Materiały źródłowe

• #1 Prophylaxis of human toxoplasmosis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5694886/

  Toxoplasmosis is an infection caused by the intracellular protozoan parasite Toxoplasma gondii, and is associated with clinically significant infection in immunocompromised individuals. […] This review aims to describe the modalities for prophylaxis of toxoplasmosis in susceptible populations, and focuses on the following: (1) prophylaxis of congenital toxoplasmosis; (2) prophylaxis of toxoplasmosis in patients with HIV/AIDS; and (3) prophylaxis of toxoplasmosis in transplant recipients. […] Prophylaxis is recommended for these two groups of individuals. […] Prevention of maternal infection is foremost in the prevention of congenital toxoplasmosis, and the preventive principles are centered around the lifecycle of the parasite Toxoplasma gondii. Education of mothers on the prevention of toxoplasmosis has also been shown to play a significant role in the prevention of maternal infection.

• #2 Toxoplasma gondii Encephalitis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/toxoplasmosis

  Toxoplasma gondii is a protozoan that can commonly cause asymptomatic infection, a mononucleosis-like syndrome, retinochoroiditis, or congenital infection in immunocompetent individuals, but it presents most often as toxoplasma encephalitis (TE) in people with HIV who are severely immunocompromised. […] People with HIV should be counseled regarding sources of Toxoplasma infection. Those with CD4 counts 200 cells/mm3 should be tested for IgG antibody to Toxoplasma soon after they are diagnosed with HIV to detect latent infection with T. gondii. […] To minimize risk of acquiring toxoplasmosis, people with HIV, especially those with CD4 counts 200 cells/mm3, should be advised not to eat raw or undercooked meat, including undercooked lamb, beef, pork, or venison, and not to eat raw shellfish, including oysters, clams, and mussels.

• #3 Toxoplasma infection – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/toxoplasma+infection/toxoplasma+infection+-+including+symptoms+treatment+and+prevention

  Toxoplasma infection is caused by a parasite Toxoplasma gondii. The parasite occurs worldwide and infection is very common. […] Human infection occurs when the parasite is taken in by mouth. This most often results from eating raw or undercooked meat or unwashed salad vegetables, but also if hands become contaminated with cat faeces during gardening or cleaning cat litter trays. […] Prevention of Toxoplasma infection […] Avoid eating and minimise handling raw meat. […] Cooking all meat thoroughly and washing hands and utensils after handling raw meat. All meat eaten by pregnant women should be cooked 'well done’. […] Wash all vegetables thoroughly before eating, especially salad vegetables. […] Use gloves when emptying cat litter trays. Trays can be disinfected with boiling water. […] Cover sandpits when not in use, to prevent cats from using them as litter. […] Cats should be fed dry, canned or cooked food. Discourage pet cats from hunting. […] Wear gloves when gardening. Hands should be washed thoroughly with soap and warm running water after contact with soil.

• #4 Toxoplasmosis in Cats | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/toxoplasmosis-cats

  Pregnant women and immunodeficient individuals are the two populations most at risk of developing health problems after T. gondii exposure. In utero infection is of the greatest concern in humans. Between one-third and one-half of infants born to mothers who acquired Toxoplasma during pregnancy are infected. The vast majority of women infected during pregnancy have no symptoms themselves, and the majority of infected infants will show no symptoms of toxoplasmosis at birth. Many of these children, however, are likely to develop signs of infection later in life, including loss of vision and hearing, mental retardation, and, in severe cases, death. […] Immunodeficient people and pregnant women were advised to avoid cats in the past; however, the CDC now advises that this is not necessary. Please refer to the CDCs website for its most recent recommendations regarding the risk of toxoplasmosis to humans. […] There is no vaccine to protect against toxoplasmosis in animals or humans.

• #5 Toxoplasmosis in Animals – Generalized Conditions – Merck Veterinary Manual

  https://www.merckvetmanual.com/generalized-conditions/toxoplasmosis/toxoplasmosis-in-animals

  To prevent infection, hands should be washed thoroughly with soap and water after contact with meat or potentially contaminated environments. The stages of T gondii are killed by cooking and contact with boiling water, and boiling water should be used to clean all cutting boards, sink tops, knives, and other materials. T gondii can also be killed by freezing. Tissue cysts are killed by heating throughout to 67C (152.6F) or by cooling to 13C (8.6F). Toxoplasma individuals in tissue cysts are also killed by exposure to 0.5 kilorad of gamma irradiation. Meat of any animal should be cooked to 67C (152.6F) before consumption, and tasting meat while cooking or while seasoning should be avoided. Pregnant women should avoid contact with cat litter, soil, and raw meat. Pet cats should be fed only dry, canned, or cooked food. The cat litter box should be emptied daily, preferably not by a pregnant woman. Gloves should be worn while gardening. Vegetables should be washed thoroughly before eating, because they may have been contaminated with cat feces. […] There is currently no vaccine to prevent toxoplasmosis in humans. Some countries have approved a vaccine to prevent abortions in sheep.

• #6 Toxoplasma infection – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/toxoplasma+infection/toxoplasma+infection+-+including+symptoms+treatment+and+prevention

  Toxoplasma infection is caused by a parasite Toxoplasma gondii. The parasite occurs worldwide and infection is very common. […] Human infection occurs when the parasite is taken in by mouth. This most often results from eating raw or undercooked meat or unwashed salad vegetables, but also if hands become contaminated with cat faeces during gardening or cleaning cat litter trays. […] Prevention of Toxoplasma infection […] Avoid eating and minimise handling raw meat. […] Cooking all meat thoroughly and washing hands and utensils after handling raw meat. All meat eaten by pregnant women should be cooked 'well done’. […] Wash all vegetables thoroughly before eating, especially salad vegetables. […] Use gloves when emptying cat litter trays. Trays can be disinfected with boiling water. […] Cover sandpits when not in use, to prevent cats from using them as litter. […] Cats should be fed dry, canned or cooked food. Discourage pet cats from hunting. […] Wear gloves when gardening. Hands should be washed thoroughly with soap and warm running water after contact with soil.

• #7 Toxoplasmosis Prevention 

  https://nutritionfacts.org/blog/toxoplasmosis-prevention/

  The parasite can get into the muscles, so we can contract it through meat consumption. […] We can also get infected through contact with feces from animals like cats. Thankfully, in cats, the danger of infection exists only when the animal is actively shedding oocysts, the tissue cysts formed by the parasite. […] Many women have heard about the cat connection but may be less aware of the risk of foodborne infection. Only about one in three may be aware that toxoplasma may be found in raw or undercooked meat. […] Nevertheless, a high percentage of women indicated that they do not eat undercooked meat during pregnancy and that they practice good hygienic measures such as washing their hands after handling raw meat, gardening or changing cat litter. […] The parasite can enter into muscles, so we can also get infected by eating meat, especially pork and poultry, the riskiest types.

• #8 Congenital Toxoplasmosis: Update on Diagnosis, Treatment, and Preventionlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na43402/2017/02/02/congenital-toxoplasmosis-update-diagnosis-treatment-and

  Maternal to fetal transmission risk increases throughout gestation (from 5% in early pregnancy to 71% after 37 weeks). […] Identified risk factors for acquiring toxoplasmosis include ingestion or handling of raw or rare meat; eating raw oysters, clams or mussels; drinking unpasteurized raw goat milk or untreated water; and household exposure to ≥3 kittens. […] Approximately half of maternal infections are asymptomatic and occur in women with no identifiable risk factors. Serologic testing is the only means of establishing presence of previous or current infection. […] Antenatal treatment is likely associated with a decrease in mother to child transmission and may improve neurologic outcome in affected infants. […] Women and infants with suspected toxoplasmosis should be evaluated and managed in consultation with a toxoplasmosis reference center (Palo Alto, California, and Chicago, Illinois), where higher specificity testing is available.

