Professional Documents
Culture Documents
PDF Toxoplasma Gondii The Model Apicomplexan Perspectives and Methods 3Rd Edition Louis M Weiss Ebook Full Chapter
PDF Toxoplasma Gondii The Model Apicomplexan Perspectives and Methods 3Rd Edition Louis M Weiss Ebook Full Chapter
https://textbookfull.com/product/the-neuroscience-of-
psychotherapy-3rd-edition-louis-cozolino/
https://textbookfull.com/product/exercises-in-epidemiology-
applying-principles-and-methods-second-edition-edition-weiss/
https://textbookfull.com/product/research-methods-in-education-
louis-cohen/
https://textbookfull.com/product/population-based-public-health-
clinical-manual-the-henry-street-model-for-nurses-3rd-edition-
patricia-m-schoon/
Uncommon Causes of Stroke 3rd Edition Louis Caplan
https://textbookfull.com/product/uncommon-causes-of-stroke-3rd-
edition-louis-caplan/
https://textbookfull.com/product/model-perspectives-structure-
architecture-and-culture-mark-r-cruvellier/
https://textbookfull.com/product/applied-methods-of-cost-
effectiveness-analysis-in-healthcare-3rd-edition-alistair-m-gray/
https://textbookfull.com/product/the-autobiography-of-benjamin-
franklin-with-related-documents-3rd-edition-louis-p-masur/
https://textbookfull.com/product/the-european-central-bank-as-a-
sustainability-role-model-philosophical-ethical-and-economic-
perspectives-harald-bolsinger/
TOXOPLASMA GONDII
TOXOPLASMA
GONDII
The Model
Apicomplexan—Perspectives
and Methods
THIRD EDITION
Edited by
Louis M. Weiss
Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
Department of Pathology, Albert Einstein College of Medicine, New York, NY, United States
Kami Kim
Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
Global Health Infectious Diseases Research Program, College of Public Health, University of South Florida, Tampa, FL,
United States
Academic Press is an imprint of Elsevier
125 London Wall, London EC2Y 5AS, United Kingdom
525 B Street, Suite 1650, San Diego, CA 92101, United States
50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States
The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom
Copyright © 2020 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details
on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted
herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information,
methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own
safety and the safety of others, including parties for whom they have a professional responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury
and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
Cover photograph: Coccidian stage of Toxoplasma gondii in the cat intestine undergoing endopolygeny (asexual division) showing the
formation of multiple daughters within the mother cell cytoplasm, while located within an intestinal epithelial cell. Original
magnification 8000X. Image provided by Dr. David Ferguson, Oxford University.
We would like to thank our families (Lisa, Hannah, Talia, and Oren; Tom, Clayton, and
Vaughan) for their patience, understanding, and tolerance during the completion of this book. In
addition, we want to thank the Toxoplasma research community for their enthusiasm and contribu-
tions to this project. The Toxoplasma research community is legendary for its generosity toward col-
leagues and new investigators. It has been a unique pleasure to be involved with such a
welcoming and intellectually stimulating group of researchers.
There have been many key research groups and individual researchers who have contributed
to the development of the critical knowledge base required for progress on this pathogen. This
book is a testament to these researchers.
We would like to dedicate this book to Elmer Pfefferkorn, PhD, Dartmouth College. Elmer’s
work paved the way for the explosion in molecular biology, cell biology, and genomic research
associated with this organism. Elmer’s intellectual rigor and deep thinking has had a significant
influence on current researchers on Toxoplasma gondii, and we are all indebted to his generosity of
spirit and profound insights into this pathogen.
Yet again we are profoundly grateful for the patience, understanding, and tolerance of our
families which was critical for the completion of this revised edition.
The third edition of this book is dedicated to the memory of all of our colleagues who have
passed away in the last several years. The work that these various researchers performed laid the
foundation for the incredible explosion of knowledge seen in this updated edition. They will be
deeply missed by the research community.
