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Toxoplasmosis of Animals
and Humans
Toxoplasmosis of Animals
and Humans
J. P. Dubey
Third edition published 2022
by CRC Press
6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742
Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for
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Typeset in Times
by codeMantra
Dedicated
This book is dedicated to my family without whose support I would not have
reached here. I was born in a family of priests in a remote village in India.
Our family profession for hundreds of years was preaching and spreading
“vedic” knowledge. My family name, Dubey, means the people who mastered
2 of 4 ancient vedas. Until recently,priesthood was an inherited profession.
My parents had no formal education and chose me to continue the family
profession of priesthood. The village had grade 4 school and I did not attend
it until 9-year-old. Considering that I was bright, my uncle, Pandit Girwar
Lal Dubey (elder brother of my father and head of family), took me to his
house in Delhi. He did not have children of his own and his house was like an
orphanage with meager resources. He had a lower level clerical job in Indian
Railways. I never had money to buy books or pay tution. I credit my success
and memory having to study from borrowed books. After obtaining 2-year
college degree, prospects for further education were zero (because my uncle
had retired with no pension) until my classmate (Avinash Arora) encouraged
me to apply to a newly opened veterinary school, Mhow, India because there
were no tuition or dormitory charges. I excelled in veterinary school and that
paved my way for free graduate studies, Ph.D., and yes marriage to my life
partner, Niti Dubey (see reference370). Nothing was planned in my life but God
has been watching over me. I am sure my parents and uncle have been watching
my achievements from heaven and happy that I have not forgotten the family
profession of spreading knowledge, albeit scientific. I appreciate the love and
support of both my sons, Ravi and Raj, who had to make sacrifices during
their growing up because I was either working in the laboratory or writing at
home. The smiling faces of my four granddaughters (Anjeli, Shalini, Ria, and
Mya and their mothers Meena and Ritu) provide incentive to keep working.
Finally, I am indebted to my wife, Niti Dubey, without whose support and love
I could not have succeeded in completing this book, and life in general.
J.P. Dubey
Contents
List of Abbreviations���������������������������������������������������������������������������������������������������������������������������������������������������� xvii
Preface to Third Edition������������������������������������������������������������������������������������������������������������������������������������������������ xix
Author���������������������������������������������������������������������������������������������������������������������������������������������������������������������������� xxi
Chapter 1
Introduction and History of Toxoplasma gondii����������������������������������������������������������������������������������������������������������������1
1.1 Introduction and History1
1.2 Discovery of the Parasite1
1.3 Transmission1
1.3.1 Congenital Transmission���������������������������������������������������������������������������������������������������������������������������1
1.3.2 Carnivorism�����������������������������������������������������������������������������������������������������������������������������������������������4
1.3.3 Fecal–Oral, Sexual Cycle, and Discovery of the Oocyst���������������������������������������������������������������������������4
1.3.4 Discovery of the Full Life Cycle and Developmental Stages in the Intestine of Cats�������������������������������5
1.4 Gratitude6
Chapter 2
Biology of Toxoplasma gondii�������������������������������������������������������������������������������������������������������������������������������������������7
2.1 Taxonomic Classification 7
2.2 Structure and Life Cycle 7
2.2.1 Tachyzoite��������������������������������������������������������������������������������������������������������������������������������������������������7
2.2.1.1 Structure�������������������������������������������������������������������������������������������������������������������������������������7
2.2.1.2 Host Invasion����������������������������������������������������������������������������������������������������������������������������12
2.2.1.3 Multiplication by Endodyogeny�����������������������������������������������������������������������������������������������13
2.2.2 Bradyzoites and Tissue Cysts������������������������������������������������������������������������������������������������������������������16
2.2.2.1 Structure�����������������������������������������������������������������������������������������������������������������������������������16
2.2.2.2 Tissue Cyst Distribution in Host Tissues���������������������������������������������������������������������������������18
2.2.2.3 Tissue Cyst Rupture and Reactivation�������������������������������������������������������������������������������������19
2.3 Life Cycle in the Definitive Host, the Cat 22
2.3.1 Bradyzoite-Induced Cycle������������������������������������������������������������������������������������������������������������������������27
2.3.1.1 Enteroepithelial Cycle��������������������������������������������������������������������������������������������������������������27
2.3.2 Oocyst-Induced Cycle������������������������������������������������������������������������������������������������������������������������������36
2.3.3 Tachyzoite-Induced Cycle������������������������������������������������������������������������������������������������������������������������36
2.4 Life Cycle in the Intermediate Hosts, Including Humans and Cats 38
2.4.1 Oocyst-Induced Infections�����������������������������������������������������������������������������������������������������������������������38
2.4.1.1 Mice������������������������������������������������������������������������������������������������������������������������������������������38
2.4.1.2 Rats�������������������������������������������������������������������������������������������������������������������������������������������41
2.4.2 Bradyzoite-Induced Infections�����������������������������������������������������������������������������������������������������������������44
2.5 Molecular Biology 44
2.6 Transmission 44
2.6.1 Transmission by Oocysts�������������������������������������������������������������������������������������������������������������������������44
2.6.1.1 Cats are Everywhere����������������������������������������������������������������������������������������������������������������44
2.6.1.2 Fatal Feline Attraction��������������������������������������������������������������������������������������������������������������55
2.6.1.3 Excretion of Oocysts by Naturally Infected Domestic Cats����������������������������������������������������55
2.6.1.4 Excretion of Oocysts by Naturally Infected Wild Felids���������������������������������������������������������62
2.6.1.5 Dispersal of Oocysts in the Environment��������������������������������������������������������������������������������63
2.6.1.6 Environmental Resistance of Oocysts��������������������������������������������������������������������������������������64
2.6.1.7 Detection of Oocysts in Environmental Samples��������������������������������������������������������������������66
2.6.1.8 Infectiousness of the Oocyst for Humans��������������������������������������������������������������������������������67
2.6.2 Transmission by Tissue Cysts������������������������������������������������������������������������������������������������������������������67
2.6.2.1 Effect of Freezing, Salting and Heat, Irradiation, High Pressure, and Vacuum Packing
on Tissue Cysts�������������������������������������������������������������������������������������������������������������������������67
vii
viii Contents
Chapter 3
Techniques for Studying Toxoplasma gondii������������������������������������������������������������������������������������������������������������������91
3.1 aboratory Maintenance of T. gondii
L 91
3.1.1 Cultivation������������������������������������������������������������������������������������������������������������������������������������������������91
3.1.1.1 Tachyzoites�������������������������������������������������������������������������������������������������������������������������������91
3.1.1.2 Tissue Cysts������������������������������������������������������������������������������������������������������������������������������92
3.1.1.3 Merozoites Enteroepithelial Stages������������������������������������������������������������������������������������������92
3.1.1.4 Oocysts�������������������������������������������������������������������������������������������������������������������������������������93
3.2 Isolation of T. gondii 95
3.2.1 Bioassays of Tissues in Mice�������������������������������������������������������������������������������������������������������������������95
3.2.1.1 Body Fluids������������������������������������������������������������������������������������������������������������������������������95
3.2.1.2 Acutely Infected Tissues����������������������������������������������������������������������������������������������������������95
3.2.1.3 Chronically Infected Tissues����������������������������������������������������������������������������������������������������95
3.2.1.4 Bioassays of T. gondii in Cats��������������������������������������������������������������������������������������������������96
3.2.1.5 Inoculation and Examination of Mice for T. gondii�����������������������������������������������������������������97
3.3 Cryopreservation98
3.4 Diagnosis99
3.4.1 Cytology, Histopathologic, and Immunohistochemical Procedures�������������������������������������������������������99
3.4.1.1 Diagnosis of Protozoal Abortion����������������������������������������������������������������������������������������������99
3.5 Immunohistological Examinations100
3.6 Serologic Procedures100
3.6.1 Modified Agglutination Test������������������������������������������������������������������������������������������������������������������100
3.6.2 Indirect Fluorescent Antibody Test������������������������������������������������������������������������������������������������������� 101
3.6.3 ELISA���������������������������������������������������������������������������������������������������������������������������������������������������� 101
3.6.3.1 General Procedure: Antigen Source��������������������������������������������������������������������������������������� 101
3.6.4 Procedure for Avidity ELISA����������������������������������������������������������������������������������������������������������������102
3.7 Polymerase Chain Reaction103
3.7.1 Extraction of DNA from Feces��������������������������������������������������������������������������������������������������������������103
Contents ix
3.7.2 Protocol for the Extraction of DNA from Fresh or Fixed Materials�����������������������������������������������������104
3.7.3 Detection of T. gondii in Soil Samples��������������������������������������������������������������������������������������������������104
3.7.4 Options for Transporting DNA Prior to Analysis����������������������������������������������������������������������������������104
3.8 Safety Concerns and Precautions While Working with T. gondii 104
Chapter 4
Toxoplasma gondii Infections in Humans (Homo sapiens)�������������������������������������������������������������������������������������������107
4.1 Serologic Prevalence107
4.2 Parasite Prevalence109
4.3 Clinical Infections109
4.3.1 Postnatally Acquired Toxoplasmosis�����������������������������������������������������������������������������������������������������109
4.3.1.1 Toxoplasmosis Outbreaks and Lessons Learned�������������������������������������������������������������������� 114
4.3.1.2 Brazil, Hotspot for Outbreaks������������������������������������������������������������������������������������������������ 116
4.3.1.3 Meatborne Outbreaks������������������������������������������������������������������������������������������������������������� 118
4.3.1.4 Multi-factorial Outbreaks in French Guiana and Suriname��������������������������������������������������120
4.3.1.5 Conclusions���������������������������������������������������������������������������������������������������������������������������� 121
4.3.2 Prenatally Transmitted (Congenital) Toxoplasmosis�����������������������������������������������������������������������������122
4.4 Parasite Strain Genetics and Clinical Toxoplasmosis in General129
4.5 Diagnosis129
4.5.1 Lymphoglandular Toxoplasmosis����������������������������������������������������������������������������������������������������������129
4.5.2 In the Immune-Deficient Patient������������������������������������������������������������������������������������������������������������130
4.5.3 In Ocular Toxoplasmosis������������������������������������������������������������������������������������������������������������������������130
4.5.4 In the Pregnant Woman�������������������������������������������������������������������������������������������������������������������������130
4.5.5 In the Fetus�������������������������������������������������������������������������������������������������������������������������������������������� 131
4.5.6 In the Baby��������������������������������������������������������������������������������������������������������������������������������������������� 131
4.6 Treatment131
4.7 Prevention132
4.7.1 Immunosuppressed Patients�������������������������������������������������������������������������������������������������������������������132
4.7.2 Prophylactic Treatment during Pregnancy��������������������������������������������������������������������������������������������132
Acknowledgments133
Chapter 5
Toxoplasma gondii Infections in Cats���������������������������������������������������������������������������������������������������������������������������135
5.1 Domestic Cats135
5.1.1 Prevalence����������������������������������������������������������������������������������������������������������������������������������������������135
5.1.1.1 Serologic Investigations����������������������������������������������������������������������������������������������������������135
5.1.1.2 Isolation of Viable T. gondii in Tissues of Cats��������������������������������������������������������������������� 145
5.1.1.3 Detection of T. gondii DNA in Tissues of Cats���������������������������������������������������������������������� 145
5.1.1.4 Prevalence of T. gondii Oocysts in Cats���������������������������������������������������������������������������������150
5.1.2 Clinical Infections and Oocyst Excretion����������������������������������������������������������������������������������������������150
