Toxoplasmosis is a parasitic disease caused by the parasite Toxoplasma gondii. It infects most animals and causes human parasitic diseases, but the primary host is the felid (cat) family. Cats get infected by eating infected rats. Rats get infected by accidentally absorbing cat faeces. The parasite subtly alters the rat's behavior. Whereas healthy rats avoid areas that smell like cat urine, infected rats may actually seek these areas out.

People usually get infected by eating raw or undercooked meat, or more rarely, by contact with cat faeces.

At least one third of the world population may have contracted a toxoplasmosis infection in their lifetime but, after the acute infection has passed, the parasite rarely causes any symptoms in otherwise healthy adults. However, people with a weakened immune system are particularly susceptible, such as people infected with HIV. The parasite can cause encephalitis (inflammation of the brain) and neurologic diseases and can affect the heart, liver, and eyes (chorioretinitis).

Transmission

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Transmission may occur through:

• Ingestion of raw or partly cooked meat, especially pork, lamb, or venison, or by hand to mouth contact after handling undercooked meat. Infection prevalence is higher in countries that traditionally eat undercooked meat, such as France. This seems to be by far the most common route of infection.

• Ingestion, accidental or otherwise, of contaminated cat faeces. This can occur through hand to mouth contact following gardening, cleaning a cat's litter box, children's sandpits, or touching anything that has come into contact with cat feces.
• Contamination of knives, utensils, cutting boards and other foods that have had contact with raw meat.
• Drinking water contaminated with Toxoplasma.
• Ingestion of raw or unpasteurized milk and milk products, particularly those containing goat's milk.
• The reception of an infected organ transplant or blood transfusion, although this is extremely rare.

The cyst form of the parasite is extremely hardy, capable of surviving exposure to cooling down to subzero temperatures and chemical disinfectants such as bleach and can survive in the environment for over a year. It is, however, susceptible to high temperatures, and is killed by cooking.

Although the pathogen has been detected on the fur of cats, the pathogen has not been found in a 'ripe' form, and direct infection from handling cats is generally believed to be very rare. Cats excrete the pathogen in their faeces for a number of weeks or months after contracting or recontracting the disease, generally by eating an infected rodent. Even then, cat faeces are not generally contagious for the first day or two after excretion, after which the cyst 'ripens' and becomes potentially pathogenic. Studies have shown that only about 2% of cats are shedding at any one time.

Pregnancy precautions

Congenital toxoplasmosis is a special form in which an unborn child is infected via the placenta. This is the reason that pregnant women should be checked to see if they have a titer to toxoplasmosis. A titer indicates previous exposure and largely ensures the unborn baby's safety. If a woman receives her first exposure to Toxoplasma while pregnant then the baby is at particular risk. A woman with no previous exposure should avoid handling raw meat, exposure to cat faeces, and gardening (a common place to find cat feces). Most cats are not actively shedding oocysts and so are not a danger, but the risk may be reduced further by having the litterbox emptied daily (oocysts require longer than a single day to become infective), and/or by having someone else empty the litterbox.

Treatment is very important for recently infected pregnant women, to prevent infection of the foetus. Since a baby's immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the body are very difficult to eradicate with antiprotozoans, an infection can be very serious in the very young.

Symptoms

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Infection has two stages:

Acute toxoplasmosis

During acute toxoplasmosis, symptoms are often flu-like: swollen lymph nodes, or muscle aches and pains that last for a month or more. Rarely, a patient with a fully functioning immune system may develop eye damage from toxoplasmosis. Young children and immunocompromised patients, such as those with HIV/AIDS, those taking certain types of chemotherapy, or persons who have recently received an organ transplant, may develop severe toxoplasmosis. This can cause damage to the brain or the eyes. Only a small percentage of infected newborns have serious eye or brain damage at birth.

Treatment

A combination of sulfadiazine and pyrimethamine should be given.

Latent toxoplasmosis

Most patients who become infected with Toxoplasma gondii and develop toxoplasmosis do not know it. In most non-immunodeficient patients, the infection enters a latent phase, during which only bradyzoites are present, forming cysts in nervous and muscle tissue. Most infants who are infected while in the womb have no symptoms at birth but may develop symptoms later in life.

Treatment

The cysts are immune to the standard acute treatments.

The antibiotic atovaquone has been used to kill Toxoplasma cysts in situ in AIDS patients In mice, a combination of atovaquone with clindamycin seemed to optimally kill cysts[http://jac.oxfordjournals.org/cgi/reprint/50/6/981.pdf.

Risk factors

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• Infants born to mothers who became infected with Toxoplasma for the first time during or just before pregnancy.
• Persons with severely weakened immune systems, such as persons with AIDS. This results from an acute Toxoplasma infection or an infection that occurred earlier in life that reactivates and causes damage to the brain, eyes, or other organs.