• #9 Toxoplasma infection – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/toxoplasma+infection/toxoplasma+infection+-+including+symptoms+treatment+and+prevention

  Toxoplasma infection is caused by a parasite Toxoplasma gondii. The parasite occurs worldwide and infection is very common. […] Human infection occurs when the parasite is taken in by mouth. This most often results from eating raw or undercooked meat or unwashed salad vegetables, but also if hands become contaminated with cat faeces during gardening or cleaning cat litter trays. […] Prevention of Toxoplasma infection […] Avoid eating and minimise handling raw meat. […] Cooking all meat thoroughly and washing hands and utensils after handling raw meat. All meat eaten by pregnant women should be cooked 'well done’. […] Wash all vegetables thoroughly before eating, especially salad vegetables. […] Use gloves when emptying cat litter trays. Trays can be disinfected with boiling water. […] Cover sandpits when not in use, to prevent cats from using them as litter. […] Cats should be fed dry, canned or cooked food. Discourage pet cats from hunting. […] Wear gloves when gardening. Hands should be washed thoroughly with soap and warm running water after contact with soil.

• #10 Prevention of congenital toxoplasmosis

  https://www.degruyter.com/document/doi/10.1515/JPM.2000.043/html?lang=en

  In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. […] Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. […] A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. […] This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.

• #11 Congenital Toxoplasmosis: Update on Diagnosis, Treatment, and Preventionlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na43402/2017/02/02/congenital-toxoplasmosis-update-diagnosis-treatment-and

  Maternal to fetal transmission risk increases throughout gestation (from 5% in early pregnancy to 71% after 37 weeks). […] Identified risk factors for acquiring toxoplasmosis include ingestion or handling of raw or rare meat; eating raw oysters, clams or mussels; drinking unpasteurized raw goat milk or untreated water; and household exposure to ≥3 kittens. […] Approximately half of maternal infections are asymptomatic and occur in women with no identifiable risk factors. Serologic testing is the only means of establishing presence of previous or current infection. […] Antenatal treatment is likely associated with a decrease in mother to child transmission and may improve neurologic outcome in affected infants. […] Women and infants with suspected toxoplasmosis should be evaluated and managed in consultation with a toxoplasmosis reference center (Palo Alto, California, and Chicago, Illinois), where higher specificity testing is available.

• #12 Prophylaxis of human toxoplasmosis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5694886/

  Screening for congenital toxoplasmosis in pregnancy is recommended in high risk individuals (HIV positive/ immunosuppressed), or in patients with ultrasound evidence of congenital toxoplasmosis such as hydrocephalus, intracranial calcifications, intra-uterine growth retardation, and hepatospenomegaly. […] Primary prophylaxis is indicated for AIDS patients with a CD4 count less 100/mm3 who are IgG positive for toxoplasmosis. […] General life style modifications are important for prevention, and are complimentary to the pharmacological modalities in the prevention of toxoplasmosis in high risk groups. […] The efficacy of prenatal treatment for congenital toxoplasmosis is controversial; current regimens used commonly include S and PS. […] Primary prophylaxis of TE in patients with HIV should be commenced in patients with Toxoplasma seropositivity with a CD4 count 100/mm3. Currently used agents include trimethoprim sulfamethoxazole (TS), and dapsone pyrimethamine (DP). […] Evidence is limited on the role of Toxoplasma prevention in organ transplantation, with possible efficacy in the use of TS and P.

• #13 Preventing Toxoplasmosis | Parasites – Toxoplasmosis (Toxoplasma infection) | CDC

  https://www.cdc.gov/toxoplasmosis/prevention/index.html

  People can take steps to reduce their risk of toxoplasmosis. […] If you are at a higher risk for toxoplasmosis, talk to your healthcare provider. […] Everyone can take steps to reduce their risk of toxoplasmosis. […] Use a food thermometer to cook food to a safe internal temperature high enough to kill Toxoplasma. Cooking meat to the USDA recommended internal temperature is the safest method to prevent infection. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Rinse fruit and vegetables under running water. […] Do not drink unpasteurized goat’s milk. […] Do not eat raw or undercooked oysters, mussels, or clams (these may be contaminated with Toxoplasma that has washed into seawater). […] Wash utensils, cutting boards, and countertops with hot, soapy water after preparing each food item.

• #14 Toxoplasma gondii Encephalitis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/toxoplasmosis

  Toxoplasma gondii is a protozoan that can commonly cause asymptomatic infection, a mononucleosis-like syndrome, retinochoroiditis, or congenital infection in immunocompetent individuals, but it presents most often as toxoplasma encephalitis (TE) in people with HIV who are severely immunocompromised. […] People with HIV should be counseled regarding sources of Toxoplasma infection. Those with CD4 counts 200 cells/mm3 should be tested for IgG antibody to Toxoplasma soon after they are diagnosed with HIV to detect latent infection with T. gondii. […] To minimize risk of acquiring toxoplasmosis, people with HIV, especially those with CD4 counts 200 cells/mm3, should be advised not to eat raw or undercooked meat, including undercooked lamb, beef, pork, or venison, and not to eat raw shellfish, including oysters, clams, and mussels.

• #15 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Preventing Exposure: Ingestion of undercooked meats that could contain tissue cysts and contact with cat feces that could contain sporulated oocysts should be avoided (AIII). […] Initiating Primary Prophylaxis: Toxoplasma-seropositive children aged 6 years with CD4 T lymphocyte (CD4) cell percentage 15% and children aged 6 years with CD4 100 cells/mm3 should be administered prophylaxis against Toxoplasma encephalitis (TE) (AIII). The preferred agent for prophylaxis of TE is trimethoprim-sulfamethoxazole, one double-strength tablet daily for adolescents and adults (or weight-equivalent dosing for children) (AII*). […] Primary preventive therapy can be discontinued once a child responds to combination antiretroviral therapy (cART) with a sustained rise in CD4 percentage above 15% for children 6 years of age, and 200 cells/mm3 for children aged 6 years (BIII).

• #16 HIV-1–Associated Toxoplasmosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441877/

  Prophylaxis against reactivation of T gondii in seropositive individuals with CD4 lymphocyte counts less than 100 cells/microliter is recommended. Trimethoprim/sulfamethoxazole is mainly used. Other options include dapsone plus pyrimethamine, folinic acid, or atovaquone with or without pyrimethamine/leucovorin. […] Patients with HIV1associated toxoplasmosis should be advised to avoid eating raw or undercooked meat and wash their hands thoroughly after handling cat litter or soil. […] An integral part of therapy is starting antiretroviral therapy (ART) agents as soon as feasible, usually within 2 weeks of starting antitoxoplasma therapy. Immune reconstitution inflammatory syndrome, which can present as a paradoxical worsening of symptoms as immunity recovers, is rarer with toxoplasmosis than mycobacterial and cryptococcal infections. Even though there are no studies about the optimal timing of ART in toxoplasmosis, early ART has clear benefits and should not necessarily be delayed beyond 2 weeks.

