WHAT IS TOXOPLASMOSIS

Toxoplasmosis is in infection that is caused by

a microscopic parasite called Toxoplasma
gondi.
These microscopic parasites live inside the
cells of humans and animals (cats and farm
animals).

HOW DO PEOPLE GET

TOXOPLASMOSIS?
By touching or coming into contact with infected cat
feces.

By eating contaminated raw or undercooked meat.

By eating contaminated unwashed fruits or vegetables.
By passing it to your unborn baby.
By organ transplant or blood transfusion

WHAT IS CONGENTIAL
TOXOPLASMOSIS
When a pregnant woman gets the infection
during pregnancy and passes it on to her fetus.
Women who get toxoplasmosis before
conception hardly ever pass the infection
during pregnancy.
Babies that get infected during the first
trimester show to have the most severe
symptoms.

HOW COMMON IS IT
Toxoplasmosis is one of the most common
infections in the world.
About 60 million people in the United States get it.
400 to 4000 babies are born with congenital
toxoplasmosis each year.
90% of the babies born with it have no symptoms
in infancy.
1 in 10 babies show symptoms when born
85% of babies show symptoms months to years
later.

WHAT ARE THE SYMPTOMS OF

TOXMOPLASMOSIS IN CHILDREN
Toxoplasmosis can cause premature birth or
stillbirth.
In most cases newborns do no show any
noticeable symptoms.
Babies born with severe toxoplasmosis usually
have:
eye infections, enlarged liver and spleen, jaundice, and
pneumonia, some may die after birth.

Babies who survive having severe toxoplasmosis

can develop:
mental retardation, impaired eyesight, cerebral palsy, seizures,
and hearing loss.

DURATION
Toxoplasmosis can multiply and spread within
a week as soon as the person gets infected,
but it can take weeks or months before the
person gets the symptoms.
Toxoplasmosis is not curable, it stays in the
persons body for life, but will remain inactive
causing no harm. (life long immune protection)
If the persons immune system is not working
correctly due to HIV or cancer therapy,
toxoplasmosis can be reactivated and cause
serious harm. (nervous system)

DIAGNOSIS DURING PREGNANCY

Ultra sounds can be done to diagnose congenital
toxoplasmosis (but are not always 100% accurate)
Doctors usually get blood samples to measure the
level of antibodies, which are the bodies defenses
in the immune system.
They have been new tests that can detect the
DNA of the genes that have toxoplasmosis
parasites. (these help detect congenital
toxoplasmosis in the fetus)

TREATMENT DURING PREGNANCY

Early diagnosis and prevention can greatly decrease the
chances of the baby getting the infection badly, but will
not reduce the chances of transmitting the infection
from mother to child.
If the pregnant woman is believed to have the infection
active and she is in her first trimester of pregnancy she
will be giving an antibiotic called spiramycin. ( Studies
show that using spiramycin can reduce the chance of the fetus
getting infected by 60%)

If the fetus is infected, and the mother is 18 weeks

gestation or more, she will be giving pyrimethamine and
sulfadiazine. (these can reduce the newborns
symptoms)

TREATMENT FOR INFECTED

Babies that are born with
toxoplasmosis are also giving
NEWBORNS

pyrimethamine and sulfadiazine. (first year of life or sometimes

longer)
The National Collaborative Chicago- Based Toxoplasmosis Study
Group found these medications to be very successful for all levels
of the infection.
*in the study they found that 72% of infected babies had normal
intelligence and motor function in their adolescence, but showed that eye
infections reappeared

Some babies still developed disabilities even after using the two
medications, because of damages done before birth.
In most cases babies are born without symptoms and therefore do
not receive early treatment and developing severe disorders.
(Massachusetts and New Hampshire screen babies for
toxoplasmosis)

PREVENTION OF TOXOPLASMOSIS
DURING PREGNANCY
Do not eat raw or undercooked meat
Wash hands after handling raw meat
Clean utensils, cutting boards, or other things that
have come in contact with raw meats.
Wash and peel fruits and vegetables
Do not empty or clean cats litter boxes (if you do use
gloves and wash hands after cleaning it)
Try to keep your cats indoors to stop them from eating
any animal that has been infected with parasites.
Use gloves when gardening (soil may have parasites
from cats.

Human Toxoplasmosis
Toxoplasmosis is a
zoonotic disease
Caused by Coccidian
protozoan Toxoplasma
gondii
Infectes a wide range of
animals, birds but does
not appear to cause
disease in them

Toxoplasmosis
A disease of the blood and lymphatic system.
Cats are a critical part of the life cycle.
It is usually acquired by eating undercooked meats
but can also be acquired by contact with cat feces.
Primary problem is a congenital infection of fetus,
resulting in either a stillbirth or a child with severe
brain damage or vision problems.

