TOXOPLASMA

JANIS ASUNCION C. BUNOAN-ACAZO, MD

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
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 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
• CNS infections and other systemic diseases – immunocompromised hosts
• 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!