• #17 15. Primary and Secondary Prophylaxis Against Opportunistic Infections in HIV AIDS | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/content/15-primary-and-secondary-prophylaxis-against-opportunistic-infections-hiv-aids

  Toxoplasma gondii […] Toxo IgG + and CD4 100** […] TMP-SMX DS daily […] […] […] Toxoplasmosis: pyrimethamine 25-50mg daily + sulfadiazine 2000-4000mg (in 2-4 divided doses) + leucovorin 10-25mg daily until CD4 200 for 3 months on ART without symptoms after having completed full treatment course. […] […] […] ** If on PCP prophylaxis not active against toxo (e.g. pentamidine or dapsone), retest toxo serology if CD4 falls 100 for initiation of appropriate prophylaxis. […] […] […] PCP and toxoplasmosis: can be stopped if CD4 count 200 for 3 months on ART. Reinitiate if CD4 falls 200.

• #18 Preventing Toxoplasmosis | Parasites – Toxoplasmosis (Toxoplasma infection) | CDC

  https://www.cdc.gov/toxoplasmosis/prevention/index.html

  People can take steps to reduce their risk of toxoplasmosis. […] If you are at a higher risk for toxoplasmosis, talk to your healthcare provider. […] Everyone can take steps to reduce their risk of toxoplasmosis. […] Use a food thermometer to cook food to a safe internal temperature high enough to kill Toxoplasma. Cooking meat to the USDA recommended internal temperature is the safest method to prevent infection. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Rinse fruit and vegetables under running water. […] Do not drink unpasteurized goat’s milk. […] Do not eat raw or undercooked oysters, mussels, or clams (these may be contaminated with Toxoplasma that has washed into seawater). […] Wash utensils, cutting boards, and countertops with hot, soapy water after preparing each food item.

• #19 Toxoplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxoplasmosis/symptoms-causes/syc-20356249

  Certain precautions can help prevent toxoplasmosis: […] Wear gloves when you garden or handle soil. Wear gloves when you work outdoors. Wash your hands with soap and water afterward. […] Don’t eat raw or undercooked meat. Use a meat thermometer to make sure meat is cooked enough. Cook whole meats and fish to at least 145 F (63 C) and let rest for at least three minutes. Cook ground meat to at least 160 F (71 C). Cook whole and ground poultry to at least 165 F (74 C). […] Don’t eat raw shellfish. Do not eat raw clams, mussels or oysters, particularly during pregnancy. […] Wash kitchen utensils thoroughly. Wash cutting boards, knives and other utensils with soapy water after contact with raw meats or unwashed fruits and vegetables. Wash your hands thoroughly before and after preparing foods.

• #20 About Toxoplasmosis | Toxoplasmosis | CDC

  https://www.cdc.gov/toxoplasmosis/about/index.html

  You can take steps to prevent toxoplasmosis infection. […] Follow these steps to reduce your risk of becoming infected with Toxoplasma gondii: […] Use a food thermometer to cook food to a safe internal temperature high enough to kill Toxoplasma. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Rinse fruit and vegetables under running water or cook them. […] Do not drink unpasteurized goat’s milk. […] Do not eat raw oysters, mussels, or clams. […] Clean areas where you handle food with hot, soapy water after preparing each food item. […] Wear gloves when gardening or touching soil or sand that may be contaminated with cat feces containing Toxoplasma. […] Wash hands with soap and water any time you touch something that may be contaminated with cat feces containing Toxoplasma. […] If you have a cat, change the litter box daily. […] Talk to your healthcare provider about additional precautions if you are a person at risk for severe infection.

• #21 Preventing Toxoplasmosis – MN Dept. of Health

  https://www.health.state.mn.us/diseases/toxoplasmosis/prevention.html

  Wash your hands after using the bathroom and changing diapers, and before handling or eating any food. […] Always wash hands after contact with farm animals, pets, animal feces, and animal environments. […] Keep raw meat separate from produce and other foods when shopping for and storing groceries. […] Wash hands, cutting boards, countertops, cutlery, and utensils after handling uncooked meat. […] Wash raw fruits and vegetables before eating. […] Freeze meat for several days before cooking to inactivate the parasite and reduce the likelihood of infection. […] Thoroughly cook raw meat and poultry. Cook all meat to an internal temperature of 160 F and until it is no longer pink in the center or until the juices become clear. […] Always wash hands after contact with farm animals, pets, animal feces, and animal environments.

• #22 Toxoplasmosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/9756-toxoplasmosis

  Reduce your risk of toxoplasmosis with safe food handling and wearing gloves and washing hands when cleaning litter boxes. […] Safe food preparation and hand washing are the most important things you can do to help prevent toxoplasmosis. […] Follow safe freezing and cooking practices before eating meat. […] Peel fruits and vegetables or wash thoroughly before eating. […] Wash cutting boards, counters, utensils and dishes with soapy water after use. […] Don’t drink unpasteurized milk. […] Don’t eat raw or undercooked clams, oysters or mussels. […] Don’t drink untreated water. […] Wear gloves when gardening and while working with soil or sand. Wash hands with soap and water afterward. […] Cover outdoor sandboxes. […] Don’t feed cats raw or undercooked meats. […] Change cat litter daily. Wear gloves and wash your hands with soap and water afterward. […] Keep cats indoors. […] If you’re pregnant or have a compromised immune system: […] Avoid changing cat litter yourself if possible. […] If you must change cat litter, wear disposable gloves and wash your hands thoroughly afterward. […] Don’t adopt a new cat or take in a stray cat.

• #23 Preventing Toxoplasmosis – MN Dept. of Health

  https://www.health.state.mn.us/diseases/toxoplasmosis/prevention.html

  Wash your hands after using the bathroom and changing diapers, and before handling or eating any food. […] Always wash hands after contact with farm animals, pets, animal feces, and animal environments. […] Keep raw meat separate from produce and other foods when shopping for and storing groceries. […] Wash hands, cutting boards, countertops, cutlery, and utensils after handling uncooked meat. […] Wash raw fruits and vegetables before eating. […] Freeze meat for several days before cooking to inactivate the parasite and reduce the likelihood of infection. […] Thoroughly cook raw meat and poultry. Cook all meat to an internal temperature of 160 F and until it is no longer pink in the center or until the juices become clear. […] Always wash hands after contact with farm animals, pets, animal feces, and animal environments.

• #24 Toxoplasmosis | American Veterinary Medical Associationmultiple-users-1addaddaddadd

  https://www.avma.org/resources-tools/pet-owners/petcare/toxoplasmosis

  You can help protect yourself, your cat, and others by learning how toxoplasmosis is spread and taking simple steps to prevent that from happening. […] No vaccine is available to protect against T. gondii, but some simple precautions can reduce the risk of exposure to the parasite and subsequent infection. Keep in mind that you’re more likely to be infected with T. gondii from undercooked meat or the environment than you are from your cat. […] Wear gloves when gardening or touching soil or sand that may be contaminated with cat feces. […] Wash your hands with soap and water immediately after working with soil or after handling raw or undercooked meat, vegetables, or unpasteurized dairy products. […] Avoid consuming or feeding pets unpasteurized milk or other unpasteurized dairy products.