5.1.3 Genetic Types of T. gondii in Domestic Cats����������������������������������������������������������������������������������������153
5.1.4 Experimental Infections in Cats������������������������������������������������������������������������������������������������������������153
5.1.4.1 Immunization of Cats to Prevent Oocyst Excretion���������������������������������������������������������������153
5.1.4.2 Serological Responses of Experimentally Infected Cats�������������������������������������������������������153
5.1.4.3 Pathogenesis of Congenital Infection�������������������������������������������������������������������������������������157
5.2 Other Felids157
5.2.1 Prevalence����������������������������������������������������������������������������������������������������������������������������������������������158
5.2.1.1 Serologic Investigations����������������������������������������������������������������������������������������������������������158
5.2.1.2 Isolation and Genetic Characterization of Viable T. gondii from Wild Felids����������������������164
5.2.1.3 Detection of T. gondii DNA from Wild Felids�����������������������������������������������������������������������164
5.2.1.4 Prevalence of T. gondii Oocysts in Wild Felids���������������������������������������������������������������������164
5.3 Clinical Toxoplasmosis in Wild Felids165
Acknowledgments166
x Contents
Chapter 6
Toxoplasma gondii Infections in Dogs (Canis familiaris)�������������������������������������������������������������������������������������������� 167
6.1 Natural Infections167
6.1.1 Serologic Investigations������������������������������������������������������������������������������������������������������������������������� 167
6.1.2 Isolation of Viable T. gondii from Tissues of Apparently Healthy Adult Dogs������������������������������������ 167
6.1.3 Detection of T. gondii DNA in Tissues of Dogs������������������������������������������������������������������������������������ 176
6.1.4 Detection of T. gondii DNA in Feces of Asymptomatic Dogs�������������������������������������������������������������� 176
6.1.5 Clinical Infections��������������������������������������������������������������������������������������������������������������������������������� 176
6.2 Experimental Infections178
6.3 Genetic Diversity of T. gondii in Dogs179
6.4 Conclusions180
Chapter 7
Toxoplasma gondii Infections in Pigs (Sus scrofa)�������������������������������������������������������������������������������������������������������� 181
7.1 Domestic Pigs 181
7.1.1 Natural Infections in Domestic Pigs������������������������������������������������������������������������������������������������������ 181
7.1.1.1 Serologic Investigations���������������������������������������������������������������������������������������������������������� 181
7.1.1.2 Serological Tests Comparison on Sera from Naturally Infected Pigs������������������������������������193
7.1.1.3 Isolation of Viable T. gondii from Pig Tissues�����������������������������������������������������������������������195
7.1.1.4 Detection of T. gondii DNA in Pig Tissues����������������������������������������������������������������������������195
7.1.1.5 Clinical Toxoplasmosis�����������������������������������������������������������������������������������������������������������195
7.1.2 Experimental Infections�������������������������������������������������������������������������������������������������������������������������203
7.1.2.1 Clinical�����������������������������������������������������������������������������������������������������������������������������������203
7.1.2.2 Immunity��������������������������������������������������������������������������������������������������������������������������������209
7.1.2.3 Congenital Toxoplasmosis������������������������������������������������������������������������������������������������������209
7.1.2.4 Tissue Cyst Formation and Persistence of T. gondii in Tissues���������������������������������������������209
7.1.2.5 Viability of T. gondii in Cured Pork Products�����������������������������������������������������������������������209
7.1.2.6 Survival of T. gondii in Vacuum-Packed Pork�����������������������������������������������������������������������209
7.2 T. gondii Infections in Wild Swine (Boars)209
7.2.1 Seroprevalence���������������������������������������������������������������������������������������������������������������������������������������209
7.2.2 Isolation of Viable T. gondii from Tissues of Wild Swine��������������������������������������������������������������������209
7.2.3 Detection of T. gondii DNA from Tissues of Wild Swine��������������������������������������������������������������������� 216
7.2.4 Congenital Toxoplasmosis in Wild Swine��������������������������������������������������������������������������������������������� 216
7.3 Genetic Types of T. gondii in Pigs216
Chapter 8
Toxoplasma gondii Infections in Sheep������������������������������������������������������������������������������������������������������������������������� 217
8.1 Natural Infections217
8.1.1 Serologic Investigations������������������������������������������������������������������������������������������������������������������������� 217
8.1.2 Isolation and Genetic Characterization of T. gondii from Tissues of Sheep�����������������������������������������236
8.1.3 Tissue Cyst Burden��������������������������������������������������������������������������������������������������������������������������������236
8.1.4 Detection of T. gondii DNA in Sheep����������������������������������������������������������������������������������������������������244
8.1.5 Abortion and Lamb Losses Due to Toxoplasmosis�������������������������������������������������������������������������������244
8.1.6 Venereal Transmission���������������������������������������������������������������������������������������������������������������������������247
8.1.7 Genetic Variability of T. gondii in Sheep����������������������������������������������������������������������������������������������247
8.2 Experimental Infections256
8.2.1 Clinical Disease in Orally Inoculated Sheep�����������������������������������������������������������������������������������������256
8.2.2 Pathogenesis of Abortion�����������������������������������������������������������������������������������������������������������������������256
8.2.3 Reducing Parasite Load by Immunization��������������������������������������������������������������������������������������������256
8.2.4 Reducing Abortion by Immunization of Ewes��������������������������������������������������������������������������������������256
8.2.5 Chemoprophylaxis���������������������������������������������������������������������������������������������������������������������������������256
8.3 Diagnosis and Pathogenesis of T. gondii-Induced Abortion257
8.4 Reducing Losses in Sheep Due to Toxoplasmosis through Prophylaxis258
Acknowledgments258
Contents xi
Chapter 9
Toxoplasma gondii Infections in Goats (Capra hircus)�������������������������������������������������������������������������������������������������259
9.1 Natural Infections259
9.1.1 Serologic Investigations�������������������������������������������������������������������������������������������������������������������������259
9.1.2 Isolation of Viable T. gondii from Tissues of Goats������������������������������������������������������������������������������270
9.1.3 Detection of T. gondii DNA in Blood, Milk, and Tissues of Goats������������������������������������������������������270
9.1.4 Clinical Infections���������������������������������������������������������������������������������������������������������������������������������270
9.1.5 Clinical Toxoplasmosis in Adult Goats��������������������������������������������������������������������������������������������������270
9.1.6 Neonatal Toxoplasmosis������������������������������������������������������������������������������������������������������������������������272
9.1.7 Genetic Diversity of T. gondii in Goats�������������������������������������������������������������������������������������������������274
9.2 Experimental Infections274
9.2.1 Earlier (pre-1988) Observations�������������������������������������������������������������������������������������������������������������274
9.2.2 Post-1988 Observations on Abortion and Protection�����������������������������������������������������������������������������275
9.2.3 Excretion of T. gondii in Milk of Experimentally Infected Goats��������������������������������������������������������275
9.2.4 Venereal and Congenital Transmission of T. gondii������������������������������������������������������������������������������275
9.2.5 Tissue Parasitization at 30 and 90 Days and Survival of Tissue Cysts in Vacuum Packing in
Goats Fed T. gondii Oocysts������������������������������������������������������������������������������������������������������������������276
9.2.5.1 Clinical, Biochemical, Serological�����������������������������������������������������������������������������������������276
9.2.5.2 Vacuum Packing Survival������������������������������������������������������������������������������������������������������277
9.2.6 T. gondii in Goat Milk and Public Health Significance�������������������������������������������������������������������������277
9.3 Treatment/Prophylaxis for Abortion277
Chapter 10
Toxoplasma gondii Infections in Cattle (Bos spp.)��������������������������������������������������������������������������������������������������������279
10.1 Natural Infections279
10.1.1 Serologic Investigations�������������������������������������������������������������������������������������������������������������������������279
10.1.2 Isolation of Viable T. gondii������������������������������������������������������������������������������������������������������������������288
10.1.3 Detection of T. gondii DNA from Cattle Tissues����������������������������������������������������������������������������������288
10.1.4 Clinical Toxoplasmosis, Congenital Infections, and Abortion��������������������������������������������������������������290
10.2 Experimental Infections290
10.2.1 Persistence of T. gondii in Tissues or Fluids������������������������������������������������������������������������������������������290
10.2.2 Congenital Transmission�����������������������������������������������������������������������������������������������������������������������290
10.3 Public Health Significance of Toxoplasmosis in Cattle291
10.3.1 Beef��������������������������������������������������������������������������������������������������������������������������������������������������������291
10.3.2 Milk��������������������������������������������������������������������������������������������������������������������������������������������������������291
10.4 Genetic Diversity of T. gondii in Cattle291
10.5 Conclusions292
Acknowledgments292
Chapter 11
Toxoplasma gondii Infections in Water Buffaloes (Bubalus bubalis)���������������������������������������������������������������������������293
11.1 Serologic Prevalence293
11.2 Attempts at Isolating Viable T. gondii 294
11.3 Presence of Tissue Cysts in Tissues or Milk294
Chapter 12
Toxoplasma gondii Infections in Equids (Horse, Donkey, Mule)���������������������������������������������������������������������������������295
12.1 Serologic Prevalence295
12.1.1 Serologic Investigations in Horses���������������������������������������������������������������������������������������������������������295
12.1.2 Serologic Prevalence in Donkeys����������������������������������������������������������������������������������������������������������295
12.1.3 Serologic Prevalence in Mules���������������������������������������������������������������������������������������������������������������295
12.1.4 Serologic Prevalence in Wild Equids����������������������������������������������������������������������������������������������������295
12.2 Isolation of Viable T. gondii from Tissues of Horses and Donkey295
xii Contents
Chapter 13
Toxoplasma gondii Infections in Camels (Camelus spp.)����������������������������������������������������������������������������������������������303
13.1 Natural Infections303
13.1.1 Serologic Investigations�������������������������������������������������������������������������������������������������������������������������303
13.1.2 Isolation of Viable T. gondii from Tissues���������������������������������������������������������������������������������������������303
13.1.3 Prevalence of T. gondii DNA in Camel Tissues������������������������������������������������������������������������������������303
13.1.4 Presence of T. gondii in Camel Milk�����������������������������������������������������������������������������������������������������303
Chapter 14
Toxoplasma gondii Infections in South American Camelids (Lama spp.)��������������������������������������������������������������������305
14.1 Seroprevalence305
14.2 Isolation and Molecular Characterization305
14.3 Clinical Toxoplasmosis305
Chapter 15
Toxoplasma gondii Infections in Chickens (Gallus domesticus)����������������������������������������������������������������������������������307
15.1 Natural Infections307
15.1.1 Prevalence����������������������������������������������������������������������������������������������������������������������������������������������307
15.1.1.1 Serologic Investigations����������������������������������������������������������������������������������������������������������307
15.1.1.2 Isolation of Viable T. gondii���������������������������������������������������������������������������������������������������307
15.1.1.3 Detection of T. gondii DNA��������������������������������������������������������������������������������������������������� 319
15.1.1.4 Detection of T. gondii by Histopathology and Immunohistochemistry��������������������������������� 321
15.1.1.5 Comparison of Serology, PCR Techniques, and Bioassay for the Detection of T. gondii����� 321
15.1.2 Clinical Infections��������������������������������������������������������������������������������������������������������������������������������� 321
15.1.3 Epidemiology and Use of Sentinel Chickens����������������������������������������������������������������������������������������� 321
15.1.4 Genetic Diversity of Viable T. gondii Isolates���������������������������������������������������������������������������������������322
15.2 Experimental Infections322
15.2.1 Clinical and Diagnosis���������������������������������������������������������������������������������������������������������������������������322
15.2.2 Effect of Breed/Strain of Chickens, T. gondii Genotype on Toxoplasmosis in Chickens���������������������325
15.2.3 Effect of T. gondii Genotype, Seroconversion, Tissue Parasitization, and Chemoprophylaxis on
Toxoplasmosis in Chickens��������������������������������������������������������������������������������������������������������������������325
15.2.4 Concurrent Infections����������������������������������������������������������������������������������������������������������������������������325
