Contact Us. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Parasites - Toxoplasmosis Toxoplasma infection. Section Navigation. Facebook Twitter LinkedIn Syndicate. People typically become infected by three principal routes of transmission: Foodborne Animal-to-human zoonotic Mother-to-child congenital Rare instances Always cook meat thoroughly and use clean knives, utensils and cutting boards on all foods.
Have someone else clean the litter box. To receive email updates about this page, enter your email address: Email Address. What's this? Immunocompromised Persons Pregnant Women Travelers. Links with this icon indicate that you are leaving the CDC website. Estimating income losses and other preventable costs caused by congenital toxoplasmosis in people in the United States.
J Am Vet Med Assoc ; The effectiveness of a prenatal education programme for the prevention of congenital toxoplasmosis. Epidemiol Infect ; Impact of primary prevention on the incidence of toxoplasmosis during pregnancy.
Obstet Gynecol ; Toxoplasmosis can be a serious opportunistic infection in persons with AIDS, and specific recommendations regarding how to prevent it have been published 4. Therefore, toxoplasmosis in persons with AIDS is not the primary focus of this report. In France, a screening program was implemented in to detect and treat Toxoplasma infection during pregnancy.
The goal of this program is to institute preventive measures for seronegative women and to ensure early diagnosis and treatment of infection acquired during pregnancy. Since the beginning of the program, premarital and prenatal medical examinations for Toxoplasma antibodies have been performed. Premarital examinations are conducted to distinguish previously infected women from women who have not been previously infected.
When a previously uninfected woman becomes pregnant, testing is conducted at her first prenatal examination during her first trimester and at six additional examinations conducted monthly during her second and third trimesters.
In addition, women are educated about prevention methods during pregnancy If these screening tests detect evidence of acute infection during pregnancy, treatment for the woman is initiated with spiramycin. If infection in the fetus is confirmed through fetal blood sampling and amniocentesis, pyrimethamine and sulfadiazine or sulfadoxine is added to the regimen Even though coverage of the French program has been incomplete, the program has been associated with a decline in the incidence of congenital infection, as well as a decline in severe disease detected at birth.
The proportion of the decline specifically attributable to the program or to the general decline in Europe in rates of seropositivity is difficult to determine because no unscreened group of women exists for comparison. Austria Austria implemented a toxoplasmosis screening program in Nearly all women who become pregnant are serologically screened early in pregnancy and, if found to be negative initially, are tested again during the second and third trimesters.
Women with Toxoplasma infections are treated as soon as infection is detected. Although seropositivity rates among pregnant Austrian women have declined from approximately As with the French program, the lack of an unscreened comparison group precludes determining the proportion of the decline attributable to the screening program, and lack of cost figures precludes cost-effectiveness analyses.
European Research Network on Congenital Toxoplasmosis The European Research Network on Congenital Toxoplasmosis was established in and has sponsored several studies regarding public health interventions for congenital toxoplasmosis. Most recently, a multicenter study was conducted to evaluate the effectiveness of toxoplasmosis treatment administered during pregnancy in preventing transmission of maternal infection to the fetus.
Pregnant women who visited one of five European university medical centers for prenatal care were screened for Toxoplasma antibodies at their first prenatal visit. Women who were seronegative were retested at least once every trimester in two centers and monthly in the other centers, until the birth of the infant.
For women who seroconverted during pregnancy, prenatal antibiotic treatment was started, and their infants were followed for 1 year after birth. Treatment regimens consisted of spiramycin or a combination of pyrimethamine and sulfadiazine.
If prenatal infection was confirmed with amniocentesis or cordocentesis, women were treated with pyrimethamine and sulfadiazine or sulfadoxine. Furthermore, the earlier antibiotics were administered after infection, the less likely sequelae were detected in the infant Finland From January through June , a cost-benefit analysis of Toxoplasma screening during pregnancy was conducted in a prospective study in Finland.
