Overview of Toxoplasma gondii
Toxoplasma gondii infection caused by a zoonotic disease most asymptomatic, such as the onset of symptoms can be manifested as headache, blurred vision, yellowing of the skin asymptomatic carriers can not be treated, symptomatic patients need deworming and other treatments most of the prognosis is good, pregnant women, the fetus, infants and young children, immunocompromised people with a poor prognosis
Definition
Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii infection [1-2].
It is mostly a latent infection, and a few may invade the eyes, brain, lymph nodes, heart and lungs, etc. Infection in pregnant women can lead to miscarriage, stillbirth and congenital malformations, and infants, young children, and those with impaired immune function have a high morbidity and mortality rate after infection [3-4].
Types
Toxoplasmosis includes congenital toxoplasmosis and acquired toxoplasmosis.
Congenital toxoplasmosis is more harmful, and infection during pregnancy can cause miscarriage, stillbirth, or malformation.
Acquired toxoplasmosis can be asymptomatic, and a few people will develop symptoms of organ involvement in the eyes, brain, lymph nodes, heart, and lungs.
Incidence
Toxoplasmosis has a worldwide distribution, with approximately 1 billion people infected worldwide, but most are in a latent infection or protozoan carrier state [1-2].
China is an endemic area with a high prevalence of toxoplasmosis infection, and the prevalence is higher in ethnic minority areas and rural populations.
Etiology
Causes
Toxoplasmosis is caused by Toxoplasma gondii infection, and the basic conditions leading to the epidemic are the following three aspects.
Source of infection
The source of infection is mainly cats or felines infected with Toxoplasma gondii.
Means of transmission
Toxoplasmosis is transmitted through both congenital and acquired infections.
Congenital infection
The fetus is infected in the mother by vertical transmission through the placenta.
Acquired infection
Gastrointestinal transmission: the main mode of transmission at present. Infection through oral ingestion after eating undercooked meat, eggs, milk containing toxoplasmosis or not washing hands after handling cat feces.
Contact transmission: contact with soil and water contaminated by oocysts, infection through damaged skin and mucous membranes.
Bloodborne transmission: Transmitted from person to person through blood transfusion, organ transplantation, etc.
Susceptible people
People are generally susceptible.
Feline pet owners, animal breeders, and slaughterhouse workers have higher infection rates. Immunocompromised people, such as patients with malignant tumors, AIDS and people taking immunosuppressants for a long time are susceptible to infection.
Pathogenesis
Toxoplasma gondii mainly invades the body through the digestive tract and causes an inflammatory reaction.
Toxoplasma gondii invades the body through the digestive tract and can spread to various organs through the bloodstream.
Toxoplasma gondii multiplies in the tissue cells of various organs, which can cause cell rupture.
The worms can stimulate the organism to produce necrotic lesions and delayed metaplasia, and form granuloma-like inflammation.
Symptoms
Main Symptoms
Toxoplasmosis includes congenital toxoplasmosis and acquired toxoplasmosis, which have different clinical manifestations.
Congenital toxoplasmosis
Congenital toxoplasmosis mostly occurs in pregnant women, and acute infection in pregnant women can cause fetal congenital toxoplasmosis through vertical transmission.
Infection in early pregnancy often causes miscarriage, stillbirth or the formation of deformed children.
Mid-pregnancy infections often result in stillbirths and preterm births, and children can be born with severe brain and eye disorders.
In late pregnancy, the fetus may develop normally, but months or years after birth, it may gradually develop heart malformations, heart block, microcephaly, deafness, or mental retardation.
Acquired toxoplasmosis
Most patients are asymptomatic or have mild symptoms, and only a few develop symptoms when the heart, eyes, lungs, and brain are involved.
Infected people are mostly asymptomatic, or they may show flu-like symptoms, such as fever, headache, muscle aches, and swollen lymph nodes.
Involvement of the heart can be complicated by myocarditis, manifested by palpitations, chest pain, dyspnea and so on.
Involvement of the eyes is more common in choroidal retinitis, manifested by blurred vision, photophobia, tearing, etc..
Involvement of the lungs, manifested by coughing, coughing up sputum, chest pain, shortness of breath and so on.
