Tropical Infection

Diseases
Gatot Sugiharto, Internist
Internal Medicine Department
Faculty of Medicine, Wijaya Kusuma University
1
Surabaya

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 TOXOPLASMOSIS

Gatot Sugiharto, Internist

Internal Medicine Department 2
Faculty of Medicine, Wijaya Kusuma University Surabaya

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Definition 3

• Toxoplasmosis is a zoonotic infection caused by a

microscopic parasite Toxoplasma gondi.
• These microscopic parasites live inside the cells of
humans and animals
• Host :
• Definitive : domestic cat and other Felidae
• Intermediate : vertebrates are the Amphibians, fish, reptiles, All
warm-blooded animals including man

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 Toxoplasma - organelles
4

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 Epidemiology 5

• Toxoplasmosis is one of the most common infections in the

world.
• About 60 million people in the United States get it.
• 400 to 4000 babies are born with congenital toxoplasmosis
each year.
• 90% of the babies born with it have no symptoms in infancy.
• 1 in 10 babies show symptoms when born
• 85% of babies show symptoms months to years later

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Transmision 6

By touching or coming into contact with infected cat

feces.

By eating contaminated raw or undercooked meat.

By eating contaminated unwashed fruits or vegetables.

By passing it to your unborn baby.

By organ transplant or blood transfusion

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Human/Congenital Transfer
7

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Toxoplasma gondii – Life cycle
8

Bradyzoite Oocyst

Tachyzoite

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T. gondii – life cycle (cont.)

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Toxoplasmosis Cycle
10

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 Toxoplasmosis in Humans 12

• Majority of cases are asymptomatic

• Mild fever, sore muscles swollen glands and lymph
nodes, similar to mononucleosis
• Immunocompromized individuals are at greater risk
 HIV patients, organ transplant patients, people on
chemotherapy
• Pregnant women’s fetus are at risk if the mother
acquires the infection during gestation.
• CDC estimates 400-4000 cases of congenital
toxoplasmosis per year.
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 Toxoplasmosis Diseases
14

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CONGENTIAL TOXOPLASMOSIS 15
A pregnant woman gets the infection
during pregnancy and passes it on to her
fetus

Women who get toxoplasmosis before

conception hardly ever pass the infection
during pregnancy

Babies that get infected during the first

trimester show to have the most severe
symptoms
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 Clinical fact 16

• Toxoplasmosis can multiply and spread within a week as soon

as the person gets infected, but it can take weeks or months
before the person gets the symptoms.
• Toxoplasmosis is not curable  stays in the person’s body for
life  remain inactive causing no harm. (life long immune
protection)
• If the person’s immune system is not working correctly due to
HIV or cancer therapy, toxoplasmosis can be reactivated and
cause serious harm. (nervous system)
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 Diagnosing Toxoplasmosis 17

• Detecting oocysts in the stool

• Serological Testing : ELISA tests
• IgG and IgM anti Toxoplasmosis
• Titers of IgG can last for years
• Titers of IgM usually persist for only 12 weeks
• Diagnosis During Pregnancy /congenital toxoplasmosis :
• Ultra sounds (not always 100% accurate)
• Measure the level of fetal antibodies
• DNA test of the genes that have toxoplasmosis parasites.
• Amniotic fluid analisys
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Toxoplasmosis - Diagnosis

18

Antibody testing may be

Followed by prenatal
PCR or by CT or MRI
scans

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Antibody testing
 Toxoplasmosis - Treatment
19
• Sulfadiazine and Pyrimethamine (Fansidar)
• Patients allergic to sulfa drugs may take
Clindamycin, Atovaquone, Clarithromycin,
Azithromycin or Dapsone
• Leucovorin (Folinic acid) may be given with
Pyrimethamine if blood counts are lowered
• AIDS patients on antiretrovirals may modify
depending on CD4 counts

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TREATMENT DURING PREGNANCY 20

• Early diagnosis and prevention  decrease the chances

of the baby getting the infection badly  but will not
reduce the chances of transmitting
• Treatment in active infection :
• First trimester of pregnancy : spiramycin. (can reduce the chance
of the fetus getting infected by 60%)
• If the fetus is infected, and the mother is 18 weeks gestation
or more : pyrimethamine and sulfadiazine  reduce the
newborn’s symptoms

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 TREATMENT FOR INFECTED
NEWBORNS 21

• Pyrimethamine and sulfadiazine (first year of life or

sometimes longer)
• 72% of infected babies had normal intelligence and motor
function in their adolescence, but showed that eye infections
reappeared
• Some still developed disabilities even after using the two
medications  damages done before birth.
• In most cases babies are born without symptoms and therefore
do not receive early treatment  developing severe disorders

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PREVENTION OF
TOXOPLASMOSIS 22

Do not eat raw or undercooked meat

Wash hands after handling raw meat

Clean utensils, cutting boards, or other things that have come in contact with
raw meats.

Wash and peel fruits and vegetables

Do not empty or clean cat’s litter boxes (if you do use gloves and wash hands
after cleaning it)
Try to keep your cats indoors to stop them from eating any animal that has been
infected with parasites.

Use gloves when gardening (soil may have parasites from cats.

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