Toxoplasmosis is a disease which is transmitted from animals to humans. This so-called zoonosis, is thereby relatively harmless to the host (human), as long as this is not either sick with HIV, or pregnant.
What is toxoplasmosis?
People with poorly functioning immune systems (e.g., due to HIV) become severely ill with this disease, which is caused by small parasites, and babies in the womb can suffer severe damage from toxoplasmosis. The causative agent of the infectious disease toxoplasmosis is the parasite Toxoplasma gondii. These small, in technical jargon titled “protozoa”, preferentially infect cats, although the animals rarely suffer serious damage. The only effect on the cats during their initial infection is diarrhea, to which the mass excretion of eggs (oocysts) is coupled. In this way, the parasite spreads and finds a new host – the cycle of toxoplasmosis begins anew.
Causes
The causes of infection with Toxoplasma gondii, that is, the development of toxoplasmosis, are rooted in different cycles of infection. In total, there are three causes: Once the infection from end host to end host. This means, a cat infects another cat through excreted eggs via feces. The protozoa are released by digestion in the intestine, pass through the intestinal wall, enter the blood and migrate to organs, as well as tissues. Next, the parasites multiply in the body cells and are again excreted in the cat’s feces – this can be as many as one million cysts per gram of feces, which is an important route of infection for humans. In what is known as the “end-host-intermediate host cycle,” cats become infected through contaminated rodent meat (e.g., from mice or rats). Infection through eating contaminated meat or transmission through the mother’s placenta to the unborn child concern the “intermediate host-intermediate host cycles” in toxoplasmosis.
Symptoms, complaints, and signs
The infection causes little or no symptoms in a healthy organism, so it often goes unnoticed. Sometimes general signs of illness occur, similar to those of the flu. Then there is fatigue, exhaustion and fever. Diarrhea and sore muscles are also possible. In the neck, the lymph nodes may swell. In exceptional cases, the brain and eyes are also affected in a healthy person. Equally rare is the inflammation of the pericardium, lungs and liver. However, if the immune system is weakened, such as in people with transplanted organs or HIV patients, the infection causes much more severe symptoms. Often there is inflammation of the connective tissue layer in the lungs, which leads to tissue changes. The result is fever, shortness of breath and dry cough. In addition, the brain is severely affected. Depending on which region of the brain is affected by the infection, neurological deficits and limitations develop. Seizures may occur and hemiplegia may occur. Painful eyes and visual disturbances, such as visual field loss, increased sensitivity to light and blurred vision, are also possible. If the infection spreads further, it can damage multiple organs. During pregnancy, toxoplasmosis is particularly dangerous because the pathogens can pass to the baby and cause severe damage or even abortion.
Diagnosis and course
For indirect detection of toxoplasmosis that has already been passed through, the physician assistant takes blood from the patient, which is examined in the laboratory for antibodies against the pathogen. Toxoplasmosis in pregnant women is problematic because the mother’s initial infection with the parasites can cause serious damage to the unborn child. The later the stage of pregnancy, the more dangerous toxoplasmosis in the mother becomes for the fetus. Infected children can have severe cognitive impairment and damage to eyes and organs such as the liver or lungs. A quarter of babies infected with toxoplasmosis in the womb are born mentally retarded and have difficulty with epilepsy and spasticity. It is all the more problematic that the costs for the examination of pregnant women are not covered by the statutory health insurance. So-called “immune suppressed” patients (HIV patients or patients after stem cell transplantation) show a particularly severe clinical picture, the so-called “cerebral toxoplasmosis”, which is characterized by neurological deficits.
Complications
Toxoplasmosis can lead to complications only in pregnant women and in the case of a weakened immune system. The disease, which is usually asymptomatic, sometimes leads to symptoms requiring treatment, such as inflammation of the heart muscle, lungs, or brain, in affected individuals. The most serious complication in connection with toxoplasmosis, however, is an infection of the unborn child by the pathogen. This happens in about half of all cases if the mother is infected with the pathogen. It is then relevant how early or late the unborn child was infected. Thus, children infected early are always damaged in health when they are born. There are a variety of symptoms. Underweight and damage to the eye tissue are particularly common. Approximately one quarter of infected premature infants and one eighth of infants who mature in the womb die as a result of the infection. Approximately half of the affected children show motor and emotional developmental disorders. In cases where the fetus was infected at a later stage, late damage usually only occurs in the course of development. Often, blindness occurs as a result of eye damage. However, mental disabilities are also possible as a result of a damaged brain. For healthy, non-pregnant individuals, toxoplasmosis has virtually no risk of complications.
When should you see a doctor?
