Toxoplasmosis

Toxoplasmosis is an infection caused by a tiny parasite called Toxoplasma gondii. This parasite lives in many warm-blooded animals, but cats are the main animals that help the parasite complete its life cycle. People usually get infected by swallowing the parasite’s microscopic forms in food, water, or soil, or by touching their mouth after handling cat litter or dirty soil. Most healthy people do not feel sick or only get mild, flu-like illness. The infection can be serious in two situations: if a person has a weak immune system, or if a woman gets infected during pregnancy and the parasite passes to the baby (congenital toxoplasmosis). The parasite can “sleep” in body tissues for years and may wake up if the immune system becomes weak. The eyes and the brain are the two organs most commonly affected when disease is severe.

Toxoplasmosis is an infection caused by a tiny parasite called Toxoplasma gondii. People can get it by eating meat that isn’t cooked well enough, by touching their mouth after handling raw meat or unwashed fruits and vegetables, by drinking contaminated water, or by contact with cat feces (for example, when cleaning a litter box). In most healthy people, the immune system controls the parasite, and there are no symptoms or only a mild, flu-like illness. However, the parasite can settle into body tissues and lie quiet (be “latent”) for years. If the immune system later becomes weak (for example, advanced HIV, chemotherapy, or high-dose steroids), the parasite can “wake up” and cause serious illness, especially in the brain or eyes. If a person becomes newly infected during pregnancy, the parasite can pass to the fetus and cause congenital toxoplasmosis, which can lead to eye and brain problems in the baby. Treatment depends on the person’s situation: many healthy, non-pregnant adults do not need medicines, but pregnant people, infants, people with eye disease, and people with weak immunity usually do. There is no medicine that completely removes the parasite from the body, so prevention and safe food handling are very important. CDC

How the parasite behaves

The parasite has two main forms inside people. One fast form, called a tachyzoite, spreads quickly during new infection and can cause symptoms. One slow form, called a bradyzoite, hides inside small cysts in muscles and the brain and can stay quiet for a long time. Cats pass hard shells of the parasite called oocysts in their stool, and these shells can survive in soil and water for months. Undercooked meat from infected animals can also carry parasite cysts. When a person swallows these forms, the parasite enters the body, multiplies, and then settles into quiet cysts. If the immune system is strong, the body controls the infection. If the immune system is weak, the parasite can reactivate and cause serious disease. In the eye, the parasite can inflame the retina and the layer under it, which can blur vision or cause dark floating spots.

Types of toxoplasmosis

1. Asymptomatic or mild acute toxoplasmosis
   This is common. Many people never know they were infected. Some get mild fever, swollen neck glands, and tiredness that goes away on its own.

2. Acute symptomatic toxoplasmosis
   The person feels like they have the flu: fever, body aches, sore throat, and swollen lymph nodes. The illness usually lasts a few weeks.

3. Latent toxoplasmosis
   After the first infection, the parasite becomes quiet inside small cysts in muscles, the brain, and the eye. There are no symptoms. The cysts can stay for years.

4. Reactivated toxoplasmosis in immunocompromised people
   If the immune system becomes weak, the parasite can wake up. This may cause severe brain infection (encephalitis) or widespread disease.

5. Ocular (eye) toxoplasmosis
   The parasite inflames the retina (the light-sensing layer). People can notice blurred vision, floaters, light sensitivity, eye pain, or a dark spot in part of the vision. It can be from a new infection or reactivation of an old scar.

6. Congenital toxoplasmosis
   Infection passes from a mother to her baby during pregnancy. The baby may be born with or develop eye disease, hearing loss, seizures, developmental delay, or brain and liver problems if not treated early.

7. Cerebral (brain) toxoplasmosis
   This is most common in people with AIDS or after a transplant. It can cause headaches, weakness on one side, confusion, fever, seizures, and typical findings on brain imaging.

8. Disseminated toxoplasmosis
   The parasite spreads to many organs at once in very weak immune systems, leading to severe illness with lung, heart, liver, and brain involvement.

