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
• 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!