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Toxoplasmosis - Wikipedia, the free encyclopedia

Toxoplasmosis

FromWikipedia,thefreeencyclopedia

Toxoplasmosisisaparasitic diseasecausedbytheprotozoan Toxoplasmagondii. [1] The parasiteinfectsmostgeneraof warm­bloodedanimals, includinghumans,butthe primaryhostisthefelid(cat) family.Animalsareinfectedby eatinginfectedmeat,by ingestionoffecesofacatthat hasitselfrecentlybeeninfected, andbytransmissionfrom mothertofetus.Catsarethe primarysourceofinfectionto humanhosts,althoughcontact withrawmeat,especiallypork, isamoresignificantsourceof humaninfectionsinsome countries.Fecalcontamination ofhandsisasignificantrisk factor. [2]

NicolleandManceauxfirst

describedtheorganismin1908,

aftertheyobservedtheparasites

intheblood,spleen,andliverof

aNorthAfricanrodent,

Ctenodactylusgondii.The

parasitewasnamedToxoplasma(arclikeform)gondii(aftertherodent)in1909.In1923,Jankureported

parasiticcystsintheretinaofaninfantwhohadhydrocephalus,seizures,andunilateralmicrophthalmia.

Wolf,Cowan,andPaige(1937–1939)determinedthesefindingsrepresentedthesyndromeofsevere

congenitalT.gondiiinfection. [2]

Uptoathirdoftheworld'shumanpopulationisestimatedtocarryaToxoplasmainfection. [3][4] The CentersforDiseaseControlandPreventionnotestheoverallseroprevalenceintheUnitedStatesas determinedwithspecimenscollectedbytheNationalHealthandNutritionalExaminationSurvey

(NHANES)between1999and2004wasfoundtobe10.8%,withseroprevalenceamongwomenof

childbearingage(15to44years)11%. [5] AnotherstudyplacedseroprevalenceintheUSat22.5%. [4] The samestudyclaimedaseroprevalenceof75%inElSalvador. [4] OfficialassessmentinGreatBritainplaces thenumberofinfectionsatabout350,000ayear. [6]

Duringthefirstfewweeksafterexposure,theinfectiontypicallycausesamild,flu­likeillnessornoillness. Thereafter,theparasiterarelycausesanyphysicalsymptomsinotherwisehealthyadults. [citationneeded] However,thosewithweakenedimmunesystems,suchasthosewithAIDSandpregnantwomen,may becomeseriouslyill,anditcanoccasionallybefatal. [citationneeded] Theparasitecancauseencephalitis

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Toxoplasmosis - Wikipedia, the free encyclopedia

Contents

1SignsandsymptomsContents 1.1Acutetoxoplasmosis 1.2Latenttoxoplasmosis 1.3Cutaneoustoxoplasmosis 1.4Psychiatricdisorders

1.1AcutetoxoplasmosisContents 1Signsandsymptoms 1.2Latenttoxoplasmosis 1.3Cutaneoustoxoplasmosis 1.4Psychiatricdisorders 1.5Contraryevidence

1.2LatenttoxoplasmosisContents 1Signsandsymptoms 1.1Acutetoxoplasmosis 1.3Cutaneoustoxoplasmosis 1.4Psychiatricdisorders 1.5Contraryevidence

1.3Cutaneoustoxoplasmosis1.1Acutetoxoplasmosis 1.2Latenttoxoplasmosis 1.4Psychiatricdisorders 1.5Contraryevidence 2Diagnosis

1.4Psychiatricdisorders1.2Latenttoxoplasmosis 1.3Cutaneoustoxoplasmosis 1.5Contraryevidence 2Diagnosis 3Transmission

1.5Contraryevidence1.3Cutaneoustoxoplasmosis 1.4Psychiatricdisorders 2Diagnosis 3Transmission 3.1Pregnancyprecautions

2Diagnosis1.4Psychiatricdisorders 1.5Contraryevidence 3Transmission 3.1Pregnancyprecautions 3.2Rodentbehavior

3Transmission1.4Psychiatricdisorders 1.5Contraryevidence 2Diagnosis 3.1Pregnancyprecautions 3.2Rodentbehavior 4Treatment

3.1Pregnancyprecautions1.5Contraryevidence 2Diagnosis 3Transmission 3.2Rodentbehavior 4Treatment 4.1Acute 4.2Latent

