of the cat family. Expectant mothers are still getting advice from delusional people about getting rid of pets to avoid contracting toxoplasmosis during pregnancy. This persistent and ancient misconception gives cats an undeserved bad reputation. Worse, it potentially forces future parents to give their kitties to shelters.

Toxoplasmosis is caused by the parasite Toxoplasma gondii, which occurs in various birds and mammals. However, T. gondii can only breed inside cats, which are the only known hosts.

Fortunately, people with healthy immune systems experience only mild symptoms, if any, from the infection. However, during pregnancy, toxoplasmosis can cause miscarriage, stillbirth, and serious problems for the baby. It is worth noting that if you have been infected with the parasite in the past, a second encounter with the parasite during pregnancy will not cause problems. You can get a free toxoplasmosis antibody test before you get pregnant at your local health center so you know how concerned you should be.

To avoid complications during pregnancy, all that is required of a pregnant woman is to take some precautions. There is no need to give up your pet.

Cats and toxoplasmosis

Cats are most commonly exposed through contact with infected wild prey such as rodents and birds. Once inside the cat's intestines, T. gondii produces millions of oocysts, which complete their life cycle in the gastrointestinal tract and are re-introduced into the environment through the cat's feces.

Oocysts can live for more than 18 months in soil and water. This is how the parasite comes into contact with animals such as rodents, sheep, and pigs. The only way domestic cats can become infected with the T. gondii parasite is if they encounter an infected rodent in their backyard or entryway. Therefore, if your cat lives in an apartment, there is virtually no chance that she will ever contract toxoplasmosis.

Another fact is that most kittens acquire toxoplasmosis from an infected mother cat, either through the placenta or while breastfeeding. Many of these kittens are stillborn or die shortly after birth. Those who survive often suffer from inflammation of the brain, lungs, or liver. Toxoplasmosis in adult animals is quite rare. Symptoms of the disease are usually seen in kittens that have never been exposed to the parasite before or in cats with a compromised immune system.

Most cases of toxoplasmosis in humans are not associated with cats

Although it is a fact that cats are one of the sources of toxoplasma infection; the truth is that living in an apartment with a cat is not a common way for people to get toxoplasmosis. Humans most commonly become infected with T. gondii through raw or undercooked meat, unwashed fruits and vegetables, and contaminated water or soil. Animals are exposed by eating contaminated meat, ingesting contaminated feces or water, or becoming infected embryonically through the placenta.

General rules of conduct to avoid infection

  1. If you are pregnant and have one or more cats, if possible, outsource the cleaning of the cat's litter box to someone else in the family during your pregnancy.
  2. Wear disposable gloves when cleaning the litter box. Also a face mask if you have immunosuppression.
  3. Try to keep the litter box clean. The longer the infected cat feces lie there, the greater the chance that the eggs of the parasite will become infectious.
  4. If you also have a dog, make sure he does not eat cat feces.
  5. Do not let your cat roam freely on the street. If you can’t refuse walks, then walk her on a watering can.
  6. Freeze meat for several days before feeding it to your cat (or preparing it for your family). Clean and wash fruits and vegetables before eating.
  7. As always, use soap and hot water to wash cutting boards, utensils, and hands after handling raw meat, poultry, seafood, and unwashed fruits or vegetables.
  8. Cover outdoor sandboxes in the country so that cats do not use them as their toilet.
  9. Wear gloves when gardening or yard work, or when you come into contact with soil, sand, or water that may be contaminated with cat feces. Wash your hands thoroughly afterwards.
  10. Avoid contact with stray cats during pregnancy. And keep in mind that the greatest risk of infection comes from kittens.

If you are pregnant, there is absolutely no need to give up your beloved cat as long as you take reasonable precautions to avoid getting infected with toxoplasmosis.

