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Useful Medical Articles

07 Mar 2021

Toxoplasmosis: risk factors, symptoms, treatment and prevention

Toxoplasmosis: risk factors, symptoms, treatment and prevention Toxoplasmosis: risk factors, symptoms, treatment and prevention

Toxoplasmosis is a parasitic infection. The disease is most often chronic or latent. In some cases, there is a negative effect on some systems of the body, primarily, the nervous system and baby if the woman carrier of the infection is pregnant, muscles, myocardium, and organs of vision.

Key points about toxoplasmosis

Infectious disease
Symptoms Often none, during pregnancy (birth defects)
Causes Parasitic infection Toxoplasma gondii
Risk factors Eating poorly cooked food, eating unwashed vegetables and fruits, exposure to infected cat feces
Diagnostic method Blood test, amniotic fluid test
Treatment During pregnancy - spiramycin or pyrimethamine/sulfadiazine and folinic acid;
Prophylaxis and treatment before pregnancy - Trimethoprim
Complications Birth defects incompatible with life, miscarriage, early pregnancy termination
Frequency Up to 50% of people, 200,000 cases of congenital toxoplasmosis a year

Causes of the disease

Toxoplasmosis is provoked by a microscopic parasite. The final carriers of the infection, i.e. those who transmit it to humans, are domestic cats. Intermediate carriers of parasites are birds, agricultural animals, and people. A person can acquire toxoplasmosis through cat feces contaminated with oocysts, through the hands of others who have touched cats, especially babies, or by eating meat from an infected animal or poultry without sufficient thermal processing. The oral route is not the only route of transmission; the pathogen penetrates through abrasions and cuts on the skin when working with the skins of invasive livestock. An infected individual is not a source of infection for other people. The only exception is an expecting woman with toxoplasmosis who transmits the infection to the fetus.

The infection can be acquired and inborn. The first type is the most common among the population. According to statistics, a third of all inhabitants of the planet have toxoplasmosis, especially people living in hot, humid climates and in villages are susceptible to it. In 95% of cases, the disease is completely symptomless. In good immunity, enough specific antibodies are formed, which limit the excessive multiplication of parasites and prevent new infection with toxoplasmosis. However, antibodies cannot prevent the pathogen from persisting for a long time inside human cells, and as soon as the strength of the immune system decreases, a relapse or flare-up of the disease occurs.

Toxoplasmosis in pregnancy

toxoplasmosis in pregnancy dangers

The infection entering the body during pregnancy is very insidious and dangerous. If the expectant mother had acquired toxoplasmosis more than 6 months before conception, then there is no reason for worry. It is worth sounding the alarm when a woman “caught” the disease while she was pregnant. What are the consequences?

- Premature birth;
- Fetal death;
- Serious disorders in the formation of the child's nervous system;
- Development of fetal abnormalities incompatible with life.

The infection during gestation can be avoided if the expectant mother takes care of her health, observes good hygiene, and takes blood tests for toxoplasmosis before conception. The examination will reveal the presence or absence of antibodies in the body. If antibodies are found, a woman can safely become pregnant. If they are not detected, then the woman should take a number of preventive measures:

- Do not eat raw, slightly fried meat, steaks with blood;
- Refrain from contact with animals, in particular, stray cats;
- Thoroughly, preferably with soap, cleanse vegetables, fruits, and especially greens before use;
- Disinfect kitchen cutting boards and utensils;
- Clean the litter box and work in the garden only in protective gloves.

Therapy of the disease during pregnancy (if diagnosed) must always be made with the most potent medicines without an exception. Unfortunately, toxoplasmosis can only be treated from the twelfth week of pregnancy because therapy for toxoplasmosis is quite specific and includes taking strong antibiotics.

Symptoms of toxoplasmosis

toxoplasmosis symptoms

The symptoms are varied. In most cases, it is not showing itself in any way. Symptoms appear with the activation of parasites in the body and the transition of the disease to the acute or chronic stage.

Symptoms of acute infection:

- Lymph nodes in the neck become larger than normal;
- Slight fever (38.5 C or 101.3 F);
- The liver and spleen are enlarged;
- The skin becomes jaundiced;
- General weakness, performance falls;
- A rash with toxoplasmosis is possible;
- Muscles lose tone;
- Temporary squint appears;
- Development of such diseases as encephalitis, pneumonia, endocarditis is possible;
- Development of the inflammatory process in the retina.

The following symptoms indicate a chronic course of the disease:

- Chronic or frequent occurrence of slightly raised body temperature – around 38 C or 101 F.
- Conventional antipyretic drugs do not lower the temperature;
- Lymph nodes in the groin and armpits are enlarged;
- The pharynx becomes inflamed;
- Toxoplasmosis in the form of chronic leads to depressive conditions, as a result of damage to the central nervous system;
- Forgetfulness;
- Chronic headaches;
- Disturbed appetite and sleep;
- Adynamia (low mobility);
- With toxoplasmosis, unfounded fears and anxiety appear;
- Immunity drops dramatically.

Having noticed at least a few of the above symptoms, you should immediately undergo an examination aimed at identifying toxoplasmosis.