Louis M. Weiss
Bronx, NY, 2019
Kami Kim
Tampa, FL, 2019
Contents
2.1 Invasive stage ultrastructure and genesis 21 5. Ocular disease due to Toxoplasma gondii
2.2 Coccidian development in the definitive host 32
JORGE ENRIQUE GOMEZ-MARIN AND
2.3 Development in the intermediate host 48 ALEJANDRA DE-LA-TORRE
References 58
5.1 Introduction 229
3. Molecular epidemiology and population 5.2 Historical landmarks in ocular toxoplasmosis 229
structure of Toxoplasma gondii 5.3 Epidemiology 231
5.4 Pathophysiology: lessons from animal models and
MARIE-LAURE DARDÉ, AURÉLIEN MERCIER, CHUNLEI SU,
ASIS KHAN AND MICHAEL E. GRIGG clinical studies 234
5.5 Host factors 236
3.1 Introduction 63 5.6 Parasite factors 237
3.2 Genetic markers 64 5.7 Animal models 240
3.3 Evolutionary history 77 5.8 Clinical characteristics 241
3.4 Global diversity and population structure 82 5.9 Diagnostic tests 257
3.5 Outbreak investigations 90 5.10 Differential diagnosis 267
vii
viii CONTENTS
5.11 The treatment and management of ocular 9. Biochemistry and metabolism of Toxoplasma
toxoplasmosis 268 gondii: purine and pyrimidine acquisition in
5.12 Conclusion 276
Toxoplasma gondii and other Apicomplexa
Acknowledgments 276
BARBARA A. FOX AND DAVID J. BZIK
References 276
9.1 Introduction 397
6. Toxoplasmosis in wild and domestic 9.2 Purines 399
animals 9.3 Pyrimidines 420
DAVID S. LINDSAY AND J.P. DUBEY
References 436
Further reading 449
6.1 Introduction 293
6.2 Toxoplasmosis in wildlife 293 10. Metabolic networks and metabolomics
6.3 Toxoplasmosis in zoos 305 JOACHIM KLOEHN, AARTI KRISHNAN, CHRISTOPHER J.
6.4 Toxoplasma gondii and endangered TONKIN, MALCOLM J. MCCONVILLE AND
species 307 DOMINIQUE SOLDATI-FAVRE
6.5 Toxoplasmosis in pets 308
6.6 Domestic farm animals 310 10.1 Introduction 451
6.7 Fish, reptiles, and amphibians 312 10.2 Genome-scale metabolic modeling 452
References 312 10.3 Central carbon metabolism 456
Further reading 320 10.4 Carbohydrate metabolism 468
10.5 Vitamins and cofactor metabolism 475
10.6 Metabolomics approaches 487
7. Toxoplasma animal models and therapeutics 10.7 Discussion and outlook 491
CARSTEN G.K. LÜDER, UTZ REICHARD AND UWE GROß References 492
18.5 The stress response and signaling pathways for 21. Regulation of gene expression in
bradyzoite formation 820 Toxoplasma gondii
18.6 Heat shock proteins 823
KAMI KIM, VICTORIA JEFFERS AND
18.7 Transcriptional control of bradyzoite genes 826 WILLIAM J. SULLIVAN JR.
18.8 Cyst wall and matrix antigens 829
18.9 Surface antigens 834 21.1 Introduction 941
18.10 Metabolic differences between bradyzoites and 21.2 Transcription in Toxoplasma 942
tachyzoites 836 21.3 Epigenetics in Toxoplasma 954
18.11 Genetic studies on bradyzoite biology 839 21.4 Posttranscriptional mechanisms in
18.12 Sexual stage morphology, biology, and Toxoplasma 966
antigens 841 21.5 Conclusion and future directions 970
18.13 Sexual stage development in cell culture 842 Acknowledgments 971
18.14 Sexual stage development in a mouse model 844 References 971
18.15 Summary 844
Acknowledgments 845 22. Proteomics and posttranslational protein
References 845
modifications in Toxoplasma gondii
Further reading 857
LOUIS M. WEISS, JONATHAN WASTLING,
VICTORIA JEFFERS, WILLIAM J. SULLIVAN JR AND KAMI KIM
19. Development and application of classical
genetics in Toxoplasma gondii 22.1 Introduction to Toxoplasma gondii proteomics 983
MICHAEL S. BEHNKE, JEROEN P.J. SAEIJ AND JON P. BOYLE 22.2 Toxoplasma gondii global proteomics 988
22.3 Toxoplasma gondii subproteomes 990
19.1 Summary 859 22.4 Toxoplasma gondii posttranslational
19.2 Biology of Toxoplasma 860 modifications 993
19.3 Establishment of transmission genetics 863 22.5 Studies on the function of posttranslational
19.4 Development of genetic mapping 867 modifications in Toxoplasma. gondii biology 999
19.5 Mapping phenotypic traits by classical 22.6 Interactions of Toxoplasma gondii posttranslational
genetics 871 modifications 1004
19.6 Future challenges 889 22.7 Conclusion 1009
Acknowledgments 890 Acknowledgments 1010
References 890 References 1010
xiii
xiv LIST OF CONTRIBUTORS
Michael E. Grigg Laboratory of Parasitic Diseases, Joachim Kloehn Department of Microbiology and
Molecular Parasitology Section, National Institute Molecular Medicine, Faculty of Medicine,
of Allergy and Infectious Diseases, National University of Geneva, Geneva, Switzerland
Institutes of Health, Bethesda, MD, United States Laura J. Knoll Department of Medical
Uwe Groß Institute for Medical Microbiology, Microbiology and Immunology, University of
University Medical Center, University of Wisconsin-Madison, Madison, WI, United States
Göttingen, Göttingen, Germany Anita A. Koshy Department of Neurology,
Marc-Jan Gubbels Department of Biology, Boston University of Arizona, Tucson, AZ, United States;
College, Chestnut Hill, MA, United States Department of Immunobiology, University of
Mohamed-Ali Hakimi Institute for Advanced Arizona, Tucson, AZ, United States; BIO5
Biosciences (IAB), Team Host-Pathogen Institute, University of Arizona, Tucson, AZ,
Interactions and Immunity to Infection, INSERM United States
U1209, University Grenoble Alpes, Grenoble, Aarti Krishnan Department of Microbiology and
France Molecular Medicine, Faculty of Medicine,
Omar S. Harb Department of Biology, University University of Geneva, Geneva, Switzerland
of Pennsylvania, Philadelphia, PA, United States Maryse Lebrun UMR 5235 CNRS, University of
Tajie H. Harris Department of Neuroscience, Montpellier, Montpellier, France
Center for Brain Immunology and Glia, David S. Lindsay Department of Biomedical
University of Virginia, Charlottesville, VA, Sciences and Pathobiology, Virginia Maryland
United States College of Veterinary Medicine, Virginia Tech,
Christopher A. Hunter Department of Blacksburg, VA, United States
Pathobiology, School of Veterinary Medicine, Melissa B. Lodoen Department of Molecular
University of Pennsylvania, Philadelphia, PA, Biology and Biochemistry, University of
United States California, Irvine, CA, United States; Institute for
Damien Jacot Department of Microbiology and Immunology, University of California, Irvine,
Molecular Medicine, Faculty of Medicine, CA, United States
University of Geneva, Geneva, Switzerland Sebastian Lourido Whitehead Institute for
Victoria Jeffers Department of Molecular, Cellular, Biomedical Research, Cambridge, MA, United
and Biomedical Sciences, University of New States; Department of Biology, Massachusetts
Hampshire, Durham, NH, United States Institute of Technology, Cambridge, MA, United
States
Asis Khan Laboratory of Parasitic Diseases,
Molecular Parasitology Section, National Carsten G.K. Lüder Institute for Medical
Institute of Allergy and Infectious Diseases, Microbiology, University Medical Center,
National Institutes of Health, Bethesda, MD, University of Göttingen, Göttingen, Germany
United States Malcolm J. McConville Department of
Kami Kim Department of Internal Medicine, Biochemistry and Molecular Biology, University
Morsani College of Medicine, University of South of Melbourne, Parkville, VIC, Australia;
Florida, Tampa, FL, United States; Global Health Metabolomics Australia, Bio21 Molecular Science
Infectious Diseases Research Program, College of and Biotechnology Institute, University of
Public Health, University of South Florida, Melbourne, Parkville, VIC, Australia
Tampa, FL, United States Rima McLeod The University of Chicago, Chicago,
Jessica C. Kissinger Center for Tropical & IL, United States
Emerging Global Diseases, Department of Markus Meissner Experimental Parasitology,
Genetics & Institute of Bioinformatics, University Department of Veterinary Sciences, Ludwig
of Georgia, Athens, GA, United States Maximilians University, Munich, Germany;
Christen M. Klinger Division of Infectious Department of Veterinary Sciences, Experimental
Diseases, Department of Medicine, University of Parasitology, Ludwig-Maximilians-University,
Alberta, Edmonton, AB, Canada Munich, Germany
LIST OF CONTRIBUTORS xv
Aurélien Mercier INSERM, Univ. Limoges, CHU Lilach Sheiner Wellcome Centre for Integrative
Limoges, UMR 1094, Tropical Parasitology, Institute of Infection, Immunity &
Neuroepidemiology, Institute of Epidemiology Inflammation, College of Medical, Veterinary &
and Tropical Neurology, Limoges, France; Centre Life Sciences, Sir Graeme Davies Building,
National de Référence Toxoplasmose/Toxoplasma University of Glasgow, Glasgow, United
Biological Resource Center, CHU Limoges, Kingdom
Limoges, France L. David Sibley Department of Molecular
Dana G. Mordue Department of Microbiology and Microbiology, Washington University School of
Immunology, New York Medical College, Medicine, St. Louis, MO, United States
Valhalla, NY, United States Anthony P. Sinai Department of Microbiology,
Silvia N.J. Moreno Department of Cellular Biology Immunology & Molecular Genetics, University of
and Center for Tropical and Emerging Global Kentucky, College of Medicine, Lexington, KY,
Diseases, University of Georgia, Athens, GA, United States
United States Dominique Soldati-Favre Department of
Naomi Morrissette Department of Molecular Microbiology and Molecular Medicine, Faculty of
Biology and Biochemistry, University of Medicine, University of Geneva, Geneva,
California, Irvine, Irvine, CA, United States Switzerland
Douglas A. Pace Department of Biological Boris Striepen Department of Pathobiology,
Sciences, California State University Long Beach, University of Pennsylvania, Philadelphia, PA,
Long Beach, CA, United States United States
Marilyn Parsons Department of Global Health, Chunlei Su Department of Microbiology, The
University of Washington, Seattle, WA, United University of Tennessee, Knoxville, TN, United
States; Department of Pediatrics, University of States
Washington, Seattle, WA, United States; Center William J. Sullivan, Jr. Departments of
for Global Infectious Disease Research, Seattle Pharmacology & Toxicology, Microbiology &
Children’s Research Institute, Seattle, WA, Immunology, Indiana University School of
United States Medicine, Indianapolis, IN, United States;
Utz Reichard Institute for Medical Microbiology, Department of Microbiology & Immunology,
University Medical Center, University of Indiana University School of Medicine,
Göttingen, Göttingen, Germany; Amedes MVZ Indianapolis, IN, United States
Wagnerstibbe for Medical Microbiology, Christopher J. Tonkin Division of Infectious
Infectious Diseases, Hygiene and Tropical Disease and Immune Defence, The Walter and
Medicine, Göttingen, Germany Eliza Hall Institute of Medical Research,
Craig W. Roberts University of Strathclyde, Parkville, VIC, Australia; Department of Medical
Glasgow, United Kingdom Biology, The University of Melbourne, Parkville,
Ellen A. Robey Department of Molecular and Cell VIC, Australia
Biology, University of California, Berkeley, CA, Giel G. van Dooren Research School of Biology,
United States Australian National University, Canberra, ACT,
David S. Roos Department of Biology, University Australia
of Pennsylvania, Philadelphia, PA, United States Jonathan Wastling Faculty of Natural Sciences,
Jeroen P.J. Saeij Department of Pathology, University of Keele, Keele, Staffordshire, United
Microbiology and Immunology, School of Kingdom
Veterinary Medicine, University of California, Louis M. Weiss Department of Pathology Albert
Davis, CA, United States Einstein College of Medicine, Bronx, NY, United
Anna Salvioni Center for Pathophysiology States; Department of Medicine, Albert Einstein
Toulouse-Purpan (CPTP), INSERM, CNRS, College of Medicine, Bronx, NY, United States
University of Toulouse, Toulouse, France Stuart Woods University of Strathclyde, Glasgow,
Frank Seeber FG16: Mycotic and Parasitic Agents United Kingdom
and Mycobacteria, Robert Koch-Institute, Berlin,
Germany
Preface to the third edition
xvii
xviii Preface to the third edition
T. gondii alters its host cell and the exquisite an initial group of 26 investigators (Fig. P1) to
dance of host-pathogen interplay is gradually meetings with over 200 participants (see
being teased out. Finally, sophisticated imag- Epilogue Figure E1 from the 15th International
ing techniques are yielding critical insights into Toxoplasmosis Congress), which reflects the
the neurobiology and immunology of T. gondii; increasing number of laboratories working on
providing new insights. this organism.
The first edition of this book was an out- The third edition of “Toxoplasma gondii: the
growth of discussions held at the Seventh model apicomplexan” was assembled to
International Congress on Toxoplasmosis in address the numerous advances in the
Tarrytown, New York in 2003 and the publica- Toxoplasma field in the past 5 years and pro-
tion of papers and review articles from this vide a single volume which would continue to
congress in March 2004 in the International represent the breadth of research efforts and
Journal for Parasitology [volume 34, number 3, data on this important pathogenic protist. We
pages 249 432]. It was evident at this congress are fortunate that so many members of the
and confirmed at the Eighth International Toxoplasma research community have gener-
Congress in 2005 (Corsica, France) that the ously donated their time and expertise to
field of study of this pathogen had matured update this book. New authors were added to
considerably since the First International this edition to revise chapters and provide
Congress occurred in 1990 at Dartmouth fresh perspectives on various topics. To this
University (Hanover, NH). This was paralleled end, the second edition contains other perspec-
by the progressive increase in attendance at tives on several of these topics and provides
this International Congress, which grew from complementary data to what is found in this
FIGURE P1 Participants in the First International Congress on Toxoplasmosis held 1990 at the Minary Conference
Center of Dartmouth College, Squam Lake, Holderness New Hampshire, United States.
Bottom: Lloyd Kasper, Rima McLeod, Jean Francois Dubremetz, John Boothroyd, Abott Laboratories (unknown).
