Symptoms
Toxoplasmosis is usually asymptomatic and unnoticed if the immune status is normal. It may manifest as flu-like symptoms such as muscle and joint pain, sore throat, swollen lymph nodes, headache, fever, and fatigue. The infection leads to immunity. If the immune system is weakened, such as observed in HIV infection and when taking immunosuppressants and cytostatic drugs, the disease progresses with complications and can lead to severe disorders of the central nervous system (toxoplasmosis encephalitis), lungs and eyes. An initial infection during pregnancy can be transmitted to the unborn child via the placenta and lead to damage that becomes apparent in the womb, at birth, or years later. These include, for example, mental retardation, blindness, and epilepsy. On the other hand, if the mother has already been infected at least 6 months before pregnancy, there is little risk to the child. It should be noted that congenital toxoplasmosis is comparatively rare in many countries.
Causes
The cause of the disease is infection with the protozoan , a unicellular and obligate intracellular parasite that occurs in three forms. The pathogen reproduces sexually in the intestines of cats and forms cysts in various animals and in humans that can be deposited in almost any organ, for example, muscle, brain, and heart. Humans become infected orally with contaminated raw meat (especially beef, pork, lamb, poultry, game), contaminated fruits and vegetables, other foods, and infected cat feces. In developing countries, infection is also possible through water, and rarely toxoplasmosis is transmitted during a blood transfusion or organ transplant.
Diagnosis
Since 2009, toxoplasmosis screening during pregnancy has been waived in many countries. Based on scientific data, the Federal Office of Public Health does not consider diagnosis or treatment of the infection during pregnancy necessary (Rudin et al, 2008).
Recommendations for pregnant women
- Pregnant women should avoid consuming raw and insufficiently cooked or roasted meat, especially beef, pork, lamb, poultry, and game (e.g., tartar, carpaccio). Do not taste the meat when it is cooked until it is completely cooked through. There are conflicting opinions on dried meat (Bündnerfleisch, raw ham), which is also made from raw meat. Curing or smoking is supposed to kill the cysts, but some authors advise against consumption, also because of a possible infestation with the resistant listeria.
- Wash hands with soap and warm water before cooking and eating.
- Wash hands and kitchen utensils thoroughly with hot water and soap after processing raw meat or offal. Separately administer meat and other foods in the kitchen.
- Freezing meat below 18°C should kill cysts.
- Wash and peel foods such as fruits and vegetables well before processing.
- Cat owners: good hand hygiene, do not give the cat raw meat, do not leave the litter box in the kitchen. Like humans, cats can be infected with raw or uncooked meat. Cleaning the cat’s litter box is best left to someone else. Otherwise, use gloves for cleaning. Cover the sandbox when children are not playing in it. Further, it is recommended not to let the cat outside, so that it can not be infected.
- Wear gloves when gardening and then wash your hands well.
see also under listeria
Drug treatment
The antiprotozoal agent pyrimethamine (Daraprim) is used in combination with a sulfonamide (e.g., sulfadiazine, sulfadoxine) to treat toxoplasmosis. The effects are based on inhibition of folic acid metabolism. Calcium folinate must always be given additionally during treatment. The most common possible adverse effects include anemia, blood count disturbances, vomiting, nausea, diarrhea, rash, and headache. Neither sulfadiazine nor sulfadoxine is currently commercially available as a finished drug in many countries. Other active ingredients:
- The lincosamide antibiotic clindamycin (Dalacin, generic) is approved for the treatment of toxoplasmosis encephalitis in patients with AIDS.
- The macrolide antibiotic spiramycin (formerly Rovamycine) is used to treat pregnant women but is no longer commercially available in many countries.
Note
The four cooking stages of beef:
| bleu | the meat is raw inside and yields strongly to finger pressure |
| saignant | the meat is raw on the inside, but is a little more cooked on the outside |
| à point | the meat is pink inside |
| bien cuit | the meat is cooked through and barely yields to finger pressure |