15.3 Conclusions325
Chapter 16
Toxoplasma gondii Infections in Other Avian Species (Excludes Gallus domesticus)�������������������������������������������������327
16.1 Turkeys (Meleagris gallopavo)327
16.2 Ducks (Anas spp.) and Geese332
16.3 Ostriches (Struthio camelus) and Other Ratites332
16.4 Other Wild Avian Species333
16.4.1 Carnivorous Birds����������������������������������������������������������������������������������������������������������������������������������333
16.4.2 Herbivorous/Insectivorous Birds�����������������������������������������������������������������������������������������������������������338
16.4.3 Migratory Birds�������������������������������������������������������������������������������������������������������������������������������������350
16.5 Clinical Toxoplasmosis in Wild Birds351
16.6 Genetic Diversity of T. gondii Isolates352
16.7 Conclusions352
Contents xiii
Chapter 17
Toxoplasma gondii Infections in Non-human Primates������������������������������������������������������������������������������������������������355
17.1 Natural Infections 355
17.1.1 Prevalence����������������������������������������������������������������������������������������������������������������������������������������������355
17.1.2 Clinical Toxoplasmosis��������������������������������������������������������������������������������������������������������������������������355
17.1.3 Genetic Diversity�����������������������������������������������������������������������������������������������������������������������������������367
17.2 Experimental Infections 367
17.3 Conclusion 368
Chapter 18
Toxoplasma gondii Infections in Australasian Marsupials�������������������������������������������������������������������������������������������369
18.1 Introduction369
18.2 Zoo Animals Outside of Australia and New Zealand369
18.3 Infections in Free-Range Marsupials in Australasia369
18.3.1 Koalas (Phascolarctos cinereus)�����������������������������������������������������������������������������������������������������������369
18.3.2 Kangaroos����������������������������������������������������������������������������������������������������������������������������������������������369
18.3.3 Wombats (Vombatus ursinus)����������������������������������������������������������������������������������������������������������������371
18.3.4 Brush-tailed Rock Wallaby (Petrogale penicillata)�������������������������������������������������������������������������������371
18.3.5 Eastern Quoll (Dasyurus viverrinus)�����������������������������������������������������������������������������������������������������371
18.3.6 Congenital/Neonatal Transmission��������������������������������������������������������������������������������������������������������371
18.3.7 Other Marsupials�����������������������������������������������������������������������������������������������������������������������������������371
18.4 Diagnosis371
18.5 Treatment372
18.6 Genetic Diversity of T. gondii from Marsupials372
18.6.1 Free-Range Marsupials��������������������������������������������������������������������������������������������������������������������������372
18.6.2 Captive Marsupials��������������������������������������������������������������������������������������������������������������������������������372
18.7 Public Health Importance373
Chapter 19
Toxoplasma gondii Infections in Marine Mammals�����������������������������������������������������������������������������������������������������375
19.1 Sea Otters (Enhydra lutris nereis, Enhydra lutris kenyoni)375
19.1.1 Serologic Investigations�������������������������������������������������������������������������������������������������������������������������375
19.1.2 Isolation of Viable T. gondii or Parasite DNA���������������������������������������������������������������������������������������375
19.1.3 Clinical Toxoplasmosis in Sea Otters����������������������������������������������������������������������������������������������������384
19.1.4 Neonatal/Congenital Toxoplasmosis in Sea Otters��������������������������������������������������������������������������������384
19.1.5 Genetic Types and Clinical Toxoplasmosis in Sea Otters���������������������������������������������������������������������384
19.2 California Sea Lion (Zalophus californianus)385
19.3 Dolphins385
19.4 Hawaiian Monk Seal385
19.5 Miscellaneous Marine Mammals385
19.6 Genetic Typing of DNA from Marine Mammals Excluding Sea Otters388
19.7 Public Health Significance388
19.8 Conclusion388
Chapter 20
Toxoplasma gondii Infections in Deer and Other Cervids��������������������������������������������������������������������������������������������389
20.1 Prevalence of T. gondii Infection389
20.1.1 White-Tailed Deer (Odocoileus virginianus)�����������������������������������������������������������������������������������������389
20.1.2 Elk (Wapiti, Cervus canadensis)�����������������������������������������������������������������������������������������������������������389
20.1.3 Roe Deer (Capreolus capreolus)�����������������������������������������������������������������������������������������������������������389
20.1.4 Red Deer (Cervus elaphus)��������������������������������������������������������������������������������������������������������������������389
20.1.5 Other Cervids�����������������������������������������������������������������������������������������������������������������������������������������389
20.1.6 Detection of T. gondii DNA in Venison������������������������������������������������������������������������������������������������390
xiv Contents
Chapter 21
Toxoplasma gondii Infections in Yak (Bos grunniens), Bison (Bison spp.), and Other Wild Ruminants���������������������397
21.1 Toxoplasmosis in Yak (Bos grunniens)397
21.2 Toxoplasmosis in Other Wild Ruminants397
21.2.1 Seroprevalence���������������������������������������������������������������������������������������������������������������������������������������397
21.2.2 T. gondii DNA����������������������������������������������������������������������������������������������������������������������������������������397
21.2.3 Clinical���������������������������������������������������������������������������������������������������������������������������������������������������397
Chapter 22
Toxoplasma gondii Infections in Bears (Ursus spp.)�����������������������������������������������������������������������������������������������������401
22.1 Introduction401
22.2 Subclinical T. gondii Infection in Bears (Ursus spp.)401
22.2.1 Black Bears (Ursus americanus)�����������������������������������������������������������������������������������������������������������401
22.2.1.1 Serological Investigations�������������������������������������������������������������������������������������������������������401
22.2.1.2 Isolation of Viable T. gondii���������������������������������������������������������������������������������������������������403
22.2.1.3 Biology and Transmission������������������������������������������������������������������������������������������������������403
22.2.2 Brown Bears (Ursus arctos)�������������������������������������������������������������������������������������������������������������������405
22.2.3 Polar Bears (Ursus maritimus)��������������������������������������������������������������������������������������������������������������405
22.3 Clinical Toxoplasmosis in Bears406
22.4 Genetic Diversity407
22.5 Public Health Significance407
Chapter 23
Toxoplasma gondii Infections in Wild Canids��������������������������������������������������������������������������������������������������������������409
23.1 Prevalence409
23.1.1 Serological Investigations����������������������������������������������������������������������������������������������������������������������409
23.1.2 Isolation of Viable T. gondii������������������������������������������������������������������������������������������������������������������ 417
23.1.3 Detection of T. gondii DNA������������������������������������������������������������������������������������������������������������������� 417
23.2 Clinical Toxoplasmosis421
23.3 Genetic Diversity424
23.4 Conclusions425
Acknowledgments425
Chapter 24
Toxoplasma gondii Infections in Rodents���������������������������������������������������������������������������������������������������������������������427
24.1 Prevalence427
24.1.1 Serologic Investigations�������������������������������������������������������������������������������������������������������������������������427
24.1.2 Isolation of Viable T. gondii from Rodent Tissues��������������������������������������������������������������������������������437
24.1.3 Detection of T. gondii DNA�������������������������������������������������������������������������������������������������������������������437
24.2 Clinical Toxoplasmosis in Rodents437
24.3 Genetic Diversity of T. gondii from Rodents437
24.4 Conclusions446
Acknowledgments446
Chapter 25
Toxoplasma gondii Infections in Rabbits (Oryctolagus spp.) and Hares (Lepus spp.)��������������������������������������������������447
25.1 Serologic Prevalence447
25.2 Parasitologic Prevalence447
Contents xv
Chapter 26
Toxoplasma gondii Infections in Bats��������������������������������������������������������������������������������������������������������������������������� 451
26.1 Introduction451
26.2 Seroprevalence451
26.3 Detection of T. gondii DNA451
26.4 Isolation of Viable T. gondii and Genetic Characterization455
26.5 Clinical Toxoplasmosis in Bats455
Chapter 27
Toxoplasma gondii Infections in Miscellaneous Animals��������������������������������������������������������������������������������������������457
27.1 Pandas (Ailurus fulgens, Ailuropoda melanoleuca)457
27.2 Hibernating and Poikilothermic Animals457
27.3 Other Miscellaneous Animals458
27.3.1 Serologic Investigation���������������������������������������������������������������������������������������������������������������������������458
27.3.2 Isolation of Viable T. gondii������������������������������������������������������������������������������������������������������������������459
27.3.3 Clinical Toxoplasmosis��������������������������������������������������������������������������������������������������������������������������459
27.3.3.1 Slender-Tailed Meerkats (Suricata suricatta)������������������������������������������������������������������������459
27.3.3.2 European Mole (Talpa europaea)������������������������������������������������������������������������������������������459
27.3.3.3 Rock hyrax (Procavia capensis)��������������������������������������������������������������������������������������������459
27.3.3.4 Fossa (Cryptoprocta ferox)�����������������������������������������������������������������������������������������������������459
References����������������������������������������������������������������������������������������������������������������������������������������������������������������������461
Index������������������������������������������������������������������������������������������������������������������������������������������������������������������������������527
List of Abbreviations
Ab: Abomosal contents Ly: Lymph node
AS: Association Ma: Masseter muscle
B: Brain MAT: Modified agglutination test (Dubey and
Bf: Beef Desmonts, 1987)354
Bl: Blood 1MAT: (Toxo-Screen DA®, Biomerieux, Marcy
CAdv: Canine adenovirus l’Etiole, France). This is the same test as
CDV: Canine Distemper Virus MAT.
CNS: Central nervous system MATt: Modified agglutination test titer
CPV: Canine parvovirus MC-PCR: Magnetic-capture PCR
CSF: Cerebrospinal fluid Mk: Milk
D: Diaphragm N-PCR: Nested PCR
DT: Sabin–Feldman dye test Nc: Neospora caninum
ELISA: Enzyme linked immunosorbent assay ND: No data or not stated
F: Fetal NS: No association
FeLV: Feline Leukemia Virus P: Placenta
FIPV: Feline Infectious Peritonitis Virus p.i.: Post-inoculation
FIV: Feline Immunodeficiency Virus PAS: Periodic acid Schiff reaction
FR: Free range PCR: Polymerase chain reaction
G: Gizzard PD: Pepsin digest
H: Heart PV: Parasitophorous vacuole
HE: Hematoxylin and eosin stain PVM: Parasitophorous vacuolar membrane
HIV: Human Immunodeficiency Virus qPCR: Quantitative PCR
i.m.: Intramuscular RFLP: Restriction fragment length polymorphism
i.p.: Intraperitoneal RT-PCR: Real-time PCR
i.v.: Intravenous s.c.: Subcutaneous inoculation
IFA: Indirect fluorescent antibody test Sc: Spinal cord
IgG: Immunoglobin G St: Stomach
IgM: Immunoglobin M SEM: Scanning electron microscopy
IHA: Indirect hemagglutination test SW: Swiss Webster albino mouse
IHC: Immunohistochemistry Sk: Skeletal muscles
IMC: Inner membrane complex Sp: Spleen
IMHA: Immune-mediated hemolytic disease Tf: Thoracic fluid
IMTP: Immune-mediated thrombocytopenia T. gondii: Toxoplasma gondii
K: Kidney T: Tongue
KO: Interferon gamma gene knockout mice TCA: T. gondii circulating antigen
LAMP: Loop-mediated amplification TEM: Transmission electron microscopy
LAT: Latex agglutination test Tg: Toxoplasma gondii
Li: Liver WB: Western blot
Lu: Lung
xvii
Preface to Third Edition
In the last years since the second edition of this book based on viable isolates and DNA directly from infected
was published in 2010, there has been an explosion of host tissue) and prospective.
knowledge concerning the parasite T. gondii and toxoplas- During the last 55 years, I have had the privilege of
mosis. One reason for this is because T. gondii has been working with virtually all hosts of T. gondii, including
and continues to be used extensively as a model for the all livestock species, wildlife, and zoo animals. I feel
cell biology of apicomplexan parasites. Although several blessed to have collaborated with hundreds of scien-
books have been published on toxoplasmosis, the pres- tists. In the interest of brevity and economy, references
ent book provides unique information on all known host cited in the first 2 editions, although mentioned, are not
types for this parasite including humans and bats and is listed in the literature cited section in the present edi-
compiled by a single author. A separate chapter on history tion. Because the literature on toxoplasmosis is vast (over
(Chapter 1) is added. 30,000 references), I have extensively borrowed tables
I view Chapter 2 as the strength of this edition as it from literature (mostly from my papers) to reduce cita-
focuses in detail on the biology of the parasite. Many tions. In the present edition, there are more than 1,500
scientists use T. gondii to investigate problems in cell citations.
biology and genetics, and in support, I have provided All surveys concerning animals that I found in litera-
information on methods of cultivation and safety proce- ture are listed to help future researchers, irrespective of
dures detailed in Chapter 3. Chapter 4, which deals with the sample size, journal or language published. The refer-
toxoplasmosis in humans, was originally written by my ences are arranged chronologically and alphabetically by
former professor and coauthor of the first edition, C. P. the first author for the benefit of readers.