Middle: Joseph Schwartzman, Elmer Pfefferkorn, Takuro Endo, Louis M. Weiss, Francoise Darcy, Phillippe Thuiliez, Marie
France Cesbron, Judy Smith, Alan Johnson, Yasu Suzuki, Takashi Asia, J.P. Dubey.
Top: Greg Felice, James L. Fishback, David Sibley, Jack Remington, Alan Sher, Jack Frenkel, David Roos, Keith Joiner,
Benjamin Luft, Bill Current.
Preface to the third edition xix
new edition. Authors of the third edition were We look forward to the ongoing tsunami of
encouraged to review older literature compre- research that will enable the field to more thor-
hensively so that their chapters could serve as oughly understand this important parasite and
free-standing reference articles. its relationship with its animal and human
In our own laboratory groups, this book has hosts giving us further insights into how T.
become our standard educational resource. We gondii has evolved into such a successful intra-
hope that this new edition will continue to pro- cellular parasite.
vide important insights into this pathogen, a
useful synthesis and summary of the current Louis M. Weiss
literature, and suggest new avenues of investi- Bronx, NY, United States, 2019
gations to current and future investigators in Kami Kim
this field. Tampa, FL, United States, 2019
C H A P T E R
1
The history and life cycle of
Toxoplasma gondii
J.P. Dubey
Animal Parasitic Diseases Laboratory, United States Department of Agriculture, Agricultural Research
Service, Beltsville Agricultural Research Center, Beltsville, MD, United States
Toxoplasma Gondii
DOI: https://doi.org/10.1016/B978-0-12-815041-2.00001-3 1 © 2020 Elsevier Ltd. All rights reserved.
2 1. The history and life cycle of Toxoplasma gondii
gundi. This stage has also been called tropho- cysts (Figs. 1.1, 1.2B, and 1.2C) to avoid confu-
zoite, the proliferative form, the feeding form, sion with oocysts. It is difficult to determine
and endozoite. It can infect virtually any cell in from the early literature who first identified
the body. It divides by a specialized process the encysted stage of the parasite (Lainson,
called endodyogeny, first described by 1958). Levaditi et al. (1928) apparently were the
Goldman et al. (1958). Gustafson et al. (1954) first to report that T. gondii may persist in tis-
first studied the ultrastructure of the tachy- sues for many months as “cysts”; however,
zoite. Sheffield and Melton (1968) provided a considerable confusion between the term
complete description of endodyogeny when “pseudocysts” (group of tachyzoites) and tis-
they fully described its ultrastructure. sue cysts existed for many years. Frenkel and
Friedlander (1951) and Frenkel (1956) charac-
terized cysts cytologically as containing organ-
isms with a subterminal nucleus and periodic
1.3.2 Bradyzoite and tissue cysts acid Schiff-positive granules (Fig. 1.2C) sur-
The term “bradyzoite” (Gr. brady 5 slow) rounded by an argyrophilic cyst wall
was proposed by Frenkel (1973) to describe the (Fig. 1.2B). Wanko et al. (1962) first described
stage encysted in tissues. Bradyzoites are also the ultrastructure of the T. gondii cyst and its
called cystozoites. Dubey and Beattie (1988) contents. Jacobs et al. (1960a) first provided a
proposed that cysts should be called tissue biological characterization of cysts when they
Toxoplasma Gondii
1.3 Parasite morphology and life cycle 3
FIGURE 1.2 Life cycle stages of Toxoplasma gondii. (A) Tachyzoites (arrowhead) in smear. Giemsa stain. Note
nucleus dividing into two nuclei (arrow). (B) A small tissue cyst in smear stained with Giemsa and a silver stain. Note the
silver-positive tissue cyst wall (arrowhead) enclosing bradyzoites that have a terminal nucleus (arrow). (C) Tissue cyst in
section, PAS. Note PAS-positive bradyzoites (arrow) enclosed in a thin PAS-negative cyst wall. (D) Unsporulated oocysts in
cat feces. Unstained. PAS, Periodic acid Schiff.
found that the cyst wall was destroyed by pep- Cats excrete oocysts (Fig. 1.2D) with a short
sin or trypsin, but the cystic organisms were prepatent period (3 10 days) after ingesting
resistant to digestion by gastric juices (pepsin- tissue cysts or bradyzoites, whereas after they
HCl), whereas tachyzoites were destroyed ingested tachyzoites or oocysts, the prepatent
immediately. Thus tissue cysts were shown to period was longer ($18 days), irrespective of
be important in the life cycle of T. gondii the number of organisms in the inocula (Dubey
because carnivorous hosts can become infected and Frenkel, 1976; Dubey, 1996, 2001, 2006).
by ingesting infected meat. Jacobs et al. (1960b) Prepatent periods of 11 17 days are thought to
used the pepsin digestion procedure to isolate result from the ingestion of transitional stages
viable T. gondii from tissues of chronically between tachyzoite and bradyzoite (Dubey,
infected animals. When T. gondii oocysts were 2002, 2005).
discovered in cat feces in 1970, oocyst excretion Wanko et al. (1962) and Ferguson and
was added to the biological description of the Hutchison (1987) reported on the ultrastructural
cyst (Dubey and Frenkel, 1976). of the development of T. gondii tissue cysts. The
Dubey and Frenkel (1976) performed the biology of bradyzoites including morphology,
first in depth study of the development of development in cell culture in vivo, conversion
tissue cysts and bradyzoites and described of tachyzoites to bradyzoites, and vice versa, tis-
their ontogeny and morphology. They found sue cyst rupture, and distribution of tissue cysts
that tissue cysts formed in mice as early as 3 in various hosts and tissues was reviewed criti-
days after their inoculation with tachyzoites. cally by Dubey et al. (1998).
Toxoplasma Gondii
4 1. The history and life cycle of Toxoplasma gondii
1.3.3 Enteroepithelial asexual and sexual stages in the cat intestine because there was
stages profuse multiplication of T. gondii 3 days post-
infection (Fig. 1.4A). The entire cycle was com-
Asexual and sexual stages (Figs. 1.3 and pleted in 66 hours after feeding tissue cysts to
1.4) were reported in the intestine of cats in cats (Dubey and Frenkel, 1972). There are
1970 (Frenkel, 1970). Dubey and Frenkel reports on the ultrastructure of schizonts
(1972) described the asexual and sexual devel- (Sheffield, 1970; Piekarski et al., 1971;
opment of T. gondii in enterocytes of the cat Ferguson et al., 1974), gamonts (Ferguson
and designated the asexual enteroepithelial et al., 1974, 1975; Speer and Dubey, 2005),
stages as Types A through E (Figs. 1.3 and 1.4) oocysts, and sporozoites (Christie et al., 1978;
rather than as generations conventionally Ferguson et al., 1979a,b; Speer et al., 1998;
known as schizonts in other coccidian para- Freppel et al., 2019). In 2005 Speer and Dubey
sites. These stages were distinguished mor- described the ultrastructure of asexual
phologically from tachyzoites (Fig. 1.3D) and enteroepithelial Types B through E and distin-
bradyzoites, which also occur in cat intestine. guished their merozoites.
The challenge was to distinguish different
FIGURE 1.3 Asexual and sexual stages of Toxoplasma gondii in sections of small intestine of cats fed tissue cysts.
H&E stain. (A) Type C (arrow) schizont with a residual body and a Type B schizont with a hypertrophied host cell nucleus
(arrowhead). 52 h p.i. (B) Heavily infected small intestine with schizonts in and gamonts in the epithelium. Five days p.i.
(C) Type D and E schizonts (a and d), a mature female gamont (e), young female gamont (b), and two male gamonts (c) in
the epithelium. (D) Tachyzoites in the lamina propria (arrows). Types B and D schizonts are below the enterocyte nucleus
and often cause hypertrophy of the parasitized cell whereas Types D and E schizonts are always above the enterocyte
nucleus and do not cause hypertrophy of the host cell even in hyperparastized cases. Tachyzoites are found in the lamina
propria of the cat intestine.
Toxoplasma Gondii
1.4 Transmission 5
animals, particularly sheep, goats, and rodents.
Congenital infections can be repeated in some
strains of mice (Beverley, 1959), with infected
mice producing congenitally infected offspring
for at least 10 generations. Beverley discontin-
ued his experiments because of high mortality
in some lines of congenitally infected mice and
because the progeny from the last generation
of infected mice was seronegative and pre-
sumed not to be infected with T. gondii. Jacobs
(1964) repeated these experiments and found
that congenitally infected mice may be infected
but not develop antibodies because of immune
tolerance. Dubey et al. (1995a) isolated viable
T. gondii from seronegative naturally infected
mice. These findings are of epidemiological
significance.