9. Toxoplasmosis during pregnancy (maternal infection)
   The mother may be asymptomatic or mildly ill. The timing of infection in pregnancy affects the risk to the baby: early in pregnancy = lower chance of transmission but more severe effects; later in pregnancy = higher chance of transmission but usually milder effects.

10. Post-transplant or transfusion-related toxoplasmosis
    Rare, but important. Donor tissue or blood can carry the parasite if not screened or if the recipient is very immunosuppressed.

Causes and risk

1. Eating undercooked pork
   Pork can carry parasite cysts. If the meat is pink or not fully cooked, the cysts can survive and infect you when you eat it.

2. Eating undercooked lamb or mutton
   Lamb often carries the parasite. Slow-roasted or rare lamb that is not hot enough inside can pass on the cysts.

3. Eating undercooked venison or game meat
   Wild game can be infected. If the meat is not cooked to a safe temperature, the parasite can enter the body.

4. Kitchen cross-contamination from raw meat
   Raw meat juices on cutting boards, knives, or hands can spread cysts to salads, bread, or other ready-to-eat foods.

5. Drinking contaminated water
   Oocysts from cat feces can wash into streams, wells, or open water supplies. Drinking or using this water unboiled can cause infection.

6. Eating unwashed fruits or vegetables
   Soil with oocysts can stick to fresh produce. If food is not washed well, the oocysts can be swallowed.

7. Handling or cleaning cat litter without protection
   Cat feces can contain oocysts. Changing litter without gloves or masks and then touching your mouth can cause infection.

8. Gardening or yard work without gloves
   Soil can hold oocysts for months. Touching the soil and then the mouth or food can transmit the parasite.

9. Children playing in uncovered sandboxes
   Outdoor sandboxes can be used by cats. Oocysts in the sand can reach a child’s mouth during play.

10. Drinking unpasteurized goat’s milk or dairy
    Rarely, live parasites can be present in unpasteurized products and can be swallowed.

11. Inhaling dust with oocysts (rare)
    Very fine dust from contaminated areas may carry oocysts that can be inhaled and then swallowed.

12. Blood transfusion from an infected donor (rare)
    This is uncommon, but parasites can be passed in blood if screening fails and the recipient is vulnerable.

13. Organ transplantation from an infected donor
    A donor organ can carry parasites. Immunosuppressive drugs make it easier for the parasite to grow.

14. Mother-to-child transmission during pregnancy
    A new infection in a pregnant person can cross the placenta and infect the fetus.

15. Reactivation in advanced HIV infection
    Old cysts can “wake up” when CD4 cell counts are very low, causing brain or eye disease.

16. Reactivation during or after chemotherapy
    Cancer treatments weaken immunity. Old cysts can reactivate and cause symptoms.

17. Reactivation after organ transplant due to anti-rejection drugs
    These medicines suppress the immune system, which allows the parasite to grow again.

18. Eating cured or dried meats that are not fully safe
    Some curing methods do not kill all cysts if temperature and salt levels are not sufficient.

19. Poor hand hygiene after handling raw meat or soil
    Not washing hands with soap and water lets cysts move from fingers to mouth.

20. Living in or traveling to high-prevalence regions
    In some areas, soil, water, and meat are more often contaminated, increasing daily exposure.

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Symptoms

1. Low-grade fever
   You feel warm and sweaty. The fever is usually mild and may come and go.

2. Tiredness and weakness
   Your body feels heavy. You want to rest more than usual. Simple tasks feel harder.

3. Sore throat
   Your throat hurts when you swallow. It can feel scratchy or dry.

4. Swollen lymph nodes (especially in the neck)
   You feel small, tender lumps in your neck. They swell because your body is fighting the parasite.

5. Muscle aches
   Your arms, legs, or back feel sore, like after heavy work or after the flu.

6. Headache
   Your head hurts in a dull, steady way. It may get better with rest or pain relief.

7. Mild skin rash (sometimes)
   Small, light rashes can appear. They usually fade without scarring.

8. Floaters in vision
   You see small dark spots moving across your view. These are shadows from debris in inflamed eye areas.

