TOXOPLASMOSIS

Zulfachmi Wahab
RSUD dr. M. Adhyatma MPH
Semarang
 WHAT IS TOXOPLASMOSIS?

Toxoplasmosis is an infection caused by a parasite most

often found in cats and farm animals. Humans can catch
this disease from:

coming into contact with infected cat feces

eating raw or undercooked meat that s infected

eating contaminated vegetables or fruits

being born with it

Note: Once a person is infected, the infection remains in

the body for life, usually in an inactive form. It can
reactivate when that persons immune system is weak.
Life cycle of Toxoplasma
About 98% of cases of Toxoplasmosis are
acquired through Congenital Toxoplasmosis.
One study showed that 76% of
infants infected with congenital
toxoplasmosis had ocular lesions,
51% had neurological involvement,
and 26% had either hydrocephalus
(increased intracranial pressure) or
michrocephaly (small brain). It is
evident that vision problems are
very common with Congenital
Toxoplasmosis.

Once the mother develops

immunity to the organism, all future
pregnancies are protected from
transmission of the organism.
 Signs and Symptoms

1. Toxoplasmosis in an otherwise healthy person

may have no symptoms or only a few swollen
glands usually in the patients neck.

2. Toxoplasmosis in a person with a weakened

immune system may only have symptoms of
swollen glands, or in the case of an infection
that attacks the brain and nervous system, the
symptoms may include fever, seizures,
headache, psychosis, and problems with vision,
speech, movement, or thinking.
3. Children born with Toxoplasmosis, which accounts for
about 98% of cases, may show symptoms including:

Fever

Swollen glands

Jaundice
An unusually large or small head

Rash

Bruises or bleeding under the skin
Anemia

Enlarged liver or spleen

Seizures
Limp muscle tone

Mental retardation

Hearing loss

Vision problems (toxoplasmosis of the eye)
 Severe clinical Intra-uterine
picture :
retinochoroiditis, infections
encephalomyelitis,
hydrocephalus,
microcephaly

Most infections result

in blindness, severe
visual impairment
and/or mental
retardation

Estimates 50-70
seriously affected
births UK ; approx
3000 congenital
cases USA
 Immunosuppression, Toxoplasma in the
malignancy, AIDS,
immunocompromise
organ transplantation
d host
Neurological
complications -
meningoencephalitis
or cerebral mass
lesions : cerebral
toxoplasmosis

Headache, confusion,
ataxia, hemiparesis,
retinochoroiditis

Endogenous versus
exogenous infection
Cerebral toxoplasmosis : Centre for Disease
Control (CDC) criteria for diagnosis

Recent onset of focal neurological

abnormality consistent with intercranial
disease or reduced consciousness

Evidence from brain imaging of a lesion

(CT or MRI)

Positive serum antibody to T. gondii or

response to treatment
Diagnostic tests for Toxoplasma

Sabin-Feldman dye test (DT)

Enzyme immunoassay for T. gondii
specific IgM (EIA)
Immunsorbent agglutination assay
(ISAGA)
Enzyme immunoassay for IgG avidity
Isolation and culture of parasite
Direct detection by microscopy and PCR
 Avoid consumption of
raw or undercooked Prevention
meat and control
Litterpans should be
changed daily

Wash hands after

handling raw meat,
litter pans & soil

Pregnant women
should avoid contact
with cats

Issue of prenatal
screening
 Treatment : toxoplasmosis
Only accepted treatment pyrimethamine
with trisulfapyrimines for 1 month

Intravenous clindamycin used to treat

encephalitis in AIDS patients

In France spiramycin has been used to

treat toxoplasmosis in pregnancy

Spiramycin is available in the US on a

case-by-case basis