Vidyya Medical News Servicesm
Vidyya, from the Sanskrit "vaidya," a practitioner who has come to understand the science of life.

Volume 1 Published - 14:00 UTC    08:00 EST    25-June-2000      
Issue 73 Next Update - 14:00 UTC 08:00 EST    26-June-2000      

Vidyya Home  Vidyya

Home Of Our Sponsor, Vidyya.  Vidyya. Home

Vidyya Archives  Vidyya Archives

Search Vidyya  Search Vidyya

Visit Our Library  Ex Libris

Subscribe To Our News Service  Subscriptions

All About Us  About Vidyya



















Back To Vidyya From The Tissue Of The Family Cat

Information For Professionals - Toxoplasma Gondii

Toxoplasma gondii is a protozoan parasite that infects most species of warm blooded animals, including humans, causing the disease toxoplasmosis.

Life Cycle:

T. gondi life cycle

Members of the cat family (Felidae) are the only known definitive hosts for the sexual stages of T. gondii and thus are the main reservoirs of infection. Cats become infected with T. gondii by carnivorism. After tissue cysts or oocysts are ingested by the cat, viable organisms are released and invade epithelial cells of the small intestine where they undergo an asexual followed by a sexual cycle and then form oocysts, which are then excreted. The unsporulated oocyst takes 1 to 5 days after excretion to sporulate (become infective). Although cats shed oocysts for only 1 to 2 weeks, large numbers may be shed. Oocysts can survive in the environment for several months and are remarkably resistant to disinfectants, freezing, and drying, but are killed by heating to 70oC for 10 minutes.
Human infection may be acquired in several ways: 1) ingestion of undercooked infected meat containing Toxoplasma cysts; 2) ingestion of the oocyst from fecally contaminated hands or food; 3) organ transplantation or blood transfusion; 4) transplacental transmission; 5) accidental inoculation of tachyzoites. The parasites form tissue cysts, most commonly in skeletal muscle, myocardium, and brain; these cysts may remain throughout the life of the host.

Geographic Distribution:
Serologic prevalence data indicate that toxoplasmosis is one of the most common of humans infections throughout the world. Infection is more common in warm climates and at lower altitudes than in cold climates and mountainous regions. High prevalence of infection in France (85%) has been related to a preference for eating raw or undercooked meat, while high prevalence in Central America has been related to the frequency of stray cats in a climate favoring survival of oocysts. The overall seroprevalence in the United States as determined with specimens collected by the third National Health and Nutritional Assessment Survey (NHANES III) between 1988 and 1994 was found to be 22%, with seroprevalence among women of childbearing age (15 to 45 years) of 10% to 15%. Acquired infection with Toxoplasma in immunocompetent individuals is generally an asymptomatic infection. However, 10% to 20% of patients with acute infection may develop cervical lymphadenopathy and/or a flu-like illness. The clinical course is benign and self-limited; symptoms usually resolve within a few months to a year.
Immunodeficient patients often have central nervous system (CNS) disease but may have myocarditis, or pneumonitis. In patients with AIDS, toxoplasmic encephalitis is the most common cause of intracerebral mass lesions and is thought to be due to reactivation of chronic infection. Toxoplasmosis in patients being treated with immunosuppressive drugs may be due to either newly acquired or reactivated latent infection.
Congenital toxoplasmosis results from an acute primary infection acquired by the mother during pregnancy. The incidence and severity of congenital toxoplasmosis vary with the trimester during which infection was acquired. Because treatment of the mother reduces the incidence of congenital infection, prompt and accurate diagnosis is extremely important. Most infants with subclinical infection at birth will subsequently develop signs or symptoms of congenital toxoplasmosis unless the infection is treated.
Ocular Toxoplasma infection, an important cause of chorioretinitis in the United States, is usually a result of congenital infection. Patients are often asymptomatic until the second or third decade of life, when lesions develop in the eye.

Laboratory Diagnosis:
The diagnosis of toxoplasmosis may be documented by:

  • Observation of parasites in patient specimens, such as bronchoalveolar lavage material from immunocompromised patients, or lymph node biopsy.
  • Isolation of parasites from blood or other body fluids, by intraperitoneal inoculation into mice or tissue culture. The mice should be tested for the presence of Toxoplasma organisms in the peritoneal fluid 6 to 10 days post inoculation; if no organisms are found, serology can be performed on the animals 4 to 6 weeks post inoculation.
  • Detection of parasite genetic material by PCR, especially in detecting congenital infections in utero.
  • Serologic testing is the routine method of diagnosis, because the techniques described above are technically complex and generally not rewarding.

Diagnostic findings

Microscopy

Toxoplasma trophozoites

A: Toxoplasma gondii in the bronchoalveolar lavage (BAL) material from an HIV infected patient. Numerous trophozoites (tachyzoites) can be seen, which are typically crescent shaped with a prominent, centrally placed nucleus. Most of the tachyzoites are free, some are still associated with bronchopulmonary cells.

Toxoplasma in cat tissue

B:Toxoplasma gondii in tissue from a cat.

Antibody detection

Serologic examination is used initially to indicate the presence of the infection by detecting Toxoplasma-specific antibodies. Serum, plasma, cerebrospinal fluid (CSF), and eye fluid specimens may all be tested for antibodies. If determination of immune status is the reason for testing, a single specimen is satisfactory. If determining the time of infection is important, two specimens drawn at least 3 weeks apart may or may not be useful. In most cases, detection of a rising IgG or IgM titer is not possible because the titers have already reached a plateau by the time the initial sample is drawn. The following algorithm may be used to determine the appropriate sequence of serological testing.

Serologic testing

Several commercial kits for Toxoplasma serologic testing are available. However, the sensitivity and specificity of these kits may vary widely from one commercial brand to another. This is of concern because serology results can influence decisions on continuation or termination of pregnancies.

Treatment:
Generally, an asymptomatic healthy, but infected, person does not require treatment. For pregnant women or persons who have weakened immune systems, spiramycin or pyrimethamine plus sulfadiazine may be used in specific cases.


Vidyya. Home |  Ex Libris |  Vidyya  | 
Subscription Information |  About Vidyya |  Vidyya Archives | 

Editor: Susan K. Boyer, RN
© Vidyya. All rights reserved.