9. Blurred vision
   Things look fuzzy or less sharp. This is common when the retina is inflamed.

10. Eye pain or redness and light sensitivity
    Your eye feels sore, looks red, and bright light bothers you. This suggests eye inflammation.

11. Confusion or trouble thinking (in weak immunity)
    You feel mentally slow or mixed up. It is a warning sign of brain involvement.

12. Seizures (fits)
    Your body shakes or you lose awareness for a short time. This can happen with brain lesions.

13. Weakness or numbness on one side of the body
    One arm or leg feels weak or numb. This can point to a brain lesion on the opposite side.

14. Poor balance or unsteady walking
    You feel wobbly or stumble. You may have trouble doing fine movements.

15. In babies: large head or bulging soft spot
    A baby may have a bigger head than expected, or the soft spot bulges. This can signal fluid buildup in the brain.

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Diagnostic tests

A) Physical examination

1. Full general exam with lymph node check
   The clinician looks at your overall health, temperature, skin, and mouth, and then gently feels the lymph nodes in your neck, underarms, and groin. Swollen, tender nodes suggest your immune system is reacting to an infection like toxoplasmosis. The doctor also looks for rash, sore throat, or fever. This exam is simple and gives many early clues.

2. Dilated eye exam with slit-lamp and indirect ophthalmoscopy
   The eye doctor places dilating drops to widen the pupils. A special microscope and lens are used to view the retina. In ocular toxoplasmosis, the doctor may see a white, fluffy area of active inflammation near an old scar and some haze from cells in the eye jelly (vitreous). This appearance strongly suggests toxoplasma in the eye.

3. Focused neurological exam
   The clinician checks your mental status, speech, strength, reflexes, coordination, and sensation. Weakness on one side, changes in reflexes, or trouble with coordination may point to a brain lesion. This helps decide whether brain imaging is needed right away.

4. Newborn and infant exam
   For babies at risk, the clinician measures head size, looks at the soft spot, checks muscle tone, examines the eyes, and feels the liver and spleen. Jaundice, a big liver or spleen, or a large head can be signs of congenital infection. Early detection improves outcomes.

B) Manual tests (simple bedside or office tests)

5. Visual acuity testing with a chart
   You read letters on a wall chart one eye at a time. If the retina is inflamed, the smallest line you can read may be worse than normal. This test is easy, fast, and repeatable, so it helps track recovery after treatment.

6. Amsler grid check for central vision
   You look at a small grid of straight lines and focus on the center dot. If the retina near the center is inflamed, lines can look wavy, dim, or missing. This simple paper test helps monitor vision changes at home and in the clinic.

7. Confrontation visual field test
   The clinician sits in front of you and brings fingers or small targets in from the sides to check your side vision. Missing areas can suggest a retinal lesion or a brain lesion affecting vision pathways. It is quick and needs no machines.

8. Pupil light test and check for a relative afferent pupillary defect (RAPD)
   The clinician shines a light in each eye and watches how the pupils react. Abnormal reactions can mean one eye or its nerve is not sending normal signals, which can happen with active retinal disease. This test is very useful when the retina looks hazy.

C) Laboratory and pathological tests

9. Toxoplasma IgM antibody (ELISA or similar)
   A blood test looks for IgM, which is an early antibody. A positive IgM can mean a recent infection, but false positives can happen. Doctors often confirm with other tests.

10. Toxoplasma IgG antibody and seroconversion
    IgG appears weeks after infection and then stays for life. A rising IgG level between two samples taken weeks apart (seroconversion) strongly suggests a new infection. This helps in pregnancy to estimate timing.

11. IgG avidity testing
    This special test measures how tightly IgG sticks to the parasite. Low avidity suggests a recent infection in the last few months. High avidity suggests an older infection, which is very important in pregnancy counseling.

12. PCR for T. gondii DNA (blood, cerebrospinal fluid, or amniotic fluid)
    PCR looks for the parasite’s genetic material. It is very helpful in brain disease (testing spinal fluid) and in suspected fetal infection (testing amniotic fluid). A positive result is strong evidence of active infection.