1.4.2 Carnivorism
Congenital transmission occurs too rarely to
FIGURE 1.4 Smears of intestinal epithelium of a cat 7 explain widespread infection in man and ani-
days after feeding tissue cysts (Giemsa stain). (A) Note mals worldwide. Weinman and Chandler
different sizes of merozoites (a c), schizont with three (1954) suggested that transmission might occur
nuclei (d), schizont with six or more nuclei and merozoites through the ingestion of undercooked meat.
are budding from the surface (e), and a multinucleated
Jacobs et al. (1960a) provided evidence to sup-
schizont (f). (B) Four biflagellated microgametes (arrows)
and merozoites (arrowhead) for size comparison. port this idea by demonstrating the resistance
to proteolytic enzymes of T. gondii derived
from cysts. They found that the cyst wall was
immediately dissolved by such enzymes but
1.4 Transmission
the released bradyzoites survived long enough
to infect the host. This hypothesis of transmis-
1.4.1 Congenital
sion through the ingestion of infected meat
The mechanism of transmission of T. gondii was experimentally tested by Desmonts et al.
remained a mystery until its life cycle was dis- (1965) in an experiment with children in a
covered in 1970. Soon after the initial discovery Paris sanitorium. They compared the acquisi-
of the organism, it was found that the C. gundi tion rates of T. gondii infection in children
were not infected in the wild and had acquired before and after admission to the sanitorium.
T. gondii infection in the laboratory. Initially, The 10% yearly acquisition rate of T. gondii
transmission by arthropods was suspected, but antibody rose to 50% after adding two portions
this was never proven (Frenkel, 1970, 1973). of barely cooked beef or horse meat to the daily
Congenital T. gondii infection in a human child diet and to a 100% yearly rate after the addi-
was initially described by Wolf et al. (1939a,b) tion of barely cooked lamb chops. Since the
and later found to occur in many species of prevalence of T. gondii is much higher in sheep
Toxoplasma Gondii
6 1. The history and life cycle of Toxoplasma gondii
than in horses or cattle, this illustrated the Histomonas through Heterakis eggs. Hutchison
importance of carnivorism in transmission of initially wanted to test the nematode theory
T. gondii. Epidemiological evidence indicates it using Toxocara canis and T. gondii transmission
is common in humans in some localities where in the dog but decided on the cat and T. cati
raw meat is routinely eaten. In a survey in model because there was no place to house
Paris, Desmonts et al. (1965) found more than dogs (J.P. Dubey, 1965, personal communica-
80% of the adult population sampled had anti- tion). Transmission of T. gondii by T. canis eggs
bodies to T. gondii. Kean et al. (1969) described made more sense because of the known zoo-
toxoplasmosis in a group of medical students notic potential of T. canis; T. cati was not, at
who had eaten undercooked hamburgers. that time, known to infect humans, but T. canis
was. Discovery of the life cycle of T. gondii
would have been delayed if Hutchinson had
worked with dogs instead of cats.
1.4.3 Fecal oral Hutchison’s (1965) report stimulated other
While congenital transmission and carnivor- investigators to examine fecal transmission of
ism can explain some of the transmission of T. gondii through T. cati eggs (Dubey, 1966,
T. gondii, it does not explain the widespread 1968; Jacobs, 1967; Hutchison et al., 1968;
infection in vegetarians and herbivores. A Frenkel et al., 1969; Sheffield and Melton,
study in Bombay, India found the prevalence 1969). The nematode egg theory of transmis-
of T. gondii in strict vegetarians to be similar to sion was discarded after Toxoplasma infectivity
that in nonvegetarians (Rawal, 1959). was dissociated from T. cati eggs (Frenkel
Hutchison (1965), a biologist at Strathclyde et al., 1969), and Toxoplasma infectivity was
University in Glasgow, first discovered T. gon- found in feces of worm-free cats fed T. gondii
dii infectivity associated with cat feces. In a (Frenkel et al., 1969; Sheffield and Melton,
preliminary experiment, Hutchison (1965) fed 1969). Finally, in 1970, knowledge of the T. gon-
T. gondii cysts to a cat infected with the nema- dii life cycle was completed by discovery of the
tode Toxocara cati and collected feces contain- sexual phase of the parasite in the small intes-
ing nematode ova. Feces floated in 33% zinc tine of the cat (Frenkel et al., 1970). T. gondii
sulfate solution and stored in tap water for 12 oocysts, the product of schizogony and game-
months induced toxoplasmosis in mice. This togony, were found in cat feces and character-
discovery was a breakthrough because, until ized morphologically and biologically (Dubey
then, both known forms of T. gondii (i.e., tachy- et al., 1970a,b).
zoites and bradyzoites) were killed by water. Several group of workers independently
Microscopic examination of feces revealed only and about the same time found T. gondii
T. cati eggs and Isospora oocysts. In Hutchison’s oocysts in cat feces (Hutchison et al., 1969,
report, T. gondii infectivity was not attributed 1970, 1971; Frenkel et al., 1970; Dubey et al.,
to oocysts or T. cati eggs. He repeated the 1970a,b; Sheffield and Melton, 1970;
experiment with two T. cati infected and two Overdulve, 1970; Weiland and Kühn, 1970;
T. cati free cats. T. gondii was transmitted only Witte and Piekarski, 1970). The discovery of
in association with T. cati infection. On this T. gondii oocyst in cat feces and its implications
basis, Hutchison (1967) hypothesized that T. has been reviewed by Frenkel (1970, 1973) and
gondii was transmitted through nematode ova. Garnham (1971).
He suspected transmission of T. gondii through In retrospect the discovery and characteriza-
the eggs of the nematode Toxocara similar to tion of the T. gondii oocyst in cat feces was
the transmission of the fragile flagellate delayed because (1) T. gondii oocysts were
Toxoplasma Gondii
1.4 Transmission 7
morphologically identical to oocysts of the Dubey, 2016), Australia (Munday, 1972), and
previously described coccidian parasite of cats the United States (Dubey et al., 1997) have
and dogs (Dubey et al., 1970a) and (2) until shown an absence of Toxoplasma on islands
1970, coccidian oocysts were sporulated in without cats, confirming the important role of
2.5% potassium dichromate. Chromation of the the cat in the natural transmission of T. gondii.
oocysts wall interfered with excystation of the Vaccination of cats with a live mutant strain of
sporozoites when oocysts were fed to mice and T. gondii on eight pig farms in the United
thus the mouse infectivity titer of the oocysts States reduced the transmission of T. gondii
was lower than expected from number of infection in mice and pigs (Mateus-Pinilla
oocysts administered (Dubey et al., 1970a). et al., 1999), thus supporting the role of the cat
These findings led to the use of 2% sulfuric in natural transmission of T. gondii.
acid as the best medium for sporulation and Historically, before the discovery of the cocci-
storage of T. gondii oocysts. Unlike dichromate, dian cycle of T. gondii, coccidian parasites were
which was difficult to wash off the oocysts, sul- considered host and site specific and to be trans-
furic acid could be easily neutralized, and the mitted by the fecal oral route. After the discov-
oocysts could be injected without washing into ery of the sexual cycle of T. gondii, several other
mice (Dubey et al., 1972). Unlike other cocci- genera (e.g., Sarcocystis and Besnoitia) were
dians, T. gondii oocysts were found to excyst found to be coccidian. Although T. gondii has a
efficiently when inoculated parenterally into wide host range, it has retained the definitive-
mice and thus alleviated the need for oral inoc- host specificity restricted to felids. Dr. J.K.
ulation for bioassay of oocysts (Dubey and Frenkel deserves the credit for initiating testing
Frenkel, 1973). of many species of animals, including wild
Ben Rachid (1970) fed T. gondii oocysts to felids, for oocyst excretion under difficult (it was
gundis which died 6 7 days later from toxo- not easy handling bob cats and ocelots in cages)
plasmosis. This knowledge about the life cycle housing conditions (Dubey, 2009). Only the
of T. gondii probably explains how gundis felids were found to excrete T. gondii oocysts
became infected in the laboratory of Nicolle. At (Frenkel et al., 1970; Miller et al., 1972).
least one cat was present in the Pasteur Although T. gondii can be transmitted in several
Laboratory in Tunis (Dubey, 1977). ways, it has adapted to be transmitted most effi-
Of the many species of animals experimen- ciently by carnivorism in the cat and by the
tally infected with T. gondii, only felids excrete fecal oral (oocysts) route in other hosts. Pigs
T. gondii oocysts (Miller et al., 1972; Jewell and mice (and presumably humans) can be
et al., 1972; Janitschke and Werner, 1972; infected by ingesting even one oocyst (Dubey
Polomoshnov, 1979; Dubey, 2010). Oocysts et al., 1996), whereas 100 oocysts may not infect
excreted into the environment have caused cats (Dubey, 1996). Cats can excrete millions of
several outbreaks of disease in humans oocysts after ingesting only one bradyzoite,
(Teutsch et al., 1979; Benenson et al., 1982; while ingestion of 100 bradyzoites may not
Bowie et al., 1997; de Moura et al., 2006). T. infect mice orally (Dubey, 2001, 2006). This infor-
gondii oocysts found in the feces of naturally mation has proved very useful in conducting
infected cougars (Aramini et al., 1998) were epidemiological studies and for the detection by
epidemiologically linked to the largest feeding to cats of low numbers of T. gondii in
recorded waterborne outbreak of toxoplasmo- large samples of meat (Dubey et al., 2005).
sis in humans (Bowie et al., 1997). Understanding the biology of T. gondii
Seroepidemiological studies on isolated islands oocyst excretion by cats (both wild and domes-
in the Pacific (Wallace, 1969, for full story see tic is essential for reducing prevalence of
Toxoplasma Gondii
8 1. The history and life cycle of Toxoplasma gondii
T. gondii in humans and animals. Although were homogenized in saline and inoculated
cats are thought to excrete oocysts only once in intracerebrally into rabbits and mice. These
their life after primary infection, there are no animals developed encephalitis, T. gondii was
guaranties that they will not do so the second demonstrated in their neural lesions, and
time. Immunity can wane with time (Dubey, T. gondii from these animals was successfully
1995); cats have excreted millions of oocysts passaged into other mice.