Symptoms, diagnosis and treatment of toxoplasmosis in animals

Infection in animals can be acute or chronic. The acute form of the disease usually occurs with a number of manifestations of the disease, and the chronic form is asymptomatic. The manifestation of clinical signs is more common in cats than in dogs. Although any dog ​​can be infested with parasites, most often they are young animals with an immature or weakened immune system. Toxoplasmosis presents with many clinical signs, including:

  • muscle weakness
  • fever
  • diarrhea
  • tremor
  • loss of coordination
  • weight loss
  • jaundice
  • depression
  • paralysis
  • loss of appetite
  • inflammation of the tonsils
  • lethargy
  • shortness of breath
  • vomiting
  • inflammation of the retina, iris, cornea.

Toxoplasmosis and pregnancy

Toxoplasmosis is one of the TORCH infections that is associated with one single sign - pathogens can be transmitted in utero: from mother to child. These infections are often the cause of problems with pregnancy and the culprits of congenital malformations in the baby.

The causative agent of toxoplasmosis is a protozoan intracellular parasite - Toxoplasma gondii , the main source of which is domestic animals. The life cycle of Toxoplasma goes with the participation of the final and intermediate hosts. Toxoplasma gondii are definitive hosts of the feline family, while intermediate hosts are many species of mammals and birds. In cats, Toxoplasma parasites parasitize not only in organs and tissues (which is typical for diseased animals and humans), but also in the intestines. A sick cat pollutes the soil, lawns, fields and gardens with its feces. Toxoplasma with feces are excreted into the environment, where they retain their viability in the form of cysts for a year and a half and can cause disease if they enter the human body. Farm animals and birds become infected by eating grass contaminated with Toxoplasma cysts.

Accordingly, the following ways of infection of people are possible:

  • consumption of undercooked or undercooked meat of animals and birds, unwashed vegetables, berries, herbs infected with toxoplasma;
  • infection directly from a sick cat, but only if the pathogen, together with saliva, lacrimal fluid, cat urine, enters the human body through damaged skin and mucous membranes.

A sick person does not release the pathogen into the environment, therefore, no danger for others poses .

Toxoplasmosis is not sexually transmitted. In addition, not every person who has got Toxoplasma into the body needs to be treated. If the immune system of an infected person has built a reliable defense, he remains practically healthy. Transmission of the pathogen from person to person is possible only with organ transplantation (transplantation) from a donor with primary toxoplasmosis or congenital route (intrauterine infection of the fetus from the mother through the placenta).

Clinic of toxoplasmosis

As mentioned above, in the vast majority of cases, the penetration of toxoplasma into the human body does not lead to the development of the disease, at least clinically expressed disease. Whether a person gets sick or not depends on the degree of pathogenicity of the pathogen itself, the amount of toxoplasma that has penetrated the body and on the state of the defenses of the human body itself.

Usually, if the disease develops, it is not severe, and very often it is so easy that it goes unnoticed, as a result of the fact that a person has been ill with toxoplasmosis, they learn by chance, according to the conclusion of a blood test.

As a rule, acute toxoplasmosis is disguised as SARS: the patient has a fever, sometimes up to 38 degrees and above, cervical and occipital lymph nodes increase, headache and muscle pain, sweating, general weakness appear. After a week, the above symptoms disappear.

If the body is weakened, the likelihood of developing the disease increases. In this case, from the gastrointestinal tract, toxoplasma enters the lymph and blood, they are carried by their current throughout the body, affecting various organs and tissues, primarily the brain, eyes, heart, and muscles.

In a severe course of the disease, encephalitis, meningoencephalitis may develop, which are accompanied by a sharp headache, seizures, loss of consciousness. But this is extremely rare.

Thus, toxoplasmosis is one of those diseases that people get sick once in a lifetime and so easily that they often do not even notice it. After the illness, persistent immunity remains for life, respectively, there can be no consequences of the disease, nor secondary infection.

Clinical manifestations of toxoplasmosis in pregnant women and newborns

Despite the fact that Toxoplasma infection is a trifle for most people, for a pregnant woman it is a real disaster.