Toxoplasmosis in children - dangers

Toxoplasmosis in kids causes failure in the work of such important systems as the nervous, digestive, and cardiovascular. Toxoplasmosis at a young age is more difficult to tolerate. Vision may drop due to clouding of the lens, squint often develops. Therefore, it is more important for parents to avoid the infection of kids with toxoplasmosis than to deal with the consequences later. Hygiene and avoiding undercooked products will help protect the child from illness.

Tests for toxoplasmosis

tests for toxoplasmosis

1. Identification of the etiological factor, the main method for diagnosing infection:
1) Serological studies - determination of specific antibodies in serum:
a) IgM - appear 1 week after the invasion, reach maximum concentration in one month and commonly disappear within 6-9 months, may persist for many months or years from the moment of infection;
b) IgA - evidence of recent infection, fades earlier than IgM;
c) IgG - maximum concentration 2-3 months from infection, persist throughout life. If it is necessary to determine the time of infection (for example, in pregnant women), the so-called avidity (strength of binding to the antigen) of IgG antibodies is determined;
2) Identification of the parasite - in patients in a state of immunosuppression, in the fetus, as well as in immunologically immature newborns and infants through PCR test (material: blood, amniotic fluid, intraocular fluid or a piece of tissue, or the affected organ, and other).
2. Other tests: in confirmed infection, an examination of the fundus is mandatory, and if there is a suspicion of CNS damage, also imaging studies of the brain (CT, MRI) that can show characteristic irregular focal changes are needed.

Differential diagnosis

Acquired form: infectious mononucleosis, cytomegalovirus infection, Hodgkin's lymphoma, non-Hodgkin's lymphomas, tuberculosis, sarcoidosis, HIV infection.

Therapy of toxoplasmosis

toxoplasmosis treatment with bactrim

As practice shows, treatment is not always required. If an individual has antibodies to toxoplasmosis, but no symptoms of the disease, then the doctor decides on therapy accordingly. The main goal of therapy is to avoid the complicated course of toxoplasmosis and protect the internal organs from damage. That is why therapy is made when the damage to the CNS and those organs that perform vital functions is identified. Therapy of toxoplasmosis is made with antibiotic therapy and chemotherapy, according to a certain scheme, which is developed by a doctor. Here we list the medications used for the therapy in different cases:

1. For prophylaxis and therapy of toxoplasmosis before conception, Trimethoprim is used according to the instruction or as prescribed by the doctor.
2. Acute acquired toxoplasmosis: in severe systemic symptoms or from affected organs, combined therapy with pyrimethamine and sulfadiazine is used for 3 weeks. Folic acid is appointed for the prevention of bone marrow inhibition. In case of intolerance to sulfadiazine, particularly in individuals infected with the HIV virus - clindamycin with pyrimethamine and folic acid are used (treatment is made in a specialized institution).
3. Ocular toxoplasmosis: treatment, as in the acute form, within 6-8 weeks in a specialized institution and under the close supervision of an ophthalmologist. Additional treatment: topical anti-inflammatory drugs and drops with GCS in the conjunctival sac.
4. In patients in a state of profound immunosuppression: in case of symptomatic manifestation of the infection, the therapy is the same as described in point 2, then long-term prophylactic use of antiparasitic drugs with prolonged action (e.g. co-trimoxazole, pyrimethamine with sulfadoxine) or azithromycin. The dosage should be established in a specialized institution.
5. Primary infection during pregnancy: in order to avoid infection transmission to the fetus spiramycin is used until the infection is found in the fetus or before delivery. In proven fetal invasion - pyrimethamine, sulfadiazine, and folic acid are used till labor. In acquired infection in the second half of pregnancy, it is recommended to skip pharmacological prophylaxis with spiramycin and immediately start the therapy with pyrimidine and sulfadiazine with the simultaneous addition of folic acid. Treatment should be carried out in a specialized institution.

Complications of toxoplasmosis

1. Inborn toxoplasmosis: delayed psychomotor development, hydrocephalus (increased intracranial pressure), epilepsy, cataract, retinal detachment.
2. Ocular toxoplasmosis: inflammation of the eyeball, persistent visual field defects, decreased vision, blindness.
3. Toxoplasmosis in immunodeficiency: multiple organ failure, transplant rejection, neurological disorders.
Toxoplasmosis prognosis
The forecast is favorable for acquired toxoplasmosis in normal immune system status, uncertain in immunocompromised patients, and in inborn infection. The overall mortality rate in cases of inborn infection reaches 10%.

Prevention of toxoplasmosis

prophylaxis of toxoplasmosis

1. Compliance with the basic rules of hygiene and nutrition:
1) Avoiding the consumption and tasting of raw or semi-raw meat and sausages, raw milk, thorough washing of hands and kitchen utensils after contact with these products;
2) Thorough washing of fruits, vegetables, and greens before consumption;
3) Use of protective gloves (rubber or latex) for work in the garden and in the field;
4) Daily cleaning of cat litter and thorough hand washing after petting cats or objects contaminated with their feces (if possible, these activities should not be performed by an expecting woman).
2. Screening serological examination: indicated in women before a planned pregnancy, as well as periodically in seronegative pregnant women.

Some of the medications for toxoplasmosis can be bought at our online drugstore but please consult your doctor before you buy any medication. It is important to take all necessary tests and get a detailed treatment plan made by a healthcare professional to receive appropriate and effective treatment.

Post by Karen Willson, gynecologist at Mother and Baby Centre, London, UK

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