• #25 Toxoplasmosis | American Veterinary Medical Associationmultiple-users-1addaddaddadd

  https://www.avma.org/resources-tools/pet-owners/petcare/toxoplasmosis

  Wash fruits and vegetables thoroughly under running water before eating, especially those grown in backyard gardens. […] Cook meat to temperatures capable of destroying Toxoplasma and other infectious organisms. For details, see this CDC resource. […] Thoroughly wash with hot, soapy water cutting boards, knives, sinks, and countertops immediately after cutting meats. […] Cover any outdoor sandboxes when not in use to prevent cats from using them as litter boxes. […] Keep your cat indoors to prevent them from hunting rodents and birds. […] Avoid feeding your cat raw foods. […] Remove waste from the cat litter box daily, before any Toxoplasma oocysts in the feces have a chance to become infective. […] Wash your hands after scooping out waste from the litter box, and dispose of used cat litter safely, preferably in a sealed plastic bag. […] If possible, avoid handling stray cats or adopting new cats during your pregnancy or illness. […] If you own a cat, ask another person to clean the litter box, if possible.

• #26 Preventing Toxoplasmosis – MN Dept. of Health

  https://www.health.state.mn.us/diseases/toxoplasmosis/prevention.html

  Wear gloves when you garden or do anything outdoors that involves handling soil. […] Wash your hands well with soap and water after outdoor activities, especially before you eat or prepare any food. […] Avoid changing the cat litter box yourself; let someone else do it. […] If you have to change it, wear disposable gloves and wash your hands with soap and water afterwards. […] Change the litter box daily because the parasite is not infectious until 1-5 days after it is shed in the feces. […] Help prevent your cat from becoming infected by keeping it indoors and feeding it only canned or dry cat food. […] Do not feed your cat raw meat. Avoid stray cats and kittens and cover your outdoor sandboxes. […] Do not get a new cat while you are pregnant.

• #27 CDC – Toxoplasmosis – Prevention & Control

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/parasites/toxoplasmosis/prevent.html

  People who are healthy should follow the guidelines below to reduce risk of toxoplasmosis. […] To prevent risk of toxoplasmosis and other infections from food: […] Cook food to safe temperatures. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Avoid drinking untreated drinking water. […] Wear gloves when gardening and during any contact with soil or sand because it might be contaminated with cat feces that contain Toxoplasma. Wash hands with soap and warm water after gardening or contact with soil or sand. […] Change the litter box daily if you own a cat. The Toxoplasma parasite does not become infectious until 1 to 5 days after it is shed in a cat’s feces. If you are pregnant or immunocompromised: […] Avoid changing cat litter if possible. If no one else can perform the task, wear disposable gloves and wash your hands with soap and warm water afterwards. […] Keep cats indoors. […] Do not adopt or handle stray cats, especially kittens. Do not get a new cat while you are pregnant.

• #28 About Toxoplasmosis | Toxoplasmosis | CDC

  https://www.cdc.gov/toxoplasmosis/about/index.html

  You can take steps to prevent toxoplasmosis infection. […] Follow these steps to reduce your risk of becoming infected with Toxoplasma gondii: […] Use a food thermometer to cook food to a safe internal temperature high enough to kill Toxoplasma. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Rinse fruit and vegetables under running water or cook them. […] Do not drink unpasteurized goat’s milk. […] Do not eat raw oysters, mussels, or clams. […] Clean areas where you handle food with hot, soapy water after preparing each food item. […] Wear gloves when gardening or touching soil or sand that may be contaminated with cat feces containing Toxoplasma. […] Wash hands with soap and water any time you touch something that may be contaminated with cat feces containing Toxoplasma. […] If you have a cat, change the litter box daily. […] Talk to your healthcare provider about additional precautions if you are a person at risk for severe infection.

• #29 Toxoplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxoplasmosis/symptoms-causes/syc-20356249

  Wash all fruits and vegetables. Wash fresh fruits and vegetables before eating, peeling or cooking. […] Don’t drink unpasteurized goat milk. Avoid unpasteurized goat milk or products made from the milk. […] Don’t drink untreated water. During pregnancy, do not drink untreated water. […] Cover children’s sandboxes. Cover sandboxes to prevent outdoor cats from using them as litter boxes. […] If you’re pregnant or otherwise at risk of toxoplasmosis, take these steps to protect yourself: […] Help your cat stay healthy. Keep your cat indoors. Feed it dry or canned cat food, not raw or undercooked meat. […] Avoid stray cats or kittens. Avoid stray cats, especially kittens. Do not get a new cat when you’re pregnant. […] Have someone else clean the litter box. Clean the box daily, if possible. If someone else can’t clean it, wear gloves and a face mask to change the litter. Then wash your hands well.

• #30 Preventing Toxoplasmosis – MN Dept. of Health

  https://www.health.state.mn.us/diseases/toxoplasmosis/prevention.html

  Wear gloves when you garden or do anything outdoors that involves handling soil. […] Wash your hands well with soap and water after outdoor activities, especially before you eat or prepare any food. […] Avoid changing the cat litter box yourself; let someone else do it. […] If you have to change it, wear disposable gloves and wash your hands with soap and water afterwards. […] Change the litter box daily because the parasite is not infectious until 1-5 days after it is shed in the feces. […] Help prevent your cat from becoming infected by keeping it indoors and feeding it only canned or dry cat food. […] Do not feed your cat raw meat. Avoid stray cats and kittens and cover your outdoor sandboxes. […] Do not get a new cat while you are pregnant.

• #31 Toxoplasmosis in Cats | Cornell University College of Veterinary Medicine

  https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/toxoplasmosis-cats

  Reducing the incidence of toxoplasmosis in cats requires measures to reduce both exposure to infective oocysts and shedding of oocysts into the environment. Cats should preferably be fed commercially prepared, cooked foods (appropriate heating inactivates any T. gondii cysts that may be present) and should not be allowed to eat uncooked meat or intermediate hosts, such as rodents. They should also be denied access to facilities housing food-producing livestock and food storage areas. […] Because cats only shed the organism for a short time, the chance of human exposure via cats they live with is relatively small. Owning a cat does not mean you will be infected with Toxoplasma. Since it takes a minimum of 24 hours for T. gondii oocysts in cat feces to sporulate and become infective, frequent removal of feces from the litter box, while wearing gloves and washing hands afterward, minimizes the possibility of infection. It is unlikely that you would be exposed to the parasite by touching an infected cat, because they usually do not carry the parasite on their fur. It is also unlikely that you would become infected through cat bites or scratches. Indoor cats that do not hunt prey or consume raw meat are unlikely to be infected with T. gondii. In the U.S., people are much more likely to become infected by eating raw meat and unwashed fruits and vegetables than by handling cat feces. The possibility of infection after gardening in soil that has been contaminated with cat feces also exists, and this possibility can be mitigated by wearing gloves and by washing hands after gardening.

• #32 Toxoplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxoplasmosis/symptoms-causes/syc-20356249

  Wash all fruits and vegetables. Wash fresh fruits and vegetables before eating, peeling or cooking. […] Don’t drink unpasteurized goat milk. Avoid unpasteurized goat milk or products made from the milk. […] Don’t drink untreated water. During pregnancy, do not drink untreated water. […] Cover children’s sandboxes. Cover sandboxes to prevent outdoor cats from using them as litter boxes. […] If you’re pregnant or otherwise at risk of toxoplasmosis, take these steps to protect yourself: […] Help your cat stay healthy. Keep your cat indoors. Feed it dry or canned cat food, not raw or undercooked meat. […] Avoid stray cats or kittens. Avoid stray cats, especially kittens. Do not get a new cat when you’re pregnant. […] Have someone else clean the litter box. Clean the box daily, if possible. If someone else can’t clean it, wear gloves and a face mask to change the litter. Then wash your hands well.

