Toxoplasma gondii

Protozoan Parasite Affecting Neuro-cerebral System

CEREBRAL TOXOPLASMOSIS

Historical Facts
1. First described in 1908, in material from a small rodent, the gondi. 2. Rediscovered in 1935 in the brain tissue of guinea pigs used for encephalitis experiments. 3. In 1939 it was found as the cause of encephalitis and chorioretinitis in a 31 day old infant. This stimulated interest in the disease. 4. In 1969 infective cysts were detected in the stools of cats experimentally infected with toxoplasmosis from mouse tissue.

Toxoplasmosis
Domestic cats and other Felidae are the definitive

host
Other vertebrates are the intermediate host

1. 2. 3. 4.

amphibians fish reptiles all warm-blooded animals including man

Life cycle

Toxoplasmosis
Human/Congenital Transfer

Toxoplasmosis in Humans
1. Majority of cases are asymptomatic 2. Mild fever, sore muscles swollen glands and lymph nodes, similar to mononucleosis 3. Immunocompromized individuals are at greater risk. HIV patients, Organ transplant patients, people on chemotherapy Toxoplasmic Encephalitis (TE) 4. Pregnant womens fetus are at risk if the mother acquires the infection during gestation. 5. CDC estimates 400-4000 cases of congenital toxoplasmosis per year. 6. Blindness, Hydrocephalus, seizures and mental retardation are common 7. 750 human deaths per year make it the 3rd most common lethal food poisoning.

Cerebral manifestation
Hydrocephalus

Cerebral Calcification

Microcephalus

Microcephalus

Ocular Manifestation
Choroido-retinitis (chorio-retinitis)

Diagnosing Toxoplasmosis
Detecting oocysts in the stool (cat) Serological TestingELISA tests

IgG and IgM

Titers of IgG can last for years Titers of IgM usually persist for only 12 weeks, but may be longer

as several months
IgG Avidity test is a new method for diagnosing recent infection
< 200 U less than 4 months 200 300 U borderline > 300 more than 4 months

Treatment
Drugs Dosage
Congenital Toxoplasma Loading : 2 mg/kg/day on Day1 & 2 Continuation : 1 mg/kg/day for 2-6 months and then 1mg/kg 3 times a week to complete 12 months Acquired Toxoplasma Loading : 2 mg/kg/day for 3 days Continuation : 1 mg/kg/day for 6 weeks Congenital Toxoplasma : 50 mg/kg/dose BD for 12 months Acquired Toxoplasma : 25-50 mg/kg/dose , 4 x daily 5-7.5 mg/kg/do PO 4 times daily (max 600 mg/dose)

Pyrimethamine

Sulphadiazine
Clindamycin

TMP/SMX
Azithromycin

5 mg/kg TMP + 25 mg/kg SMX IV/PO BD

Used in adults with Pyrimethamine in sulfa- allergic pts

Control
Clean the liter box daily (it takes 1-5 days for the oocysts to

sporulate and become infective)

Cook all meat and fish thoroughly Pregnant women should use caution when exposed to cat liter or

gardening have another person clean the liter box

Wash hands and counter top thoroughly after preparing raw meats

and fishes
Immunocompromized individuals should use the same caution with

cat litter and cooking of meats.

Pork is reported to be the most common meat infected Hunters should wear gloves when dressing wild animals