3.2Rodentbehavior2Diagnosis 3Transmission 3.1Pregnancyprecautions 4Treatment 4.1Acute 4.2Latent 5Epidemiology 6History

4Treatment3Transmission 3.1Pregnancyprecautions 3.2Rodentbehavior 4.1Acute 4.2Latent 5Epidemiology 6History 7Societyandculture

4.1Acute3.1Pregnancyprecautions 3.2Rodentbehavior 4Treatment 4.2Latent 5Epidemiology 6History 7Societyandculture

4.2Latent3.2Rodentbehavior 4Treatment 4.1Acute 5Epidemiology 6History 7Societyandculture 7.1Notablecases

5Epidemiology3.2Rodentbehavior 4Treatment 4.1Acute 4.2Latent 6History 7Societyandculture 7.1Notablecases 8Otheranimals

6History4Treatment 4.1Acute 4.2Latent 5Epidemiology 7Societyandculture 7.1Notablecases 8Otheranimals

7Societyandculture4Treatment 4.1Acute 4.2Latent 5Epidemiology 6History 7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats

7.1Notablecases4.1Acute 4.2Latent 5Epidemiology 6History 7Societyandculture 8Otheranimals 8.1Livestock 8.2Domesticcats 8.3Marinemammals

8Otheranimals5Epidemiology 6History 7Societyandculture 7.1Notablecases 8.1Livestock 8.2Domesticcats 8.3Marinemammals 9Seealso

8.1Livestock6History 7Societyandculture 7.1Notablecases 8Otheranimals 8.2Domesticcats 8.3Marinemammals 9Seealso 10References

8.2Domesticcats7.1Notablecases 8Otheranimals 8.1Livestock 8.3Marinemammals 9Seealso 10References 11Bibliography

8.3Marinemammals7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats 9Seealso 10References 11Bibliography 12Externallinks

9Seealso7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats 8.3Marinemammals 10References 11Bibliography 12Externallinks

10References7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats 8.3Marinemammals 9Seealso 11Bibliography 12Externallinks

11Bibliography7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats 8.3Marinemammals 9Seealso 10References 12Externallinks

12Externallinks7.1Notablecases 8Otheranimals 8.1Livestock 8.2Domesticcats 8.3Marinemammals 9Seealso 10References 11Bibliography

Signsandsymptoms

Infectionhastwostages:

Acutetoxoplasmosis

Duringacutetoxoplasmosis,symptomsareofteninfluenza­like:swollenlymphnodes,ormuscleachesand

painsthatlastforamonthormore.Rarelywillahumanwithafullyfunctioningimmunesystemdevelop

severesymptomsfollowinginfection.Youngchildrenandimmunocompromisedpeople,suchasthose

withHIV/AIDS,thosetakingcertaintypesofchemotherapy,orthosewhohaverecentlyreceivedan

organtransplant,maydevelopseveretoxoplasmosis.Thiscancausedamagetothebrain(encephalitis)or

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Toxoplasmosis - Wikipedia, the free encyclopedia

theeyes(necrotizingretinochoroiditis).Infantsinfectedviaplacentaltransmissionmaybebornwitheither

oftheseproblems,orwithnasalmalformations,althoughthesecomplicationsarerareinnewborns.The

toxoplasmictrophozoitescausingacutetoxoplasmosisarereferredtoasTachyzoites,andaretypically

foundinbodilyfluids.

Swollenlymphnodesarecommonlyfoundintheneckorunderthechin,followedbytheaxillae(armpits) andthegroin.Swellingmayoccuratdifferenttimesaftertheinitialinfection,persist,and/orrecurfor varioustimesindependentlyofantiparasitictreatment. [11] Itisusuallyfoundatsinglesitesinadults,butin children,multiplesitesmaybemorecommon.Enlargedlymphnodeswillresolvewithinonetotwo

monthsin60%ofcases.However,aquarterofthoseaffectedtaketwotofourmonthstoreturntonormal,

and8%takefourtosixmonths.Asubstantialnumber(6%)donotreturntonormaluntilmuchlater. [12]

Latenttoxoplasmosis

ItiseasyforahosttobecomeinfectedwithToxoplasmagondiianddeveloptoxoplasmosiswithout knowingit.Inmostimmunocompetentpeople,theinfectionentersalatentphase,duringwhichonly bradyzoitesarepresent,formingcystsinnervousandmuscletissue.Mostinfantswhoareinfectedwhilein thewombhavenosymptomsatbirth,butmaydevelopsymptomslaterinlife. [13]