• #33 Toxoplasmosis | American Veterinary Medical Associationmultiple-users-1addaddaddadd

  https://www.avma.org/resources-tools/pet-owners/petcare/toxoplasmosis

  Wash fruits and vegetables thoroughly under running water before eating, especially those grown in backyard gardens. […] Cook meat to temperatures capable of destroying Toxoplasma and other infectious organisms. For details, see this CDC resource. […] Thoroughly wash with hot, soapy water cutting boards, knives, sinks, and countertops immediately after cutting meats. […] Cover any outdoor sandboxes when not in use to prevent cats from using them as litter boxes. […] Keep your cat indoors to prevent them from hunting rodents and birds. […] Avoid feeding your cat raw foods. […] Remove waste from the cat litter box daily, before any Toxoplasma oocysts in the feces have a chance to become infective. […] Wash your hands after scooping out waste from the litter box, and dispose of used cat litter safely, preferably in a sealed plastic bag. […] If possible, avoid handling stray cats or adopting new cats during your pregnancy or illness. […] If you own a cat, ask another person to clean the litter box, if possible.

• #34 Toxoplasma Prevention Before You Become Pregnant (Food Safety for Moms-to-Be) | FDA

  https://www.fda.gov/food/people-risk-foodborne-illness/toxoplasma-prevention-you-become-pregnant-food-safety-moms-be

  Did you know that you could feel healthy, but still have toxoplasmosis? This foodborne illness is caused by the parasite, Toxoplasma gondii, and it could be harmful to you and your baby if you become pregnant. […] If you have a cat, you should: Have someone else change the litter box, if possible. If you have to clean it, wear disposable gloves and wash your hands thoroughly with soap and warm water afterwards. Change the litter box daily. The parasite doesn’t become infectious until 1 to 5 days after it’s shed in the feces. Wear gloves when gardening in a garden or handling sand from a sandbox because cats may have excreted feces in them. Be sure to wash your hands with soap and warm water afterwards. Cover outdoor sandboxes to prevent cats from using them as litter boxes. Feed your cat commercial dry or canned food. Never feed your cat raw meat because it can be a source of the T. gondii parasite. Keep indoor cats indoors. Be especially cautious if you bring outdoor cats indoors. Avoid stray cats, especially kittens. Don’t get a new cat while you’re pregnant. […] Yes, to be safe. Also, see your doctor or healthcare provider if you have questions about toxoplasmosis.

• #35 Toxoplasmosis – Prophylaxis (how to prevent) – TORCH

  https://www.torch.ro/en/toxoplasmosis/toxoplasmosis-prophylaxis-how-to-prevent/

  Feeding the cat only with dry food, special for cats or cooked food, not sufficiently heat-prepared; […] Changing the litter of the cat daily (the parasite becomes infected 1-5 days after the removal in the cats feces), but not by the pregnant woman; […] Avoiding stray cats; […] Do not adopt a new cat during pregnancy. […] Women who have been diagnosed with acute infection are advised not to get pregnant less than 6 months after diagnosis, although there are no studies to establish a clear safety period. […] Avoid cat litter cleaning as much as possible. […] If there is no one else who can perform this task, you must wear gloves and wash your hands rigorously with soap and water after cleaning the cat litter. […] You must make sure that the cat litter is changed daily. Toxoplasma does not become infectious until after 1-5 days after the oocysts has been eliminated through the cats feces.

• #36 Toxoplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxoplasmosis/symptoms-causes/syc-20356249

  Wash all fruits and vegetables. Wash fresh fruits and vegetables before eating, peeling or cooking. […] Don’t drink unpasteurized goat milk. Avoid unpasteurized goat milk or products made from the milk. […] Don’t drink untreated water. During pregnancy, do not drink untreated water. […] Cover children’s sandboxes. Cover sandboxes to prevent outdoor cats from using them as litter boxes. […] If you’re pregnant or otherwise at risk of toxoplasmosis, take these steps to protect yourself: […] Help your cat stay healthy. Keep your cat indoors. Feed it dry or canned cat food, not raw or undercooked meat. […] Avoid stray cats or kittens. Avoid stray cats, especially kittens. Do not get a new cat when you’re pregnant. […] Have someone else clean the litter box. Clean the box daily, if possible. If someone else can’t clean it, wear gloves and a face mask to change the litter. Then wash your hands well.

• #37 Toxoplasmosis | Pregnancy Birth and Baby

  https://www.pregnancybirthbaby.org.au/toxoplasmosis

  Toxoplasmosis does not normally make healthy people unwell. […] You can avoid infection by cooking meat thoroughly, washing fruits and vegetables and by drinking clean water. […] Washing your hands after touching soil, gardening or changing cat litter can also prevent infection. […] If you are pregnant or immunocompromised, try to take precautions to try and prevent getting toxoplasmosis. […] Food and hygiene tips: Avoid handling raw meat. Wash your hands, utensils, countertop and sinks if they touch raw meat. Wash your hands before eating. […] Make sure that any meat you eat is properly cooked. If it was frozen, it should have been at -20C for at least 24 hours before eating. […] Wash or peel raw fruits and vegetables. […] Do not drink untreated water. Do not have unpasteurised milk or its products.

• #38 Toxoplasmosis – Prophylaxis (how to prevent) – TORCH

  https://www.torch.ro/en/toxoplasmosis/toxoplasmosis-prophylaxis-how-to-prevent/

  Feeding the cat only with dry food, special for cats or cooked food, not sufficiently heat-prepared; […] Changing the litter of the cat daily (the parasite becomes infected 1-5 days after the removal in the cats feces), but not by the pregnant woman; […] Avoiding stray cats; […] Do not adopt a new cat during pregnancy. […] Women who have been diagnosed with acute infection are advised not to get pregnant less than 6 months after diagnosis, although there are no studies to establish a clear safety period. […] Avoid cat litter cleaning as much as possible. […] If there is no one else who can perform this task, you must wear gloves and wash your hands rigorously with soap and water after cleaning the cat litter. […] You must make sure that the cat litter is changed daily. Toxoplasma does not become infectious until after 1-5 days after the oocysts has been eliminated through the cats feces.

• #39 Toxoplasma gondii Encephalitis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/toxoplasmosis

  Cat owners with HIV whose CD4 counts are 200 cells/mm3 and who are seronegative should be advised to have a nonpregnant person without HIV change the litter box daily. If a person with HIV must change the litter box themselves, they should wear gloves and wash their hands thoroughly afterward. […] Toxoplasma-seropositive people who have CD4 counts 100 cells/mm3 should receive prophylaxis against TE. […] The preferred primary prophylaxis regimen is one double-strength tablet daily of TMP-SMX. […] Prophylaxis against TE should be discontinued in adults and adolescents with HIV receiving ARV therapy with sustained suppression of plasma HIV RNA levels below the detection limits of available assays whose CD4 counts increase to 200 cells/mm3 for more than 3 months. […] Primary prophylaxis should be reintroduced if the CD4 count decreases to 100 cells/mm3 regardless of the HIV plasma viral load.