Beattie, who passed away in 1987 before the edition was I would like to acknowledge those who made this
even published. I have revised the content but kept the book possible; I feel guilty that I cannot possibly list all
original format and added worldwide estimates of rates of them. Oliver Kwok, Camila Cezar, Fernando Murata,
of congenital toxoplasmosis. Each of the remaining book and other colleagues and staff in my laboratory who have
chapters 5–27 deals with toxoplasmosis in known host helped with proofreading and preparations of tables. Dr.
types of T. gondii, including a chapter on marine mam- Chunlei Su’s help concerning data and interpretation of
mals that are dying from toxoplasmosis. In these chap- genetic types and Dr. Yurong Yang’s help with Chinese
ters, I have extensively reviewed literatures from 2009 to literature are gratefully acknowledged. I am also grate-
2021, provided factual data, and have avoided specula- ful to many scientists (some acknowledged individually
tion. For each of these hosts, a similar format is used that in Chapter 1), who have contributed to this book in more
includes prevalence (serological, detection of DNA, and than one way.
isolation of viable parasite), epidemiology, clinical dis-
ease, diagnosis, genetic characterization (data separated J.P. Dubey
xix
Author
xxi
Chapter 1
1.1 INTRODUCTION AND HISTORY Splendore1168 discovered the same parasite in a rabbit in
Brazil, also erroneously identifying it as Leishmania, but
Toxoplasma gondii is one of the most well-studied he did not name it.
parasites because of its medical and veterinary impor- It is a remarkable coincidence that this disease was
tance. It is used extensively as a model for cell biology of first recognized in laboratory animals and was first
apicomplexan organisms. Two recently published books thought to be Leishmania by both groups of investiga-
provide an update of its cell biology, molecular biology, tors. Both Nicolle and Splendore were medical doctors.
and methods to study it.1228,1311 Some of the advantages Charles Jules Henri Nicolle was a well-known French sci-
of using this parasite for cell biology are as follows: entist and eventually received the Nobel Prize in 1928 for
T. gondii is large enough to be easily seen under the his work on typhus. Manceaux, also French, was an assis-
light microscope, can be grown in virtually any warm- tant to Nicolle. Alfonso Splendore had emigrated from
blooded cell line, can be maintained indefinitely in mice Italy to Brazil, where he made numerous contributions in
and cell culture, and there is only one species that infects microbiology; he was to become the Chief Scientist at the
all hosts. Additionally, this parasite is readily amenable Bacteriological Laboratory at Portuguese Hospital, São
to genetic manipulation, with refined protocols for clas- Paulo, Brazil. It is noteworthy that although they were on
sic and reverse genetics, high transfection efficiency, different continents, they communicated with each other
and expression of epitope tags. Recently a book was regarding their discoveries.435
published that detailed methods to study its cell biology
and genetic manipulation.1228 The third edition of the
book “Toxoplasma gondii”: The Model Apicomplexan- 1.3 TRANSMISSION
Perspective and Methods has 1,184 pages contributed by
numerous expert in the field.1311 Transmission of T. gondii was at first a mystery. Soon
It has been more than a century since the discovery of the after its discovery, it was found that gundis, native to the
parasite in 1908 and the event was celebrated with publication of foothills and mountains of southern Tunisia, were not
historical accounts of the parasite and its biology.394,399,491,911,1310 infected naturally, but acquired infection in captivity. T.
Historic landmarks are summarized in Table 1.1. gondii was suspected to be transmitted by arthropods
because it was found in the blood of the host and transmis-
sion of Plasmodium and Leishmania by arthropods was
1.2 DISCOVERY OF THE PARASITE on the minds of researchers at the time. Many scientists
investigated possible transmission by several species of
Nicolle and Manceaux928 found a protozoan in tissues arthropods with completely unsuccessful results.522
of a hamster-like rodent, the gundi, Ctenodactylus gundi,
which was being used for leishmaniasis research in the 1.3.1 Congenital Transmission
laboratory of Charles Nicolle at the Pasteur Institute in
Tunis. Nicolle initially believed the parasite to be a piro- It is ironic that the congenital mode of transmission
plasm, then Leishmania, but soon realized that he had dis- was recognized first, because it is not the most common
covered a new organism and named it T. gondii based on mode of transmission of T. gondii. In 1939, 3 pathologists
the morphology (mod. L. toxo = arc or bow, plasma = life) working in New York City conclusively identified T. gondii
and the host.929 Thus, its complete designation is T. gondii in an infant girl who was delivered full-term by Caesarean
(Nicolle and Manceaux, 1908) Nicolle and Manceaux section on 23 May 1938 at Babies Hospital, New York.1318
1909. In retrospect, the correct name for the parasite The girl developed convulsive seizures at 3 days of age and
should have been T. gundii; Nicolle and Manceaux had lesions were noted via an ophthalmoscope in the maculae
incorrectly identified the host as Ctenodactylus gondi. of both eyes. She died when she was only 1-month-old and
1
2 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Table 1.1
Summary of Landmarks in the History of T. gondiia
Finding Reference
Etiologic Agent
Protozoa found in the rodent, Ctenodactylus gundi in Tunisia Nicolle and Manceaux (1908)
Protozoa found in a rabbit in Brazil Splendore (1908)
Name T. gondii proposed (taxon = bow, plasma = form, in Greek) Nicolle and Manceaux (1909)
First viable T. gondii isolate obtained from an animal Sabin and Olitsky (1937)
First isolate of T. gondii from human Wolf et al. (1939)
Human and animal T. gondii proven identical Sabin (1941)
Pathogenesis of toxoplasmosis, including hydrocephalus Frenkel and Friedlander (1951); Frenkel (1953, 1956)
Parasite Morphology and Life Cycle
Tachyzoite (trophozoite, feeding form, proliferative form, endodyozoite)
Term tachyzoite proposed (tachy = fast, zoite = life) Frenkel (1973)
Endodyogeny described Goldman et al. (1958)
Ultrastructure described Gustafson et al. (1954); Sheffield and Melton (1968)
Tissue cyst, bradyzoite, cystozoite
Cyst recognized Levaditi et al. (1928)
Cyst described cytologically Frenkel and Friedlander (1951); Frenkel (1956)
Ultrastructure described Wanko et al. (1962); Ferguson and Hutchison (1987)
Term bradyzoite proposed (bradys = slow, zoon = animal) Frenkel (1973)
Term tissue cyst proposed Dubey and Beattie (1988)
Bradyzoite resistance to digestive enzymes recognized Jacobs et al. (1960a)
Development of tissue cysts and bradyzoites described Dubey and Frenkel (1976)
Complete biology of bradyzoites and tissue cysts reviewed Dubey et al. (1998)
Feline enteroepithelial stages
Coccidian phases described Frenkel et al. (1970); Hutchison et al. (1970); Sheffield and
Melton (1970); Dubey and Frenkel (1972)
Oocyst morphology described Dubey et al. (1970b)
Five asexual T. gondii types (A–E) described Dubey and Frenkel (1972)
Ultrastructure of coccidian stages described Sheffield (1970); Piekarski et al. (1971); Ferguson et al.
(1974, 1975, 1979a, 1979b); Christie et al. (1978); Speer,
Clark, and Dubey (1998); Speer and Dubey (2005)
Lipid metabolism determines host specificity of T. gondii oocyst excretion 310
in cats
Transmission
Congenital
Transmission demonstrated in human Wolf et al. (1939)
Repeated transmission found in house mouse Beverley (1959)
Congenital transmission found in a large wild animal species, white-tailed Dubey et al. (2008)
deer
Carnivorism, transmission by meat of intermediate hosts
Suggested carnivorous transmission Weinman and Chandler (1954)
Transmission by meat found in humans Desmonts et al. (1965)
Fecal-oral
Transmission by a resistant fecal form of T. gondii demonstrated Hutchison (1965)
Coccidian phase recognized Hutchison et al. (1970, 1971); Frenkel et al. (1970); Dubey
et al. (1970a, 1970b); Sheffield and Melton (1970);
Overdulve (1970)
Definitive and intermediate hosts defined, including excretion of oocysts Frenkel et al. (1970); Miller et al. (1972); Jewell et al.
only by felids (1972)
First oocyst-inhaled/ingested human toxoplasmosis outbreak described Teutsch et al. (1979)
Genetics and Different Genetic T. gondii Strains
Recombinants and genetic crosses produced Pfefferkorn and Pfefferkorn (1980)
Isoenzyme differences used to distinguish T. gondii strains Dardé et al. (1987); Tibayrene et al. (1991)
Restriction fragment length polymorphism used to group T. gondii strains Sibley et al. (1992); Howe and Sibley (1995)
into 3 Types (I–III)
(Continued)
INTRODUCTION AND HISTORY OF T. GONDII 3
an autopsy was performed. The brain, spinal cord, and the lamb chops). Since the prevalence of T. gondii is much
right eye were removed for examination. Free and intra- higher in sheep than in horses or cattle, this illustrated
cellular T. gondii were found in lesions of encephalomyeli- the importance of carnivorism in the transmission of
tis and retinitis of the girl. Portions of cerebral cortex and T. gondii. Although beef is rarely infected with T. gondii,
spinal cord were homogenized in saline and inoculated viable T. gondii has been isolated from horsemeat destined
intracerebrally into rabbits and mice, producing encepha- for human consumption and severe toxoplasmosis has
litis. T. gondii was demonstrated in the neural lesions and been reported in humans in France after eating imported
T. gondii from these animals was successfully passaged horsemeat (see Chapter 4). This experiment in Paris was
into other mice. Congenital transmission was later found justified ethically because of the prevailing belief at that
to occur in many species of animals, particularly sheep617 time the feeding of uncooked meat was beneficial in
and rodents.403 recovery from tuberculosis (pers. comm., G. Desmonts); it
is detailed here to indicate how valuable information can
1.3.2 Carnivorism be obtained from simple experiments.
Weinman and Chandler1309 suggested that transmis- 1.3.3 Fecal–Oral, Sexual Cycle, and
sion might occur through the ingestion of undercooked Discovery of the Oocyst
meat. This hypothesis for transmission via the ingestion
of infected meat was tested by Desmonts et al.305 in an While congenital transmission and carnivorism can
experiment with children in a Paris sanatorium. They explain some of the transmission of T. gondii, it does not
compared the acquisition rates of T. gondii infection in explain the widespread infection in vegetarians and herbi-
children before and after admission to the sanatorium. Of vores. The real breakthrough in the discovery of the life
the 1,125 children admitted to the Children’s Tuberculosis cycle of the parasite came when Hutchison667 first discov-
Department of the Hospital of Brévannes, 641 (56.9%) ered T. gondii infectivity was associated with cat feces.
had no antibodies to T. gondii at the time of admission, Dr. William McPhee Hutchison was a parasitologist
whereas 204 of 641 children became seropositive during in the Department of Biology, Strathclyde University,
their hospital stay. The mean duration of hospitalization Glasgow, Scotland. He had a Ph.D. in parasitology, but
of these children was 9 months (from 3 months to > 1 year). had never researched protozoans before. In a preliminary
Children were serologically tested at admission and then experiment, he fed the Beverley strain of T. gondii tissue
every 4 months until the end of hospitalization (although cysts to a cat experimentally infected 2 months previously
some children given just one test). All the children were with Toxocara cati.667 Feces containing nematode ova
given beef meat juice (1 teaspoon/day) and raw horsemeat were collected starting 2 weeks after feeding T. gondii.
(20–60 g, 2 or 3 times/week); these children represented The feces, after floatation in 33.0% zinc sulfate solution
the control group. The monthly rate of acquisition of and storage in tap water in an open beaker for 12 months
T. gondii infection was 4.8%, which was 5 times higher to embryonate T. cati eggs, induced toxoplasmosis in
than for the general population (deduced from data in mice. This discovery was a breakthrough because, until
children at the time of admission). For the experimental then, both known forms of T. gondii, i.e., tachyzoites and
group (66 children), barely cooked lamb chops were added bradyzoites, were killed by water. Microscopic exami-
twice a week to the usual diet of beef meat juice and raw nation of feces revealed only T. cati eggs and Isospora
horsemeat. The monthly rate of acquisition of T. gondii oocysts. In Hutchison’s667 published report, T. gondii
infection was 9.2%, which was nearly twice that of the infectivity was not attributed to either oocysts or T. cati
other hospitalized children. They estimated that the time eggs. He suspected transmission of T. gondii via the eggs
required to infect 50.0% of the hospital population has of T. cati, similar to the transmission of the fragile flag-
to be 5 years for a general population, a little more than ellate Histomonas meleagridis via Heterakis gallinae
1 year for the hospitalized children (usual diet), but a little eggs. He initially wanted to test the nematode hypoth-
more than 6 months for the experimental group (those fed esis using Toxocara canis and T. gondii transmission in
INTRODUCTION AND HISTORY OF T. GONDII 5
a dog. However, he decided on the cat and T. cati model earthworms, flies, and cockroaches could act as transport
because there was no place to house dogs.394 Transmission hosts and further disseminate oocysts in the environment.
of T. gondii by T. canis eggs made more sense because of Like other coccidian oocysts, T. gondii oocysts were
the known zoonotic potential of T. canis; T. cati was not, found to be highly resistant to environmental influences,
at that time, known to infect humans, but T. canis was. It including commonly used disinfectants (see Tables 2.22,
is probable that the discovery of the life cycle of T. gondii 2.23—Chapter 2). I am still searching for a chemical that
would have been delayed if Hutchison had worked with will kill T. gondii oocysts without harming humans.
dogs instead of cats. One of the most intriguing recent findings related
Hutchison668 proposed transmission of T. gondii via to oocyst biology concerns widespread T. gondii infec-
T. cati eggs. He used 2 cats (#5, #8) in the second experi- tions in marine mammals (Chapter 19). Who would have
ment whose serological status for T. gondii had not been thought that noncaptive marine mammals would die of
determined.668 Cat #5 had previously been experimentally toxoplasmosis acquired from freshwater runoff from land
infected with T. cati and was excreting nematode ova in contaminated with oocysts? We are indeed surrounded by
the feces. Cat #8 had not been infected with T. cati. He fed seas contaminated with T. gondii oocysts.
