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Toxoplasmosis Clinical Signs Diagnosis and Treatment

Toxoplasmosis:

•          Caused by protozoan – Toxoplasma gondii
•          The domestic cat is the definitive host with infections via:
•          Ingestion of cysts (meats, garden products)
•          Contact with oocysts in faeces
•          Much higher prevalence of infection in European countries (ie France, Greece)
•          Acute infection usually asymptomatic
•          1/3 risk of fetal infection with primary maternal infection in pregnancy
•          Infection rate higher with infection in the 3rd trimester
Fetal death higher with infection in the 1st trimester

Clinical Manifestations

•          Most (70-90%) are asymptomatic at birth
•          The classic triad of symptoms:
•          Chorioretinitis
•          Hydrocephalus
•          Intracranial calcifications
•          Other symptoms include fever, rash, HSM, microcephaly, seizures, jaundice, thrombocytopenia, lymphadenopathy
•          Initially asymptomatic infants are still at high risk of developing abnormalities, especially chorioretinitis 
chorioretinitis-in-toxoplasmosis
Chorioretinitis

Diagnosis:

•          Maternal IgG testing indicates past infection (but when…?)
•          Can be isolated in culture from the placenta, umbilical cord, infant serum
•          PCR testing on WBC, CSF, placenta
•          Not standardized
•          Newborn serologies with IgM/IgA

Toxo Screening:

•          Prenatal testing with varied sensitivity not useful for screening
•          Neonatal screening with IgM testing implemented in some areas
•          Identifies infected asymptomatic infants who may benefit from therapy

Prevention and Treatment:

•          Treatment for pregnant mothers diagnosed with acute toxoplasmosis.
•          Spiramycin daily
•          Macrolide antibiotic
•          Small studies have shown this reduces the likelihood of congenital transmission (up to 50%)
•          If infant diagnosed prenatally, treat mom
•          Spiramycin, pyrimethamine (anti-malarial, dihydrofolate reductase inhibitor), and sulfadiazine (sulfa antibiotic)
•          Leucovorin rescue with pyrimethamine
•          Symptomatic infants
•          Pyrimethamine (with leucovorin rescue) and sulfadiazine
•          Treatment for 12 months of total
Improved neurologic and developmental outcomes demonstrated (compared to untreated pts or those treated for only one month
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