Toxoplasmosis is an infection caused by the intracellular parasite ‘Toxoplasma gondii’. It infects multiple warm-blooded animals including humans, livestock, and birds (all of whom act as intermediate hosts). Cats are the only definitive hosts to T. gondii, which means that the parasite is only able to sexually reproduce in felines (both wild and domesticated).
Most people have heard of toxoplasmosis due to the risks an infection poses to pregnant women. If infection occurs during pregnancy it can cause abortion or congenital defects to the fetus.
Life cycle of T. gondii:
Oocysts – The infected cat sheds thousands of oocysts in the feces. These are incredibly hardy and can survive in the environment for years. At this point, they are ‘unsporulated’ (and non-infective) but become sporulated between 1-5 days depending on environmental conditions. Once sporulated, they are infective. The next host becomes infected by ingesting water, food or soil contaminated with sporulated oocysts.
Tachyzoites – Once ingested, oocysts cell walls dissolve, and the parasites invade host cells. Once inside, they convert to tachyzoites which rapidly multiply. The cell ruptures and dies, releasing the tachyzoites into the bloodstream, where they are spread to other organs and tissues in the body.
Bradyzoites – At this point, the host’s own immune system mounts an attack in the infection. In response to this, tachyzoites convert to bradyzoites, becoming cysts within the tissue. Tissue cysts can remain in the host for the entire lifetime. The location of these cysts varies from species to species, but commonly affected parts include the brain, eyes, heart and skeletal muscles. At this point, if the host (for example a rat, bird, cow etc) consumes infected tissue containing cysts, they become infected.
Oocysts are shed in the stool 3-10 days after infection, which continues for two weeks. Felines are the only host who sheds oocysts in their feces. After a cat eats infected prey or raw meat containing cysts, they break open, multiplying in the small intestinal wall, producing oocysts, which are then shed in the feces (intraintestinal cycle). Other tachyzoites in the intestinal wall move into other parts of the cat’s body, eventually forming bradyzoites (cysts).
Transmission in cats:
Cats become infected when they consume prey or meat containing bradyzoite tissue cysts.
Ingesting sporulated oocysts shed in feces.
It is also possible for a mother cat to pass on the infection to her unborn kittens (congenital transmission).
More severe symptoms will depend on which part of the body is infected but can include inflammation in the eye (retina, iris or cornea), pneumonia, central nervous system disorders such as head pressing and circling, pancreatitis, hepatitis (inflammation of the liver), jaundice, vomiting and diarrhea, enlarged lymph nodes.
Diagnosis in cats:
Diagnosis usually involves a routine blood test to detect antibodies in the blood. Your veterinarian could also examine a stool sample, although this would only offer a diagnosis if the cat was shedding oocysts at the time.
Treatment in cats:
In healthy immunocompetent cats, treatment generally isn’t necessary. A course of antibiotics for at risk cats.
There are four modes of infection in humans.
Consuming water, undercooked or raw vegetables containing oocysts
Consuming raw or undercooked meat containing tissue cysts (bradyzoites)
Ingestion of oocysts via contaminated cat feces
Mother to baby transmission in utero. This usually occurs if the mother is infected for the first time during pregnancy, however, re-activation of latent infection can occur in women who have suppressed immune systems due to medical conditions such as HIV, organ recipients who are on immunosuppressive drugs or those on high doses of corticosteroids.
The percentage of people who have had toxoplasmosis varies from country to country, but worldwide, approximately 1 in 3 people have antibodies to the parasite. The most common mode of infection is via contaminated soil, undercooked meat or improperly washed fruit and vegetables.
As with cats, symptoms are usually rare in immunocompetent and up to 80% of people infected are unaware they have the infection. If symptoms do occur, they may include:
Localised lymph node tenderness
Flu-like symptoms such as a sore throat, fever, headache
Severe toxoplasmosis in humans can sometimes occur and cause damage to the eyes, brain, heart, and liver. This is more likely to happen in immunocompromised individuals such as people with HIV, organ transplant recipients and patients undergoing chemotherapy.