In most cases, toxoplasmosis does not cause symptoms. People with preexisting conditions may experience flu-like symptoms such as fever, fatigue, and headache and aching limbs. A visit to the doctor is necessary if noticeable complaints occur that affect the well-being. Then the family doctor must be consulted. Severe symptoms such as fever and fatigue require a specialist diagnosis. Balance disorders, signs of paralysis and seizures must also be clarified by a doctor. Toxoplasmosis is caused by an infection with a bacterial pathogen. If the symptoms occur in connection with the consumption of raw or poorly cooked meat, medical advice is required. Contact with infected cats and forest animals can also cause the disease. In case of a concrete suspicion, the doctor should be consulted. Toxoplasmosis is treated by an internist. In severe cases, hospitalization is indicated. Once ill, persons should use regular medical progress controls to ensure that the disease has not broken out again. Regular medical check-ups are necessary, especially because of the relatively long incubation period of several weeks.
Treatment and therapy
Unlike other infectious diseases such as rubella or cytomegaly, toxoplasmosis can certainly be treated during pregnancy. The earlier it is started, the better the prognosis for the infant. Treatment differs depending on the week of pregnancy. Up to the 16th week of pregnancy, spiramycin is the drug of choice; after this time, administration of a combination of several agents (sulfadiazine, folinic acid, and pyrimethamine) over a longer period of time is indicated (4 weeks). In patients with a weakened immune system, the physician also treats with a combination of the drugs sulfadiazine, folinic acid and pyrimethamine over the same period of time. There is a correlation between the occurrence of toxoplasmosis in these patients and the T-helper cell count in the blood. If the helper cell count drops below 200/µl, prophylaxis with cotrimoxazole three times a week is sufficient to prevent toxoplasmosis disease.
Prevention
Toxoplasmosis is a serious risk, especially for pregnant women and their babies. Precautions are essential to avoid contracting the pathogen. All sausages made from raw meat, such as raw ham or tea sausage, can contain cysts, as can, of course, raw meat. Therefore, consumption of these foods should be avoided. Of course, no pregnant woman should clean the litter box. Be careful with small cats, they are more often infected with toxoplasmosis primary than adult animals. Washing hands after cuddling is mandatory here to prevent infection with toxoplasmosis. Ideally, the woman should refrain completely from contact and handling with cats at the beginning of pregnancy.
Aftercare
Follow-up care for toxoplasmosis is generally limited to a few check-ups after the infection has been overcome, provided that no complicating features are present in the patient. Often, toxoplasmosis goes largely unnoticed in healthy individuals after infection and heals on its own. Complications are mainly the infection in pregnancy and in immunosuppressed patients. Follow-up care in the event of a complication or an unusually severe course is essential. In pregnancy, after acute treatment, it must be ensured that the unborn child has not suffered any damage from the infection. The risk of miscarriage or premature birth is also present and must be strictly controlled by the appropriate specialists. Further treatment in generally healthy patients is generally not necessary. Depending on the physician’s assessment of the necessity of antibiotic treatment, follow-up care in this case may also focus on the direct consequences of antibiotic therapy. Basically, it is necessary to look at the patient’s general condition or aggravating treatment circumstances in order to tailor follow-up care to the patient. Since infection often occurs through cats, the source of infection should be identified and it should be ensured at the latest during the follow-up period that no further infections can occur. However, once an infection is overcome, immunity can be assumed as a result.
What you can do yourself
Toxoplasmosis infection is usually treated therapeutically. The patient is prescribed, among others, the active substances spiramycin or sulfadiazine, which should alleviate the symptoms quickly. Accompanying hygiene measures apply. Pregnant women in particular should take good care of their personal hygiene and change their diet accordingly. For example, raw or insufficiently heated animal products should be avoided. Pork, poultry and lamb in particular should be avoided. Vegetables and fruit must be washed thoroughly before consumption or further processing. Regular hand washing is advisable in any case. This is especially true after gardening or visiting a playground. Wearing gloves is recommended when gardening. Cat owners should switch from fresh to canned food and clean the litter box daily with hot water. Failure to do so may result in transmission of the dangerous pathogen. Proven toxoplasmosis home remedies include coconut oil, sugar and apple cider vinegar. Apple cider vinegar, in particular, helps with various symptoms of the disease. Sugar and coconut oil remove the breeding ground for the parasites. In consultation with a homeopath, medicinal herbs and medicinal plants such as wormwood or Bunias orientalis can also be tried. The information brochure of the Federal Institute for Risk Assessment contains further information on the prevention, diagnosis and treatment of toxoplasmosis.
