Toxoplasmosis

The mother may

be infected by
improper
handling cat litter

The foetus may

Handling or ingesting contract infection
under cooked infected through placenta
meat from infected
mother
 Toxoplasma gondii ---- Toxoplasmosis
Geog. Distribution----- worldwide
Toxoplasma gondii infect man, animals (cats) & poultry
Stages from I to IV infective II
stages to man Unsporulated
Pseudocyst oocyst in Cats
(Tachyzoite) intestine
Macrophage

In Tissue Pass out in cat’s stool

& developed on the
III
ground
I 4 sporozoites
Tissue cyst
(Bradyzoites) IV
Tachyzoite In Blood Sporulated oocyst
Trophozoite
 Mode of Infection with Toxoplasma
1- Oral route (ingestion):
Contaminated food or drink
Handling cat excreta Sporulated
Infected undercooked meat oocyst
Tissue cyst Pseudocyst

2- Organ transplantation

Tachyzoites
3- Blood transfusion

4- Transplacental route
 Mode of Infection

5- Contamination of mucous
membrane & skin abrasion
(in research workers & butchers)

Tachyzoites
 Development of Toxoplasma in cat intestine
Sporozoite & bradyzoite
Tisuue cyst & •
attack epithelial cells
sporulated oocyst
Infective stage•
Unsporulated oocyst
Pass in stool of the cat
Zygote
♂

merozoites
♀
gametocyte

(sexual cycle) ; Cat is the definitive host

Development of Toxoplasma in infected human intestine

Ingested

Pseudocyst
containing
(Tachyzoite)

Sporulated oocyst containing

sporozoites
Tissue cyst containing
Reach the lumen of small (Bradyzoites)
intestine
Development of Toxoplasma in infected human intestine
Villi of small Blood vessel
intestine
Lamina
propria

Penetrate the lamina propria &

multiply as tachyzoites & enter
the circulation

Villi of small
intestine
Lamina
propria
Blood vessel
 Brain

Eyes

Parentral Skeletal
muscle

Circulating tachyzoites reach Heart

various tissues especialy

and form Tissue cyst

That persist for human’s life
 Pathogenesis and clinical Picture
Toxoplasmosis is considered an opportunistic infection

Congenital infection:
Congenital toxoplasmosis

Acquired infection:
Acquired toxoplasmosis

Recrudescence
Toxoplasmosis in immunocompromized patients
 Congenital Toxoplasmosis

Depends on :
1- Protective immunity of the mother
2- Age of the foetus at the time of infection
Loss of the foetus: (abortion or still birth)- Full Term baby
Early neonatal manifestations:
CNS affection, eye affection, systemic manifestations
Hydrocephalus, microcephaly, spasticity, palsy,
convulsions.
Retinochoroditis (bilateral)
Fever, pneumonitis, hepatomegaly, jaundice,
lymphadenitis
 Congenital Toxoplasmosis

Late manifestations:

Complications due to CNS involvement

Eye affection in adolescence or adulthood

 CNS affection

Hydrocephalus Microcephaly

Convulsion
 Acquired Toxoplasmosis

Depends on :
1- Immune status of infected person
2- Age of infected person
3- Virulence of infecting strain of Toxoplasma
Asymptomatic (tissue cysts are present)
occur in the majority of cases
Lymphadenitis, fever, headache, myalgia, skin rash and
Splenomegaly
Retinochoroditis in adolescence
producing blindness
III-Toxoplasmosis in the immunocompromized

Encephalitis leading to death. It is due to

reactivation of latent cerebral cysts

Organ transplant patients develop acute

disseminated toxoplasmosis
 Diagnosis

1- Clinical
Various clinical manifestations

2- Imaging
X- ray: calcification

CT& MRI: Lesions in brain – late cerebral calcifications

 Laboratory diagnosis of Toxoplasmosis

Serology:
- Detection of IgM indicates active infection
- Detection of IgG (rising titer indicates
active infection)
- Sabin Feldman dye test
Sabin& Feldman put Toxoplasma trophozoites on slide
They Add patient’s serum on trophozoites and stained
If trophozoites get stained serum is –ve for toxoplasma
If trophozoites did not stained serum is +ve for toxoplasma

Frenkel test (Toxoplasmin I.D. test)

Molecular techniques:
Detection of Parasite DNA in patients serum.
 Laboratory diagnosis of Toxoplasmosis

- Detection of IgM in baby’s blood indicates foetal infection

- Maternal IgM doesn’t cross the placenta

- Detection of parasite’s DNA in

infant’s urine or in amniotic fluid
 Treatment

Pyrimethamine + Trisulphapyrimidine
(combination Drug therapy)

Spiramycin (to infected pregnant women) (3 gm daily)

Atovaquone (Encephalitis in AIDS)

 Case
A baby was born with congenital anomaly as shown
in the figure below, the main complaint was fever
and convulsions. His mother gave a history of having
a cat at home.
a- What is your parasitic diagnosis?
and name the anomaly
Congenital toxoplasmosis.
The anomaly name is hydrocephalus
b- How can you confirm your diagnosis?

Detection of anti toxoplasma IgM antibodies

in baby’s blood.
Detection of raising titter of anti toxoplasma
IgG antibodies in blood.
 C- How was the baby infected?
Tachyzoites from infected mother crossed the
placenta and infected the foetus
D- What are the factors affecting the severity of foetal
damage?
- Age of the foetus at the time of infection
- The protective immunity of the mother
E-Mention other congenital anomalies which may be presented
due to such infection ?
1- Early neonatal manifestations: in the form
CNS affection: microcephaly, spasticity, palsy, convulsions.
Eye affection: Retinochoroditis
Systemic manifestations: Fever, pneumonitis, hepatomegaly,
jaundice, lymphadenitis
2- Late manifestations: in the form
Mental retardation and eye affection