TOXOPLASMA GONDII PARASITE

Toxoplasmosis diagnosis treatment and prevention is simplified in this article. Toxoplasmosis is a parasitic infection caused by the TOXOPLASMA GONDII PARASITE. In healthy individuals Toxoplasmosis may be an asymptomatic infection or at best cause flu like illness. It is usually overcome by a healthy immune system. The main complications occur in pregnant and immune compromised individuals. Infants born to mothers with toxoplasmosis also have serious complications.

Transmission of TOXOPLASMA GONDII PARASITE to a child is more likely if the mother is infected in the 3^rd trimester and least likely if the infection is in the 1^st trimester. On the other hand when it comes to severity of disease and complications, the earlier the infection causes a more severe disease in the child.

The manifestations occur much later in the teens in children. Its unusual that children with toxo are born with signs and symptoms of toxoplasmosis.

The cardinal symptoms w.r.t toxoplasmosis include visual symptoms, hearing loss and mental status changes or seizures. These should be looked for and urgently managed.

The main reservoir for transmission of TOXOPLASMA GONDII PARASITE are infected cats as they are the only host in which the parasite can reproduce. In an infected individual the parasite forms cysts in various organs of the body including the heart and brain.

An infected individual with toxoplasmosis is not contagious and cant transmit the infection to close contacts. However, it can be transmitted via cat feces, infected water/milk, infected transplant donor, contaminated food and utensils.

Testing starts with serology (ELISA antibody testing). This is not done routinely for every patient. Screening is mainly done for pregnant and the immune compromised patient subset. Positive antibodies test mean either an active infection or previously resolved infection. Negative antibody test may occur in the window period or if the person hasn’t been exposed to the parasite at all. Diagnosis is confirmed if the organism is demonstrated in the body fluids or tissue samples/ biopsy. PCR and molecular studies are also used in this regard though their sensitivity is poor.

If a pregnant patient is infected then amniocentesis and ultrasound scan are advised to look for infection in the baby. Amniocentesis can be done at 20 weeks gestation if congenital toxoplasmosis is suspected. Ultrasound may be used to rule out features typically associated with toxoplasmosis such as hydrocephalus. Ultrasound is not diagnostic for toxoplasmosis and may only provide a clue.

Brain imaging is done in immune compromised patients to look for any cerebral lesions typical in toxoplasmosis.

Treatment is with pyrimethamine and sulfadiazine combination both for acute infection and in immune compromised patients. Though in immune compromised patients, improving the CD 4 count is more beneficial. There may be no need to take the toxoplasmosis meds if your CD 4 count is corrected/ raised.

In pregnant patients infected with toxoplasmosis if the baby isn’t affected then Spiramycin can be advised to reduce the risk of development of neurological manifestations of congenital toxoplasmosis. If tests show that the infant is infected then pyrimethamine and sulfadiazine can be advised but it is usually not given due to the overall serious side effects in pregnancy. If the infant has toxoplasmosis then pyrimethamine with sulfadiazine and folic acid is recommended as treatment.

Preventive measures include

1. Avoiding raw or undercooked food/ meat
2. Using gloves while handling soil and when in garden
3. Avoid unpasteurized milk
4. Clean all utensils thoroughly
5. Wash vegetables and fruits properly before consuming
6. For pregnant patients, avoid interaction with cats to minimize transmission risk
7. For cat enthusiast, keep your cats healthy, vaccinated and nourished with clean food