13. Cerebrospinal fluid (CSF) analysis
    If brain infection is suspected, a lumbar puncture can collect CSF to check cells, protein, and sometimes do PCR. In toxoplasmosis, CSF can be normal or show mild changes, so CSF PCR is the key part of this test. The procedure is done with careful sterile steps.

14. Tissue biopsy and histology (eye or brain when safe and needed)
    In rare, uncertain cases, a small tissue sample is taken for a pathologist to examine. The pathologist may see tachyzoites or cysts. Biopsy is usually reserved for cases where cancer, tuberculosis, or fungal infection must be ruled out.

D) Electrodiagnostic tests

15. Electroencephalogram (EEG)
    Small sensors are placed on the scalp to record brain electrical activity. If a person has seizures or confusion from brain lesions, the EEG can show abnormal waves. It supports the diagnosis and guides seizure treatment.

16. Visual evoked potentials (VEP)
    You look at a screen with a checkerboard pattern. Electrodes on the scalp record how fast signals travel from the eye to the brain. Delayed signals can happen when the retina or optic nerve is inflamed by toxoplasma.

E) Imaging tests

17. Brain MRI with contrast
    MRI is the best test to look for brain lesions in immunocompromised people. Toxoplasma often makes “ring-enhancing” spots with swelling around them. The number, shape, and location help doctors choose treatment and rule out other diseases like lymphoma.

18. Brain CT scan (when MRI is not available or urgent)
    CT is faster and widely available in emergencies. It can show lesions and swelling. It is less detailed than MRI but still useful for quick decisions.

19. Optical coherence tomography (OCT) of the retina
    OCT uses harmless light to scan the layers of the retina. In ocular toxoplasmosis, it shows swelling, fluid, and later a thin scar. OCT helps plan treatment and monitor healing.

20. Ultrasound in pregnancy and newborns
    Obstetric ultrasound can show signs that suggest fetal infection, such as enlarged brain ventricles or calcifications. After birth, head ultrasound in newborns can also show fluid spaces and calcifications. Ultrasound is safe and repeatable.

Non-pharmacological treatments

(These are supportive measures that work alongside medicines when medicines are indicated. They do not kill the parasite by themselves.)

1. Activity pacing and rest – Gentle routines and extra sleep reduce fatigue while the immune system works.

2. Hydration – Plenty of fluids support kidney function, especially important if you later take sulfonamides that can crystallize in urine. (Your clinician will tell you if that applies.) EACS Guidelines

3. Balanced nutrition – Regular meals with adequate protein, fruits, and vegetables support healing (details on safe food choices below).

4. Eye-strain reduction – For ocular disease, protect from bright light (sunglasses, dim screens) and avoid driving at night during flares to lower photophobia and glare stress.

5. Stop contact lenses during active eye inflammation – Lowers irritation and infection risk until the eye is quiet.

6. Avoid unsupervised steroids – Steroids can worsen toxoplasma if used alone; they must be paired with anti-parasite therapy and specialist guidance. American Academy of Ophthalmology

7. Fever comfort care – Cool compresses, tepid sponge baths, breathable clothing; these ease symptoms while your clinician decides on medication needs.

8. Headache hygiene – Dark, quiet room; gentle neck/shoulder stretches; relaxation breathing can lessen headache while medical therapy starts.

9. Ophthalmology follow-up – Timed check-ups (often every 1–2 weeks during active lesions) to track healing and adjust therapy; urgent review for new floaters or vision drop. American Academy of Ophthalmology

10. Neurology/infectious diseases coordination – For brain disease or HIV, coordinated care improves outcomes and timing of therapies. ClinicalInfo

11. HIV care linkage – Rapid evaluation for and initiation/optimization of antiretroviral therapy (ART) to rebuild immunity after acute treatment. ClinicalInfo

12. Pregnancy counseling – Maternal-fetal medicine support to decide on spiramycin vs. other regimens and fetal testing. CDC

13. Food-safety upgrades at home – Cook meats to safe internal temperatures, wash produce well, separate raw and ready-to-eat foods, and avoid unpasteurized milk/shellfish. (Full details below.) CDC+1FoodSafety.gov

14. Water hygiene – Use safe treated water; avoid untreated water when traveling or outdoors. U.S. Food and Drug Administration

