MICROBIO-PARASITOLOGY TOXOPLASMOSIS • Toxoplasma gondii • obligate intracellular parasitic one -celled eukaryote, (Eucoccidoria,sarcocystidae) • felids such as domestic cats are the only known definitive hosts in which the parasite may undergo sexual reproduction • Highly resilient, oocysts can survive and remain infective for many months in cold and dry climates EPIDEMIOLOGY • more than 60% of some populations have been infected with Toxoplasma • Infection is often highest in areas of the world that have hot, humid climates and lower altitudes, because the oocysts survive better in these types of environments • USA: T. gondii antibody seroprevalence among persons > 6 years of age was 12.4%, and among women 15–44 years of age was 9.1% LIFE CYCLE OF TOXOPLASMA M O D E O F T R A N S M I S S I O N CLINICAL MANIFESTATIONS • Generally asymptomatic • Mild “flu-like” symptoms for months then spontaneously resolves • can become reactivated if the person becomes immunosuppressed • In pregnant women: miscarriage, stillborn child, child born with signs of congenital toxoplasmosis (e.g., abnormal enlargement or smallness of the head) • Retinochoroiditis – eye pain, tearing of the eyes, blurred vision, photophobia • Toxoplasma encephalitis – most common central nervous system infection in AIDS patients • Involve a growing mass like a tumor with symptoms of headache, focal neurologic signs, seizures • TORCHES – cross the blood brain barrier • Only affects pregnant women not previously infected with toxoplasma • PREGNANT WOMEN SHOULD AVOID CATS! LABORATORY DIAGNOSIS • 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 LABORATORY DIAGNOSIS TREATMENT • DOC: Pyrimethamine – targets tachyzoites • Pyrimethamine + Leucovorin + Sulfadiazine or Clindamycin • Alternative: trimethoprim + sulfamethoxazole • atovaquone and pyrimethamine + azithromycin (not extensively studied) • Adults: pyrimethamine 100 mg for 1 day as a loading dose, then 25 to 50 mg per day, plus sulfadiazine 2 to 4 grams daily for 2 days, followed by 500mg to 1 gram dose four times per day, plus folinic acid (leucovorin) 5- 25 mg with each dose of pyrimethamine; • Pediatric dose: pyrimethamine 2 mg/kg first day then 1 mg/kg each day, plus sulfadiazine 50 mg/kg two times per day, plus folinic acid (leucovorin) 7.5 mg per day) • Therapy should be given for 4 to 6 weeks, followed by reevaluation of the patient’s condition • Toxoplasmosis (PAMF-TSL) and the Toxoplasmosis Center at the University of Chicago for treatment of congenitally infected infants are: • Pyrimethamine: 2 mg/kg per day orally, divided twice per day for the first 2 days; then from day 3 to 2 months (or 6 months if symptomatic) 1 mg/kg per day, orally, every day; then 1 mg/kg per day, orally, 3 times per week • Sulfadiazine: 100 mg/kg per day, orally, divided twice per day • Folinic acid (leucovorin): 10 mg, 3 times per week Cheat on a test today, kill a patient tomorrow!