T. gondii–infected mice to each cat for 5 days and floated
feces in zinc sulfate to collect ova. After incubating the 1.3.4 Discovery of the Full Life Cycle
ova in water to embryonate them, he orally inoculated and Developmental Stages
fecal floats to groups of 6 mice. T. gondii infection was in the Intestine of Cats
achieved from the feces of cat #5 from day 13 through
day 30, when the experiment was terminated; fecal floats As stated earlier, it became clear in 1970 that there
from cat #8 were all negative. He then reversed the role was profuse multiplication of T. gondii in the intestine
of cat #5 and cat #8. He gave an anthelmintic to cat #5, to of cats after eating tissue cysts. The challenge was to
remove worms, and experimentally infected cat #8 with sort out different asexual stages in enterocytes because
T. cati—and repeated T. gondii feeding and fecal infec- the entire asexual and sexual cycle could be completed
tivity testing. As he expected, no fecal infectivity was in 60 hours.334 We have found 5 morphologically distinct
detected in the feces of cat #5, but cat #8 was excreting types of T. gondii that could develop in enterocytes before
T. gondii in feces from days 17–30 when the experiment gametogony. These stages are designated types A–E
was terminated. Thus, T. gondii was transmitted only in (instead of generations because there are several genera-
association with T. cati infection. Hutchison had a precon- tions within each T. gondii type). These asexual stages in
ceived hypothesis of nematode transmission of T. gondii. the feline intestine are structurally distinct from tachyzo-
In hindsight, we now know that the chance of success of ites that also develop in the lamina propria. The entero-
Hutchison’s second experiment was remote (perhaps 1 in epithelial stages (Types A–E, gamonts) are formed in the
1,000, or more) because cats usually excrete oocysts only intestinal epithelium and the development of types B–E
upon primary exposure; once they become immune, they schizonts in enterocytes has been confirmed ultrastruc-
usually do not excrete oocysts upon re-exposure to the turally.1167 Occasionally, type B and C schizonts develop
parasite.403 within enterocytes that are displaced beneath the epithe-
Hutchison’s experiment is described here again, for lium into the lamina propria.
the benefit of future graduate students, to underscore that I should emphasize that the asexual types A–C are
even a brilliantly planned experiment requires repetition time-dependent stages, few in number, and difficult to
to support a hypothesis. It also illustrates that seminal find.403
discoveries can be made in small laboratories with lim- To locate these early stages, I examined hundreds of
ited resources. The nematode theory of the transmission sections from the small intestines of cats fed tissue cysts.
of this parasite was discarded in 1969, and the T. gondii To find the earliest stage, type A, I had sectioned at 5 μm
oocyst was discovered in 1970 (Table 1.1). the entire duodenum of a kitten fed tissue cysts and micro-
Seroepidemiological studies on isolated islands in scopically examined all sections at 1,000× magnification.
the Pacific,1276 Australia,912 and the USA377 have shown The success in finding enteroepithelial stages was in
an absence of T. gondii on islands without cats, confirm- part due to the use of newborn kittens still nursed by their
ing the important role of the cat in the natural transmis- dam. This procedure allowed me to infect part of the litter
sion of T. gondii. Wallace’s study on Pacific Islands was with T. gondii tissue stages and to keep 1–2 littermates
remarkable and full of challenges. These islands are really as controls. The litter was killed as soon as oocysts were
remote and their main contact with the outside world is excreted, and before oocysts were sporulated, thus avoid-
via USA Coast Guard cutter ships. Wallace was allowed ing contamination of the environment. Until then, new-
only 2 days to work on each island. He was also one of born animals were not used for coccidiosis research.
the first to find T. gondii oocysts in the feces of naturally The mystery why only cats can excrete T. gondii
infected cats (Chapter 5). Additional studies revealed that oocysts was resolved recently.310 Felines are the only
6 TOXOPLASMOSIS OF ANIMALS AND HUMANS
mammals that lack delta-6-desaturase activity in their toxoplasmosis (see Table 1.1). Elmer Pfefferkorn, with his
intestines, which is required for linoleic acid metabolism, wife Lorraine Cassidy Pfefferkorn (see Table 1.1), made
resulting in systemic excess of linoleic acid. T. gondii the first genetic cross of T. gondii and laid the foundation
sexual development occurs when cultured feline intesti- for genetic research on T. gondii.
nal epithelial cells are supplemented with linoleic acid. I am grateful for collaborations, friendship, and
Inhibition of murine delta-6-desaturase and supplemen- guidance from Drs. Ajzenberg, D., Almería, S., Alvarado-
tation of their diet with linoleic acid allowed T. gondii Esquivel, C., Beattie, C.P*., Beverley, J. K.A*, Boothroyd,
sexual development in mice. This mechanism of species J.C., Boyle, J.P., Desmonts, G*., Dardé, M.L., Dumetre,
specificity is the first defined for a parasite sexual cycle.310 A., Fayer, R., Feldman, H. A.*, Ferguson, D. J. P., Frenkel,
Personal experiences leading to the discovery of the J. K.*, Gamble, H.R., Gennari, S.M., Gómez-Marin, J.E.,
oocyst and full life cycle of T. gondii were reviewed.370,435 Grigg, M. E., Hartley, W.M.*, Hill, D, E., Jacobs, L.*,
Jones, J. L., Lehmann, T., Lindsay, D.S., Lopes, A.P.A.,
Lunney, J.K., McLeod, R., Montoya, J. G., Munday,
1.4 GRATITUDE B.L*., Murrell, K.D., Pande, B.P.*, Pena, H.F.J., Pradhan,
A.B., Remington, J. S*., Rosenthal, B.M., Schares, G.,
This account will not be complete without mention- Sibley, L.D., Speer, C.A., Su, C., Thulliez, Ph, Urban,
ing contributions of 2 virologists, Albert Bruce Sabin, and J.F., Venturini, L.*, Venturini, M.C., Villegas, E., Villena,
Elmer Roy Pfefferkorn who made profound contributions I., Weiss, L. M., and many others during the 60 years of
to T. gondii biology. Dr. Sabin, who is best known for devel- research on toxoplasmosis that made this book possible
oping the polio virus vaccine, also isolated and distributed (*now deceased). I am grateful to all those who made it
worldwide the famous R.H. strain of T. gondii, developed possible for me to be part of it or observer for half the his-
the Sabin–Feldman dye test, and developed treatment for tory (1908–2020) of T. gondii.
Chapter 2
2.1 TAXONOMIC CLASSIFICATION was known of the complete life cycle of most Isospora
species until 1970, when the life cycle of T. gondii was
T. gondii is a coccidian parasite with cats as the defini- discovered. Until then, Isospora species were consid-
tive host and warm-blooded animals as intermediate ered parasites of carnivores (dogs, cats) and birds were
hosts. It belongs to not thought to be host-specific. In 1970, the oocyst of
T. gondii was discovered (see Chapter 1). This finding
Phylum: Apicomplexa; Levine, 1970 was a breakthrough in medical and veterinary sciences
Class: Sporozoasida; Leukart, 1879 and eventually led to the recognition of several new taxa
Subclass: Coccidiasina; Leukart, 1879 of economically important Toxoplasma-like parasites
Order: Eimeriorina; Leger, 1911
(e.g., Hammondia, Neospora, Sarcocystis) and discov-
Family: Toxoplasmatidae, Biocca, 1956
Genus: Toxoplasma Nicolle and Manceaux, 1909
ery of their life cycles.
Historically, T. gondii originated probably as a coccid-
There is only one species of Toxoplasma, T. gondii. ian parasite of cats with a fecal-oral cycle. With domestica-
Coccidia are among the most important parasites of tion, it adapted transmission by several modes, including
animals, and they were the first protozoa discovered.446 transmission by fecal-oral cycle, by carnivorism, and
The oocyst is the key stage of all coccidians, and their transplacentally. Although T. gondii can be transmitted in
classification was based on the number of sporozoites many ways, cats are essential for its natural propagation.
and structure of the oocyst. Oocysts with 4 sporocysts, There are 3 infectious stages of T. gondii: the tachyzoites,
each with 2 sporozoites (total 8 sporozoites), are clas- the bradyzoites, and oocysts. These stages are linked in a
sified as Eimeria. Coccidiosis due to Eimeria species complex life cycle (Figure 2.1).
is one of the most economically important diseases of
poultry, cattle, sheep, goats, and many other herbivores;
it is difficult to raise livestock coccidia-free. Oocysts 2.2 STRUCTURE AND LIFE CYCLE
with 2 sporocysts, each with 2 sporozoites, were origi-
nally classified as Isospora (now Cystoisospora). In 2.2.1 Tachyzoite
the last 2 decades Cyclospora (2 sporocysts each with
2 sporozoites) and Cryptosporidium (4 naked sporozo- 2.2.1.1 Structure
ites) have become prominent because of public health
concern. Tachyzoite (táchos = speed in Greek) is the rapidly mul-
Before the discovery of the life cycle of T. gondii, tiplying stage. The tachyzoite is crescent-shaped, approxi-
coccidians were considered host-specific with a simple mately 2 × 6 μm (Figures 2.2a and 2.3a), with a pointed
1-host life cycle. Infection was confined to the intestines anterior (conoidal) end and a rounded posterior end. In
and usually to enterocytes. With few exceptions, Eimeria histological sections, tachyzoites are often round, 2–4 μm
species still follow this life cycle. The host becomes in diameter with a central vesicular nucleus (Figure 2.3d).
infected by ingesting sporulated oocysts of Eimeria. Ultrastructurally, it has complex structure with several
After excystation, the sporozoites penetrate intestinal organelles.68,135,150,492,910,955,1089 The tachyzoite consists of
epithelial cells and multiply asexually before forming various organelles and inclusion bodies including a pel-
male and female gamonts. Oocysts are produced after licle (outer covering), cytoskeleton (inner membrane
fertilization and are passed in feces in a noninfective complex (IMC), subpellicular microtubules, apical rings,
unsporulated stage. Sporulation occurs outside the host polar rings, a conoid), secretory (rhoptries, micronemes,
and oocyst become infectious. Unlike Eimeria, the life dense granules) micropore, a mitochondrion, endoplas-
cycle of which has been known for many years, little mic reticulum, a Golgi complex, ribosomes, rough and
7
8 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.1
Life cycle of T. gondii.
smooth endoplasmic reticula, nucleus, acidocalcisomes, originate from the apical cap, above the 22 subpellicular
amylopectin granules, Golgi apparatus, and an apicoplast microtubules. One or more cytostome-like-structures,
(Figures 2.3–2.5). The pellicle consists of 3 membranes: 1 termed micropores, are present at the apical half of the
plasmalemma and 2 closely applied membranes that form parasite. Micropore is a 150-nm diameter in-foldings of
an IMC. The IMC is formed from a patchwork of flattened the plasma membrane with a thickened collar. The func-
vesicles derived from endoplasmic reticulin and Golgi tion of micropore is not clear but thought to be uptake of
system. The inner membrane is discontinuous at the ante- materials.
rior tip above the polar rings, at the micropore and at the There are 2 apical and 2 polar rings (outer and inner).
basal complex posterior pore at the extreme posterior tip The apical rings are located at the anterior tip of the para-
of the zoite. Additionally, a network of filamentous intra- site and consist of electron dense material (Figure 2.2d).
membranous particles (IMPs) with a mean diameter of The outer ring encircles the top of the resting conoid. The
8–10 nm and composed of a group of proteins (alveolins) outer polar ring is an electron-dense thickening of the
that are located below the IMC. These 22 rows of IMPs IMC at the anterior end of the tachyzoite. The inner
BIOLOGY OF T. GONDII 9
Figure 2.2 Schematic drawings of T. gondii stages. (a) Tachyzoite. (b) Bradyzoite. (c) Sporozoite. 1. Pellicle. 2. Conoidal (ante-
rior) end. 3. Posterior end. 4. Micropore. 5. Rhoptry. 6. Microneme. 7. Apicoplast. 8. Amylopectin granules. 9. Dense
granules. 10. Golgi body. 11. Mitochondrion. 12. Endoplasmic reticulin. 13. Nucleus. (d) Apical complex. 14. Internal
microtubules. 15. Microtubules of conoid. 16. IMC. 17. Plasmalemma. 18. Apical ring 1. 19. Apical ring 2. 20. Polar ring
1. 21. Polar ring 2. 22. Subpellicular tubules. (e) Macrogamont. 23. Veil forming bodies. 24. Wall forming bodies (WFB)
1. 25. WFB 2. 26. Lipid body. 27. Mitochondrion. 28. Endoplasmic reticulum. 29. Nucleus. 30. Amylopectin granules.