• #40 HIV-1–Associated Toxoplasmosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441877/

  Prophylaxis against reactivation of T gondii in seropositive individuals with CD4 lymphocyte counts less than 100 cells/microliter is recommended. Trimethoprim/sulfamethoxazole is mainly used. Other options include dapsone plus pyrimethamine, folinic acid, or atovaquone with or without pyrimethamine/leucovorin. […] Patients with HIV1associated toxoplasmosis should be advised to avoid eating raw or undercooked meat and wash their hands thoroughly after handling cat litter or soil. […] An integral part of therapy is starting antiretroviral therapy (ART) agents as soon as feasible, usually within 2 weeks of starting antitoxoplasma therapy. Immune reconstitution inflammatory syndrome, which can present as a paradoxical worsening of symptoms as immunity recovers, is rarer with toxoplasmosis than mycobacterial and cryptococcal infections. Even though there are no studies about the optimal timing of ART in toxoplasmosis, early ART has clear benefits and should not necessarily be delayed beyond 2 weeks.

• #41 15. Primary and Secondary Prophylaxis Against Opportunistic Infections in HIV AIDS | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/content/15-primary-and-secondary-prophylaxis-against-opportunistic-infections-hiv-aids

  Toxoplasma gondii […] Toxo IgG + and CD4 100** […] TMP-SMX DS daily […] […] […] Toxoplasmosis: pyrimethamine 25-50mg daily + sulfadiazine 2000-4000mg (in 2-4 divided doses) + leucovorin 10-25mg daily until CD4 200 for 3 months on ART without symptoms after having completed full treatment course. […] […] […] ** If on PCP prophylaxis not active against toxo (e.g. pentamidine or dapsone), retest toxo serology if CD4 falls 100 for initiation of appropriate prophylaxis. […] […] […] PCP and toxoplasmosis: can be stopped if CD4 count 200 for 3 months on ART. Reinitiate if CD4 falls 200.

• #42 Toxoplasmosis

  https://mobile.fpnotebook.com/ID/Parasite/Txplsms.htm

  Trimethoprim-Sulfamethoxazole, Bactrim, or Septra DS daily (same as for Pneumocystis Prophylaxis) or […] Dapsone and Pyrimethamine has also been used […] Chronic Suppression (Secondary Prophylaxis, until CD4 Count 200 for 6 months) […] Sulfadiazine 2-4 g/day orally divided bid to qid (or Clindamycin 600 mg every 8 hours) AND […] Pyrethamine 25-50 mg orally every 24 hours AND […] Folinic Acid 10-25 mg orally every 24 hours

• #43 Toxoplasma gondii Encephalitis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/toxoplasmosis

  Cat owners with HIV whose CD4 counts are 200 cells/mm3 and who are seronegative should be advised to have a nonpregnant person without HIV change the litter box daily. If a person with HIV must change the litter box themselves, they should wear gloves and wash their hands thoroughly afterward. […] Toxoplasma-seropositive people who have CD4 counts 100 cells/mm3 should receive prophylaxis against TE. […] The preferred primary prophylaxis regimen is one double-strength tablet daily of TMP-SMX. […] Prophylaxis against TE should be discontinued in adults and adolescents with HIV receiving ARV therapy with sustained suppression of plasma HIV RNA levels below the detection limits of available assays whose CD4 counts increase to 200 cells/mm3 for more than 3 months. […] Primary prophylaxis should be reintroduced if the CD4 count decreases to 100 cells/mm3 regardless of the HIV plasma viral load.

• #44 Toxoplasmosis – Infectious Diseases – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/toxoplasmosis

  Washing hands thoroughly after handling raw meat, soil, or cat litter is essential to help prevent toxoplasmosis. Food possibly contaminated with cat feces should be avoided. Meat should be cooked to 165 to 170 F (73.9 to 76.7 C). […] Pregnant women are advised to avoid contact with cats. If contact is unavoidable, pregnant women should at least avoid cleaning cat litter boxes or wear gloves when doing so. Gloves should also be worn while gardening to avoid contact with soil. […] Primary chemoprophylaxis is recommended for patients with HIV and a positive IgG T. gondii serologic test once CD4 cell counts are 100/mcL. Trimethoprim/sulfamethoxazole one double-strength tablet once a day, which also is prophylactic against Pneumocystis jirovecii, is typically used. If this dosage is not tolerated, alternatives are one double-strength tablet 3 times a week or one single-strength tablet once a day. Alternatives for patients who cannot tolerate trimethoprim/sulfamethoxazole at all include dapsone 50 mg once a day plus pyrimethamine 50 mg once a week and leucovorin 25 mg once a week; or dapsone 200 mg once a week plus pyrimethamine 75 mg once a week plus leucovorin 25 mg once a week. Chemoprophylaxis is continued until the CD4 cell count is 200/mcL.

• #45 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Preventing Exposure: Ingestion of undercooked meats that could contain tissue cysts and contact with cat feces that could contain sporulated oocysts should be avoided (AIII). […] Initiating Primary Prophylaxis: Toxoplasma-seropositive children aged 6 years with CD4 T lymphocyte (CD4) cell percentage 15% and children aged 6 years with CD4 100 cells/mm3 should be administered prophylaxis against Toxoplasma encephalitis (TE) (AIII). The preferred agent for prophylaxis of TE is trimethoprim-sulfamethoxazole, one double-strength tablet daily for adolescents and adults (or weight-equivalent dosing for children) (AII*). […] Primary preventive therapy can be discontinued once a child responds to combination antiretroviral therapy (cART) with a sustained rise in CD4 percentage above 15% for children 6 years of age, and 200 cells/mm3 for children aged 6 years (BIII).

• #46 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Preventing Exposure: Ingestion of undercooked meats that could contain tissue cysts and contact with cat feces that could contain sporulated oocysts should be avoided (AIII). […] Initiating Primary Prophylaxis: Toxoplasma-seropositive children aged 6 years with CD4 T lymphocyte (CD4) cell percentage 15% and children aged 6 years with CD4 100 cells/mm3 should be administered prophylaxis against Toxoplasma encephalitis (TE) (AIII). The preferred agent for prophylaxis of TE is trimethoprim-sulfamethoxazole, one double-strength tablet daily for adolescents and adults (or weight-equivalent dosing for children) (AII*). […] Primary preventive therapy can be discontinued once a child responds to combination antiretroviral therapy (cART) with a sustained rise in CD4 percentage above 15% for children 6 years of age, and 200 cells/mm3 for children aged 6 years (BIII).

• #47 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Preventing Exposure: Ingestion of undercooked meats that could contain tissue cysts and contact with cat feces that could contain sporulated oocysts should be avoided (AIII). […] Initiating Primary Prophylaxis: Toxoplasma-seropositive children aged 6 years with CD4 T lymphocyte (CD4) cell percentage 15% and children aged 6 years with CD4 100 cells/mm3 should be administered prophylaxis against Toxoplasma encephalitis (TE) (AIII). The preferred agent for prophylaxis of TE is trimethoprim-sulfamethoxazole, one double-strength tablet daily for adolescents and adults (or weight-equivalent dosing for children) (AII*). […] Primary preventive therapy can be discontinued once a child responds to combination antiretroviral therapy (cART) with a sustained rise in CD4 percentage above 15% for children 6 years of age, and 200 cells/mm3 for children aged 6 years (BIII).