15. Garden and soil precautions – Wear gloves, wash hands after gardening or handling sand/soil that may be contaminated by cat feces. CDC

16. Cat-litter changes – If possible have someone else change it; if you must, wear gloves and wash hands; change daily because oocysts need 1–5 days to become infectious. U.S. Food and Drug Administration

17. Keep cats indoors and feed cooked/commercial food – Reduces their exposure to infected prey and lowers your risk at home. CDC

18. Medication adherence coaching – Pill boxes, reminders, and side-effect plans help complete long regimens (often 4–6 weeks or more). ClinicalInfo

19. Avoid raw/undercooked meats during recovery – Prevents re-exposure while lesions heal. CDC

20. Timely referral for procedures when needed – For sight-threatening ocular complications or hydrocephalus in infants, prompt specialist interventions improve outcomes. PubMedThe Journal of Neuroscience

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Drug treatments

(Typical adult dosing shown where consistent with major references; pediatric/pregnancy/HIV care differs—follow specialist guidance. Folinic acid = leucovorin is used to protect bone marrow.)

1. Pyrimethamine (antiparasitic, antifolate)
   Dose (adult, treatment phase): often 50–75 mg orally once daily after a loading dose per clinician; always paired with a sulfonamide and leucovorin. Duration: commonly 4–6 weeks for acute disease, longer for CNS disease or ocular recurrences per specialist. Purpose: core anti-toxoplasma drug. Mechanism: blocks parasite folate metabolism. Key side effects: bone-marrow suppression (low blood counts), GI upset; must give leucovorin. Drugs.comHopkins Guides

2. Sulfadiazine (sulfonamide antibiotic)
   Dose (adult): typically 2–4 g/day in 2–4 divided doses with pyrimethamine + leucovorin. Duration: often 4–6+ weeks. Purpose: partner drug with pyrimethamine. Mechanism: inhibits folate pathway in parasite. Key side effects: allergy/rash, crystalluria/renal issues—hydrate well and monitor kidneys. Hopkins GuidesEACS Guidelines

3. Leucovorin = Folinic acid (antidote/protective)
   Dose: 10–25 mg orally daily (adjust per counts). Purpose: protects bone marrow from pyrimethamine’s antifolate effect without feeding the parasite. Mechanism: bypasses blocked folate step in human cells. Key side effects: uncommon; essential co-medication. Hopkins Guides

4. Trimethoprim–Sulfamethoxazole (TMP–SMX)
   Dose (example adult treatment for TE per guidelines/ABX references): regimens vary (e.g., TMP 5 mg/kg twice daily IV/PO); also widely used for prophylaxis in HIV. Purpose: alternative to pyrimethamine-based therapy and for prevention in high-risk HIV. Mechanism: dual folate pathway blockade. Key side effects: rash, cytopenias, renal effects, hyperkalemia. ClinicalInfoEACS Guidelines

5. Clindamycin (systemic)
   Dose (alternative partner): often 300 mg orally four times daily with pyrimethamine + leucovorin, or higher mg/kg dosing in TE under specialist care. Purpose: alternative when sulfadiazine is not tolerated. Mechanism: inhibits protein synthesis in the parasite. Key side effects: diarrhea, risk of C. difficile. eMedicinePMC

6. Azithromycin (alternative partner)
   Dose: combined with pyrimethamine in some regimens (e.g., 900–1200 mg/day studied); used when standard regimens are not suitable. Purpose: alternative option in select cases. Mechanism: protein synthesis inhibition. Key side effects: GI upset, QT prolongation; monitor interactions. PMC+1

7. Atovaquone
   Dose: used as an alternative (often 1500 mg orally twice daily) in combination strategies when others are not tolerated; specialist-directed. Purpose: salvage/alternative therapy. Mechanism: blocks parasite mitochondrial electron transport. Key side effects: GI upset; needs fatty meal to enhance absorption. PMC

