 
Toxoplasmosis
Toxoplasma gondii
http://www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/default.htm

What is toxoplasmosis?
Toxoplasmosis is an infection caused by a single-celled parasite named 
Toxoplasma gondii. It is found throughout the world. More than 60 million people 
in the United States probably are infected with the Toxoplasma parasite, but 
very few have symptoms because the immune system usually keeps the parasite from 
causing illness.

Once infected with Toxoplasma is my cat always able to spread the infection to 
me?
No. Cats can only spread Toxoplasma in their feces for a few weeks after they 
are first infected with the parasite. Like humans, cats rarely have symptoms 
when first infected, so most people don't know if their cat has been exposed to 
Toxoplasma. There are no good tests available to determine if your cat is 
passing Toxoplasma in its feces.

http://www.thebody.com/nmai/toxo.html

Toxoplasmosis
July 27, 2002
* What Is Toxoplasmosis?
* How Is Toxo Treated?
* How Do I Choose a Treatment for Toxo?
* Can Toxo Be Prevented?
* The Bottom Line

What Is Toxoplasmosis?
Toxoplasmosis (toxo) is an infection caused by the parasite Toxoplasma gondii. A 
protozoa is a single-celled animal. A parasite lives inside another living 
organism (the host) and takes all of its nutrients from the host.
The toxo parasite is very common in cat feces, raw meat, raw vegetables, and the 
soil. It can get into your body when you breathe in dust. Up to 50% of the 
population is infected with toxo. A healthy immune system will keep toxo from 
causing any disease. It does not seem to spread from person to person.
The most common illness caused by toxo is an infection of the brain 
(encephalitis).Toxo can also infect other parts of the body. Toxo can lead to 
coma and death. The risk of toxo is highest when your T-cell (CD4+) counts are 
below 100. 
The first signs of toxo include fever, confusion, headache, disorientation, 
personality changes, tremor, and seizures. Toxo is usually diagnosed by testing 
for antibodies to Toxoplasma gondii. 
The toxo antibody test shows whether you have been exposed to toxo. A positive 
test does not mean that you have toxo encephalitis. However, a negative antibody 
test means that you are not infected with toxo.
Brain scans by computerized tomography (CT scan) or magnetic resonance imaging 
(MRI scan) are also used to diagnose toxo. A CT scan for toxo can look very 
similar to scans for other opportunistic infections. An MRI scan is more 
sensitive and can make it easier to diagnose toxo.

How Is Toxo Treated?
Toxo is treated with a combination of pyrimethamine (Daraprim(r)) and 
sulfadiazine. Both drugs can cross the blood-brain barrier. 
The toxoplasma protozoa needs vitamin B to live. Pyrimethamine stops toxo from 
getting vitamin B. Sulfadiazine prevents toxo from using it. The normal dosage 
of these drugs is 50 to 75mg of pyrimethamine with 2 to 4 grams per day of 
sulfadiazine. 
These drugs both interfere with vitamin B and can cause anemia. People with toxo 
usually take Leucovorin, a form of folic acid (a B vitamin), to prevent anemia.
This combination of drugs is very effective against toxo. Over 80% of people 
show improvement within 2 to 3 weeks.
Toxo usually comes back after the first episode. People who have had toxo should 
keep taking the anti-toxo drugs at a lower, maintenance dose.

How Do I Choose a Treatment for Toxo?
If you are diagnosed with toxo, your doctor will probably prescribe 
pyrimethamine and sulfadiazine. This combination can cause a drop in white blood 
cells, and kidney problems. 
Also, sulfadiazine is a sulfa drug. Almost half the people who take it have an 
allergic reaction. This usually is a skin rash, sometimes a fever. 
Allergic reactions can be overcome using a desensitization procedure. Patients 
start with a very small amount of the drug. They get increasing amounts until 
they can tolerate the full dose.
People who cannot tolerate sulfa drugs can use clindamycin (Cleocin(r)) instead 
of sulfadiazine in the combination.

Can Toxo Be Prevented?
The best way to prevent toxo is to take strong anti-HIV medications. You can be 
tested to see if you have been exposed to toxo. If not, you can reduce your risk 
of infection by not eating undercooked meat or fish, and by wearing gloves and a 
face mask and washing thoroughly if you clean a cat box.
If you have less than 100 T-cells, you should take medication to prevent toxo. 
People with less than 200 T-cells usually take Bactrim or Septra to prevent 
pneumocystis carinii pneumonia (PCP). These drugs also protect you against toxo. 
See Fact Sheet 512 for more information on PCP. If you can't tolerate Bactrim, 
your doctor can use other drugs. 