Possible effects on human behavior

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The findings of behavioral alteration in rats and mice have led some scientists to speculate that toxoplasma may have similar effects in humans, even in the latent phase that had previously been considered asymptomatic. Toxoplasma is one of a number of parasites that require alteration of host's behaviour for their life cycle" 'Cat Box Disease' May Change Human Personality And Lower IQ". The Daily Telegraph. April 8, 2000 The changes observed are likely due to the presence of cysts in the brain, which produce or induce production of a neurotransmitter, possibly dopamine"Increased risk of traffic accidents in subjects with latent toxoplasmosis: a retrospective case-control study". Jaroslav Flegr, Jan Havlícek, Petr Kodym, Marek Malý and Zbyněk Smahel. BMC Infectious Diseases. 2002, 2:11 [http://www.biomedcentral.com/1471-2334/2/11, therefore acting similarly to dopamine reuptake inhibitor type antidepressants.

The evidence for behavioral effects on humans, although intriguing, is relatively weak. There have been no randomized clinical trials studying the effects of toxoplasma on human behavior. Although some researchers have found potentially important associations with toxoplasma, it is possible that these associations merely reflect factors that predispose certain types of people to infection.

Studies have found that toxoplasmosis is associated with an increased car accident rate, roughly doubling or tripling the chance of an accident relative to uninfected people."Increased risk of traffic accidents in subjects with latent toxoplasmosis: a retrospective case-control study". Jaroslav Flegr, Jan Havlícek, Petr Kodym, Marek Malý and Zbyněk Smahel. BMC Infectious Diseases. 2002, 2:11 name="incrisk4">"Is Toxoplasma gondii a potential risk for traffic accidents in Turkey?". Yereli K, Balcioglu IC, Ozbilgin A., Forensic Sci Int. 2005 Dec 2 "If our data are true then about a million people a year die just because they are infected with toxoplasma," the researcher Jaroslav Flegr told The Guardian."Can a parasite carried by cats change your personality?". The Guardian. September 25, 2003 ^*" target="_blank" >The data shows that the risk decreases with time after infection, but is not due to age."Increased risk of traffic accidents in subjects with latent toxoplasmosis: a retrospective case-control study". Jaroslav Flegr, Jan Havlícek, Petr Kodym, Marek Malý and Zbyněk Smahel. BMC Infectious Diseases. 2002, 2:11 "Dirt infection link to car crashes". BBC News. August 10, 2002 [http://news.bbc.co.uk/1/hi/health/2176548.stm" target="_blank" >^*

Other studies suggest that the parasite may influence personality. There are claims of toxoplasma causing antisocial attitudes in men and promiscuity"Dangerrrr: cats could alter your personality". Times Online. June 23, 2005 (or even "signs of higher intelligence""Can a parasite carried by cats change your personality?". The Guardian. September 25, 2003 schizophrenia and manic depression in all infected persons. A 2004 study found that toxoplasma "probably induce^*" target="_blank" >a decrease of novelty seeking.""Probable neuroimmunological link between Toxoplasma and cytomegalovirus infections and personality changes in the human host," BMC Infectious Diseases, 5:54. 2004. [http://www.biomedcentral.com/1471-2334/5/54

The possibility that toxoplasmosis is one cause of schizophrenia has been studied by scientists at least since 1953. These studies, many written in languages other than English, had attracted little attention from U.S. researchers until they were publicized through the work of prominent psychiatrist and advocate E. Fuller Torrey. In 2003, Torrey published a review of this literature, reporting that almost all the studies had found that schizophrenics suffer from elevated rates of toxoplasmosis infection. These types of studies are suggestive but cannot confirm a causal relationship (because of the possibility that schizophrenia increases the likelihood of toxoplasmosis infection, rather than the other way around). "Toxoplasma gondii and Schizophrenia". E. Fuller Torrey and Robert H. Yolken. Emergent Infectious Diseases. November 2003 ^*.

Human prevalence

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In the U.S. NHANES III national probability sample, 22.5% of 17,658 persons >12 years of age had Toxoplasma-specific IgG antibodies, indicating that they had been infected with the organism. It is thought that between 30% and 60% of the world's population are infected. However, there is large variation countries: in France, for example, about 85% of the population are carriers, probably due to a high consumption of raw and lightly cooked meat.

Animal prevalence

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A University of California Davis study of dead Sea Otters collected from 1998 to 2004 found that toxoplasmosis was the cause of death for 13% of the animals. Proximity to freshwater outflows into the ocean were a major risk factor. Ingestion of oocysts from cat faeces is considered to be the most likely ultimate source."Treating Disease in the Developing World." Talk of the Nation Science Friday. December 16, 2005. National Public Radio. http://www.npr.org/templates/story/story.php?storyId=5058325 17:30-22:00

Footnotes

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External links

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• Parts of this article are taken from the public domain CDC factsheet: Toxoplasmosis
• CDC document: Toxoplasma gondii Infection in the United States, 1999 – 2000
• Woman killed her daughter, who was suffering worsening pain from the parasitic condition toxoplasmosis, and planned to shoot herself -- BBC News Article ^*

Apicomplexa | Parasitic diseases | Infectious diseases | Zoonoses

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