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Toxoplasmosis PDF
Toxoplasmosis PDF
Toxoplasmosis Manitoba
Health
Public Health
blood transfusion or organ transplantation from an and usually become undetectable within six to nine
infected donor. months. On rare occasions, IgM-specific antibodies
are detectable for as long as two years following
Occurrence:
acute infection. Tests to detect IgA antibodies,
General: Worldwide in mammals and birds.
which fall to undetectable concentrations sooner
Infection in humans is common.
than IgM antibodies, are useful in diagnosing
Manitoba: Toxoplasmosis first became congenital infections and when more precise
reportable in January 1999. Fifty persons tested information about the duration is needed. These
positive for IgM and/or IgG in 1999. tests are available only in reference laboratories.
Incubation Period: From 10 to 23 days in one Tests for specific IgM antibodies should be
common-source outbreak from ingestion of performed by an experienced laboratory; test kits
undercooked meat; five to 20 days in an outbreak used by some laboratories can give false-positive
associated with cats. and false-negative results.
cerebrospinal fluid may be tested by PCR for primary Toxoplasma infection during gestation,
genetic evidence of the parasite. Congenital should be evaluated for congenital toxoplasmosis.
toxoplasmosis also can be diagnosed serologically by
Diagnosis of ocular toxoplasmosis is based on
the detection of Toxoplasmosis-specific IgM or IgA
observation of characteristic retinal lesions in
or the persistence of Toxoplasma IgA beyond 12
conjunction with serum Toxoplasma-specific IgG or
months of age. Cadham Provincial Laboratory
IgM antibodies.
should be requested to forward samples to a
reference laboratory that performs the mouse
inoculation and the Toxoplasma IgM and IgA assays Key Investigations
by the double-sandwich IgM EIA (DS-IgM EIA) or
None, except in outbreaks when possible sources of
IgM immunosorbent agglutination assay (ISAGA).
infection should be investigated.
The DS-IgM EIA and the ISAGA detect
Toxoplasma IgM in approximately 75-80% of
infants with congenital infection. The sensitivity of Control
both the immunoflourescent and capture-EIA
assays for Toxoplasma IgM are significantly less than Management of Cases:
that of the DS-IgM, IgA EIA or ISAGA assays, and Treatment:
negative results with these assays do not exclude Most cases of acquired infection do not
congenital infection. Circulating maternal require specific antimicrobial therapy.
Toxoplasma IgG antibodies in an uninfected infant
usually become undetectable by six to 12 months When indicated, the combination of
of age. pyrimethamine and sulfadiazine, which is
synergistic against Toxoplasma, is the most
Infants should be evaluated for congenital widely accepted regimen for children and
toxoplasmosis if they are born to women who are adults with acute, symptomatic disease.
infected concurrently with HIV and Toxoplasma or Pyrimethamine, 1 mg/kg per day
to women who have evidence of primary (maximum daily dose, 25 mg) orally once
Toxoplasma infection during gestation. a day in combination with sulfadiazine,
HIV Infection: Persons with HIV infection, 85 to 100 mg/kg per day in four divided
latently infected with Toxoplasma, have variable doses (maximum daily dose, 8g) should
titres of IgG antibody to Toxoplasma but rarely be given for three to six weeks.
have IgM antibody. While seroconversion and four- Supplemental folinic acid (calcium
fold rises in IgG antibody titres may occur, the leucovorin) must be administered
ability to diagnose active disease in AIDS patients is concurrently (5-10 mg every three days
commonly impaired by immunosuppression. In orally or parenterally) to prevent
many cases, a presumptive diagnosis of Toxoplasma hematologic toxic effects. Alternatively,
encephalitis is based on the presence of the pyrimethamine can be used in
characteristic clinical and roentgenographic findings combination with clindamycin if the
in an HIV-infected patient who is seropositive for patient does not tolerate sulfadiazine. The
Toxoplasma IgG. If the patient does not respond to use of corticosteroids in the management
an empiric trial of anti-Toxoplasma therapy, of ocular complication and of central
demonstration of T. gondii organisms, antigen, or nervous system disease is controversial.
DNA in biopsied tissue, blood, and/or Persons infected with HIV who have had
cerebrospinal fluid may be necessary to confirm the toxoplasmic encephalitis should receive
diagnosis. suppressive therapy. Regimens for primary
Infants born to women who are dually infected treatment are also effective for suppressive
with HIV and Toxoplasma, or who have evidence of therapy.