8. Spiramycin (for pregnancy to reduce fetal transmission)
   Dose: commonly 1 g (≈3 million units) orally every 8 hours; often used before about 18 weeks when fetal infection is not documented, to lower transmission risk. Purpose: reduce trans-placental spread. Mechanism: concentrates in placenta, limits parasite passage. Key notes: obtained via special access in some countries; if fetal infection is confirmed later in gestation, regimens change to pyrimethamine-based combinations under specialist care. Side effects: GI upset. CDCHopkins Guides

9. Adjunct corticosteroids for eye disease (e.g., oral prednisone)
   Dose: only with anti-parasite therapy and eye-specialist supervision; doses vary (e.g., ~0.5 mg/kg/day) when significant inflammation threatens vision. Purpose: reduce damaging inflammation around active retinal lesions. Risks: if given alone or too early, steroids can worsen infection—must be paired with anti-toxoplasma drugs. American Academy of Ophthalmology

10. Intravitreal clindamycin + dexamethasone (local eye injections)
    Use: For selected cases of sight-threatening ocular toxoplasmosis, an eye surgeon may inject medicines directly into the eye as an alternative or addition to systemic therapy. Rationale: delivers high local drug levels with fewer systemic effects. Evidence: randomized studies and clinical series support this approach in appropriate patients. Risks: procedure-related, discussed by the retina specialist. AAO JournalPubMedScienceDirect

Duration and maintenance: Brain (TE) and severe ocular disease often need at least 6 weeks of acute therapy, followed by longer “maintenance” (secondary prophylaxis) until immunity recovers (for example, CD4 >200 for >3–6 months in HIV). Your specialist will tailor this. Hopkins Guides

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Dietary “molecular” supplements

(Always clear supplements with your clinician—some interact with medicines. Do not replace prescribed drugs with supplements.)

1. Folinic acid (leucovorin) – This is a medicine, not a typical supplement, but it functions like an activated folate to protect the bone marrow during pyrimethamine therapy. Usual 10–25 mg/day as prescribed. Do not substitute plain folic acid during acute treatment without your clinician’s advice. Hopkins Guides

2. Vitamin D – 600–800 IU/day (15–20 µg) is common; supports general immune function. Avoid high doses unless prescribed.

3. Zinc – 8–11 mg/day typical; supports wound healing and immunity; excess zinc can cause nausea and copper deficiency.

4. Vitamin C – 75–90 mg/day typical; helps iron absorption and general immune health.

5. Selenium – ~55 µg/day supports antioxidant enzymes; excess can be toxic—don’t exceed safe upper limits.

6. Omega-3 (fish oil EPA/DHA) – ~1 g/day often used for general eye/retina support; may affect bleeding risk at higher doses.

7. Lutein + Zeaxanthin – Often 10 mg/2 mg daily for general macular health; supportive only, not a treatment for toxoplasma lesions.

8. Probiotics – May reduce antibiotic-associated diarrhea; pick products with defined CFU and strains; take at a different time from antibiotics.

9. B-complex (without excess folic acid during PYR therapy) – Discuss with your clinician; folate handling is special during pyrimethamine use.

10. General multivitamin – At standard daily values can support nutrition during long regimens; avoid megadoses.

Note: No vitamin or herbal product has been proven to kill T. gondii in people. Medicines do that.

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Therapies aimed at immunity/tissue protection

You asked for “hard immunity booster, regenerative, stem cell drugs.” There are no approved stem cell drugs or miracle immune boosters for toxoplasmosis. Here is what actually helps and is used in practice:

1. Combination antiretroviral therapy (ART) for HIV – Not a single drug and dosing is individualized. ART restores CD4 counts over time and lowers relapse risk after TE treatment. Starting or optimizing ART is central to long-term control. ClinicalInfo

2. Leucovorin (folinic acid) – 10–25 mg/day to protect bone marrow during pyrimethamine therapy; prevents treatment-limiting cytopenias. Hopkins Guides

3. Filgrastim (G-CSF) – e.g., 5 µg/kg/day subcutaneously under supervision if severe neutropenia occurs from therapy; supports white-cell recovery so treatment can continue. (Specialist decision.)

4. Erythropoiesis-stimulating agent (epoetin alfa) – Example 50–100 units/kg 3×/week for significant anemia from prolonged antifolate therapy; used case-by-case under hematology guidance.