the second time after challenge with unrelated Wolf, Cowen, and Paige reviewed in detail
organisms (Dubey, 1976) or challenge with het- their own cases and those reported by others,
erologous T. gondii strains (Zulpo et al., 2018). particularly Janků (1923), and Torres (1927)
Therefore pregnant women should avoid con- of T. gondii like encephalomyelitis and chor-
tact with cat feces, irrespective of the serologi- ioretinitis in infants (Wolf and Cowen, 1937,
cal status of the cat. 1938; Wolf et al., 1939a,b, 1940; Cowen et al.,
After the discovery of the life cycle of 1942; Paige et al., 1942). Janků (1923), an oph-
T. gondii in the cat, it became clear why thalmologist from Czechoslovakia, was cred-
Australasian marsupials and New World mon- ited earlier with finding a T. gondii like
keys are highly susceptible to clinical toxoplas- parasite in a human eye. The following
mosis. The former evolved apparently in the description of the case of Janků is taken from
absence of the cat (there were few or no cats in the English translation published by Wolf
Australia and New Zealand before settlement and Cowen (1937): “The patient was born
by Europeans) and the latter lives on tree tops, with left microphthalus and became blind at
not exposed to cat feces. In contrast, marsu- the age of 3 months, and had hydrocephalus.
pials in America and Old World monkeys are The child died when 11 months old. The eyes
resistant to clinical toxoplasmosis (Dubey and and brain were removed at autopsy. Grossly,
Beattie, 1988). the child had internal hydrocephalus but the
brain was not available for histopathological
examination. Chorioretinitis was present in
both eyes and cysts-like structures (termed
1.5 Toxoplasmosis in humans sporocysts by Janků) were seen in the right
eye.” Janků (1923) thought that this parasite
1.5.1 Congenital toxoplasmosis was Encephalitozoon (a microsporidia). The
Three pathologists, Wolf, Cowen, and Paige material from this case is thought to be
from New York, United States, first conclu- destroyed in World War bombing, and so
sively identified T. gondii in an infant girl who confirmation of these findings is not possible.
was delivered full term by cesarean section on Torres (1927) found protozoa in lesions of
May 23, 1938, at Babies Hospital, New York encephalitis in a 2-day-old girl in Rio de
(Wolf et al., 1939a,b). The girl developed con- Janeiro, Brazil. Numerous organisms were
vulsive seizures at 3 days of age, and lesions seen, but these were thought to be a new
were noted in the maculae of both eyes species of Encephalitozoon. This patient
through an ophthalmoscope. She died when a also had myocarditis and myositis. In the
month old and an autopsy was performed. At Netherlands, de Lange (1929) found protozoa
postmortem, brain, spinal cord, and right eye in sections of the brain of a 4-month-old
were removed for examination. Free and intra- child that was born with hydrocephalus.
cellular T. gondii were found in lesions of These sections were reexamined by Wolf and
encephalomyelitis and retinitis of the girl. Cowen, and a full account was reviewed by
Portions of cerebral cortex and spinal cord Sabin (1942).
Toxoplasma Gondii
1.5 Toxoplasmosis in humans 9
Sabin (1942) summarized all that was the child and became the famous RH strain.
known of congenital toxoplasmosis in 1942 Only small lesions of nonsuppurative encepha-
and proposed typical clinical signs of litis were found microscopically in the brain of
congenital toxoplasmosis: hydrocephalus or this child. Neither gross lesions and nor any
microcephalus, intracerebral calcification, and viral or bacterial infections were found. This
chorioretinitis. These signs helped in the clini- child most likely had acquired T. gondii infec-
cal recognition of congenital toxoplasmosis. tion recently, and the blow to the head was
Frenkel and Friedlander (1951) published a coincidental and unrelated to the onset of
detailed account of five fatal cases of toxoplas- symptoms. It is noteworthy that some mice
mosis in infants that were born with hydro- infected with the original RH strain did not die
cephalus; T. gondii was isolated from two of until day 21 postinoculation. By the third-
these infants. They described the pathogenesis passage mice died in 3 5 days after inocula-
of internal hydrocephalus as a blockage of the tion. The RH strain of T. gondii has since 1938
aqueduct of Sylveus due to ventriculitis result- been passaged in mice in many laboratories.
ing from a T. gondii antigen antibody reaction. After this prolonged passage, its pathogenicity
This lesion is unique to human congenital toxo- for mice has been stabilized (Dubey, 1977), and
plasmosis and has never been verified in other it has lost the capacity to produce oocysts in
animals (J.P. Dubey, unpublished). This report cats (Frenkel et al., 1976). Additional details of
was the first in depth description of lesions of history of toxoplasmosis in humans were given
congenital toxoplasmosis not only in the by Dubey (2008) and Weiss and Dubey (2009).
central nervous system but also other organs.
Hogan (1951) also provided the first detailed 1.5.2.2 Toxoplasmosis in adults
clinical description of ocular toxoplasmosis. Pinkerton and Weinman (1940) identified
T. gondii in the heart, spleen, and other tissues
of a 22-year-old patient who died in 1937 in
1.5.2 Acquired toxoplasmosis Lima, Peru. The patient exhibited fever and con-
comitant Bartonella sp. infection. Pinkerton and
1.5.2.1 Children Henderson (1941) isolated T. gondii from blood
Sabin (1941) reported toxoplasmosis in a and tissues of two (50 and 43 years old) indivi-
6-year-old boy from Cincinnati, Ohio. An duals who died in St. Louis, Missouri. Recorded
asymptomatic child with initials of RH was hit symptoms included rash, fever, and malaise.
with a baseball bat on October 22, 1937. He These were the first reports of acute toxoplas-
developed a headache 2 days later and convul- mosis in adults without neurological signs.
sions the day after. He was admitted to the
hospital on the 7th day but without obvious 1.5.2.2.1 Lymphadenopathy
clinical signs. Except for lymphadenopathy Siim (1956) drew attention to the fact that
and enlarged spleen, nothing abnormal was lymphadenopathy is a frequent sign of acquired
found. He then developed neurological signs toxoplasmosis in adults, and these findings
and died on the 30th day of illness. The brain were confirmed by Beverley and Beattie (1958)
and spinal cord were removed for histopatho- who reported on the cases of 30 patients. A full
logical examination and bioassay. Because of appreciation of the clinical symptoms of
the suspicion of polio virus infection a homog- acquired toxoplasmosis was achieved, when
enate of cerebral cortex was inoculated into outbreaks of acute toxoplasmosis were reported
mice. T. gondii was isolated from the inoculated in adults in the United States (Teutsch et al.,
mice, and this isolate was given the initials of 1979) and in Canada (Bowie et al., 1997).
Toxoplasma Gondii
10 1. The history and life cycle of Toxoplasma gondii
Toxoplasma Gondii
1.7 Diagnosis 11
and categorizing them by hosts and topics. common cause of fatal encephalomyelitis in
This work proved useful for literature searches horses in the Americas (Dubey et al., 2001).
before electronic databases. S. neurona was also found to cause systemic
Toxoplasmosis in sheep deserves special disease entities involving eyes, lungs, muscles,
attention because of its economic impact. and neural tissues in pets and wildlife (Dubey
William Hartley, a well-known veterinary et al., 2015).
pathologist from New Zealand, and his associ- The finding of T. gondii in marine mammals
ates J.L. Jebson and D. McFarlane, discovered deserves special mention. Before the discovery
T. gondii like organisms in the placentas and of T. gondii oocyst, no one would have sus-
fetuses of several unexplained abortions in pected that the marine environment would be
ewes in New Zealand. They called it New contaminated with T. gondii and that fish-
Zealand Type II abortion. Hartley and eating marine mammals would be found
Marshall (1957) finally isolated T. gondii from infected with T. gondii (Dubey et al., 2003a,b;
aborted fetuses. Hartley (1961) and Jacobs and Conrad et al., 2005; Thomas et al., 2007; Miller
Hartley (1964) experimentally induced toxo- et al., 2008; Dubey, 2010). Thomas and Cole
plasmic abortion in ewes. The identification of (1996) and Cole et al. (2000) isolated viable
T. gondii abortion in ewes was a landmark dis- T. gondii from sea otters in the United States.
covery in veterinary medicine. Prior to that Several reports have now appeared that con-
protozoa were not recognized as cause of epi- firm that T. gondii can occur in many species of
demic abortion in livestock. Subsequently, marine mammals (Dubey, 2010).
Beverley and Watson (1961) recognized epi-
demics of ovine abortion in the United
Kingdom. Dubey and Towle (1986) and Dubey
1.7 Diagnosis
and Beattie (1988) summarized all that was
known about toxoplasmosis in sheep and its
The current management, diagnosis, and
impact on agriculture. Millions of lambs are
clinical manifestations of T. gondii infection in
still lost throughout the worldwide due to this
humans are discussed in Chapter 4, Human
infectious disease.
Toxoplasma infection.