The Bottom Line
Toxoplasmosis is a serious opportunistic infection. If you have not been 
exposed, you can reduce your risk of exposure by not eating undercooked meat or 
fish, and taking extra precautions if you clean a cat box.
You can take strong anti-HIV medications to keep your T-cell count up. If your 
T-cell count falls below 100, talk with your doctor about taking drugs to 
prevent toxo.
If you develop headaches, disorientation, seizures, or other possible signs of 
toxo, see your doctor immediately. With earlydiagnosis and treatment, toxo can 
be treated effectively.
If you do develop toxo, you should continue to take the anti-toxo drugs to 
prevent another episode.

This document was provided by the New Mexico AIDS InfoNet.


--------------------------------------------   
http://web.vet.cornell.edu/Public/FHC/toxo.html  
Toxoplasmosis in Cats 
Toxoplasmosis, a disease of cats and other mammalian species, is caused by a 
parasitic protozoan, Toxoplasma gondii. Protozoa are single-celled organisms 
that are among the simplest creatures in the animal kingdom. Although infection 
with Toxoplasma is fairly common, actual disease caused by the parasite is 
relatively rare.
The Life Cycle of Toxoplasma
Cats, domestic and wild, are the definitive host (host in which the adult, or 
sexually mature stage, of the parasite is produced) and are the parasite's 
primary reservoir of infection. Domestic cats are important in transmission of 
Toxoplasma to other animals and human beings, which become involved only as 
intermediate hosts of the parasite. Consumption of raw meat tissues is another 
important means of transmission.
Cats acquire Toxoplasma infection by eating any of the three infective stages of 
the parasite: cyst, oocyst, or tachyzoite. Following ingestion of cysts in 
infected prey (rodents or birds), the intraintestinal infection cycle begins. 
This cycle occurs only in members of the cat family. The organisms multiply in 
the wall of the small intestine and produce oocysts, which are then excreted in 
great numbers in the feces for two to three weeks. Within five days the shed 
oocysts may sporulate, becoming infectious to other animals and to humans. 
Sporulated oocysts are highly resistant to environmental conditions and can 
survive in moist shaded soil or sand for many months.
During the intraintestinal infection cycle in the cat, some Toxoplasma organisms 
released from the ingested cysts penetrate more deeply into the wall of the 
intestine and multiply as tachyzoite forms. Very soon these forms spread out 
from the intestine to other body sites, starting the extraintestinal infection 
cycle. Eventually the cat's immune system restrains this stage of the organism, 
which then enters a dormant or "resting" stage by forming cysts in muscles and 
brain. Most cysts probably remain dormant for the life of the host. The 
extraintestinal infection cycle occurs not only in cats but also in the 
intermediate hosts (including humans).
Most healthy exposed cats shed oocysts during acute infection with Toxoplasma, 
but will not shed them after the acute infection. Even in those few cats that do 
re-excrete oocysts after another exposure to Toxoplasma, the number of oocysts 
shed is smaller and may even be insufficient to transmit the parasite 
effectively.
Ingestion of tissue cysts in infected prey or in other raw meat is probably the 
most common route by which cats are exposed to Toxoplasma. Congenital infection 
(transmission from mother to fetus) occurs in sheep, goats, and humans, but is 
much less common in cats.
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Signs
Most cats show no clinical signs of infection with Toxoplasma. Occasionally, 
however, clinical disease-toxoplasmosis-occurs, kittens and young adult cats 
being more often affected than older animals. Lethargy, depression, loss of 
appetite, and fever are typical early nonspecific signs. Pneumonia, manifested 
by respiratory distress of gradually increasing severity, is the outstanding 
sign in many cats. Hepatitis (inflammation of the liver) may cause vomiting, 
diarrhea, prostration, and jaundice (yellowing of the mucous membranes). 
Inflammation of the pancreas and enlargement of lymph nodes also occur. 
Toxoplasmosis can also affect the eyes and central nervous system, producing 
inflammation of the retina or anterior ocular chamber, abnormal pupil size and 
responsiveness to light, blindness, incoordination, heightened sensitivity to 
touch, personality changes, circling, head pressing, twitching of the ears, 
difficulty in chewing and swallowing food, seizures, and loss of control over 
urination and defecation.
In some cases, coinfection with feline leukemia virus (FeLV) or feline 
immunodeficiency virus (FIV) may predispose a cat to develop toxoplasmosis.
Diagnosis
Toxoplasmosis may be strongly suspected by the history, signs of illness, and 
the results of supportive laboratory tests. A presumptive diagnosis may be made 