(f) Microgamete. 31. Perforatorium. 32. Basal body. 33. Flagellum 1. 34. Flagellum 2. 35. Flagellum 3. 36. Microtubule.
37. Mitochondrion. 38. Nucleus.
ring anchors the subpellicular microtubules. The conoid originate from the inner polar ring and run longitudi-
(0.3 × 0.4 µm) is a truncated hollow cone and consists nally approximately two-thirds of length of the cell, just
of tubulin structures wound like compressed springs beneath the IMC (Figure 2.4). They are evenly spaced,
(Figure 2.2d). Twenty-two subpellicular microtubules and their distal ends are not capped. In addition, there
10 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.3 Tachyzoites (a–d) and tissue cysts (e–i) of T. gondii. (a) Tachyzoites (arrow) are crescent-shaped compared with red blood
cells (arrowhead), impression smear, mouse lung (Giemsa). (b) Fluorescent image of 2 dividing tachyzoites, expressing
YFP ± tubulin (cyan) and RFP-TgMORN1 (yellow). The apical ends (arrowhead) of the parasites are oriented toward the top
of the image. The 2 dome-like structures in each parasite are daughter cortical cytoskeletons highlighted by YFP ± tubulin
(cyan) and RFP-TgMORN1 (yellow). Arrow points to nonconoidal end. (Courtesy of Drs. K. Hu and John Murra, University
of Pennsylvania, Philadelphia, USA.) (c) Group of tachyzoites showing Golgi (Grasp-mRFP; red, arrow) and apicoplast
(anti-acyl carrier protein with Alexa 488; green, arrowhead) with DAPI staining. (Courtesy of Dr. Boris Striepen, University
of Georgia, Athens, USA.) (d) Group of tachyzoites (arrow) in a PV in the lamina propria of small intestine of cat. Dividing
tachyzoites (arrow) are bigger in size and plump. Arrowhead points to a host cell nucleus. Histologic section (H&E). (e)
Small tissue cyst. Note thin silver-positive cyst wall (arrowhead) and bradyzoites with terminal nuclei (arrow). Impression
smear, mouse brain. Wilder’s silver stain plus Giemsa. (f) Tissue cyst with a thin PAS-negative (or faintly stained) cyst wall
(arrowhead) intensely PAS-positive bradyzoites (arrow). Histologic section of the brain. PAS reaction counter-stained with
hematoxylin. (g) Tissue cyst from the mouse brain, demonstrating green fluorescent protein (GFP) expressing bradyzoites
(green, arrowhead). The cyst wall stained with antibody to cyst wall protein 1 (CST1) followed by a rhodamine labeled sec-
ondary antibody (red, arrow). (Courtesy of Drs. Joshua Mayoral and Louis M. Weiss, Albert Einstein College of Medicine,
Bronx, New York, USA.) (h) Tissue cyst freed from mouse brain. Note hundreds of bradyzoites (arrowhead) enclosed in a
thin cyst wall (arrow). Unstained. (i) Tissue cyst in histological section of mouse brain, 14 months p.i. Note only nuclei of
bradyzoites (arrowhead) are visible and the cyst wall is very thin (arrow). H&E.
BIOLOGY OF T. GONDII 11
Figure 2.4
T. gondii tachyzoites as seen by helium ion scanning microscopy. (a, b) Rosettes of tachyzoites attached to residual
body by posterior end. Note profuse intravacuolar network (arrowhead). The tachyzoites are partially covered by host
cell (double arrowheads). (c, d) Apical end of extracellular T. gondii tachyzoites. Note subpellicular microtubules (arrow-
heads) arising from polar ring (arrow) of the conoid (c). The subpellicular microtubules are covered by the pellicle
simulating a tear-drop appearance. (Courtesy of Wanderley de Souza and Marcia Attias, Universidade Federal do Rio
de Janeiro, Brazil.)
are two 400-nm long intraconoidal tightly bound micro- Another organelle that has been identified is called plant-
tubules. The subpellicular microtubules are like a rib like vacuole; it is enclosed in a single membrane.
cage and are arranged in a gentle counterclockwise spiral. The nucleus is usually situated toward the central area
Individual microtubules have prominent transverse stria- of the tachyzoite. It is nearly spherical with an anterior
tions. Between the anterior tip and the nucleus there are up concavity. It consists of a nuclear envelope with pores,
to 10 club-shaped organelles called rhoptries (Figure 2.5). clumps of chromatin, and a centrally located nucleolus.
A rhoptry consists of an anterior narrow electron dense The mitochondrion is branched, nearly as long as the
neck up to 2.5 µm long that extends into the interior of the whole tachyzoite, and has bulbous cristae. It is thought
conoid, and a sac-like, often labyrinthine posterior end (up to be an endosymbiont. Considerable biological curiosity
to 0.25 × 1 µm). Micronemes are electron-dense rod-like has been focused on a nonphotosynthetic organelle called
structures (250 × 50 nm) that are at the anterior end of the the plastid (Figure 2.2a). It is a 4-membrane bound, alga-
parasite around the polar ring (Figure 2.5). Dense gran- derived obligatory endosymbiont structure. It has an extra
ules are electron dense, approximately 200 nm in diam- chromosomal 35 kb DNA. It is approximately 500 nm in
eter and scattered throughout the tachyzoite but mostly in diameter and filled with granular filamentous material. At
the posterior end. Acidocalcisomes, approximately 10, are the posterior (nonconoidal) end of the tachyzoite, there is
acidic organelles that are involved in calcium regulation. a basal complex structure.
12 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.5
TEM of T. gondii tachyzoites. (a) Longitudinal section of an intracellular tachyzoite in cell culture. Am, amylopectin gran-
ule; Co, conoid; Dg, electron-dense granule; Go, Golgi complex; Mn, microneme; No, nucleolus, Nu, nucleus; Pv, parasi-
tophorous vacuole; Rh, rhoptry; Lb, lipid. (b) A tachyzoite penetrating a neutrophil in mouse peritoneum; note the moving
junction (Mj) at the site of penetration into the neutrophil and the extraordinary early development of the tubulovesicular
membranes (Tv) in the space between the neutrophil and the tip of the tachyzoite. (Dubey, J.P., Lindsay, D.S., Speer,
C.A., 1998, Clin. Microbiol. Rev., 11, 267–299.381)
2.2.1.2 Host Invasion their contents through the plasmalemma just above the
conoid to the exerior. The mechanical events involved in
Although tachyzoites can move by gliding, flexing, zoite attachment and penetration include (i) gliding of the
undulating, and rotating, they have no visible means of zoite; (ii) probing of the host cell with the zoite’s conoidal
locomotion such as cilia, flagella, or pseudopodia. Instead, tip; (iii) indenting the host cell plasmalemma; (iv) form-
their motility is powered by the actin-myosin motor com- ing a moving junction (Figure 2.5b) that moves posteriorly
plex anchored to the IMC. The intracellular components along the zoite as it penetrates into the host cell; and (v)
and the extracellular milieu have been called the glideo- partially exocytosing micronemes, rhoptries, and dense
some.529,614 The outermost IMC membrane is studded with granules. T. gondii can penetrate a variety of nucleated
myosin complexes, like a conveyor-belt system. T. gondii cell types from a wide range of hosts, indicating that the
is nonmotile at room temperature. The gliding occurs biochemical receptors involved in attachment and penetra-
counterclockwise and tachyzoite can move up to 10 µm tion are probably common to most animal cells. T. gondii
in 1 second.1138 can penetrate the host plasmalemma in 26 seconds. The
Functions of the conoid, rhoptries, and micronemes are invasion involves 2 Ca2+-dependent events of protrusion of
not fully known but are probably associated with host-cell the conoid and secretion of microneme and rhoptry con-
penetration and creating an intracellular environment suit- tents forming a moving junction. The tachyzoite is tem-
able for parasite growth and development and exit from the porarily deformed as it penetrates and squeezes through
host cell. The conoid can rotate, tilt, extend, and retract the host plasmalemma. Recent studies have shown that the
as the parasite probes the host-cell plasmalemma imme- tachyzoite can gain entry in host by endocytosis as well as
diately before penetration. Rhoptries have a secretory active penetration.1010 The parasite is quickly surrounded
function associated with host cell penetration, secreting by a membrane that is evidently derived from the host-cell
BIOLOGY OF T. GONDII 13
plasmalemma minus host proteins. This membrane is des- and underwent endodyogeny to form tachyzoites. Even
tined to become the parasitophorous vacuole (PV) mem- though the sporozoites were just passing through ileal
brane (PVM); and a number of parasite proteins associate enterocytes, they still formed PVs that contained exocy-
with it including rhoptry proteins, ROP2, 3, 4, and 7. ROP2 tosed dense granule material and well-developed TMNs
is located on the host-cell cytoplasmic side of the PVM (Figures 2.6 and 2.7). Exocytosed material and TMNs
suggesting a role in host/parasite biochemical communica- associated with the PVs of sporozoites in transit across
tion. Within a few minutes after penetration, tachyzoites the intestinal epithelium indicate that parasite replica-
modify the newly formed PV and the PVM with parasite tion does not always follow the formation of a parasite-
proteins and a tubular membranous network (TMN) forms modified PV. After entering cells in the lamina propria,
within the PV within first hour of invasion. The TMNs are sporozoites presumably formed a second PV multiplied
antigenically and structurally different from PVM but have by endodyogeny.
connections to it.292 The PVM acquires pore structures that As stated earlier, most studies on host parasite interac-
freely allow charged molecules up to 1,200 kDals to dif- tions were performed with tachyzoites.1138 Recently, host
fuse bidirectionally between the PV and host-cell cyto- cell-sporozoite interaction in vitro was studied ultrastrc-
plasm. Dense granule associated proteins are secreted turally and by immunofluorescence.1207 Within 1–5 min-
into the PV. Collectively, these modifications establish a utes of incubation of human foreskin fibroblasts cultures
parasite-friendly environment within the host-cell cyto- with sporozoites, a moving junction was formed, as shown
plasm conducive to parasite replication. The PVM is not by the presence of a rhoptry neck protein (RON4)-positive
a homogenous structure of uniform thickness. The vol- ring around the invading parasite or the accumulation of
ume of PV may increase many folds within 24 hours of its RON4 at the sporozoite rear end, considered typical of
formation. The organelles in progeny are synthesized de invading or just invaded zoites. An unusual feature was
novo; however, a recent study proposed recycling of micro- the presence of sporozoite-specific trails (ssts) at the non-
neme protein MIC2 from mother to daughter tachyzo- conoidal (rear) end of the sporozoite (Figure 2.8). These
ites.991 Tachyzoites continue to divide by endodyogeny. In ssts were 10–100 μm long, generally formed a straight
vivo, most groups of tachyzoites are arranged randomly line, and consisted of tubulo-vesicular structures associ-
due to asynchronous cycles of endodyogeny. However, ated with dense granule proteins, including GRA1. PVM-
occasionally rosettes are formed due to synchronous divi- enclosed sporozoites could traverse host cells, exit intact,
sion (Figure 2.4a and b). In rapidly dividing tissue culture and infect new cells.1207 At any stage of the host-parasite
adapted strains, T. gondii within a vacuole may divide interaction, sporozoites were surrounded by only 1 PVM;
synchronously, but this is not the norm. Rarely, tachyzo- the secondary large vacuole observed in a previously is
ites of certain strains may divide by binary fission. The now considered an artifact.1165
host-cell ruptures when it can no longer support the growth
of tachyzoites. Exit from the host cell is mediated by a pro- 2.2.1.3 Multiplication by Endodyogeny
tein (TgPLP1) secreted by the parasite. A highly dynamic
F-actin network connects individual tachyzoites support- Tachyzoites multiply asexually within the host
ing multidirectional vesicular transport.991 One interesting cell by repeated endodyogeny, a specialized form of
and elusive phenomenon is association of host mitochon- reproduction in which 2 progeny form within the par-
dria and endoplasmic reticulum (ER) to the PV.11 Within ent parasite (Figure 2.9), consuming it. In endodyog-
minutes of tachyzoite invasion into the host cell, host mito- eny, the Golgi complex and the apicoplast divide, first
chondria and ER are tightly associated with PVM and the becoming 2 at the anterior end of the nucleus, along
extent of this juxtaposed association does not change with with the formation of 2 centrosomes from the nucleus.