Sanger and Cole (1955) were first to isolate
T. gondii from a food animal. Dubey and
Beattie (1988) and Dubey (2010) reviewed the
worldwide literature on toxoplasmosis in
1.7.1 Sabin Feldman dye test
humans and other animals. The discovery and Development of a novel serologic test, the
naming of two new organisms, Neospora cani- dye test, by Sabin and Feldman (1948), was
num (Dubey et al., 1988) and Sarcocystis neurona perhaps the greatest advancement in the field
(Dubey et al., 1991), that were previously of toxoplasmosis. The dye test is highly sensi-
thought to be T. gondii, resulted in new infor- tive and specific with no evidence for false
mation on the host distribution of T. gondii. We results in humans. Even titers as low as 1:2 are
now know that cattle and horses are resistant meaningful for the diagnosis of ocular disease.
to clinical T. gondii; there have been no con- The ability to identify T. gondii infections based
firmed cases of clinical toxoplasmosis in either on a simple serological test opened the door
cattle or horses (Dubey, 2010). N. caninum was for extensive epidemiological studies on the
found to be a common cause of abortion in incidence of infection. It became clear that
cattle worldwide (Dubey, 2003; Dubey et al., T. gondii infections are widely prevalent
2017), and S. neurona was found to be a in humans in many countries. It also
Toxoplasma Gondii
12 1. The history and life cycle of Toxoplasma gondii
demonstrated that the so-called tetrad of chickens (Dubey et al., 2016). Even low MAT
clinical signs considered indicative of clinical titers (,1:10) were found specific.
congenital toxoplasmosis occurred in other
diseases and assisted in the differential diagno-
sis (Sabin and Feldman, 1949; Feldman and 1.7.4 Detection of Toxoplasma gondii
Miller, 1956). DNA
Burg et al. (1989) first reported detection of
T. gondii DNA from a single tachyzoite using
1.7.2 Detection of IgM antibodies the B1 gene in a polymerase chain reaction
(PCR). Several subsequent PCR tests have been
Remington et al. (1968) first proposed the
developed using different gene targets.
usefulness of the detection of IgM antibodies in Overall, this technique has proven very useful
cord blood or infant serum for the diagnosis of in the diagnosis of clinical toxoplasmosis
congenital toxoplasmosis since IgM antibodies (Remington et al., 2011).
do not cross the placenta, whereas IgG antibo-
dies do cross the placenta. Remington (1969)
modified the indirect fluorescent antibody test
and the ELISA (Naot and Remington, 1980) to 1.8 Treatment
detect IgM in cord blood. Desmonts et al.
(1981) developed a modification of IgM-ELISA, Sabin and Warren (1942) reported the effec-
combining it with the agglutination test (IgM- tiveness of sulfonamides against murine toxo-
ISAGA) to eliminate the necessity for an plasmosis, and Eyles and Coleman (1953)
enzyme conjugate. Although IgM tests are not discovered the synergistic effect of combined
perfect, they have proved useful for screening therapy with sulfonamides and pyrimeth-
programs (Remington et al., 2001). amine; the latter is the standard therapy for
toxoplasmosis in humans (Remington et al.,
2001). Garin and Eyles (1958) found spiramycin
1.7.3 Direct agglutination test to have antitoxoplasmic activity of in mice.
Since spiramycin is nontoxic and does not
The development of a simple direct aggluti- cross placenta, it has been used prophylacti-
nation test has aided tremendously in the sero- cally in women during pregnancy to reduce
logical diagnosis of toxoplasmosis in humans transmission of the parasite from mother to
and other animals. In this test, no special fetus (Desmonts and Couvreur, 1974b).
equipment or conjugates are needed. This test
was initially developed by Fulton (1965) and
improved by Desmonts and Remington (1980)
1.9 Prevention and control
and Dubey and Desmonts (1987) who called it
the modified agglutination test (MAT). The 1.9.1 Serologic screening during
MAT has been used extensively for the diagno-
sis of toxoplasmosis in animals (Dubey, 2010).
pregnancy
The sensitivity and specificity of MAT has Georges Desmonts initiated studies in
been validated by comparing serologic data Paris, France in the 1960s looking at serocon-
and isolation of the parasite from naturally and version in women during pregnancy and the
experimentally infected pigs (Dubey, 1997; transmission of T. gondii to the fetus. Blood
Dubey et al., 1995a,b) and naturally infected was obtained at the first visit, at 7 months,
Toxoplasma Gondii
References 13
and at the time of parturition. Desmonts initi- consumption remains the easiest and most eco-
ated prophylactic treatment of women who nomical method of reducing transmission of
seroconverted during pregnancy. Results of T. gondii through meat.
the 15-year study demonstrated that (1) infec-
tion acquired during the first two trimesters
was most damaging to the fetus, (2) not all 1.9.3 Animal production practices
women that acquired infection transmitted it Extensive epidemiological studies on pig
to the fetus, (3) women seropositive prior to farms in the United States in 1990s concluded
pregnancy did not transmit infection to the that keeping cats out of the pig barns and rais-
fetus, and (4) treatment with spiramycin ing pigs indoors can reduce T. gondii infection
reduced congenital transmission, but not clini- in pigs (Dubey et al., 1995a,b; Weigel et al.,
cal disease in infants (Desmonts and 1995). Because of changes in pig, husbandry
Couvreur, 1974a,b). At about the same time, prevalence of viable T. gondii in pigs is reduced
Thalhammer (1973, 1978) initiated a similar to ,1% (Dubey et al., 2005). Because ingestion
screening program for pregnant women in of infected pork is considered the main meat
Austria. In addition to scientific knowledge, source of T. gondii for humans (at least in the
these screening programs have helped to dis- United States), the prevalence of T. gondii in
seminate information for the prevention of humans in the United States has decreased in
toxoplasmosis. the past decade (Jones et al., 2007).
A neonatal serological screening and early
treatment for congenital T. gondii infection was
initiated in Massachusetts, United States in 1.9.4 Vaccination
1980s (Guerina et al., 1994). The efficacy of
Vaccination of sheep with a live cyst-less
treatment of T. gondii infection in the fetus and
strain of T. gondii reduces neonatal mortality in
newborn is not fully delineated, and many
lambs, and this vaccine is available commer-
issues related to the cost and benefit of screen-
cially (Wilkins and O’Connell, 1983; Buxton
ing and treatment in pregnancy and in new-
and Innes, 1995). To date, there is no vaccine
borns remain to be examined.
suitable for human use.
Toxoplasma Gondii
Another random document with
no related content on Scribd:
[Inhoud]
RATTEN, KOGELFLESCHJES EN LADDERS!
Het is voor negenen in den morgen. Een gedeelte van de bende staat voor de
school te knikkeren.
Een schel gefluit kondigt de nabijheid van Ambro aan en deze komt in vollen
draf aangerend, z’n knikkerzak boven z’n hoofd zwaaiend, als een cavalerist,
die op den vijand aanrukt.
Maar Ambro luistert niet naar hem. Hij is vervuld van het groote nieuws, dat
hij ze moet vertellen.
„Daar zou ik zoo’n drukte van maken? Neen, ’t is geen zij, maar een hij.”
„Nog eenmaal raden,” roept Ambro en hij zet een gewichtig gezicht.
„Nou,” zegt Chris. „Dan is er nog maar een die ’t kan zijn … de directeur van
den Dierentuin.”
Wim Bolk was met de noorderzon vertrokken, want z’n vertrek viel juist in de
groote vacantie, toen het meerendeel der jongens uit de stad was.
Den eersten tijd had hij nog wel met hen gecorrespondeerd, ofschoon die
correspondentie uitsluitend bestond uit een prentkaart, met zijn naam er
onder. Maar vrij spoedig hielden ook deze levensteekenen op en dachten de
jongens niet meer aan elkaar.
„Zeg, jongens, hij komt weer hier wonen,” zei Ambro. „Z’n vader is weer
overgeplaatst.”
„In Haarlem. Hij vraagt me of jullie ’t allemaal goed maken en of het Hol van
Kaan nog bestaat. Met September gaat hij naar de H.B.S.”
„We hebben veel keet met hem gehad,” zegt Chris. „’t Was een eerste-klas-
keet-schopper.”
„An z’n brief zou je ’t niet zeggen,” zegt Ambro die den brief voor den dag
haalt.
Gij zult waarschijnlijk Uw oud mede-lid, die thans de pen heeft opgenomen om zijne
vroegere bondgenooten te verwittigen van zijn … barst!… ik kan er niet uit komen.
[143]
Zeg, kerels, ik kom fijn weer in Rotterdam wonen, en dan zullen we de peentjes
opscheppen.
Dan wij, hè! Weet jullie nog, die keet aan de haven, toen Ambro aan de kraan hing.
Toen ik ’t die brave Haarlemmer halletjes vertelde, wilden ze ’t niet eens gelooven.
Een was wel eens in Rotterdam geweest en had, bij z’n terugkeer, z’n voeten
geveegd, vóór hij in Haarlem aankwam.
Nou, ik heb wat vaak naar de Rotterdamsche modder verlangd! Nog twee weekie’s,
dan ben ik er weer!
Leeft Alebes nog? Maken jullie het allemaal goed? En hoe staat ’t met het Hol van
Kaan? Met September ga ik naar de H.B.S. Jullie ook zeker? Ik hoop maar, dat we
allemaal op dezelfde komen. Een reuzen-keet, zeg!