Cutaneoustoxoplasmosis

Whilerare,skinlesionsmayoccurintheacquiredformofthedisease,includingroseolaanderythema multiforme­likeeruptions,prurigo­likenodules,urticaria,andmaculopapularlesions.Newbornsmayhave punctatemacules,ecchymoses,or“blueberrymuffin”lesions.Diagnosisofcutaneoustoxoplasmosisis basedonthetachyzoiteformofT.gondiibeingfoundintheepidermis.Itisfoundinalllevelsofthe

epidermis,isabout6μmby2μmandbow­shaped,withthenucleusbeingone­thirdofitssize.Itcanbe

identifiedbyelectronmicroscopyorbyGiemsastainingtissuewherethecytoplasmshowsblue,the nucleusred. [14]

Psychiatricdisorders

Studieshaveshownthetoxoplasmosisparasitemayaffectbehaviorandmaypresentasorbeacausativeor contributoryfactorinvariouspsychiatricdisorders,suchasdepression,anxiety,and schizophrenia. [15][16][17] In11of19scientificstudies,T.gondiiantibodylevelswerefoundtobe significantlyhigherinindividualsaffectedbyfirst­incidenceschizophreniathaninunaffectedpersons. Individualswithschizophreniaarealsomorelikelytoreportaclinicalhistoryoftoxoplasmosisthanthose inthegeneralpopulation. [18] RecentworkattheUniversityofLeedshasfoundtheparasiteproducesan enzymewithtyrosinehydroxylaseandphenylalaninehydroxylaseactivity.Thisenzymemaycontributeto thebehavioralchangesobservedintoxoplasmosisbyalteringtheproductionofdopamine,a neurotransmitterinvolvedinmood,sociability,attention,motivation,andsleeppatterns.Schizophreniahas longbeenlinkedtodopaminedysregulation. [19] Minocycline,anantibioticcapableofpassingtheblood­ brainbarrierusedfortreatingtoxoplasmosis,hasbeenfoundtoalleviatethesymptomsof schizophrenia. [20]

ChronicinfectionwithT.gondiihastraditionallybeenconsideredasymptomaticinimmunocompetent humanhosts.However,accumulatingevidencesuggestslatentinfectionmaysubtlyinfluencearangeof humanbehaviorsandtendencies,andinfectionmayalterthesusceptibilitytoorintensityofanumberof affective,psychiatric,orneurologicaldisorders. [21]

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LatentT.gondiiinfectioninhumanshasbeenassociatedwithimpairedpsychomotorperformance, enhancedrisk­takingpersonalityprofiles,andhigherincidenceofautomobileaccidents. [21] Moreover, correlationshavebeenfoundbetweenpositiveantibodytiterstoT.gondiiandOCD,Parkinson’sdisease, Alzheimer’sdisease,suicideinpeoplewithmooddisorders,andbipolardisorder. [21] Positiveantibody titerstoT.gondiihavebeenshowntobenotcorrelativewithmajordepressionordysthymia. [22]

ThemostsubstantialbodyofevidencelinkingT.gondiitoaneurologicaldisorderinvolvesthepotential associationbetweenschizophreniaandinfectionwiththeparasite. [23][24] Asof2013,atleast38studies havefoundapositivecorrelationbetweenT.gondiiantibodytitersandschizophrenia. [21][25] Whilethe vastmajorityofthesestudiestestedpeoplealreadydiagnosedwithschizophreniaforT.gondiiantibodies, significantassociationsbetweenT.gondiiandschizophreniahavebeenfoundpriortotheonsetof schizophreniadiseasesymptoms. [23]

InmostofthecurrentstudieswherepositiveassociationshavebeenfoundbetweenT.gondiiantibody titersandcertainbehavioraltraitsorneurologicaldisorders,T.gondiiseropositivitytestsareconducted aftertheonsetoftheexamineddiseaseorbehavioraltrait;thatis,itisoftenunclearwhetherinfectionwith theparasiteincreasesthechancesofhavingacertaintraitordisorder,orifhavingacertaintraitordisorder increasesthechancesofbecominginfectedwiththeparasite. [26] Groupsofindividualswithcertainbehavioraltraitsorneurological disordersmaysharecertainbehavioraltendenciesthatincreasethe likelihoodofexposuretoandinfectionwithT.gondii;asaresult, itisdifficulttoconfirmcausalrelationshipsbetweenT.gondii infectionsandassociatedneurologicaldisordersorbehavioral traits. [26]