Primary exposure to toxoplasmosis during pregnancy is the only situation in which toxoplasmosis poses a serious risk. Frankly speaking, the probability of such an infection is not great - according to statistics, no more than 1% of women become infected with toxoplasmosis during pregnancy, in other words, this is one pregnant woman out of a hundred.

In addition, about 63% of women who have already developed immunity to toxoplasmosis in Belarus. Moreover, even if the mother is infected with toxoplasmosis, intrauterine infection does not always occur (!). The likelihood of infection of the baby depends on how long the pregnancy Toxoplasma entered the body of a pregnant woman.

There is a certain relationship:

  • the earlier the gestational age, the greater the risk of severe consequences when the fetus is infected with toxoplasmosis and the less the likelihood of infection itself;
  • The later in pregnancy infection occurs, the higher the rate of transmission of toxoplasmosis to the fetus and the lower the risk of severe fetal injury.

So if the infection of the mother occurred in the first trimester of pregnancy, the probability of overcoming the placental barrier by toxoplasma is small (about 15%), since the placenta is still not very permeable to pathogens. In this case, everything can end well (a healthy baby will be born), or a spontaneous abortion will occur due to the development of defects incompatible with the life of the baby.

In the second trimester, toxoplasma enters the blood of the fetus more easily, as a result of which the likelihood of congenital toxoplasmosis increases to 20%. If infection of the fetus has occurred, the pathogens will accumulate and multiply in the brain, affecting the eyes and the central nervous system of the fetus. The immune system will soon cope with the disease and destroy all pathogens in the body, but some of the child's cells will be destroyed. As a result, increased intracranial pressure, mental retardation, epilepsy and blindness. That is why, when infected with toxoplasmosis at the initial stage of pregnancy, a pregnant woman is often offered to make an artificial termination of pregnancy.

By the third trimester, the probability of infection increases to 50-60%, but the fetus is already more resistant to the destructive effects of Toxoplasma - the baby can be born without any visible abnormalities, and the consequences of the infection may appear months or even years later.

Signs of congenital toxoplasmosis at birth may include fever, rash, enlargement of the liver and spleen, microcephaly, seizures, jaundice, changes in blood tests. The so-called classical triad of congenital toxoplasmosis includes chorioretinitis, hydrocephalus, and the presence of intracranial calcifications.

With timely treatment, the risk of infection of the baby is only 1-5%. It is important to emphasize once again that the danger is only toxoplasmosis, which the woman contracted during the current pregnancy. Accordingly, if a woman has already had toxoplasmosis before pregnancy (at least three months before her), her unborn child is not threatened by toxoplasmosis. In a situation where a woman loses a child due to toxoplasmosis during pregnancy, after six months she can become pregnant again, no longer fearing toxoplasmosis (!).

Prophylactic treatment to prevent congenital toxoplasmosis not available ! If a proven infection of a pregnant woman occurred in the 1st trimester of pregnancy, as a rule, it is recommended to terminate the pregnancy, and if there is a threat of miscarriage, it is not saved. In case of infection in the second trimester, which is reliably diagnosed, an additional examination of the fetus is indicated. It includes: Ultrasound, detection of Toxoplasma in the amniotic fluid (amniocentesis + culture analysis or PCR).

Termination of the pregnancy is also recommended in case of proven infection of the fetus.

In case of refusal to interrupt, specific therapy is carried out with drugs that are detrimental to toxoplasma.

Pregnant women should not be treated before 12-16 weeks of pregnancy. At the same time, correction of violations of various organs is carried out, which requires an individual approach to each patient. When infected in the third trimester, abortion is not carried out, specific therapy is used. As mentioned above, timely therapy significantly increases the likelihood of having a healthy baby. If the trouble, nevertheless, came, the treatment of newborns with confirmed toxoplasmosis is mandatory, as well as observation during the year. In the case of a primary infection of a pregnant woman with toxoplasmosis, regardless of the outcome of the pregnancy, one can be sure that at least the next child will not be afraid of congenital toxoplasmosis, thanks to the immunity acquired by the mother.

Memo for seronegative infection T . Gondii pregnant woman