Komen jullie me allemaal van den trein halen, dan schrijf ik nog hoe laat ik kom.
Wim.
„Ik had ’m ook geen gezicht meer aangekeken,” zegt Puckie. [144]
Ze vonden het allen eenparig fijn, dat ie terugkwam en Ambro vond, dat zijn
terugkeer feestelijk gevierd moest worden.
„Fijn, vanmiddag vrij, kunnen we verder vergaderen in het Hol,” zegt Ambro.
In korten tijd ligt het schoolplein, eerst zoo vol lawaai van joelende jongens,
nu stil en verlaten daar en wordt de schooldeur hard en onverbiddelijk achter
ze gesloten.
„Maar, dat is niets, dan maar wat turnen.” En meteen trekt hij zich op aan een
horizontale ijzeren stang en maakt den buik-zwaai.
In minder dan geen tijd bengelen nu alle jongens aan de zijstangen naast de
leege hokken.
„Neen,” zegt Ambro. „In dien kletsregen is ’t niks gedaan, dan zijn ze d’r niet
eens.”
„Wel neen, niet buiten,” schreeuwt Chris terug. „Hier zitten d’r bij de vleet.
Maar we moeten voorzichtig te werk gaan,… ik weet precies door welk gaatje
ze ’m piepen. Daar ginds,” wijst hij. „Tegen ’t schot bij den chimpansee.”
„Dat ’s te gevaarlijk,” zegt Paul. „Een rat in angst vliegt je naar de keel.”
„O, daar heb je juffrouw Piepzak! Hoor je ’t jongens, Paul knijpt ’m alweer,”
plaagt Puckie.
„Als we ons nou koest houden, komen ze daar maïs vreten, want je begrijpt
wel, dat ze, als we blijven schreeuwen en lawaai schoppen, kalm in hun
holletje blijven.”
„Ik begrijp er niks van,” zegt Ambro. „Wat mot je nou eigenlijk met die cape?”
„Laat me dan ook uitspreken. Achter deze deuren stellen we ons op, dan zal
je zien, dat de ratten spoedig komen, want toen we daarnet binnenkwamen
zag ik ze „weg-peesen”. Dan gaan ze, zòò, langs den heelen muur en aan het
einde moeten ze een gangetje oversteken voor ze bij hun hol zijn. [146]
„Wij loopen met een cape daar ook naar toe, zoo hard we kunnen, hè! dan
gooien we de cape bliksemsnel op een rat en gaan er op dansen. Ben
reuzen-bak, jongens! ik heb ’t al meer gedaan.”
„Och, Lutjebroek, als je bang bent, hoepel dan maar op. Trouwens, we doen
er een goed en nuttig werk meê.”
„Ja,” merkt Paul schamper op. „Een maand den tuin uit als je een dooje rat op
het kantoor brengt.”
„En één ding, jongens, kop dicht! Wie kabaal maakt, krijgt een peut in z’n
ribben.”
„Er kaikt mit één oogie!” imiteert Ambro een clown waarvan hij pas genoten
heeft, als hij Chris zoo naar één punt ziet staren.
Maar vijf stompen doen hem er aan herinneren, dat het wachtwoord „kop
dicht” is.
„Nog één keer,” dreigt veldheer Chris. „En dan smeer je ’m maar, jij bederft
altijd alles met je flauwe kul.” [147]
Hun geduldig wachten wordt beloond. Een stevige rat schiet met een telkens
afgebroken vaart rrrtsss langs den muur.
Zóó is bij op zijn hoede voor dreigend gevaar, dat hij zich telkens
onbewegelijk houdt, en, geen onraad bespeurend, weer snel vooruit schiet.
De jongens behoeven zich nu geen geweld meer aan te doen om stil te zijn.
Ademloos bespieden ze, met groote tintelende oogen, iedere beweging van
hun prooi.
De rat loopt z’n noodlot tegemoet, hij is den bak met maïs genaderd.
Als een pijl uit den boog, schiet Chris met zijn cape vooruit, de jongens volgen
hem. En de rat vliegt in volle vaart terug langs den muur, maar Chris is hem
vóór, en juist, als het dier het gangetje oversteekt werpt hij handig de cape
over hem heen en begint luid schreeuwend, een woesten oorlogsdans boven
op hem.
De jongens volgen direct zijn voorbeeld en als een troepje Indianen om een
gevangen blanken broeder, zoo voeren ze hun krijgsdans uit.
De rat, die niet weet, hoe hij ’t heeft, wijst door sprongen de plaats aan waar
hij zich onder de cape bevindt en iedere sprong, wordt beantwoord met een
trap naar zijn kant.
„Hou op, jongens, da’s wreed,” roept Paul met [148]ongewone stemverheffing.
„As-t-ie dood moet, best, maar dan ineens.”
Ze zien hem daar ineens, bleek en klein tegen den muur gedrukt staan.
„Bah! hij is bang,” zegt smalend Chris.
„Maar ik vind jullie laf. Je hebt ’m nou toch gepakt, laat ’m nou weer los.”
Deze woorden van Paul hebben de jongens toch even tot kalmte gebracht, en
de rat heeft deze tijdelijke rust benut om onder de cape weg te schieten en
vliegensvlug in zijn hol te verdwijnen.
„Dàt kê-je denken,” antwoordt Chris. „Nou duurt ’t uren voor-ie weer komt.”
„Paul kijkt er beteuterd van,” zegt Ambro. „Jij [149]moet maar rokken gaan
dragen,” smaalt Piet.
Paul, nu gerustgesteld over het lot van de rat, trekt zich van al die gezegden
bitter weinig aan.
Chris, die inziet, dat er niet veel meer in het oude apenhuis te doen valt, zegt:
„We zullen zien,” en met loopt hij naar den ingang en constateert het heugelijk
feit, dat de zon is doorgebroken.
Geen van hen weet iets te bedenken en de bende slentert doelloos voort in
de richting van de groote sociëteit.
„Eerst me vriendin bezoeken,” zegt Ambro. „Ik weet geen raad van den dorst.”
De vriendin van Ambro is een oude juffrouw, meer bekend onder den naam
van „het watervrouwtje”. Ze verkoopt glazen water voor 1 cent per stuk en is
tevens opper-„privaat”-meesteres.
Ambro stond bij haar in een goed blaadje, omdat hij dikwijls voor haar op de
torenklok ging kijken hoe laat het was. Als belooning mocht hij dan zooveel
water drinken als hij wilde.
Maar nu, zonder haar opdracht af te wachten, bracht hij haar de tijding, dat
het zeven minuten [150]over drieën was, waarop ze hem vriendelijk bedankte
en vroeg of hij niet wat wilde drinken.
„Zes glazen drink ik vandaag,” was het antwoord van Ambro. „En als ik ze niet
alleen op kan, zullen me vrienden wel helpen.”
En zich tot dezen richtend, riep hij: „Jongens, ik geef een rondje water.”
Zes groote glazen werden naar binnen geklokt. De jongens namen afscheid
van het oudje en vervolgden hun weg.
Toen ze de sociëteit genaderd waren, riep Puckie: „Kijk es, het kelderluik staat
open, laten we stiekum naar binnen kruipen en lol maken.”
Een ontelbaar aantal stoeltjes stond in lange rijen tegen den achtermuur van
de sociëteit, klaar, om vervoerd te worden naar het groote terrein bij de
muziektent.
„Zou er niemand zijn,” fluistert Ambro en hij luistert aandachtig aan het
kelderluik.
„Ik hoor niks. Nou stil, jongens, ik zal wel voor gaan.” En hij daalt
behoedzaam het trapje af, dat naar den kelder voert. De rest van de bende
volgt. En nu staan ze in den half-duisteren kelder.
„En vol ratten,” plaagt Ambro. „Volgen jullie me maar, straks zitten we in stik-
duisteren nacht.”
De kelder loopt door onder de geheele sociëteit en heeft dus een verbazende
omvang. [151]
De jongens staan nu voor een vierkant gat in den muur, ongeveer een meter
boven den beganen grond.
Het schaarsche licht, dat door een raampje valt, maakt, dat ze nog net
kunnen zien, waar ze zich bevinden.
„Hier moeten we inkruipen,” zegt Ambro. „Maar pas op, dat je je kop niet
stoot, ’t is hier bar laag.”
„Een mooie boel hier,” gromt Chris. „Waar kruip ik eigenlijk over heen?
Kolengruis of zand?”
„Dat zal je wel zien als je weer buiten bent,” zegt Ambro en hij waarschuwt
voor een gaspijp, die dwars over hun weg ligt.
„Waar ga je eigenlijk naar toe,” roept Karel, die evenmin als Chris erg veel
pleizier schijnt te hebben in dit duistere avontuur.
„Nog veertig meter ongeveer moeten we vooruit kruipen, dan komen we uit de
benauwenis en vinden als belooning voor ons ploeteren een heelen stapel
kogelfleschjes.”
Dit „prikkelende” vooruitzicht doet de jongens verder zonder morren hun weg
vervolgen over stof en kolengruis, gaspijpen en glasscherven en dat alles,
kruipend op hun buik in volslagen duisternis.
„Ik zoek frambozen uit,” zegt Piet. „Als je tenminste zien kan wat je te pakken
hebt.”