Contraryevidence

ToxoplasmagondiiisbeneficialtomicewithAlzheimer'sdisease. [27] MurineanaloguestotheComt,DRD4andDAT1human genesalsoexist,andthesegenesarerelatedtoAlzheimer's disease. [28] DAT1,forexample,encodestheneuralmembranes

throughwhichdopaminereturnstothecell.DAT1genemutations

areresponsiblefortoorapiddopamineuptake,whichresultsin deficiencyinextracellulardopamine.SinceT.gondiiproduces dopamine,ithasapotentialtoovercomethesegene­related disordersalsoinhumans,mainlybecausethemechanisms

encodedbyComt,DRD4,andDAT1arebothmurineandhuman.

ToofastDAT1dopamineuptakeisrelatedtootherneurological

disorders [29][30] whichcanpotentiallybenefitfromT.gondii dopaminesynthesis.Itisaninterestingopenquestionwhether

mammalswithDAT1polymorphismsaregeneticallybetter

adaptedtoT.gondiiinfection.

Micrograph ofalymphnodeshowing thecharacteristicchangesof toxoplasmosis(scatteredepithelioid

Micrographofalymphnodeshowing

thecharacteristicchangesof

toxoplasmosis(scatteredepithelioid

histiocytes(palecells),monocytoid

cells(top­centerofimage),large

germinalcenters(leftofimage))

ExamplesofgeneticfactorsinParkinson'sdiseaseareLRRK2mutationsGly2019Ser,I2020T,andothers.

SomeevidenceindicatesexposuretopesticidescausesParkinson'sdisease [31] Thediseasepresentswhen

80%oftheneuronsthatproducedopamineinthesubstantianigradie.Thisshortageofdopaminecouldbe

compensatedbyT.gondii,whichisknowntoproducedopamine.

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Diagnosis

Toxoplasmosiscanbedifficulttodistinguishfromprimarycentralnervoussystemlymphoma,andasa

result,thediagnosisismadebyatrialoftherapy(pyrimethamine,sulfadiazine,andfolinicacid(USAN:

leucovorin)),followedbyabrainbiopsyifthedrugsproducenoeffectclinicallyandnoimprovementon

repeatimaging.

Toxoplasmosiscannotbedetectedwithimmunostaining.LymphnodesaffectedbyToxoplasmahave

characteristicchanges,includingpoorlydemarcatedreactivegerminalcenters,clustersofmonocytoidB

cells,andscatteredepithelioidhistiocytes.

Transmission

Transmissionmayoccurthrough:

Lifecycleof Toxoplasmagondii

LifecycleofToxoplasmagondii

Ingestionofraworpartlycookedmeat,especiallypork,lamb, orvenisoncontainingToxoplasmacysts:Infectionprevalence incountrieswhereundercookedmeatistraditionallyeaten hasbeenrelatedtothistransmissionmethod.Tissuecysts mayalsobeingestedduringhand­to­mouthcontactafter handlingundercookedmeat,orfromusingknives,utensils,or cuttingboardscontaminatedbyrawmeat. [33] Ingestionofcontaminatedcatfeces:Thiscanoccurthrough hand­to­mouthcontactfollowinggardening,cleaningacat's litterbox,contactwithchildren'ssandpits,ortouchinga leech;theparasitecansurviveintheenvironmentforovera year. [34]

Catsexcretethepathogenintheirfecesforanumberofweeksafter

contractingthedisease,generallybyeatinganinfectedrodent.Even

then,catfecesarenotgenerallycontagiousforthefirstdayortwoafterexcretion,afterwhichthecyst

'ripens'andbecomespotentiallypathogenic. [35]