enlargement of the PV. The T. gondii vacuole does not fuse Next, the conoid, the anterior portions of the IMCs,
with host lysosomes. After exit from the host cell, parasite and the subpellicular microtubules of the progeny cells
can leave long trails.1138 These trails include SAG1, MIC2, appear as 2 dome-shaped structures anteriorly. The
and actin but not myosin.991 parasite nucleus becomes horseshoe-shaped and the
Most of the available information concerning the ends of the nucleus move into the dome-shaped ante-
interaction of T. gondii zoites with host cells has been rior ends of the developing progeny. The IMC and
derived from in vitro cultivation with tachyzoites. Limited subpellicular microtubules continue to extend posteri-
information is available on initial host-cell interaction orly and surround one half of the nucleus, which even-
with bradyzoites and sporozoites. In 1 study, host ER, but tually pinches into 2. Partitioning of the ER and the
not mitochondria, surrounded the initial phases of PV for- mitochondrion continue. Rhoptries and micronemes
mation.601 In mice orally inoculated with oocysts, spo- are synthesized de novo in the progeny. The progeny
rozoites excysted and passed through enterocytes and continues to grow until they reach the surface of the
goblet cells of the mouse ileal epithelium and entered the parent. The IMC of the parent disappears, and its outer
lamina propria where they infected all cells of the host, membrane becomes the plasmalemma of the progeny
14 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.6
TEM of T. gondii sporozoites in mouse ileum at 2 hours after oocyst oral inoculation. (a) Two intracellular sporozoites
located above the host nucleus (Hn) in an ileal enterocyte; note the electron-dense material (Ed) in the PV surrounding
the sporozoite cut in cross-section and the tubulovesicular membranous network (Tm) in the other sporozoite. Am, amy-
lopectin granule; Dg, dense granule; Mn, microneme; Nu, nucleus of sporozoite; Rh, rhoptry. (b) Sporozoite located at the
base of an ileal enterocyte. BI, basal lamina of the intestinal epithelium; Hn, host cell nucleus; Mv, microvilli of enterocyte;
Lp, lamina propria. (Speer, C.A., Clark, S., Dubey, J.P., 1998, J. Parasitol., 84, 505–512.1166)
cells. The organelles in progeny are synthesized de endodyogeny. In vivo, most groups of tachyzoites
novo; however, a recent study proposed recycling of are arranged randomly due to asynchronous cycles
the microneme protein MIC2 from mother to daugh- of endodyogeny. However, occasionally rosettes are
ter tachyzoites.991 Tachyzoites continue to divide by formed due to synchronous division (Figure 2.10). In
BIOLOGY OF T. GONDII 15
Figure 2.7
TEM of T. gondii sporozoites in ileal lamina propria of a mouse at 6 hours after feeding irradiated sporulated oocysts.
(a) Two sporozoites in a macrophage (Mo); Ec, enterocyte; En, endothelial cell of blood vessel. (b) Sporozoite within
a macrophage; Dg, dense granule; Go, Golgi complex; Mn, microneme; Nu, nucleus; Pv, parasitophorous vacuole;
Rh, rhoptry; Tn, tubulovesicular membrane network. (Dubey, J.P., Thayer, D.W., Speer, C.A., Shen, A.K., 1998, Int. J.
Parasitol., 28, 369–375.380)
rapidly dividing tissue culture adapted strains, T. gondii The rate of invasion and growth varies depending on
within a vacuole may divide synchronously, but this is the strain of T. gondii and the host cells. After entry of
not the norm. Rarely, tachyzoites of certain strains may tachyzoites into a host cell, there is a variable period of
divide by binary fission. The host cell ruptures when it lag phase before the parasite divides, and this lag phase is
can no longer support the growth of tachyzoites. Exit partly parasite-dependent. Mouse virulent strains of T. gon-
from the host cell is mediated by a protein (TgPLP1) dii grow faster in cell culture than “avirulent” strains, and
secreted by the parasite. some strains of T. gondii form more rosettes than others.
16 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.8
TEM of T. gondii sst arising from the posterior end of a sporozoite (arrowheads). (a, b) An intracellular sporozoite point-
ing with its conoidal end toward the extremity of a human foreskin fibroblast protrusion, arising from the posterior pole
of the PVM. Note: posteriorly located nucleus (nu), clumps of amylopectin granules (am), and a dense granule (dg) in
sporozoite. (Tartarelli, I., Tinari, A., Possenti, A., Cherchi, S., Falchi, M., Dubey, J.P. and Spano, F., 2020, Int. J. Parasitol.,
50, 1099–1115.1207)
2.2.2 Bradyzoites and Tissue Cysts cysts are elongated and may be 100 μm long. Although
tissue cysts may develop in visceral organs, including the
2.2.2.1 Structure lungs, liver, and kidneys, they are more prevalent in the
neural and muscular tissues, including the brain, eyes, and
After a few rounds of multiplication, tachyzoite con- skeletal and cardiac muscles.
verts into a slowly replicating stage, bradyzoite, and The tissue cyst wall is elastic, argyrophilic, <0.5 μm
becomes enclosed in cyst wall (see Chapter 3 for stage thick (Figure 2.3), and it encloses hundreds of crescent-
conversion).865 The bradyzoite is the encysted stage of the shaped bradyzoites, 5–8.5 × 1–3 μm in size. The tissue
parasite in tissues. Bradyzoites are also called cystozo- cyst wall is only faintly periodic acid-Schiff (PAS) posi-
ites. To avoid confusion between the term cyst (also called tive compared to the enclosed bradyzoites (Figure 2.3f).
pseudocyst) in tissues versus oocyst in feces, we proposed The cyst wall contains chitin-like polysaccharides and
the term tissue cyst for the encysted stage of the parasite.355 glycoproteins that are detectable by fluorescently labelled
Tissue cysts grow and remain intracellular as the brady- lectins (Figure 2.3g).200,678 The tissue cyst develops within
zoites divide by endodyogeny. Tissue cysts vary in size; the PV in the host cell cytoplasm. The PV is rarely vis-
young tissue cysts may be as small as 5 μm in diameter ible in older tissue cysts. The thickness and the charac-
and contain only 2 bradyzoites (Figure 2.11), while older ter of the cyst wall may vary depending on the age of the
ones may contain thousands of organisms (Figure 2.3h). parasite and the host cell parasitized (Figure 2.12). The
Occurrence of odd numbers of bradyzoites in young tis- tissue cyst wall is uneven in thickness and appears rough.
sue cysts indicates asynchronous division. In histological The outer limiting membrane, probably derived both from
sections tissue cysts in the brain are often spheroidal and the host and the parasite, is lined with granular mate-
rarely reach a diameter of 70 μm, whereas intramuscular rial (hereon termed granular layer, GL) which also fills
BIOLOGY OF T. GONDII 17
Figure 2.9
TEM of an in vivo T. gondii tachyzoite undergoing endodyogeny. Note Cd, conoid of developing tachyzoite; Co, conoid
of mother tachyzoite; Dg, electron-dense granule; Ga, Golgi adjunct; Hm, host cell mitochondrion; Hn, host cell nucleus;
Id, inner membrane complex of developing tachyzoite; Im, inner membrane complex of mother tachyzoite; Mi, mitochon-
drion; Mn, microneme; Nu, nuclei of daughter tachyzoites; Pl, plasmalemma of mother tachyzoite; Pm, parasitophorous
vacuolar membrane; Pv, parasitophorous vacuole; Rh, rhoptries of daughter tachyzoites. (Dubey, J.P., Lindsay, D.S.,
Speer, C.A., 1998, Clin. Microbiol. Rev., 11, 267–299.381)
the space between the bradyzoites. In fixed material, the surrounded by host mitochondria, depending on the host-
GL consists of granules or particulate material with few cell parasitized or unknown factors. Mitochondria were
vesicles. In older tissue cysts, the GL has deep invagina- not surrounded in the tissue cyst in Figure 2.11b, but many
tions of the outer limiting membrane with interconnecting were present in the tissue cyst in Figure 2.12; both tissue
branches or channels extending up to half width of the GL. cysts were in mouse brain. The accumulation of micro-
Bradyzoites are juxtaposed against the GL (Figure 2.13). tubules and intermediate filaments around the tissue cyst
Some bradyzoites degenerate, especially in older tissue wall apparently provide rigidity to the tissue cyst wall.969
cysts. In younger tissue cysts, the bradyzoites are often Tissue cysts are metabolically active and small molecules
plump and contain relatively fewer organelles than in older (10 kDa) can diffuse through the tissue cyst wall.
tissue cysts (Figure 2.13). Factors regulating the formation Bradyzoites differ structurally only slightly from
of tissue cysts in vivo are not fully understood. The PV in tachyzoites (Table 2.1). They have a nucleus situated
tissue cysts lacks typical TMN found in tachyzoites. The toward the posterior end, whereas the nucleus in tachyzo-
matrix between bradyzoites has vesicles, lipid-like bodies, ites is more centrally located. The contents of rhoptries
and tubular structures. The tissue cyst may or may not be in bradyzoites are usually electron dense, whereas those
18 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.10
TEM of 4 T. gondii tachyzoites in final stages of endodyogeny that are still attached by their posterior ends to a common
residual body (Rb); note that several host cell mitochondria (*) are situated in close proximity to the PV, which con-
tains extensively developed tubulovesicular membranes (Tv); Am, amylopectin granule; Co, conoid; Dg, electron-dense
granule; Hn, host cell nucleus; Mn, microneme; Mp, micropore; Nu, nucleus; Rh, rhoptry. (Dubey, J.P., Lindsay, D.S.,
Speer, C.A., 1998, Clin. Microbiol. Rev., 11, 267–299.381)
in tachyzoites are labyrinthine. However, the contents of 2.2.2.2 Tissue Cyst Distribution in Host Tissues
rhoptries in bradyzoites vary with the age of the tissue cyst.
Bradyzoites in younger tissue cysts may have labyrinthine Tissue cyst distribution is in part controlled by the
rhoptries, whereas those in older tissue cysts are electron host, as shown with studies in rodents and cats.376,378
dense. Also, most bradyzoites have 1–3 rhoptries that are Knowledge on distribution of tissue cysts and the num-
looped back on themselves (Figure 2.13a). Bradyzoites ber present per gram of tissue are of epidemiologic sig-
contain several amylopectin granules which stain red with nificance. In food animals, more tissue cysts are present
PAS reagent; such material is either in discrete particles in muscles than in the brain. Distribution of tissue cysts
or is absent in tachyzoites. Bradyzoites are thinner than in different organs of animals fed oocysts of the GT-1
tachyzoites. There are more micronemes in bradyzoites, strain of T. gondii is shown in Table 2.2. In all hosts,
reaching posterior to the nucleus (Figure 2.13b). Even in muscular tissues were more parasitized than the brain,
the youngest tissue cyst containing only 2 bradyzoites, the and tissue cysts were also present in visceral tissues.
nucleus can be terminally located (Figure 2.11a). Tissue Similar observations were made with naturally infected
cysts are an integral part of the life cycle of T. gondii and animals (Table 2.3). Heart was the most consistently
are formed as early as 3 days p.i. In my opinion, there are infected organ. In a comparative study, pepsin digests of
no cyst-less strains of T. gondii in nature. the brains, heart, and leg muscles of chickens and cats
BIOLOGY OF T. GONDII 19
Figure 2.11
T. gondii tissue cysts in mouse brain. (a) Impression smear. Five small tissue cysts with silver positive cyst wall. Silver
stain and Giemsa. (b) TEM of a tissue cyst with only 4 bradyzoites. This is the youngest tissue cyst that I have examined
by TEM. Note well defined cyst wall clearly within a PV. The enclosed organisms have only a few organelles (amylopec-
tin granules-Am, rhoptries-Ro, micronemes-Mn, dense granules-Dg, and a conoid-Co), but the nucleus (Nu) is terminal.