En Ambro, die dit reeds lang wist, maar zonder dit aanlokkelijk vooruitzicht
geen kans zag de bende mee te krijgen op dezen luguberen tocht door de
catacomben, zegt met het onnoozelste gezicht van de wereld:
„Hebben we daarvoor zoo gezwoegd? Als je nog eens wat weet,” zegt Chris,
z’n handen van kolengruis reinigend.
„Nou, wees maar koest,” kalmeert Ambro. „Jullie krijgen ieder van mij een
mooi glazen knikkertje,” en meteen ketst hij met kracht een kogelfleschje
tegen den muur.
„Hier heb je er al een,” zegt hij, het glazen kogeltje aan Paul gevend. [153]
In minder dan geen tijd, heeft ieder een stuk of tien fleschjes gebroken en met
rijken buit belaân, wordt langs denzelfden moeilijken weg de terugtocht
aanvaard.
„Ik zal blij zijn als we weer buiten staan. Au!” schreeuwt Puckie, die vergeten
is, dat de zoldering maar een halve meter hoog is.
„Puckie denkt, dat z’n kop een kogelfleschje is,” lacht Ambro.
„Zouden ze niets gehoord hebben,” vraagt Paul bevreesd.
„Vast en zeker,” stelt Ambro hem gerust. „We vinden nu de deur gesloten en
een man tot de tanden toe gewapend er voor. Maar dat is niets, ik weet een
geheimen uitgang.”
Eindelijk zijn ze weer bij het vierkante gat gekomen, waardoor heen ze hun
tocht begonnen zijn.
„Wat moeten we nou beginnen?” zegt Paul en ook de andere jongens zien de
toekomst donker in.
In werkelijkheid, wilde Ambro z’n makkers slechts schrik aanjagen, want, het
kelderluik stond nog open en de geheime gang bestond slechts in zijn
verbeelding.
„Hij liegt,” roept Chris, die direct na Ambro [154]het gat bereikte. „We kunnen er
uit, hoor!”
„Hè, gelukkig maar,” zucht Paul opgelucht „Ik was al bang den tuin uitgetrapt
te worden.”
Behouden staat het zestal weer buiten en als ze elkaar bekijken, schateren ze
het uit. Ze zijn veranderd in negers, hun kleeren, bedekt met een dikke laag
stof en spinrag, de gezichten zwart van kolengruis.
„Ja, jullie hebben lol,” zegt Paul beteuterd. „Maar ik heb pas een nieuw pakkie
an, daar zit weer wat op.”
„Kolengruis zit er op,” plaagt Ambro. „En dat zal er wel af gaan ook,” en hij
begint Paul zóó hardhandig af te kloppen, dat deze het uitschreeuwt van pijn.
„Tjonge, jonge, wat stuift het? Weet je wat we doen, jongens? we gaan straks
naar het weiland achter het spoor en brengen onze kleertjes weer netjes in
orde, en …”
„Da’s van later zorg,” valt Piet Ambro in de rede. „Ik zie een hooge ladder
staan.”
„Des te beter, dan ga jij op den uitkijk staan en waarschuwt als er iemand
aankomt,” zegt Piet.
„Hij gaat heelemaal tot het dak, zie je wel. Ik [155]zal wel weer voorgaan.” En
Ambro begint de ladder te beklimmen.
„Goed uitkijken, Paul,” roept hij toen hij midden op de ladder is gekomen.
Piet wil hem onmiddellijk volgen, maar de ladder begint bij deze beweging zoo
onregelmatig te zwiepen, dat Ambro, een beetje benauwd, naar beneden kijkt
en tot Piet schreeuwt:
En Piet houdt zich nu stil en hoeft niet lang te wachten, want Ambro is het
bovenste terras van de sociëteit genaderd.
„Hè, wat een fijn uitzicht!” zegt hij uitblazend. „Piet, nou kan je komme.”
„Wat nou?” vraagt Chris. „Daar staan we! Vriezen we dood, dan vriezen we
dood!”
„O, we kunnen nog hooger,” is Ambro’s antwoord. „En dan zullen we wel
verder zien.”
„Jij commandeert ons maar den heelen middag,” zegt Chris. „En wij doen
maar als makke schapen je zin.”
Ambro heeft nu een tweede ladder ontdekt, veel kleiner dan die ze
beklommen hebben en die naar het dak voert. [156]
Hij haalt een groote fluit voor den dag en wijst naar een paar
goederenwagens op het spoorterrein achter den Dierentuin, die gerangeerd
moeten worden.
De fluit van den rangeerder had hem de booze gedachte ingegeven, ook zijn
fluit te gebruiken en daarmee den boel in de war te sturen.
De jongens zitten nu naast elkaar langs de daklijst. Plotseling laat Ambro een
langgerekt gefluit hooren en zóó zuiver was de nabootsing van het rangeer-
signaal, dat de machinist in den waan werd gebracht en de locomotief tot
staan bracht, met het gevolg, dat onmiddellijk een tegen-signaal volgde van
den rangeerder.
En toen Ambro voor de tweede maal deze grap uithaalde, kreeg de man de
bende op het dak in de gaten en begon luid vloekend met zijn vuist te dreigen,
terwijl hij ze den raad gaf gauw met dat spelletje op te houden.
De waarschuwing van den man werd ontvangen met een waar hoongelach
van de brutale bengels, maar plotseling werden ze opgeschrikt door een
alarmkreet van Paul, die hen toeriep dat de werklieden in aantocht waren.
„Hij houdt ons voor ’t lappie,” zegt Ambro. [157]„Hij is natuurlijk bang, dat we
weer den tuin uitgetrapt worden, blijf maar gerust zitten, jongens, en die kerel
aan den overkant kan toch niet bij ons komen, laat die maar vloeken.”
„Help es, Jan,” zegt de metselaar tot z’n zoon, een stevige, jonge borst. „We
zullen es effe dat laddertje weghalen,” en luid voegde hij er aan toe: „Dan
hebbe de heere daarbofe gratis losjies!”
„Zie je wel,” zegt Chris boven nijdig tot Ambro. „Paul hield ons niet voor de
mal, da’s niks voor hem.”
„Hij heeft weer es wat gedaan,” vult Puckie aan en de heele bende is ineens
tegen Ambro.
„Leggen jullie nou niet an me kop te kletsen,” zegt deze. „Maar laten we liever
een middel bedenken, hoe we zonder die ladder naar beneden kunnen
komen.”
„Dat wordt nek breken,” zegt Karel. „Ik heb geen zin in een doodval.”
„Al gevonden,” juicht Ambro. „Ze zullen een reuzen-strop hebben! Vlug
jongens, volg me!” en hij daalt de kleine ladder af, naar ’t eerste terras.
Ambro had reeds ontdekt, dat één ervan open stond en fluisterend tot de
jongens zegt hij: „Dàt deurtje is onze redding, maar we moeten voorzichtig
zijn en goed kijken of die vent van het Museum ons niet in de gaten heeft.”
„Die maft het grootste deel van den dag,” zegt Piet. „Dus we hebben kans.”
„Inderdaad, de mummie maft,” zegt hij blij-verrast. „Nou zachtjes, jongens. Als
we hem eenmaal voorbij zijn, is het zaakie gezond.”
„Wat een strop,” lacht Ambro. „Dat hadden ze niet gedacht, de kevers! Ik ga
ze vertellen, dat er vijf jongens in nood zitten, want mij hadden ze toch niet in
de gaten.”
„Mijnheer,” spreekt hij den ouden metselaar aan. „Aan den anderen kant van
de sociëteit staan vijf jongens te schreeuwen, ze kunnen d’r niet af. Boven op
het dak, mijnheer, heelemaal boven.”
„Ja, ja, ik weet ’t,” zegt de oude man. „Laat ze maar schreeuwen, me hebbe
den tijd. Asse-me naar huis gaan, magge ze d’r af, en dat duurt nog een paar
uurtjes.”
„Hè toe, laat u ze d’r af, ’t huilen staat ze nader dan ’t lachen.”
En als ze weer allemaal bij elkaar zijn, maakt hij van z’n hand een toeter en
schreeuwt tot den metselaar:
„Meheer! hier zijn ze al! De spreeuwen kenne vliege, leg ze zout op hun
staart!” [160]
Op een dezer dagen komt Paul al ’s morgens vroeg naar Ambro toe om hem
te vragen of hij lust heeft hem te vergezellen naar Delft, waar hij een pakje
moet brengen naar zijn grooten broer, die daar in garnizoen ligt.
„’t Is wèl een heel eind, heen en terug,” zegt Ambro, die niet veel voelt voor
zoo’n reuzenloop.
„Bê-je mal! niet loopen! we gaan heen en terug met het bootje.”
„’t Zal niet gaan, man, ik heb nog maar twee kwartjes en die ga ik niet in één
dag opmaken.” [161]
„Dat hoeft ook niet; moeder fuift ons. Ik vond ’t saai om alleen te gaan en
vroeg of ik jou mee mocht nemen. Dat vond moeder best en ze gaf me
reisgeld voor ons allebei.”
„Dan is ie fijn en nu ben ik je man,” zei Ambro. „Ik zal ’t even aan moeder gaan
zeggen.”
„Kom mee, Paul, dan tracteer ik op appelen, dan hebben we wat te bikken
onderweg.”