Although cats and their feline relatives are the only hosts in which T. gondii reproduces, the parasite is found in humans and numerous other animals, including rodents, birds, pigs, and sheep. (1) Cats play a vital role in T. gondii’s life cycle and the spread of toxoplasmosis to people. A cat becomes infected with T. gondii after eating birds or small mammals infected with the parasite, according to the American Veterinary Medical Association (AVMA). (2) The parasites then reproduce in the cat’s small intestine and form oocysts, which are thick-walled cysts containing zygotes. The cat eventually sheds the oocysts in its feces. “Cats usually only shed oocysts in their feces once during their lifetime, with a few exceptions, and many infected with T. gondii may never shed oocysts at all,” explains Heather Stockdale Walden, PhD, an assistant professor of parasitology at the University of Florida College of Veterinary Medicine in Gainesville. A single cat can shed millions of oocysts for up to three weeks after infection, according to the Centers for Disease Control and Prevention (CDC). Most infected cats show no signs or symptoms, Walden says, but a feline that is shedding oocysts can infect its litter box. Humans can become infected by accidentally ingesting oocysts after cleaning the litter box or after touching anything that has come in contact with the cat’s feces that contain T. gondii. Other animals become infected when they ingest soil, water, or plants contaminated with oocysts. (3) “Most people don’t have symptoms with toxoplasmosis or have mild symptoms like fever and muscle aches, as with any infection,” says Amy Edwards, MD, a pediatric infectious disease specialist at UH Rainbow Babies & Children’s Hospital in Cleveland. “It’s usually pretty nonspecific.” According to the National Institutes of Health (NIH), other symptoms may include: (4)
Enlarged and tender lymph nodes in the head and neckHeadacheSore throat
If you have a weakened immune system, such as from HIV or cancer, you may experience more severe symptoms, such as:
ConfusionFever and headacheBlurred visionSeizuresNauseaPoor coordination
Eating uncooked or raw meat that’s infected with the parasite, particularly venison, pork, or lambDrinking water or another liquid that’s been contaminated with the parasiteEating food that’s been contaminated with the parasite through direct contact or indirectly through knives, utensils, or cutting boardsAccidentally ingesting tiny particles of infected meat after handling it and failing to wash your handsEating fruit or vegetables that have been in contact with soil or water contaminated with the parasite and have not been washed, peeled, or cooked
You can also get toxoplasmosis by swallowing particles of oocyst-laden cat feces, such as if you touch your mouth after cleaning or changing your cat’s litter, handle objects that have come into contact with cat feces, or garden without gloves. In very rare cases, you can get the disease through a blood transfusion or an organ transplant, the CDC reports. If a woman tests positive during pregnancy, a doctor will check to see if the baby is infected. This is done by testing fluid from the amniotic sac for evidence of toxoplasmosis. Ultrasounds can also detect certain signs of infection, including fluid buildup in the brain. (5) Those requiring treatment will be put on medication that can take weeks or even months to clear the infection, Edwards says. Drugs that are commonly used for healthy (nonpregnant) adults who are infected include pyrimethamine and sulfadiazine, plus folinic acid (leucovorin), according to the Mayo Clinic. (5) People with weakened immune systems, such as those living with HIV, may also be treated with these drugs until their condition improves, although some will require lifelong treatment at a lower dose or with alternative drugs, the CDC reports. (6) Other drug combinations may also be used in these situations, such as pyrimethamine plus clindamycin. Pregnant women in their first or early second trimester are commonly treated with spiramycin, while those in their late second or third trimester are commonly treated with pyrimethamine and sulfadiazine plus leucovorin. Newborns are generally treated with pyrimethamine and sulfadiazine plus leucovorin for their first year of life. These are general guidelines and would be customized to each patient’s specific needs and risk factors. (5)
Prevention of Toxoplasmosis