Pregnancyprecautions

Congenitaltoxoplasmosisisaspecialforminwhichanunbornfetusisinfectedviatheplacenta.Apositive

antibodytiterindicatespreviousexposureandimmunity,andlargelyensurestheunbornfetus'safety.A

simpleblooddrawatthefirstprenataldoctorvisitcandeterminewhetherornotawomanhashadprevious

exposureandthereforewhetherornotsheisatrisk.IfawomanreceivesherfirstexposuretoT.gondii

whilepregnant,thefetusisatparticularrisk.Awomanwithnopreviousexposureshouldavoidhandling

rawmeat,exposuretocatfeces,andgardening(catfecesarecommoningardensoil).Mostcatsarenot

activelysheddingoocysts,soarenotadanger,buttheriskmaybereducedfurtherbyhavingthelitterbox

emptieddaily(oocystsrequirelongerthanasingledaytobecomeinfective),andbyhavingsomeoneelse

emptythelitterbox.However,whileriskscanbeminimized,theycannotbeeliminated.Forpregnant

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womenwithnegativeantibodytiters,indicatingnopreviousexposuretoT.gondii,serologytestingas

frequentasmonthlyisadvisableastreatmentduringpregnancyforthosewomenexposedtoT.gondiifor

thefirsttimedecreasesdramaticallytheriskofpassingtheparasitetothefetus.

Despitetheserisks,pregnantwomenarenotroutinelyscreenedfortoxoplasmosisinmostcountries (Portugal, [36] France, [37] Austria, [37] Uruguay, [38] andItaly [39] beingtheexceptions)forreasonsofcost­ effectivenessandthehighnumberoffalsepositivesgenerated.Asinvasiveprenataltestingincurssome risktothefetus(18.5pregnancylossespertoxoplasmosiscaseprevented), [37] postnatalorneonatal screeningispreferred.Theexceptionsarecaseswherefetalabnormalitiesarenoted,andthusscreening canbetargeted. [37]

SomeregionalscreeningprogrammesoperateinGermany,SwitzerlandandBelgium. [39]

Treatmentisveryimportantforrecentlyinfectedpregnantwomen,topreventinfectionofthefetus.Sincea

baby'simmunesystemdoesnotdevelopfullyforthefirstyearoflife,andtheresilientcyststhatform

throughoutthebodyareverydifficulttoeradicatewithantiprotozoans,aninfectioncanbeveryseriousin

theyoung.

In2006,aCzechresearchteamdiscoveredwomenwithhighlevelsoftoxoplasmosisantibodieswere

significantlymorelikelytohavebabyboysthanbabygirls.Inmostpopulations,thebirthrateisaround 51%boys,butwomeninfectedwithT.gondiihaduptoa72%chanceofaboy. [40]

Rodentbehavior

InfectionwithT.gondiihasbeenshowntoalterthebehaviorofmiceandratsinwaysthoughttoincrease therodents’chancesofbeingpreyeduponbycats. [23][41][42] Infectedrodentsshowareductionintheir innateaversiontocatodors;whileuninfectedmiceandratswillgenerallyavoidareasmarkedwithcat urineorwithcatbodyodor,thisavoidanceisreducedoreliminatedininfectedanimals. [23][42][43] Moreover,someevidencesuggeststhislossofaversionmaybespecifictofelineodors:whengivena choicebetweentwopredatorodors(catormink),infectedrodentsshowasignificantlystrongerpreference tocatodorsthandouninfectedcontrols. [44][45]

T.gondii­infectedrodentsshowanumberofbehavioralchangesbeyondalteredresponsestocatodors. Ratsinfectedwiththeparasiteshowincreasedlevelsofactivityanddecreasedneophobicbehavior. [41][46] Similarly,infectedmiceshowalterationsinpatternsoflocomotionandexploratorybehaviorduring experimentaltests.Thesepatternsincludetravelinggreaterdistances,movingathigherspeeds,accelerating forlongerperiodsoftime,andshowingadecreasedpause­timewhenplacedinnewarenas. [47] Infected rodentshavealsobeenshowntohavedifferencesintraditionalmeasuresofanxiety,suchaselevatedplus mazes,openfieldarenas,andsocialinteractiontests. [47][48]

Treatment

Treatmentisoftenonlyrecommendedforpeoplewithserioushealthproblems,suchaspeoplewithHIV

whoseCD4countsareunder200,becausethediseaseismostseriouswhenone'simmunesystemisweak.

Trimethoprim/sulfamethoxazoleisthedrugofchoicetopreventtoxoplasmosis,butnotfortreatingactive

disease.

Acute

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Themedicationsprescribedforacutetoxoplasmosisare:

Sulfadiazine—anantibioticusedincombinationwithpyrimethaminetotreattoxoplasmosis

Combinationtherapyisusuallygivenwithfolicacidsupplementstoreduceincidenceof

CombinationtherapyismostusefulinthesettingofHIV.