Recently there have been suggestions that toxoplasmosis may trigger schizophrenia in humans.
Healthy, non-pregnant individuals usually require no treatment.
If you are pregnant or are immunocompromised due to HIV or medications your caregiver will prescribe a course of antibiotics.
Effects on the fetus:
Transplacental infection occurs in cats and pregnant women who become infected for the first time during pregnancy. Tachyzoites cross the placenta and invade fetal cells, this is particularly dangerous during the first trimester when the organs are developing. Toxoplasmosis in the unborn baby can lead to miscarriage, low birth weight, vision problems, hearing loss, hepatosplenomegaly (enlarged liver and spleen), jaundice, learning disabilities and mental retardation. Between 80-90% of babies who acquired the infection in utero have retinal infection leading to inflammation and possibly a chorioretinal scar containing the inactivated cyst (bradyzoite).
In pregnant women, it is easier to pass toxoplasmosis on to the fetus during the second and third trimesters, however, the disease is typically milder in the last 10 weeks of pregnancy than if the embryo/fetus is infected during the first and second trimesters.
What happens if a pregnant woman becomes infected with toxoplasmosis?
If you or your doctor suspect you have toxoplasmosis, as a precaution, you will be put on a course of antibiotics (usually spiramycin) to reduce the chances of passing the infection onto your unborn baby.
Your caregiver will recommend an amniocentesis to determine if the baby has the infection.
Multiple ultrasounds throughout your pregnancy to look for abnormalities will be necessary if it is determined your baby has toxoplasmosis.
Should a pregnant woman rehome her cat?
No, this isn’t necessary. If you are pregnant and have a cat, we recommend you speak to your doctor or midwife who may suggest a blood test to check for antibodies to toxoplasmosis. The presence of antibodies means you have had exposure to T. gondii at some stage in your life. This means your immune system has already built up a resistance, therefore you are very unlikely to become re-infected. My own obstetrician tested me multiple times during my two pregnancies as I was negative and he wanted to ensure I remained negative (I also had a cat who had tested positive).
What precautions can a pregnant woman take to avoid toxoplasmosis?
Unwashed fruit and vegetables and undercooked meat are the greatest sources of infection. Drinking untreated water (from a stream or river for example) and gardening are also potential sources of infection.
Avoid cleaning the litter trays, if this is not possible wear gloves and a mask. During my pregnancy, I would also change and wash my clothes after cleaning litter trays.
Scoop solids from litter trays at least once a day to remove oocysts before they sporulate.
Cook meat thoroughly, it should not be pink inside, and the juices run clear. Freezing meat for at least 24 hours (-4F) also kills T. gondii.
Wash your hands after handling animals.
Wear gloves in while gardening.
Wash fruit and vegetables thoroughly before eating.
Wash your hands after handling raw meat, fruit, and vegetables.
Don’t let your cat(s) hunt.
Wash your hands before eating.
Cover sandboxes to prevent cats defecating in them.
Don’t drink unpasteurised milk.
Thoroughly cleaning chopping boards and utensils. Use separate boards for fruit/vegetables and meat.
Keep the litter tray away from the kitchen and other eating areas.
Are there other ways to catch toxoplasmosis from my cat?
The only way you can catch toxoplasmosis from your cat is ingestion of the sporulated oocysts via the feces (either directly, or via contaminated soil, food etc). You can not catch toxoplasmosis from a bite, scratch, cat urine or petting and stroking your cat.
What about immunocompromised people?
Immunocompromised people can still enjoy living with their cat but must take precautions listed above.
If an immunocompromised person is looking to obtain a cat, it is worthwhile looking at an older (2 years or above).
Regularly treat your cat for parasitic infections such as worms and fleas.
Yearly physical exams for your cat are also important, including fecal tests and vaccinations.