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10/11
Objectives
To be able to Name the Tissue coccidia that cause human disease and state the habitats of each State the source (s) of infection, entry to and exit of agent from humans Describe the life cycle with stages and events Identify the stages that cause pathogenic effects Outline laboratory methods of identification of organism Identify points in the life cycle where preventive measures are applicable Describe the pathogenicity List the clinical features Describe transmission, prevention and control of toxoplasmosis
COCCIDIA
Intracellular protozoans; alternation of asexual & asexual
Development in epithelial cells (usually gut) of the definitive host TISSUE COCCIDIA INTESTINAL COCCIDIA-
Toxoplasma gondii
Toxoplasma gondii
Coccidian parasite Cats ONLY known DEFINITIVE HOST INTERMEDIATE HOSTS: widespread in birds & mammals
Sri Lanka > 50% healthy adults have Ab. Many animals (dogs, cats, rodents are positive; cats 24% )
obligate intracellular parasite of all nucleated cells Latent infection is common It is an important opportunistic parasite
1. Tachyzoites (endozoites) and pseudocysts Crescent shape, 4 8 m with single nucleus found in macrophages (pseudocyst) or any nucleated cell . Multiply rapidly (tachyzoites) . Pseudocysts can cross the placenta
found in any part of the body Organs commonly affected are brain, eye, heart. Cyst wall is by the parasite and host. Zoites in true cysts multiply slowly (bradyzoites)
3.Oocyst formed in the small intestine of the cat and passed in cat faeces. Each sporulated oocyst contains 02 sporocysts and each sporocyst has 04 sporozoites NOT FOUND IN HUMANS and other intermediate hosts
Life cycle
Only known definitive hosts for Toxoplasma gondii are members of family Felidae (domestic cats and their relatives)
Definitive host
Oocysts take 2-5 days to sporulate in the environment and become infective.
Pathogenesis
Tachyzoites actively invade the cells Multiply rapidly Form intracellulaer pseudocyst This leads to cellular disruption, released tachyzoites infect adjacent cells As the host immunity develops,Tissue true cyst form, containing bradyzoites Periodic excystation can occur
clinical disease
majority asymptomatic except in Neonates immunocompromised eg. Transplant surgery, AIDS
In Immunodeficient patients- mostly due to reactivation Common _ central nervous system (CNS) disease encephalitis
In patients with AIDS, toxoplasmic encephalitis is the most common cause of intracerebral mass lesions
but may have retinochoroiditis, pneumonitis, or other systemic disease.
Ocular toxoplasmosis Most common cause of infectious posterior Uveitis Due to periodic reactivation of congenital toxoplasmosis or acquired acute infection
Usually unilateral Active lesion is whitish with illdefine margins ( cotton wool appearance) and pigmented when quiescent Involves macular in majority
CONGENITAL TOXOPLASMOSIS
occurs generally with acute (1ry) infection in Mother (endometrial reactivation reported))
Placental infection
but foetal damage severe during early pregnancy- abortion, intra uterine death
diagnosis
Indirect
Detection of IgM, IgA or low avidity IgG , rising IgG titreindicate acute infection, IgG Past infection
Serological tests available 1.Sabin-Felman dye test Gold standard 2.IFAT 3. IHA 4. ELISA
antibodies to T gondii are present in the patient's serum, they will damage the organisms damaged organisms will not take up the dye and appear as pale "ghosts" compared to undamaged organisms.
The
test needs live tachyzoites and is difficult to perform, so other serological tests are typically used. However, the test is very sensitive and specific and remains the reference method.
especially in detecting congenital infections in utero. Amniotic Fluid - parasite DNA by PCR Prenatal diagnosis: Fetal US - calcifications / hydrocephalus
Amniocentesis
Done around 16th week of pregnancy A long needle is inserted into the Amniotic sac and amniotic fluid is drawn.
Transmission
Parasitic stages that can be transmitted to humans Oocysts
Tachyzoites or pseudocysts
Bradyzoites or true cysts
Food and water borne a) oocysts via contaminated Vegetables, fruits and water
Transmission
Accidental ingestion of oocysts in contaminated soil (e.g. not washing hands after gardening)
Drinking water contaminated with the Toxoplasma oocysts
true cysts (bradyzoites) eating uncooked or undercooked meat of infected animal Accidental ingestion of
undercooked, contaminated meat after handling it and not washing hands thoroughly (Toxoplasma cannot be absorbed through intact skin) Eating food that was contaminated by knives, utensils, cutting boards, or other foods that had contact with raw, contaminated meat
Rarely Organ transplant recipients can become infected by receiving an organ from a Toxoplasma-positive donor.
Tachyzoites or pseudocysts
PREVENTION
Reduce Risk of Toxoplasmosis from Food
Avoid eating raw/undercooked meat -15 C for 3 days -65 C 4-5 minutes -4 C persists for months salt/nitrates kills cysts,
Wash cutting boards, dishes, counters, utensils, and hands with hot soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables.
Avoid eating raw/undercooked meats -
Wash foods such as green salads leaves and fruits, especially if it is to be eaten uncooked.
Feed cats only canned or dried commercial food or well-cooked food, not raw or undercooked meats.
Change the litter box daily . The Toxoplasma parasite does not become infectious until 2 to 5 days after it is shed in a cat's faeces
SARCOSPORIDIOSIS / SARCOCYSTOSIS
Two types - Intestinal sarcocystosis Muscle sarcocystosis Organism - Sarcocystis spp. many species present
coccidian parasite, tissue protozoan Life cycle - requires two hosts ; a definitive host & an intermediate host man can be the definitive host for some species and an intermediate host for some other species In the definitive host - sporogony in intestinal mucosae with the production of sporocysts (infective stage) In the intermediate host-sarcocysts or Meischers tubes in muscle (intermediate stage)
Muscle sarcocystosis
Man act as the intermediate host
True/ false regarding toxoplasmosis Cats act as definitive hosts Oocysts could be found in human faeces True cysts can be transmitted by blood transfusion Tachyzoites can be transmitted by mosquito bite Risk of congenital infection increase with duration of pregnancy If the mother get infected during the later part of pregnancy, foetal damage is sever Known to cause life- threatening infections in immunocompromized patients