. CombinationtherapyismostusefulinthesettingofHIV. Clindamycin Spiramycin

Spiramycin—anantibioticusedmostoftenforpregnantwomentopreventtheinfectionoftheir

children

(otherantibiotics,suchasminocycline,haveseensomeuseasasalvagetherapy).

Latent

Inpeoplewithlatenttoxoplasmosis,thecystsareimmunetothesetreatments,astheantibioticsdonot

reachthebradyzoitesinsufficientconcentration.

Themedicationsprescribedforlatenttoxoplasmosisare:

Atovaquone—anantibioticthathasbeenusedtokillToxoplasmacystsinsideAIDSpatients [49] Clindamycin—anantibioticwhich,incombinationwithatovaquone,seemedtooptimallykillcysts inmice [50]

Epidemiology

T.gondiiinfectionsoccurthroughouttheworld,althoughinfectionratesdiffersignificantlybycountry. [51]

Forwomenofchildbearingage,asurveyof99studieswithin44countriesfoundtheareasofhighest

prevalencearewithinLatinAmerica(about50–80%),partsofEasternandCentralEurope(about20–

60%),theMiddleEast(about30­50%),partsofSoutheastAsia(about20–60%),andpartsofAfrica(about

20–55%). [51]

1999to2004found9.0%ofUS­bornpersons12–49yearsofagewereseropositiveforIgGantibodies

againstT.gondii,downfrom14.1%asmeasuredintheNHANES1988–1994. [52] Inthe1999–2004

survey,7.7%ofUS­bornand28.1%offoreign­bornwomen15–44yearsofagewereT.gondii

seropositive. [52] Atrendofdecreasingseroprevalencehasbeenobservedbynumerousstudiesinthe UnitedStatesandmanyEuropeancountries. [51]

Becausetheparasiteposesaparticularthreattofetuseswhenitiscontractedduringpregnancy, [53] much oftheglobalepidemiologicaldataregardingT.gondiicomesfromseropositivitytestsinwomenof childbearingage.SeropositivitytestslookforthepresenceofantibodiesagainstT.gondiiinblood,so whileseropositivityguaranteesonehasbeenexposedtotheparasite,itdoesnotnecessarilyguaranteeone ischronicallyinfected. [54]

History

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TheT.gondiiprotozoanwasfirstdiscoveredbyNicolleandManceaux,whoin1908isolateditfromthe

AfricanrodentCtenodactylusgundi,thenin1909differentiatedtheorganismfromLeishmaniaandnamed

itToxoplasmagondii. [37] Thefirstrecordedcongenitalcasewasnotuntil1923,andthefirstadultcasenot until1940. [37] In1948,aserologicaldyetestwascreatedbySabinandFeldman,whichisnowthe standardbasisfordiagnostictests. [55]

Societyandculture

Notablecases

ArthurAshe(tennisplayer)developedneurologicalproblemsfromtoxoplasmosis(andwaslater foundtobeHIV­positive). [56] MerrittButrick(actor)wasHIVpositiveanddiedfromtoxoplasmosisasaresultofhisalready weakenedimmunesystem. [57] PrinceFrançois,CountofClermont(pretendertothethroneofFrance);hisdisabilitycausedhimto beoverlookedinthelineofsuccession. LeslieAsh(actress)contractedtoxoplasmosisinthesecondmonthofpregnancy. [58] SebastianCoe(Britishmiddledistancerunner) [59] MartinaNavratilovasufferedfromtoxoplasmosisduringthe1982USOpen. [60] LouisWain(artist)wasfamousforpaintingcats;helaterdevelopedschizophrenia,whichsome believewasduetotoxoplasmosisresultingfromhisprolongedexposuretocats. [61] JaroslavFlegr(biologist)isaproponentofthetheorythattoxoplasmosisaffectshumanbehavior. [62]

Otheranimals

AlthoughT.gondiihasthecapabilityofinfectingvirtuallyallwarm­bloodedanimals,susceptibilityand ratesofinfectionvarywidelybetweendifferentgeneraandspecies. [63] Ratesofinfectioninpopulationsof thesamespeciescanalsovarywidelyduetodifferencesinlocation,diet,andotherfactors.