To prevent toxoplasmosis infection from food, the CDC recommends the following guidelines: Use a food thermometer to assure meat and poultry are cooked to safe temperatures. According to the U.S. Department of Agriculture (USDA), whole cuts of meat should be cooked to an internal temperature of least 145 degrees F; ground meat should be cooked to at least 160 degrees F; and poultry should be cooked to at least 165 degrees F. Peel or thoroughly wash fruit and vegetables before consuming. Thoroughly wash cutting boards, dishes, utensils, and surfaces that have come in contact with raw meat or poultry, seafood, and unwashed produce. Do not consume unpasteurized goat milk. Avoid eating raw or undercooked oysters, mussels, and clams. To prevent infection from cats, cat owners should change the litter box daily, avoid feeding their pet raw or undercooked meat, and keep their cat indoors to reduce the risk of infection. Pregnant women should not clean the litter box if possible, or if there is no one else able to, should wear disposable gloves and wash their hands after. Everyone should avoid drinking untreated water and wear gloves while gardening or when coming into contact with soil or sand. Remember to always wash your hands afterward, as there might be contamination with cat feces in these areas. (7) But if you had the disease before becoming pregnant, your child is not at risk for toxoplasmosis — your immune system confers protection. It’s sometimes recommended to wait at least six months after an infection before becoming pregnant, according to the CDC. “Toxoplasmosis can be transmitted across the placenta to the unborn child when a pregnant woman acquires the infection for the first time while she is pregnant and not immune,” explains Rima McLeod, MD, a professor at the University of Chicago and medical director of the University of Chicago Medicine Toxoplasmosis Center. “The unborn child is immunologically immature, and so the infection can be particularly harmful to their eyes, brain, and general well-being. That damage can be recurring and manifested lifelong.” Toxoplasmosis during pregnancy can also result in miscarriage, stillbirth, or a child born with signs of the disease, such as an abnormal head size. Additionally, it’s possible to develop ocular (eye) disease from T. gondii, usually if you were born with toxoplasmosis. The disease can cause inflammatory retinal lesions and scarring, resulting in eye pain, light sensitivity, tearing, and blurred vision. (8) Some research suggests that T. gondii can affect personality and behavior, including causing neuroticism, schizophrenia, depression, and suicidal tendencies. A June 2015 study published in the journal Schizophrenia Research, for example, concluded that cat ownership in childhood is significantly more common in families in which the child later becomes “seriously mentally ill.” The mechanism, researchers hypothesize, could be toxoplasmosis. (9) The theory, though, is that when the parasite gets into the brain, “depending on where it lodges, it can cause chronic inflammation. This can slowly damage the brain in that area, leading to neurological or psychological problems depending on the area involved,” Edwards explains. However, in the aforementioned study, the researchers observed only a correlative link between childhood cat ownership and future mental illness; more studies are needed before researchers can definitively say that one causes the other. What’s more, a February 2016 study published in the PLoS One points to flaws in previous research and concludes that there is little scientific evidence that T. gondii is related to increased risk of psychiatric disorder. (10) What’s more, up to 60 percent of some populations across the globe are infected by the parasite, the CDC reports. (3) American Veterinary Medical Association (AVMA) The American Veterinary Medical Association is the nation’s leading advocacy organization for veterinarians. Stay informed on the most up-to-date info on how toxoplasmosis affects cats and tips on how you can help keep your pet and family safe. Toxoplasmosis Research Institute and Center This Chicago-based nonprofit performs and promotes research on toxoplasmosis and optimal care for those affected. Learn about the organization’s latest research findings or read personal stories from families impacted by toxoplasmosis on the center’s website. The Companion Animal Parasite Council (CAPC) The Companion Animal Parasite Council is an independent council of veterinarians, veterinary parasitologists, and other animal healthcare professionals established to create guidelines for the optimal control of parasites that threaten the health of pets and their owners. In addition to information on toxoplasmosis, CAPC offers helpful, bookmarkable resources on what to do if your pet becomes infected by other parasites, including ticks, fleas, tapeworms, and ear mites.