5. Dexamethasone for cerebral edema (adjunct, not immune booster) – Used cautiously when mass effect from TE lesions causes life-threatening brain swelling; always alongside anti-toxoplasma drugs. ClinicalInfo

6. Intravitreal dexamethasone with clindamycin for ocular inflammation – Local, sight-saving anti-inflammatory effect while antiparasitic drug controls the infection. AAO Journal

Why not stem cells or “immune booster shots”? There is no clinical evidence for stem cell drugs or quick immune boosters to treat toxoplasmosis in humans. The proven pathway is anti-parasite medication plus restoring immune function (for example, ART in HIV) and careful supportive care. ClinicalInfo

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Surgeries or procedures

1. Intravitreal injection (clindamycin + dexamethasone) – A retina specialist injects medicine directly into the eye for active sight-threatening lesions; aims to control local infection/inflammation quickly while limiting whole-body side effects. AAO Journal

2. Pars plana vitrectomy (PPV) – Microsurgery to remove the vitreous gel if there is non-clearing vitreous hemorrhage, dense inflammatory debris, traction, or retinal detachment from ocular toxoplasmosis. Goal: clear media, relieve traction, repair detachment, and improve/restore vision. Surgeons avoid operating during hot, active inflammation if possible. PubMedAmerican Academy of Ophthalmology

3. Retinal detachment repair (e.g., PPV ± scleral buckle, laser, gas/oil) – If toxoplasma-related scarring or traction causes a retinal tear/detachment, surgery reattaches the retina and seals breaks to preserve vision. PMC

4. Cataract surgery – After prolonged inflammation or steroid treatment, cataract may form; removing the cloudy lens restores clarity once the eye is quiet and safe to operate. (Timing and implant choices are individualized.)

5. Ventriculoperitoneal (VP) shunt for congenital hydrocephalus – In some infants with congenital toxoplasmosis, fluid builds up in brain ventricles. A neurosurgeon places a shunt to drain fluid to the abdomen, relieving pressure and protecting brain development. Early treatment is linked to better outcomes. The Journal of NeuroscienceOxford AcademicUChicago Medicine

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Prevention

1. Cook meats to safe internal temperatures – Whole cuts ≥145°F (63°C) plus 3-minute rest; ground meats ≥160°F (71°C); poultry ≥165°F (74°C). Use a thermometer. CDCFoodSafety.gov

2. Freeze meat for several days at 0°F (-18°C) before cooking to reduce parasite cysts. CDC

3. Wash fruits and vegetables under running water; peel when possible. CDC

4. Avoid unpasteurized milk (especially goat’s milk) and raw shellfish. CDC

5. Separate raw and ready-to-eat foods; clean knives/boards/counters with hot soapy water. U.S. Food and Drug Administration

6. Don’t sample meat until it’s fully cooked. FoodSafety.gov

7. Use safe water (avoid untreated water, especially when traveling). U.S. Food and Drug Administration

8. Handle cat litter safely – If possible, have someone else change it; if you do it, wear gloves and wash hands; change daily because oocysts need 1–5 days to become infectious. U.S. Food and Drug Administration

9. Wear gloves for gardening/handling soil or sand; wash hands afterward. CDC

10. Pregnancy-specific – You can keep your cat; keep it indoors and feed cooked/commercial food; avoid adopting new/stray cats during pregnancy; follow litter and food safety closely. ACOGCDC

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When to see a doctor

• Immediately for severe headache, confusion, seizures, weakness/numbness, high fever, neck stiffness, or new behavior changes—these may signal brain involvement. (Emergency.) ClinicalInfo

• Urgently for vision loss, new floaters, flashing lights, eye pain, or a dark patch in your vision—these may signal ocular toxoplasmosis. American Academy of Ophthalmology

• Pregnancy – If you’re pregnant (or planning pregnancy) and think you were exposed—through undercooked meat, contaminated water, or cat feces—seek care promptly to discuss testing and possible treatment (e.g., spiramycin early in pregnancy to reduce transmission when appropriate). CDC