by demonstration of a fourfold or greater increase in antibody titers to 
Toxoplasma (indicating a recent infection) over a three- or four-week period in 
a cat showing signs suggestive of toxoplasmosis. A definitive diagnosis requires 
either microscopic examination of tissues or tissue impression smears for 
distinctive pathologic changes and the presence of tachyzoites or inoculation of 
suspect material into laboratory mice.
The presence of significant antibody levels in a healthy cat suggests that the 
cat has been previously infected and now is most likely immune and not excreting 
oocysts. The absence of antibody in a healthy cat suggests that the cat is 
susceptible to infection and thus would shed oocysts for one to two weeks 
following exposure.
Treatment and Prevention
The two drugs that are most often used-pyrimethamine and sulfadiazine-act 
together to inhibit Toxoplasma reproduction. Treatment must be started as soon 
as possible after diagnosis and continued for several days after signs have 
disappeared. In acute illness, treatment is sometimes started on the basis of a 
high antibody titer in the first test. If clinical improvement is not seen 
within two to three days, the diagnosis of toxoplasmosis should be questioned.
Pyrimethamine may be unpalatable or toxic to some cats, even if given in small 
amounts. Recently, the antibiotic clindamycin has been reported to be effective 
in treating feline toxoplasmosis, with few side-effects observed.
No vaccine is as yet available to prevent either Toxoplasma infection or 
toxoplasmosis in cats, humans, or other species. Research in this area is in 
progress.
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Toxoplasma and Human Health
Although the incidence of toxoplasmosis among humans probably has not changed 
significantly over the years, awareness and concern about the disease have 
increased within the medical and veterinary communities. It has been estimated 
that 30 to 50 percent of the world's human population has been infected with 
Toxoplasma and harbors the clinically inapparent cyst form. This encysted form 
is important because, if given the opportunity, it can produce disease in 
immunocompromised patients. For this reason veterinarians are often called on to 
clarify the role that cats play in the transmission of Toxoplasma to humans.
Contact with oocyst-contaminated soil is probably the major means by which many 
different species-rodents, ground-feeding birds, sheep, goats, pigs, and cattle, 
as well as humans living in developing countries-are exposed to Toxoplasma. In 
the industrialized nations most transmission to humans is probably due to eating 
undercooked infected meat, particularly lamb and pork (in many areas of the 
world, approximately 10 percent of lamb and 25 percent of pork products contain 
Toxoplasma cysts). The organism may also on occasion be present in some 
unpasteurized dairy products, such as goat's milk.
Congenital infection is of greatest concern in humans. About one-third to one-
half of human infants born to mothers who have acquired Toxoplasma during that 
pregnancy are infected. In general, Toxoplasma infection of the fetus is least 
common (but disease is most severe) if the maternal infection occurs during the 
first trimester of pregnancy. Fetal infection is most common (but disease is 
least severe, often without symptoms) if the maternal infection occurs during 
the third trimester. The vast majority of women infected during pregnancy have 
no symptoms of the infection themselves.
It has been estimated that Toxoplasma is responsible for over three thousand 
human congenital infections in the United States each year, most of which are 
symptomless. Among symptomatic individuals, symptoms may be present at birth, or 
may first appear weeks, months, or even years later (the majority of clinical 
cases appearing at puberty, for example, are the result of congenital, rather 
than recent, infection). Ocular and central-nervous-system disturbances, 
deafness, fever, jaundice, rash, and respiratory disease, in varying 
combinations, are among the more common clinical manifestations in these 
patients. In immunocompromised persons-those undergoing immunosuppressive 
therapy (e.g., for cancer or organ transplantation) or those with an 
immunosuppressive disease such as AIDS-enlargement of the lymph nodes, ocular 
and central nervous-system disturbances, respiratory disease, and heart disease 
are among the more characteristic symptoms. In these patients-especially those 
with AIDS-relapses of the disease are common, and the mortality rate is high.
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Minimizing Exposure
Tissue cysts can be destroyed by thoroughly cooking meat to an internal 
temperature of 70°C (158°F) for at least 15 to 30 minutes. Freezing and thawing, 
salting, smoking, or pickling will not reliably destroy cysts in meat. 