The study compared costs of screening alternatives for primary infections during pregnancy with the costs of no screening. Furthermore, screening along with health education was more beneficial than health education alone The study findings suggest screening is beneficial in countries with low incidence of congenital toxoplasmosis, such as Finland. The findings of other studies suggest screening programs can also be beneficial in areas with high incidences of congenital toxoplasmosis 30,36, NWTPCT's Assessment Although the findings of the European studies suggest Toxoplasma screening programs of women of childbearing age can prevent cases of congenital toxoplasmosis, several concerns could limit support for such programs in the United States.
NWTPCT participants identified the need for cost-effectiveness studies to enable comparison of the benefits of expanded testing in the United States, the costs of such testing, and the unintended adverse consequences that might accompany such testing e.
Screening Programs for Newborns Denmark During June August , researchers in Denmark conducted a newborn screening study for toxoplasmosis. Approximately 90, infants were screened for Toxoplasma -specific IgG antibodies days after birth. Infants born to mothers who seroconverted during pregnancy were subsequently examined physically and serologically for 1 year; for those with confirmed congenital infections, treatment was initiated with courses of pyrimethamine and sulfadiazine, alternating with spiramycin During , serum levels of Toxoplasma -specific IgM antibodies were also determined.
The IgM test conducted within 10 days of birth resulted in a false-positive rate of 0. In addition, the low rates of false-positives and false-negatives suggested this method would be feasible in large-scale newborn screening programs in areas with low seroprevalence rates of toxoplasmosis.
If IgM antibodies are detected, an extensive clinical evaluation is performed, and a 1-year treatment regimen is initiated with a combination therapy of pyrimethamine and sulfa-diazine During , a total of 52 of the , infants screened had confirmed congenital infections; 50 appeared normal on routine neonatal examination and had toxoplasmosis diagnosed through screening alone.
Treatment was provided for these infants, and compliance with therapy was observed. After 1 year of treatment, only one 2. The findings of this program demonstrated that screening newborns for congenital toxoplasmosis is feasible in the United States. Costs were relatively low because the system used by the program to collect and process specimens was the same one already used for screening newborns for eight other diseases. On the basis of these preliminary cost estimates, this screening program appears to be a favorable alternative, considering the financial and social costs associated with raising a visually or mentally impaired child One specific recommendation was for CDC to support a detailed, cost- effectiveness evaluation of the program.
Education Programs for Women The third approach to preventing toxoplasmosis focuses on educating women of childbearing age about minimizing their risk for infection with Toxoplasma. Education interventions assume that increased knowledge results in awareness, which consequently results in changes in risky behavior and declines in infection rates.
Messages emphasize the importance of avoiding eating raw or undercooked meat, handling raw meat safely, and washing hands after gardening or changing cat litter boxes Canada A study conducted as part of prenatal classes at Canadian public health agencies evaluated the effect of a minute teaching session on three behaviors: practices associated with cleaning the cat litter box and limiting the cat's diet to cooked food; safe food-handling practices; and handwashing after exposure to cat feces, garden soil, or raw meats.
Among women in the classes, behavior improved regarding practices associated with cats; however, behavior regarding food-handling practices remained unchanged.
In addition, improvement occurred in handwashing practices but only among professional women Belgium During , a Belgium study assessed the effectiveness of educational sessions held in hospital settings. Baseline data were collected during , when no education measures were in effect. During , education sessions were provided to pregnant women. NWTPCT's Assessment NWTPCT participants considered education programs to be a potentially powerful intervention because of their low cost and because pregnant women were highly motivated to protect the health of their babies.
However, participants emphasized that the impact of educational programs was difficult to evaluate because of the limited number of comparative studies a conducted with rigorous scientific methodology and b of sufficient size to enable calculation of the effectiveness of the intervention compared with its cost.