• #48 Toxoplasmosis

  https://mobile.fpnotebook.com/ID/Parasite/Txplsms.htm

  Trimethoprim-Sulfamethoxazole, Bactrim, or Septra DS daily (same as for Pneumocystis Prophylaxis) or […] Dapsone and Pyrimethamine has also been used […] Chronic Suppression (Secondary Prophylaxis, until CD4 Count 200 for 6 months) […] Sulfadiazine 2-4 g/day orally divided bid to qid (or Clindamycin 600 mg every 8 hours) AND […] Pyrethamine 25-50 mg orally every 24 hours AND […] Folinic Acid 10-25 mg orally every 24 hours

• #49 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Most experts recommend treating pregnant women with acute toxoplasmosis in an attempt to prevent fetal infection (BII). […] Empiric therapy should be strongly considered for newborns of HIV-infected mothers who had symptomatic or asymptomatic primary Toxoplasma infection during pregnancy, regardless of whether treatment was administered during pregnancy (BIII). […] The preferred regimen for suppressive therapy for TE is sulfadiazine plus pyrimethamine and leucovorin (AI*). Please refer to http://www.daraprimdirect.com for information regarding access to pyrimethamine. If pyrimethamine is unavailable clinicians may substitute trimethoprim-sulfamethoxazole dosed according to age and weight.

• #50 Toxoplasmosis

  https://mobile.fpnotebook.com/ID/Parasite/Txplsms.htm

  Trimethoprim-Sulfamethoxazole, Bactrim, or Septra DS daily (same as for Pneumocystis Prophylaxis) or […] Dapsone and Pyrimethamine has also been used […] Chronic Suppression (Secondary Prophylaxis, until CD4 Count 200 for 6 months) […] Sulfadiazine 2-4 g/day orally divided bid to qid (or Clindamycin 600 mg every 8 hours) AND […] Pyrethamine 25-50 mg orally every 24 hours AND […] Folinic Acid 10-25 mg orally every 24 hours

• #51 Prophylaxis of human toxoplasmosis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5694886/

  Toxoplasmosis is an infection caused by the intracellular protozoan parasite Toxoplasma gondii, and is associated with clinically significant infection in immunocompromised individuals. […] This review aims to describe the modalities for prophylaxis of toxoplasmosis in susceptible populations, and focuses on the following: (1) prophylaxis of congenital toxoplasmosis; (2) prophylaxis of toxoplasmosis in patients with HIV/AIDS; and (3) prophylaxis of toxoplasmosis in transplant recipients. […] Prophylaxis is recommended for these two groups of individuals. […] Prevention of maternal infection is foremost in the prevention of congenital toxoplasmosis, and the preventive principles are centered around the lifecycle of the parasite Toxoplasma gondii. Education of mothers on the prevention of toxoplasmosis has also been shown to play a significant role in the prevention of maternal infection.

• #52 Prevention of congenital toxoplasmosis

  https://www.degruyter.com/document/doi/10.1515/JPM.2000.043/html?lang=en

  In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. […] Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. […] A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. […] This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.

• #53 Toxoplasmosis: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/toxoplasmosis

  Most experts recommend treating pregnant women with acute toxoplasmosis in an attempt to prevent fetal infection (BII). […] Empiric therapy should be strongly considered for newborns of HIV-infected mothers who had symptomatic or asymptomatic primary Toxoplasma infection during pregnancy, regardless of whether treatment was administered during pregnancy (BIII). […] The preferred regimen for suppressive therapy for TE is sulfadiazine plus pyrimethamine and leucovorin (AI*). Please refer to http://www.daraprimdirect.com for information regarding access to pyrimethamine. If pyrimethamine is unavailable clinicians may substitute trimethoprim-sulfamethoxazole dosed according to age and weight.

• #54 Pediatric Toxoplasmosis Treatment & Management: Approach Considerations, Complications, Consultations

  https://emedicine.medscape.com/article/1000028-treatment

  Preventing the infection is particularly important for women who are pregnant and for patients who are seronegative and immunocompromised. […] Avoid consuming raw or undercooked meat, unpasteurized milk, and uncooked eggs. Wash hands after touching raw meat and after gardening or having other contact with soil. Wash fruits and vegetables. Avoid contact with cat feces. Disinfect litter for 5 minutes with nearly boiling water. In an attempt to prevent congenital toxoplasmosis, routine serologic screening of pregnant women has been performed in order to identify fetuses at risk of becoming infected. Treatment during pregnancy results in a 50% reduction in incidence of infection in infants. […] When feasible, avoid transfusions of blood products from a donor who is seropositive to a patient who is seronegative and immunocompromised. In addition, transplant recipients who are seronegative should, if possible, receive organs from donors who are seronegative.

• #55 Prevention of congenital toxoplasmosis

  https://www.degruyter.com/document/doi/10.1515/JPM.2000.043/html?lang=en

  In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. […] Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. […] A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. […] This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.

• #56 Congenital Toxoplasmosis: Update on Diagnosis, Treatment, and Preventionlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na43402/2017/02/02/congenital-toxoplasmosis-update-diagnosis-treatment-and

  Maternal to fetal transmission risk increases throughout gestation (from 5% in early pregnancy to 71% after 37 weeks). […] Identified risk factors for acquiring toxoplasmosis include ingestion or handling of raw or rare meat; eating raw oysters, clams or mussels; drinking unpasteurized raw goat milk or untreated water; and household exposure to ≥3 kittens. […] Approximately half of maternal infections are asymptomatic and occur in women with no identifiable risk factors. Serologic testing is the only means of establishing presence of previous or current infection. […] Antenatal treatment is likely associated with a decrease in mother to child transmission and may improve neurologic outcome in affected infants. […] Women and infants with suspected toxoplasmosis should be evaluated and managed in consultation with a toxoplasmosis reference center (Palo Alto, California, and Chicago, Illinois), where higher specificity testing is available.

• #57

  https://link.springer.com/article/10.1007/s10393-019-01405-7

  Studies indicate that large regions of terrestrial, aquatic, and marine environments may be contaminated. […] Current patterns of human-driven environmental change and globalization of travel and trade can enhance the spillover and spillback of Toxoplasma and parasites of animal origin into human populations, introduce pathogens into critically endangered animal populations, and further facilitate propagation locally, regionally, and globally. […] A key component of a One Health response to toxoplasmosis must include greater communication of the risks and pathways of exposure to T. gondii. […] Widespread participation, especially with human and veterinary health practitioners, is necessary to stem the societal and ecosystem impacts of toxoplasmosis. […] Local capacity also includes a commitment to laws to control the number of feral domestic cats on the landscape to minimize the risk of transmission of T. gondii. […] Comprehensive and sound policies and control interventions based on science are required to reduce these astronomical impacts.

• #58 Toxoplasmosis: Background, Etiology and Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/229969-overview

  Primary prevention based on prenatal education could be an effective strategy to reduce congenital toxoplasmosis. Educate the public in toxoplasmosis-prevention methods, such as protecting children’s play areas from cat litter. Mothers with toxoplasmosis must be completely informed of the diseases potential consequences to the fetus. […] Infection can occur by ingestion of oocysts following the handling of contaminated soil or cat litter or through the consumption of contaminated water or food sources (eg, unwashed garden vegetables). […] The routine use of cotrimoxazole prophylaxis in the United States and internationally has also likely significantly decreased the incidence of CNS toxoplasmosis.