Toxoplasmosis
The normal final host is
cat and relatives in the
family Felidae, only
hosts in which the
Oocyst producing
sexual stage of
Toxoplasma can
develop

By feeding on Mice brains Cats

can get Infected

Events on Rat to Cat

Transmission

Spread from Rats Cats to

Humans

Spread of Toxoplasmosis

Development in Cat
Organisms ( either
sporozoites from Oocysts or
Bradyzoites from tisse cysts
) invade the muscle cells of
cats samll intestine where
they from Schizonts or
Gametocytes after sexual
fusion of Gametes,oocysts
develop exit from the host
cells into the gut lumen of
the cat and pass out via
feces

Structure of Sporozoites
In each Oocysts two
sporocysts form and in
about 48 hours four
sporozoites form within
sporocyst.
The Oocyst with its
each Sporozoites when
ingested can either
repeat its sexual cycle in
a Cat

Events on Development in man

When man ingests Oocysts
with eight Sporozoites
excreted in Cats feces, can
establish an infection and
reproduces Asexually
In humans Oocysts open in
duodenum and releases
eight Sporozoites which
pass through the gut wall
Circulate in body and
invade various cells

Cycles of Development in Man

Invasion of Lymphnodes lead to

chronic infections
Sporozoites invade various
cells especially
macrophages where they
from Trophozoites further
multiply break out and
spread the infection to
lymphnodes and other
organs
The rapidly multiplying
Crescentric cell
(Tachyzoites ) initiate the
acute stage of disease

Invade Organs
Brain involvement carries higher
Morbidity
and
Mortality
In futher development they

penetrate new cells

especially Eye and Brain.
Further development slows
down in these organs called
ad Bradyzoites to form a
quiescent tissue cysts
The event lead to chronic
stage of disease

Fate of Tissue Cysts

Showing multiple tissue cysts
The tissue cysts are
infective when ingested
by cats or eaten by other
animals, where tissue
cysts are formed
In man it dead end of
disease

Implications on Human Health

In Humans produces
1 Congenital
Toxoplasmosis
2 Post natal
Toxoplasmosis

Many Humans at risk with

Toxoplasmosis

Congenital Toxoplasmosis
Congenital infection
develop in fetus only
when non immune
mothers are infected
during pregnancy
Post natal
Toxoplasmosis is less
severe.

Other Human Infections

Early detection reduce Morbidity
Toxoplasmosis produces
severe Human
infections in patient
with
AIDS
The chronic infection is
altered to Acute
manifestations

Toxoplasmosis - Immunosupressed
Varying degrees of
disease may occur in
Immunosupressed
indivudals results in
Retinitis
Chorioretinits
Pneumonias
Other non specific
manifestions

Toxoplasmosis - Retinitis

Morphology and Identification

of
Toxoplasmosis

The Trophozoites are boat

shaped
Thin walled cell
Size is 47 x2-4 microns lie
within tissue cells
But appear larger when
outside the tissue cell
Stain lightly with Giemsas
stain
True cysts contain many
thousands of spore like
Bradyzoites

Culturing Toxoplasma
Toxoplasma gondii may
be cultured in the
presence of living cells
in the culture tissues or
eggs
Organisms can be seen
intracellularly or
extracellularly

Pathogenesis
The Tacyzoites have predilection for parenchymal cells
and Reticulo endothelial system and directly destroys the
cells.
Humans are relatively resistant to infection
But low grade infection of lymph node persists
When tissue cysts ruptures releases number of
Bradyzoites
Local hypersensitivity reaction may cause inflammation.
Causes blocking of blood vessels
Causes death of cells near damaged area

Congenital Infection
Lead to
Still Birth
Chorioretinits
Intracellular calcification
Psychomotor disturbances
Hydrocephaly
Microcephaly
Prenatal toxoplasmosis may
manifest with blindness
apart from congenital
defects

Toxoplasmosis in Pregnancy
In 1 st Trimester
May lead to still birth
Major central nervous
system anomalies
In 2nd Trimester
Less severe complications
Birth Anomalies still
common

Babies infected with congenital

Toxoplasmosis manifest with

brain damage
enlarged spleen and liver
eye damage
jaundice
poor motor coordination
unusually small head
rash

Late Anomalies in Toxoplasmosis

Clinical manifestation in infected fetus may be
delayed until long after birth
Even may present during early childhood.
Neurological problems of learning difficulties may
be caused by long delayed effects of late prenatal
infection.

Diagnosis of Toxoplasmosis
Desired specimens,
Blood ( Buffy coat of
heparinised sample )
Sputum
CSF
Exudates
Lymphnodes
Tonsil tissues
Striated muscle biopsy
Ventricular fluid in Neonates

Microscopic Examination of Tissues

Smears and sections stained
with Giemsas stain
Periodic acid Schiff method
preferred
The densely packed cysts
seen in the brain or other
parts of nervous system
suggest chronic infection

Serology
Sabin Feldman dye
test
based on principle that
Antibodies to Toxoplasma
appear in 2-3 weeks that will
render the membrane of the
laboratory cultured living
T.gondii impermeable to
Alkaline methylene blue
,So the organism are
unstained in the
presence of serum
with antibodies

Newer Methods in Diagnosis

Immuno florescent assay
method.
ELISA for IgM and IgG
detection
PCR
Frankels intracutaneous test
useful for epidemiologcal
purpose

Immunity
Acquired immunity in
women is particularly
protective to the fetus.
In Immunosupressed and
AIDS patients changes the
host resitance and causes
chronic infection becomes
fulminating acute
Toxoplasmosis

Treatment
Combination of Pyramethamine and
Sulphadiazine or Trisulfapyramidines
Other alternative Drugs
Spiramycin
Clindamycin
Trimethoprim Sulphmethoxazole
In pregnancy Spriamycin is recommended drug

Control of Toxoplasmosis
Avoidance of human contact
with Cat feces is highly
important measure.
Changing of Cat litter and
safe disposal can prevent
transmision
Pregnant women should
avoid contact with kittens

Screening of pregnant women

Periodic screening of
pregnant women with
high risk for IgG and
IgM antibodies to
Toxoplasmosis is
recommended

Care of the Meat

Avoid eating raw or
undercooked meat.
Freezing < -200c
Heating at 500c for 4-6
minutes destroys the
cysts and sterilizes the
meat.