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TOXOPLASMOSIS

Dr.T.V.Rao MD
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.
Toxo pl as mos is
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 4–7 x2-4
microns lie within
tissue cells
But appear larger
when outside the
tissue cell
Stain lightly with
Giemsa’s 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 Giemsa’s
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
Newer Methods in Diagnosis

Immuno florescent
assay method.
ELISA for IgM and IgG
detection
PCR
Frankel’s
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.
Created for Health Awareness
on Toxoplasmosis
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com