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- Toxoplasma gondii is an obligate intracellular protozoan parasite.
- Most common latent protozoan infection
- Clinically significant disease typically manifests only in pregnancy or in an immunocompromised patient.
- Acute self-limited infection in immunocompetent
- Acute symptomatic or reactivated latent infection in immunocompromised persons
- Congenital toxoplasmosis (acute primary infection during pregnancy)
- Ocular toxoplasmosis
- The earlier fetal infection occurs, the more severe.
- Risk of perinatal death is 5% if infected in 1st trimester.
- Pregnant immunocompromised and HIV-infected women should undergo serologic testing.
- Counsel pregnant women regarding risks.
- Serologic testing during pregnancy is controversial.
- Prevalence of congenital toxoplasmosis in the United States: 10 to 100/100,000 live births
- Predominant sex: male > female
- Present in every country. Seropositivity rates range from <10% to >90% (1)[A].
- In the United States, 11% of individuals aged 6 to 49 years are seropositive.
- Age-adjusted prevalence in the United States is 23%.
- Seroprevalence among women in the United States is 15%.
Etiology and Pathophysiology
Transmission to humans
- Ingestion of raw or undercooked meat, food, or water containing tissue cysts or oocytes that is usually from soil contaminated with feline feces
- Transplacental passage from infected mother to fetus; risk of transmission is 30% on average.
- Blood product transfusion or solid-organ transplantation
- Ingested T. gondii oocysts enter host’s gastrointestinal tract where bradyzoites/tachyzoites are released, penetrate contiguous cells, replicate, and are transported to susceptible tissues causing clinical disease.
Human leukocyte antigen (HLA) DQ3 is a genetic marker for susceptibility in HIV/AIDS patients.
- Immunocompromised states, including HIV infection with CD4 cell count <100/μL
- Primary infection during pregnancy; risk of fetal transmission increases with gestational age at seroconversion. Transmission in the 1st trimester is associated with more severe consequences.
- Chronically infected immunocompromised pregnant women are at increased risk for transmitting congenital toxoplasmosis.
- Avoid eating undercooked meat: Cook to 152°F (66°C) or freeze for 24 hours at ≤−12°C.
- Avoid drinking unfiltered water.
- Wash produce thoroughly.
- Strict hand hygiene after touching soil
- Wear gloves and wash hands after handling raw meat or cat litter.
- Avoid shellfish (Toxoplasma cysts).
Commonly Associated Conditions
- Chorioretinitis; self-limiting, febrile lymphadenopathy; mononucleosis-like illness
- Potential association with schizophrenia
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