Sue Binder, M. Kenneth Boyer, M. Luke's Medical Center W. Congress Parkway Chicago, Illinois Steve Crutchfield, Ph. Washington, D. Alfred DeMaria, Jr. Vance Dietz, M. Dubey, Ph. Zoonotic Diseases Laboratory U. Department of Agriculture Barc-East Bldg. Roger Eaton, Ph. Ruth Etzel, M. Ronald Gibbs, M. Ruth Gilbert, M. Carol Herman, M. Peter Hotez, M. Dennis Juranek, D. Ruth Lynfield, M.
Minneapolis, Minnesota James McAuley, M. Westside Center for Disease Control W. Ogden Avenue Chicago, Illinois Rima McLeod, M. The University of Chicago E. Martin Meltzer, Ph. Atlanta, Georgia Marilyn Mets, M. Thomas Navin, M. Eskild Petersen, M. Jack Remington, M. Rigoberto Roca, M. Peter Schantz, V.
Jack Schlater, D. David Sibley, Ph. Washington University School of Medicine S. Euclid Avenue, Campus Box St. Louis, Missouri Kirk Smith, D. Philippe Thulliez, M.
Ralph Timperi, M. This conversion may have resulted in character translation or format errors in the HTML version. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.
Contact GPO for current prices. Department of Health and Human Services. Hughes, M. Colley, Ph. Contaminated human urine and feces could possibly be a source of infection but transmission from this source has not been proved. Person to person transmission occurs only from mother to child. A pregnant woman who acquires toxoplasmosis infection can pass the organism to the developing fetus through the placenta. The risk of the fetus being affected and the severity of the disease depends on what stage during pregnancy the mother acquires the infection.
The baby is most at risk if the mother becomes infected in the third trimester, but the earlier in the pregnancy the infection occurs, the more serious the outcome for the baby. Many early infections end in stillbirth or miscarriage. Infants who survive may have issues such as seizures, enlarged liver and spleen, yellowing of skin and eyes jaundice or severe eye infections. Some effects are not seen at birth, and may occur in their teen years or later.
Toxoplasmosis is seldom diagnosed or reported because most patients with a healthy immune system have no signs or symptoms of the disease. Some short-term effects of toxoplasmosis may include fever, muscle pain, sore throat, headache, swollen lymph nodes and fatigue. Unless tests are carried out to confirm a Toxoplasma infection, these symptoms can be mistaken for the "flu". The long-term or chronic effects of the infection result when the cysts spread to the brain and muscle cells.
The cysts, which can stay in the body as long as the person lives, can rupture and cause severe illness including damage to the brain, eyes and other organs. Another form of the disease ocular toxoplasmosis can also affect the eyes leading to partial loss of sight or to blindness in one or both eyes. The time between contact with the infected source and the development of the disease is not known.
In one outbreak caused by eating under cooked meat, the disease developed 10 to 23 days after exposure. Another outbreak caused by contact with contaminated cat feces occurred 5 to 20 days after exposure. Medical advice should be sought if infection is suspected. The need for and the length of treatment depends on the severity of the infection or the possibility of damage to vital organs. Toxoplasmosis is treated primarily with antibacterial and anti-parasitic drugs for about four weeks.
Laboratories can perform blood and tissue tests to confirm infection with Toxoplasma gondii. Sources of occupational infection include contact with infected raw meat, infected animals, contaminated soil or water, or contact with contaminated cat feces. Laboratory personnel who have handled contaminated needles or glassware have also contracted toxoplasmosis. Remove all feline feces daily. Dried litter should be disposed of without shaking. Flush feces down the toilet, carefully bag them for disposal, burn them or bury them deeply.
Disinfect litter pans daily by scalding. Wear disposable gloves when handling litter boxes or working in soil or sand that is possibly contaminated with cat feces. Wash hands after removing gloves.
House all members of the cat family in a separate room or building to prevent infecting other animals. Do not feed cats raw meat. If this is not possible, feed meat that has been previously frozen as it is less likely to be infected than fresh meat. Where practical, use and store equipment and tools for cleaning up cat feces in the area where cats are housed.
Where appropriate gloves when in contact with raw meat. Wash hands thoroughly with soap and water. Do not touch mouth and eyes when handling raw meat.
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