• #59 Prevention of congenital toxoplasmosis

  https://www.degruyter.com/document/doi/10.1515/JPM.2000.043/html?lang=en

  In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. […] Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. […] A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. […] This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.

• #60

  https://link.springer.com/article/10.1007/s10393-019-01405-7

  One Health recognizes the interconnectedness of the health of people, animals, plants, and the environment from the local to the global levels and employs a holistic approach encouraging and expanding transdisciplinary collaborations, integrative research, capacity building, clinical practice, policy, and communication among many stakeholders. […] New research on the impacts of toxoplasmosis increases the need for greater institutional awareness of the pathways of infection and comprehensive and transdisciplinary actions to control transmission using the One Health approach. […] Such cooperation has thus far been elusive, perhaps in part to a lack of familiarity with the biology of T. gondii or its significant adverse impacts on health. […] A better understanding of the environmental abundance of oocysts is critical to holistic determinations of health risks.

• #61 Prevention of congenital toxoplasmosis

  https://www.degruyter.com/document/doi/10.1515/JPM.2000.043/html?lang=en

  In utero infection with Toxoplasma gondii may result in congenital defects such as hydrocephalus, chorioretinitis and mental retardation; these defects may be present at birth or may develop later in life. […] Prevention of this disease can be achieved in different ways. The most effective measure is to prevent the acquisition of the disease during pregnancy by avoiding risk factors for Toxoplasma gondii infection. Health education may decrease the incidence of toxoplasmosis during pregnancy by 60%. A second preventive measure is based on serologic screening during pregnancy to identify infected women. Treatment during pregnancy results in a significant reduction in the incidence of sequelae including severe handicaps. […] A third possible intervention is treating infected neonates. Antibiotic treatment of infected children has a beneficial effect on the development of sequelae and the sooner therapy is started after birth, the better the outcome. […] This overview presents the potential benefits and harms of these different options available for the prevention of congenital toxoplasmosis.

• #62 Prophylaxis of human toxoplasmosis: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5694886/

  Screening for congenital toxoplasmosis in pregnancy is recommended in high risk individuals (HIV positive/ immunosuppressed), or in patients with ultrasound evidence of congenital toxoplasmosis such as hydrocephalus, intracranial calcifications, intra-uterine growth retardation, and hepatospenomegaly. […] Primary prophylaxis is indicated for AIDS patients with a CD4 count less 100/mm3 who are IgG positive for toxoplasmosis. […] General life style modifications are important for prevention, and are complimentary to the pharmacological modalities in the prevention of toxoplasmosis in high risk groups. […] The efficacy of prenatal treatment for congenital toxoplasmosis is controversial; current regimens used commonly include S and PS. […] Primary prophylaxis of TE in patients with HIV should be commenced in patients with Toxoplasma seropositivity with a CD4 count 100/mm3. Currently used agents include trimethoprim sulfamethoxazole (TS), and dapsone pyrimethamine (DP). […] Evidence is limited on the role of Toxoplasma prevention in organ transplantation, with possible efficacy in the use of TS and P.

• #63 Toxoplasmosis | American Veterinary Medical Associationmultiple-users-1addaddaddadd

  https://www.avma.org/resources-tools/pet-owners/petcare/toxoplasmosis

  You can help protect yourself, your cat, and others by learning how toxoplasmosis is spread and taking simple steps to prevent that from happening. […] No vaccine is available to protect against T. gondii, but some simple precautions can reduce the risk of exposure to the parasite and subsequent infection. Keep in mind that you’re more likely to be infected with T. gondii from undercooked meat or the environment than you are from your cat. […] Wear gloves when gardening or touching soil or sand that may be contaminated with cat feces. […] Wash your hands with soap and water immediately after working with soil or after handling raw or undercooked meat, vegetables, or unpasteurized dairy products. […] Avoid consuming or feeding pets unpasteurized milk or other unpasteurized dairy products.

• #64 Toxoplasmosis | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/toxoplasmosis

  Pregnant women and people who have compromised immune systems should take precautions against toxoplasmosis. […] A pregnant woman and people with compromised immune systems can take simple precautions to reduce the risk of infection with the parasite. These include: Wash hands after handling raw meat. Cook meat (including kangaroo meat) thoroughly until the juices run clear. Do not eat rare or medium-rare meat dishes. Wash vegetables to remove any traces of soil. Wash hands thoroughly before eating. Immediately wash cutting boards, knives and any other implements that have come into contact with raw meat. Wear gloves while gardening. Avoid contact with cats. Get someone else to handle litter trays. Make sure litter trays are cleaned and disinfected daily practicing good hygiene (gloves and hand washing), as it takes at least 24 hours for the oocysts passed in cat faeces to become infective.

• #65 Toxoplasmosis | American Veterinary Medical Associationmultiple-users-1addaddaddadd

  https://www.avma.org/resources-tools/pet-owners/petcare/toxoplasmosis

  Wash fruits and vegetables thoroughly under running water before eating, especially those grown in backyard gardens. […] Cook meat to temperatures capable of destroying Toxoplasma and other infectious organisms. For details, see this CDC resource. […] Thoroughly wash with hot, soapy water cutting boards, knives, sinks, and countertops immediately after cutting meats. […] Cover any outdoor sandboxes when not in use to prevent cats from using them as litter boxes. […] Keep your cat indoors to prevent them from hunting rodents and birds. […] Avoid feeding your cat raw foods. […] Remove waste from the cat litter box daily, before any Toxoplasma oocysts in the feces have a chance to become infective. […] Wash your hands after scooping out waste from the litter box, and dispose of used cat litter safely, preferably in a sealed plastic bag. […] If possible, avoid handling stray cats or adopting new cats during your pregnancy or illness. […] If you own a cat, ask another person to clean the litter box, if possible.

• #66 Preventing Toxoplasmosis | Parasites – Toxoplasmosis (Toxoplasma infection) | CDC

  https://www.cdc.gov/toxoplasmosis/prevention/index.html

  People can take steps to reduce their risk of toxoplasmosis. […] If you are at a higher risk for toxoplasmosis, talk to your healthcare provider. […] Everyone can take steps to reduce their risk of toxoplasmosis. […] Use a food thermometer to cook food to a safe internal temperature high enough to kill Toxoplasma. Cooking meat to the USDA recommended internal temperature is the safest method to prevent infection. […] Freeze meat for several days at sub-zero (0 F) temperatures before cooking to greatly reduce chance of infection. […] Rinse fruit and vegetables under running water. […] Do not drink unpasteurized goat’s milk. […] Do not eat raw or undercooked oysters, mussels, or clams (these may be contaminated with Toxoplasma that has washed into seawater). […] Wash utensils, cutting boards, and countertops with hot, soapy water after preparing each food item.

• #67 Toxoplasmosis – Prevention in Pregnancy – Dr Michael Flynn

  https://www.drmichaelflynn.com.au/toxoplasmosis-prevention-pregnancy/

  Raw or undercooked meat is an important source of infection. […] Meat should be cooked to 152F (66C) or higher, or frozen for 24 hours in a household freezer (at less than -12C), both of which are lethal to tachyzoites and bradyzoites. […] Nevertheless, it seems sensible for pregnant women with cats to ask someone else to change the litter box daily (fresh cat faeces are not infectious). […] Hand washing is the single most important measure to reduce transmission of microorganisms from one site to another on the same patient. Therefore, hand-washing is important after activities such as preparing food or gardening.

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