• Weak immunity (e.g., HIV, chemo, transplant) – If you have fever, headache, confusion, or focal neurologic symptoms, or new eye symptoms, seek care urgently; you may need immediate imaging and treatment. ClinicalInfo

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What to eat and what to avoid

1. Eat thoroughly cooked beef, lamb, pork, and game (follow temperatures above). CDC

2. Eat well-washed produce (rinse under running water; peel when possible). CDC

3. Choose pasteurized dairy (avoid raw/unpasteurized milk, especially goat’s). CDC

4. Enjoy cooked fish and seafood (fish to 145°F/63°C; cook shellfish until shells open/flesh opaque). CDC

5. Use clean cutting boards—keep one for raw meats and one for ready-to-eat foods; sanitize after use. U.S. Food and Drug Administration

6. Avoid raw or undercooked meat dishes (e.g., tartare, carpaccio, undercooked kebabs). CDC

7. Avoid tasting meat while cooking—wait until it reaches safe temperature. FoodSafety.gov

8. Avoid unwashed herbs/greens—wash thoroughly; spin dry. CDC

9. Avoid untreated water—use bottled/boiled water when in doubt. U.S. Food and Drug Administration

10. During pregnancy—follow the above strictly; keep your cat indoors and stick to commercial or well-cooked foods for pets. ACOG

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Frequently Asked Questions

1) Do all people with toxoplasmosis need medicine?
No. Healthy, non-pregnant adults with mild illness often recover without drugs. Pregnant people, infants, people with eye disease, or people with weak immunity generally need treatment. CDC

2) What is the first-line treatment when medicine is needed?
Usually pyrimethamine + sulfadiazine + leucovorin; alternatives exist when allergies or side effects occur. Hopkins Guides

3) How long does treatment last?
Often 4–6 weeks for acute disease; brain disease and some eye cases may need longer and then maintenance therapy in HIV until CD4 recovers. Hopkins Guides

4) I have HIV—how do I avoid TE (brain disease)?
Take ART as prescribed, keep CD4 counts up, and follow prophylaxis plans (often TMP-SMX when CD4 is low). ClinicalInfo

5) Is it safe to keep my cat during pregnancy?
Yes, with precautions: keep the cat indoors, feed commercial/cooked food, and have someone else change the litter daily. ACOGCDC

6) What cooking temperatures kill T. gondii?
Whole cuts of meat 145°F (63°C) with 3-minute rest; ground meats 160°F (71°C); poultry 165°F (74°C). CDC

7) Does freezing meat help?
Yes. Freezing for several days at 0°F (−18°C) reduces parasite cysts (still cook properly afterward). CDC

8) What’s the role of spiramycin in pregnancy?
When acute infection is identified early in pregnancy and fetal infection isn’t documented, spiramycin is used to reduce transmission to the fetus. Later or confirmed fetal infection leads to different regimens. CDC

9) Can vitamins cure toxoplasmosis?
No. Supplements may support general health but do not kill the parasite. Medicines are required when treatment is indicated.

10) Why is leucovorin always mentioned with pyrimethamine?
Leucovorin protects your bone marrow from pyrimethamine’s antifolate effect, reducing dangerous low blood counts. Hopkins Guides

11) Are steroids safe in ocular toxoplasmosis?
They can help with inflammation only when started with anti-toxoplasma therapy and under specialist care. Never self-start steroids. American Academy of Ophthalmology

12) What if I can’t tolerate sulfadiazine?
Alternatives include clindamycin or TMP-SMX–based regimens guided by your specialist. eMedicineEACS Guidelines

13) What procedures are used for eye complications?
Selected patients may receive intravitreal clindamycin+dexamethasone, and surgery such as vitrectomy or detachment repair if needed. AAO JournalPubMed

14) How is hydrocephalus from congenital toxoplasmosis treated?
Often with a ventriculoperitoneal shunt to drain fluid; early treatment is linked to better outcomes. The Journal of Neuroscience

15) Will I always carry the parasite?
There’s no proven way to completely clear dormant cysts in humans; preventing re-exposure, staying healthy, and (for HIV) maintaining ART are key. CDC

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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 28, 2025.