Involvement of the brain can lead to encephalitis and meningitis, manifesting as epilepsy, vertigo, drowsiness, coma and so on.
Complications
Toxoplasma gondii infection in fetuses, infants, malignant tumors, patients with AIDS and patients receiving long-term immunosuppressive therapy is very likely to be followed by bacterial infection, with high fever, chills, and impaired consciousness [4-6].
Consultation
Department of Medicine
Department of Infectious Diseases
If you have a history of contact with dogs or cats, or if you have eaten raw meat and have fever, muscle aches, cough, sputum, etc., you can consult the Department of Infectious Diseases.
For example, if you have a cough and sputum, you can consult the Department of Respiratory Medicine.
Obstetrics
Toxoplasma gondii infection is suspected in women during preparation for pregnancy or during pregnancy, they should consult the obstetrics department.
Pediatrics
Newborns or children with fever, crying, etc. should consult the pediatrics department.
Preparation
How to get to the doctor: registration, preparation of documents, FAQs
Tips for the doctor
You may be required to undergo a full body checkup, etc., so you should wear loose-fitting clothing.
Checklist for medical preparation
Symptom list
Pay particular attention to the time of onset of symptoms, special symptoms, etc.
Are there any symptoms such as fever, headache, muscle aches, etc.?
Are there any symptoms such as enlarged lymph nodes, cough, phlegm, etc.?
Any blurred vision, photophobia, tearing, etc.?
List of medical history
Any recent raw consumption of undercooked meat?
Any recent handling of cat feces?
Any organ transplants, blood transfusions, etc.?
Checklist
Test results in the last 1 week, which can be brought to the doctor’s office
Laboratory tests: blood test, liver function, etc.
Imaging tests: chest CT, etc.
Medication List
Medication used in the last 1 week, if available, bring along the box or package for medical consultation
Antihelminthic drugs: Ethacridine, Sulfadiazine, Azithromycin, etc.
Antipyretic medications: ibuprofen, acetaminophen, etc.
Diagnosis
Diagnosis is based on
Medical history
Patients with this disease may have the following epidemiologic history.
There is ingestion of undercooked meat.
A history of exposure to cat feces.
Have a history of organ transplantation or blood transfusion.
Clinical manifestations
Most of the patients have no obvious symptoms after infection. Some patients may have flu-like symptoms such as fever, muscle aches, swollen lymph nodes, and a few may have cough, sputum, blurred vision and photophobia.
Pregnant women may experience miscarriage, preterm labor, stillbirth, or formation of malformed babies after infection.
Patients with impaired immune function may develop high fever, chills, and impaired consciousness after infection.
Laboratory Tests
Blood Tests
Peripheral blood leukocytes are normal or slightly elevated, and the proportion of lymphocytes and eosinophils is slightly elevated.
Pathogenetic examination
Toxoplasma gondii can be found in direct smears of the patient’s blood, cerebrospinal fluid, bronchoalveolar lavage fluid, sputum, and amniotic fluid.
Toxoplasma gondii trophozoites or encapsulated toxoplasmosis can be found in biopsies of lymph nodes, muscle, liver and placenta of patients.
Immunologic examination
Serum and cerebrospinal fluid may show Toxoplasma IgG and IgM antibodies. After Toxoplasma gondii infection, IgM antibodies can appear on the 5th to 7th day, and IgM antibody positivity or more than 4-fold increase of IgG antibody within 2 weeks can diagnose the disease at an early stage.
Toxoplasma IgG antibody positivity alone suggests previous infection with Toxoplasma gondii.
Toxoplasma circulating antigens can be detected in serum or body fluids during acute infection.
Differential diagnosis
Toxoplasmosis can cause fever, muscle aches, enlarged lymph nodes, cough, sputum, blurred vision, and other related symptoms. Symptoms are not specific and need to be differentiated from diseases with similar symptoms, and a definitive diagnosis must be made by finding the causative agent or a positive serologic test.
Lymph node enlargement caused by Toxoplasma gondii needs to be differentiated from EBV infection and lymph node tuberculosis.
Lung infections caused by Toxoplasma need to be differentiated from bacterial pneumonia and tuberculosis.