Livestock

Amonglivestock,pigs,sheep,andgoatshavethehighestratesofchronicT.gondiiinfection. [64] The prevalenceofT.gondiiinmeat­producinganimalsvarieswidelybothwithinandbetweencountries, [64] andratesofinfectionhavebeenshowntobedramaticallyinfluencedbyvaryingfarmingandmanagement practices. [65] Forinstance,animalskeptoutdoorsorinfree­rangingenvironmentsaremoreatriskof infectionthananimalsraisedindoorsorincommercialconfinementoperations. [65][66]

IntheUnitedStates,thepercentageofpigsharboringviableparasiteshasbeenmeasured(viabioassayin miceorcats)tobeashighas92.7%andaslowas0%,dependingonthefarmorherd. [66] Surveysof seroprevalence(T.gondiiantibodiesinblood)aremorecommon,andsuchmeasurementsareindicativeof thehighrelativeseroprevlanceinpigsacrosstheworld. [67] Alongwithpigs,sheepandgoatsareamong themostcommonlyinfectedlivestockofepidemiologicalsignificanceforhumaninfection. [64] Prevalence

ofviableT.gondiiinsheeptissuehasbeenmeasured(viabioassay)tobeashighas78%intheUnited

States, [68] anda2011surveyofgoatsintendedforconsumptionintheUnitedStatesfounda seroprevalenceof53.4%. [69]

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Duetoalackofexposuretotheoutdoors,chickensraisedinlarge­scaleindoorconfinementoperationsare notcommonlyinfectedwithT.gondii. [65] Free­rangingorbackyard­raisedchickensaremuchmore commonlyinfected. [65] Asurveyoffree­rangingchickensintheUnitedStatesfounditsprevalencetobe 17%–100%,dependingonthefarm. [70] Becausechickenmeatisgenerallycookedthoroughlybefore consumption,poultryisnotgenerallyconsideredtobeasignificantriskfactorforhumanT.gondii infection. [71]

AlthoughcattleandbuffalocanbeinfectedwithT.gondii,theparasiteisgenerallyeliminatedorreduced toundetectablelevelswithinafewweeksfollowingexposure. [65] Tissuecystsarerarelypresentinbuffalo meatorbeef,andmeatfromtheseanimalsisconsideredtobelow­riskforharboringviable parasites. [64][66]

HorsesareconsideredresistanttochronicT.gondiiinfection. [65] However,viablecellshavebeenisolated fromUShorsesslaughteredforexport,andseverehumantoxoplasmosisinFrancehasbeen epidemiologicallylinkedtotheconsumptionofhorsemeat. [66]

Domesticcats

TheseroprevalenceofT.gondiiindomesticcats,worldwide,hasbeenestimatedtobearound30–40%. [72] IntheUnitedStates,noofficialnationalestimatehasbeenmade,butlocalsurveyshaveshownlevels variedbetween16%and80%. [72] A2012surveyof445purebredpetcatsand45sheltercatsinFinland foundanoverallseroprevalenceof48.4%. [73] A2010surveyofferalcatsfromGiza,Egypt,foundan overallseroprevalenceof97.4%. [74]

Mostinfectedcatswillshedoocystsonlyonceintheirlifetimes,foraperiodofaboutonetotwo weeks. [72] Althoughthisperiodofsheddingisquitetransient,millionsofoocystscanbeshed,witheach oocystcapableofspreadingandsurvivingformonths. [72] Anestimated1%ofcatsatanygiventimeare activelysheddingoocysts. [65]

Marinemammals

AUniversityofCalifornia,Davisstudyofdeadseaotterscollectedfrom1998to2004found

toxoplasmosiswasthecauseofdeathfor13%oftheanimals. [77] Proximitytofreshwateroutflowsintothe oceanwasamajorriskfactor.Ingestionofoocystsfromcatfaecesisconsideredtobethemostlikely ultimatesource. [78] Surfacerunoffcontainingwildcatfaecesandlitterfromdomesticcatsflusheddown toiletsarepossiblesourcesofoocysts. [79] Theparasiteshavebeenfoundindolphinsandwhales. [17] ResearchersBlackandMassiebelieveanchovies,whichtravelfromestuariesintotheopenocean,maybe helpingtospreadthedisease.

Seealso

helpingtospreadthedisease. Seealso TORCHinfection en.wikipedia.org/wiki/Toxoplasmosis 9/15

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