Restricting the access of pet cats to rodents and birds and offering them only 
cooked meat, commercially prepared cat food, and pasteurized dairy products 
should prevent most transmission. (Nor should humans eat uncooked meat or 
unpasteurized dairy products.) Scavenging can be discouraged by placing secure 
lids on all garbage cans.
Because excreted oocysts are highly resistant to environmental conditions and 
millions may be present in a single stool, contamination of garden soil, flower 
beds, children's sandboxes, cats' litter boxes, and other areas of loose, moist 
soil where cats defecate may be extensive. Under such conditions transmission of 
oocyts to humans can be minimized by the following measures:
* Avoid contact with potentially contaminated soil, or wear rubber gloves during 
contact, and follow by washing hands vigorously and thoroughly with soap and 
water.
* Cover children's sandboxes to prevent contamination by cats.
* Dispose of feces from litter boxes daily or every other day to remove oocysts 
before they sporulate and become infective.
* Disinfect potentially contaminated litter boxes with scalding water or with 
dry-heat sterilization (55°C, 131°F).
* Chemical disinfection does not reliably destroy oocysts.
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Specific Recommendations for Pregnant Women
A pregnant woman (or one who contemplates pregnancy) can minimize exposure to 
Toxoplasma by taking the following measures:
* Exclude rare or undercooked meat and unpasteurized dairy products from the 
diet.
* Test household cats for antibodies to Toxoplasma. Assuming that a cat is 
healthy, a positive antibody test indicates that the animal is most probably 
immune and not excreting oocysts and thus would be an unlikely source of 
infection. A healthy antibody-negative cat is most probably susceptible to 
infection and would shed oocysts for one to two weeks after exposure to 
Toxoplasma. If possible, the cat should be tested before the woman becomes 
pregnant.
* Have herself tested for antibodies, preferably before becoming pregnant. A 
positive test would indicate past infection that will not be transmitted to the 
fetus. The presence of antibodies also lessens the likelihood that congenital 
transmission would occur should she be exposed again to the parasite during 
pregnancy. An antibody-negative woman would thus be at greater risk of 
transmitting Toxoplasma to the fetus should she become infected during 
pregnancy.
* Protect cats from infection (or reinfection) by preventing access to birds, 
rodents, uncooked meat, and unpasteurized dairy products.
* Avoid handling litter boxes. Even if a cat is antibody-positive and hence most 
likely immune, there exists a potential for reshedding of oocysts (although in 
much smaller numbers than during the initial infection). For safety, litter 
boxes should be changed daily or every other day by another person to eliminate 
any potential for accidental infection.
* Avoid handling free-roaming cats, because the fur or paws could be 
contaminated with oocysts, which might be transmitted by hand-to-mouth contact. 
Any cat allowed indoors should be kept off the bed, pillows, blankets, or other 
furnishings the woman uses.
* Avoid handling any cat showing signs of illness.
* Wear rubber gloves if working with garden soil. Uncooked vegetables, whether 
grown in a home garden or supplied commercially, should be washed thoroughly 
before ingestion, in case they have been contaminated by cat feces.
* Make a habit of vigorously and thoroughly washing hands with soap and water 
after contact with soil, cats, unpasteurized dairy products, or uncooked meat or 
vegetables.
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Prepared by the Cornell Feline Health Center, Cornell University, College of 
Veterinary Medicine, Ithaca, New York 14853-6401, and the American Association 
of Feline Practitioners. The ultimate purpose of the Feline Health Center is to 
improve the health of cats by developing methods to prevent or cure feline 
diseases and by providing continuing education to veterinarians and cat owners. 
Much of that work is made possible by the financial support of friends. (c)1990 
by Cornell University. Reviewed 1994. All rights reserved. Cornell University is 
an equal opportunity, affirmative aciton educator and employer. 

Home | Site Map | Mission & Contact | Owner Resources | Practitioner's Page | 
How You Can Help | Goods & Services 

(c) Cornell University College of Veterinary Medicine
Questions or Comments ?
Last Revised on 8/2/02


---------------------------------
Good summary of life cycle 
Protozoa as Human Parasites

http://www-micro.msb.le.ac.uk/224/Parasitol.html 

--------------------------------- 
Will grape seed extract work 
http://www.nutriteam.com/listeria.htm
Protozoa's yes

http://www.nutriteam.com/index2.html

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