Encephalopathy caused by Toxoplasma needs to be differentiated from encephalopathy caused by rubella, herpes simplex, and cytomegalovirus infections.
Eye symptoms caused by Toxoplasma need to be differentiated from keratitis, total ophthalmoplegia, etc.
Treatment
Aim of treatment: Relief of symptoms, prevention and reduction of complications.
Treatment principle: asymptomatic patients with toxoplasmosis can be left untreated, while symptomatic patients need anthelmintic and other treatments.
Deworming treatment
Adults with normal immune function are usually asymptomatic and do not need deworming treatment.
Patients with vital organ involvement, long-term persistent symptoms, immune deficiency, pregnant women or infants with congenital infection need to be treated with deworming drugs.
Deworming drugs include acetamiprid, sulfadiazine, azithromycin, etc. Acetylspiramycin is mostly used to treat pregnant women in the fourth month of pregnancy.
Symptomatic treatment
Thymosin can be applied to improve immunity.
Those with brain infection can apply glucocorticoids for a short period of time to prevent cerebral edema if necessary [1-2,7-8].
Questions you may be concerned about
What is the fastest treatment for toxoplasmosis?
The treatment of toxoplasmosis is based on drug therapy, and symptomatic treatment is also needed in the acute stage. Due to individual differences, there is no how to treat the fastest way.
1. Drug treatment: If adults are infected with toxoplasmosis, they are generally asymptomatic with the worm state, and these people do not need anti-worm treatment. For acute toxoplasmosis, you should take drugs such as acetamiprid and sulfadiazine under the doctor’s removal for treatment.
2. Symptomatic treatment: patients infected with Toxoplasma gondii, if in the acute stage, may have symptoms of fever, these patients should take symptomatic treatment, such as drinking more water, using warm towels to wipe the skin and other physical cooling methods, if the body temperature is more than 38.5 ℃, you can orally ibuprofen, acetaminophen and other antipyretic drugs.
If the examination reveals toxoplasmosis infection, it is recommended to choose the appropriate treatment according to the individual’s situation. If a pregnant woman is suffering from Toxoplasma gondii, in addition to conventional treatment, she also needs to observe whether the fetus is malformed, and terminate the pregnancy if necessary if the fetus grows and develops abnormally.
Prognosis
Cure
Most people with latent infection and no or mild symptoms do not require treatment and have a good prognosis.
Patients with impaired immune function may lead to systemic dissemination of the infection, invading the eyes, brain, lymph nodes, heart, lungs and other parts of the body, with a risk of death.
Infected pregnant women who receive prompt treatment may result in a lower incidence of congenital infection.
Hazards
Infection in pregnant women may lead to miscarriage, preterm labor, stillbirth, and fetal malformation.
Affected children may suffer from microcephaly, deafness, mental retardation, etc., which may affect their lives.
Daily
Daily management
Daily diet needs to be supplemented with a variety of food types to ensure nutritional intake.
Adopt a good routine, ensure sufficient rest, avoid exertion and staying up late to maintain immunity.
Diseases with impaired immune function, such as AIDS and tumors, should be treated actively.
Pregnant women should undergo regular serologic testing for Toxoplasma gondii.
Prevention
There is no specific vaccine to prevent this disease. Dietary hygiene and fecal management can be used to help prevent Toxoplasma infection.
Control of infectious sources
Pay attention to the feeding and management of cats, regular quarantine of pets, wear gloves when cleaning cat feces and wash hands with soap and water after handling.
Cut off the transmission pathway
Improve environmental hygiene and manage water sources, feces and livestock.
Do not eat raw or undercooked meat, shellfish and other food, do not drink goat’s milk that has not been sterilized by high temperature, and do not eat unwashed vegetables and fruits.
Do not come into close contact with animals such as cats and dogs of unknown health status.
Protecting susceptible people
Avoid close contact with animals such as cats and dogs during pregnancy, and have regular checkups during pregnancy, with the first test at 10 to 12 weeks of gestation, and those who are negative must be retested 2 to 3 times during pregnancy for timely treatment [9-12].
The staff of slaughterhouses and meat processing plants should have good personal hygiene and regular testing of serum antibodies.