(c) TEM of a small intracellular cyst with well-developed cyst wall. Note cyst wall (arrowheads) and amylopectin (Am) in
bradyzoites. The host cell nucleus (Hcn) is closely applied to the cyst wall. The PV is no longer visible. (From Dubey,
J.P., 2010, Toxoplasmosis of Animals and Humans, 2nd ed., CRC Press, Boca Raton.403)
were bioassayed in mice, 5 mice per digest (Table 2.4). 2.2.2.3 Tissue Cyst Rupture and Reactivation
Hearts were more positive than brains. Additionally,
the proportion of mice infected versus inoculated was Unlike food animals, murine brain has more tissue
also higher for the heart than the brain, indicating that cysts than other organs. Although more tissue cysts are
more T. gondii were present in the infected hearts than found per gram of tissue in mice than other hosts, the fate
brains (Table 2.4). The amount of tissue bioassayed was of tissue cysts is difficult to study in mice because mice
not the issue as in case of chickens; the entire brain was are never completely immune to T. gondii, and new tissue
bioassayed. cysts are formed even in chronic infections (Figure 2.14).
Estimates of T. gondii per gram of muscle in lambs In a quantitative study, tissue cyst rupture was found in
and goats naturally infected with T. gondii were low only 2 (0.27%) of 750 tissue cysts examined in the brains of
(Table 2.5). For this, 5, 10, and 50 g samples from natu- experimentally infected mice, although T. gondii-positive
rally infected lambs and goats from a local grocery were debris was found in 8 (1.4%) glial nodules.489,490 Another
bioassayed in mice for T. gondii. Not all 5 and 10 g sam- paper quantitatively studied the dynamics of tissue cysts in
ples were infected, indicating uneven distribution of tissue CBA/J mice infected with the ME 49 strain. Tissue cysts
cysts (Table 2.5). were separated by Percoll gradient fractionation from the
Bioassays of different tissues of naturally infected brains of mice euthanized at 3, 4, 5, 6, and 8 weeks p.i. The
pigs, goats, and lambs indicated that T. gondii was pres- number of tissue cysts and their sizes was remarkably simi-
ent in virtually all edible tissues (Table 2.6). T. gondii lar 3–8 weeks p.i.; both small (<40 μm) and large (>70 μm)
was widely distributed in the tissue of infected food tissue cysts were found at all time points.1304 There was no
animals. evidence for cyclic rupture of tissue cysts and formation of
20 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Figure 2.12
TEM of a T. gondii tissue cyst in the heart of a naturally infected brushtail possum (Trichosurus vulpecula) from
Australia. The cyst wall (Cw) is butted against the cytoplasm of the cardiac myocyte. Note 1 plump bradyzoite with an
anterior conoid (Co), subterminal nucleus (Nu), amylopectin (Am), and numerous micronemes (Mn). (From Dubey, J.P.,
2010, Toxoplasmosis of Animals and Humans, 2nd ed., CRC Press, Boca Raton.403)
many new tissue cysts. Evidence indicated that the loss of because serological negativity does not equate with para-
tissue cysts (if any) is balanced by emergence of an equal site ‘‘cure”. When and how tissue cysts rupture is largely
number of tissue cysts destroyed. 1304 Whether this phe- unknown. Treatment with corticosteroids, antilympho-
nomenon is peculiar to the strain of mouse and the ME 49 cyte serum, and anti-interferon antibody is known to
strain requires further study.1304 induce immunosuppression and relapse due to toxoplas-
Factors affecting tissue cyst rupture are largely mosis. The animal model, route of inoculation, stage of
unknown. Tissue cyst rupture has rarely been documented T. gondii used for primary infection, and criteria used for
in naturally infected immunocompetent hosts. I have evaluation of relapses are all important considerations.
examined tissues of many naturally infected animals, For example, hamsters are more corticosteroid-sensitive
found ruptured tissue cysts only rarely.403 than mice or rats, and oral administration of cortico-
In a more recent study in experimentally infected rats, steroids is less effective than parenterally administered
tissue cyst rupture was frequent (Figures 2.15 and 2.16).434 corticosteroids.
However, there was no evidence for reactivation and the The genesis of new generations of tissue cysts in chroni-
presence of tachyzoites. Although observations were lim- cally infected mice is unknown. Clusters of tissue cysts are
ited to rats infected for 2 months, there was no evidence found in mice infected with certain strains of T. gondii, and
for the formation of new tissue cysts.434 sometimes in clinically normal mice. Whether bradyzoites
Little information is available concerning the mecha- leak out from intact tissue cysts is uncertain but unlikely.
nisms of relapse. Intact tissue cysts probably do not cause The rupture of tissue cysts and subsequent multiplication
any harm and persist for the life of the host, but this con- of tachyzoites can lead to fulminating toxoplasmosis even
cept has been questioned.1070 There are no definitive data in chronically infected mice. Tachyzoites may persist in
concerning the persistence of tissue cysts or lack of it chronic infection in certain hosts.
BIOLOGY OF T. GONDII 21
Figure 2.13
TEM of a T. gondii tissue cyst in mouse brain, 6 months p.i. (a) Note numerous bradyzoites are enclosed in cyst wall
(arrowheads). Several bradyzoites (marked 1-4) have looped rhoptries; 1 rhoptry is almost as long as the bradyzoite and
the blunt end of the rhoptry is pointed towards conoid (arrows). (b) Longitudinal section of a bradyzoite with an anterior
conoid (Co), few rhoptries (Ro), amylopectin granules (Am), dense granules (Dg), nucleus (Nu), cyst wall (Cw), numer-
ous haphazardly arranged micronemes (Mn), a mitochondrion (Mt); the posterior end is thickened (double arrows). The
cyst wall membrane is invaginated and the branches extend half-way into the interior of the cyst wall (arrowheads). Host
mitochondria (arrows) surround the cyst wall. (From Dubey, J.P., 2010, Toxoplasmosis of Animals and Humans, 2nd ed.,
CRC Press, Boca Raton.403)
Table 2.1 Relative Numbers (Mean, Range) of Organelles and Inclusion Bodies in Sporozoites, Tachyzoites, and Bradyzoites
of the VEG Strain of T. gondii as Determined Ultrastructurallya
Stage Rhoptries Micronemes Dense Granules Amylopectin Lipid
Sporozoite 5.9 (2–11) 55 (40–78) 9.4 (5–15) 7.8 (3–13) 1.25 (1–3)
Tachyzoite 6.7 (2–11) 25 (19–38) 9.1 (5–17) 2.4 (1–6) 0.6 (0–2)
Bradyzoite 5.5 (2–8) 75.5 (36–112) 2.7 (1–5) 21.8 (7–38) 0
a Source: Dubey, J.P., Lindsay, D.S., Speer, C.A., 1998, Clinic. Microbiol. Rev., 11, 267–299.381
Table 2.2 Persistence of T. gondii in Tissues of Animals Fed Oocysts the GT-1 Straina
Species Days p.i. Liver Kidneys Brain Skeletal Muscles Heart Diaphragm Reference
Sheep 97–173 6/8b 5/8 4/8 6/8 7/8 6/8 Dubey (1984)
Goats 335–441 6/6 3/6 5/6 6/6 6/6 6/6 Dubey (1982)
Horses 33–476 0/13 1/13 2/13 2/13 3/13 ND Dubey (1985)
Cattle 256, 267 2/2 1/2 0/2 1/2 0/2 0/2 Dubey (1983)
Pigs 38–171 2/8 2/8 8/8 5/8 8/8 4/8 Dubey et al. (1984, 1986); Dubey (1988)
Elk 73 1/2 0/2 2/2 1/2 1/2 2/2 Dubey et al. (1980)
Bison 28 1/1 0/1 0/1 0/1 0/1 ND Dubey (1983)
Coyotes 49–84 ND 1/4 3/4 4/4 2/4 2/4 Dubey (1982)
Foxes 36 2/2 ND 2/2 2/2 2/2 ND Dubey et al. (1983)
Dogs 166, 167 1/4 0/4 0/4 4/4 3/4 ND Dubey (1985)
a Source: Dubey, J.P., Lindsay, D.S, Speer, C.A., 1998, Clinic. Microbiol. Rev., 11, 267–299.381 For references see this paper.
b No. of infected animals/no. of animals fed T. gondii. Pepsin digests of tissues (50 g) were bioassayed in mice.
22 TOXOPLASMOSIS OF ANIMALS AND HUMANS
Table 2.3 Prevalence (%) of Viable T. gondii in Brain and Muscles of Naturally Infected Animalsa
Host No. Bioassayed Brain Muscle (Organ) Reference
Sheep 31 29.0 58.0 (diaphragm) Jacobs et al. (1963)
Chickens 136 49.2 89.5 (heart) Dubey (2010)
Goats 10 30.0 100.0 (skeletal muscle) Dubey (1983)
Dogs 43 46.5 81.3 (heart) Dubey et al. (2007a–2007c)
Cats 60 20.0 56.6 (skeletal muscle) Dubey (1981); Dubey et al. (1986);
Dubey et al. (2006); Dubey et al. (2007)
Source: Dubey, J.P., 2010, Toxoplasmosis of Animals and Humans, 2nd ed., CRC Press, Boca Raton. For references see
this book.403
a 50–100 g of tissue was digested in pepsin and homogenates bioassayed in mice.
Table 2.4 Prevalence (%) of Viable T. gondii in Brain, Heart, and Leg Muscles of Naturally Infected Chickens and Cats
a Chickens (n = 26)431 bCats (n = 15)387
No. of chickens No. of Mice Positive/130 No. Bioassay No. of Mice Positive/75
Tissue Bioassay Positive (%) Mice Inoculated (%) Positive (%) Mice Inoculated
Brain 3 (11.5) 5 (3.8) 4 (26.6) 18 (24.0)
Heart 26 (100.0) 115 (88.4) 13 (86.6) 50 (66.6)
Leg muscle 11 (42.3) 28 (21.5) 9 (60.0) 38 (50.6)
a Whole brain, whole heart and 100 g of leg muscle bioassayed; total mice per tissue: 130 (5 per tissue of each chicken).
b 50 g of each tissue bioassayed; total per tissue 75 (5 mice per tissue of each cat).
Table 2.5 Presence of Viable T. gondii in Skeletal Muscle Samples of Naturally Infected Lambs and Goats Determined by
Bioassay in Mice
No. of Positive Samples/Total Samples No. of Positive Mice/
Host Sample Size (g) Tested (%) Total Mice Inoculated (%)
Lambs 5 8/24 (33.3) 13/48 (27.0)
10 12/24 (50.0) 18/48 (37.5)
50 17/20 (85.0) 63/100 (63.0)
Table 2.6 Distribution of Viable T. gondii in Tissues of Naturally Infected Pigs, Goats, and Lamb
Grams of Tissue
Host No. Bioassayed Infected Tissues Reference
Pig 4 50 Arm picnic of 3, Boston butt of 2, ham of 1, spare ribs of 2, 351
bacon of 1, tongue of 3, diaphragm of 2, heart of 2, and
brain of 1, but not from kidney and liver
Goat 5 50 Liver of 1, kidneys of 1, hearts of 4, diaphragms of 4, rear leg 340
muscles of 5, and brain of 1
Lamb 8 100 Legs of 8, lamb chops of 7, tongue of 7, and heart of 3 357
2.3 LIFE CYCLE IN THE 3 infectious stages of T. gondii, i.e., tachyzoites, brady-
DEFINITIVE HOST, THE CAT zoites, and oocysts. Prepatent periods (time to the excre-
tion of oocysts after initial infection) and frequency of
Cats, not only domestic (Felis catus) but nearly oocyst excretion vary according to the stage of T. gon-
all species of felids (Table 2.7), can excrete T. gondii dii ingested (Table 2.8). Prepatent periods are 3–10 days
oocysts. Cats excrete oocysts after ingesting any of the after ingesting tissue cysts, and more than 18 days after
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the Lake Tchad. He observed them in flocks, and in considerable
numbers. Hitherto they have been sparingly seen by travellers, and
few specimens have reached our collections.
BOTANICAL APPENDIX.