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What is toxoplasmosis?
Toxoplasmosis is an infection you can get from a microscopic parasite called Toxoplasma gondii. Although the infection generally causes a mild, symptomless illness in people with healthy immune systems, it's risky during pregnancy because the parasite may infect the placenta and your unborn baby.
Researchers estimate that of the over 4 million births in the United States each year, between 400 and 4,000 babies are born with toxoplasmosis (known as congenital toxoplasmosis). This infection can be mild or severe, causing stillbirth, long-term structural and neurological damage, and other devastating effects. The good news is there's a lot you can do to avoid becoming infected in the first place.
What are my chances of getting toxoplasmosis and infecting my baby?
Only about 15 percent of women of childbearing age are immune to toxoplasmosis, according to the Centers for Disease Control and Prevention (CDC). Fortunately, the number of women who contract the infection during pregnancy is still relatively small, and not all of them transmit it to their babies.
Your baby's risk of becoming infected rises as your pregnancy progresses. If you get infected with toxoplasmosis in the first trimester, the risk that your baby will also be infected is about 15 percent. If you get infected in the second trimester, your baby's risk is about 30 percent, and it's 60 percent in the third trimester. However, while the transmission rate is higher in late pregnancy, toxoplasmosis is more likely to be severe for your baby if he becomes infected in the first trimester.
There's also a very small risk of infecting your baby if you contract the infection within a few months before becoming pregnant. If you know that you've been infected recently, some experts suggest waiting for six months before trying to conceive.
How is toxoplasmosis spread?
Experts estimate that about half of toxoplasmosis infections are caused by eating raw or undercooked infected meat, but you can also get the parasite by eating unwashed contaminated produce, drinking contaminated water, or handling contaminated soil, cat litter, or meat and then touching your mouth, nose, or eyes.
Toxoplasmosis can't be transmitted from person to person, with the exception of transmission from mother to baby during pregnancy or from an infected blood transfusion or organ transplant.
Do I have to get rid of my cat?
No. You've probably heard that cat feces are a major source of toxoplasmosis, but that doesn't mean you need to get rid of your beloved pet. You'll want to take some extra precautions, though. Here's the scoop on how cats can become infected and transmit the infection.
Felines are a natural host for the parasite, and it reproduces in their intestines. A cat may become infected with toxoplasmosis from eating infected prey or undercooked meat, or by drinking unpasteurized milk or contaminated water.
The parasites then form "oocysts" in the cat's gut, and the cat excretes millions of these oocysts daily for up to three weeks. (Oocysts can't be seen with the naked eye, and in most cases you'll have no idea that your cat is sick.)
The oocysts become infectious 24 hours or so after they're excreted. Under the right conditions, they can live in the soil, sand, or litter and remain infectious for up to 18 months. During this time, they spread, contaminating water, fruits, and vegetables, and infecting warm-blooded species, including humans, that come in contact with them and ingest them.
So while it's possible to get infected with toxoplasma oocytes from direct contact with cat feces (such as handling the litter of a newly infected cat), you can also be exposed to oocytes elsewhere – while gardening, eating unwashed vegetables, or drinking contaminated water, for instance.
So how do I avoid getting infected if I have a cat?
Here are some guidelines if you live with a cat:
- Have other people empty the litter box, and have them do it daily. This reduces the risk of infection because the oocysts aren't infectious for the first 24 hours after they're excreted. If you must do the job, wear disposable gloves and wash your hands well afterward. Some experts also suggest wearing a mask in case any particles become airborne when the litter is stirred up.
- To keep your cat from becoming infected while you're pregnant, feed him only commercial cat food or well-cooked table scraps – never raw or undercooked meat.
- Keep him indoors so he won't hunt down potentially infected prey like mice or birds. (Remember, though, that even an indoor cat might catch a mouse.)
- Keep the kitty off the kitchen counter and dining table.
- Though it's unlikely your cat has any parasites in his fur, it's a good idea to wash your hands after playing with him, especially before eating or otherwise putting your hands to your mouth.
- Don't get a new kitten or cat while you're pregnant, and don't play with stray cats or kittens.
What is the risk from eating meat?
Although cats pass the parasite in their feces, other infected species harbor the parasite in their tissue forever, in so-called "tissue cysts." Pork, lamb, and game meat (like venison) are major culprits, but any type of meat may be infected, so all meat should be handled and cooked appropriately.
Heat will kill the parasites, but if you eat raw or undercooked meat (or touch it and then touch your mouth, nose, or eyes), you can be infected by these tissue cysts.
Safe meat-preparation guidelines:
- Freeze meat for several days before cooking. This will reduce – but not eliminate – the chance of infection.
- Cook meat well. This is the only way to be certain you've eliminated toxoplasmosis. Use a food thermometer to test the internal temperature of meat. Most meat should be cooked to a temperature of 160 degrees Fahrenheit, or 180 degrees F in the thigh for whole poultry. It's best to use a thermometer, but if you're doing without, cook the meat until it's no longer pink in the middle and the juices run clear. Be sure not to sample meat you're cooking before it's done.
- Avoid salt-cured or smoked meats such as Genoa salami, Parma ham, and prosciutto unless you first heat them until they're steaming. (For example, they're fine if cooked on a pizza.) If they're not cooked, they're risky because they might have been processed without thorough heating or with no heat at all. Also, don't eat dried meats like jerky, which may have not gotten sufficiently hot during the drying process.
What else can I do to avoid an infection?
Here are some other guidelines to keep in mind:
- Don't drink unpasteurized milk or products made from unpasteurized milk (like some cheese and yogurt), and avoid raw eggs.
- Wash or peel fruits and vegetables before eating.
- Wash counters, cutting boards, dishes, utensils, and your hands with hot, soapy water after working with unwashed produce or uncooked meat, poultry, or seafood.
- Don't touch your mouth, nose, or eyes while preparing food, and always wash your hands before eating. Also make sure cuts and open sores aren't in contact with potential sources of exposure to the parasite. Wear disposable gloves if you have any cuts on your hands.
- Keep flies and cockroaches away from your food.
- Avoid potentially contaminated water. Use bottled water when camping or traveling in developing countries.
- Wear gloves while gardening, and don't touch your hands to your mouth, nose, or eyes until they've been washed thoroughly afterward.
- Avoid public sandboxes, and cover your child's sandbox when it's not in use. If that's not always possible, then stay out of it. (Toxoplasmosis isn't likely to be harmful to your child and you can't catch it from him if he does get it, but you do need to stay away from sand that might contain infected cat feces.)
How will I know if I get toxoplasmosis?
Without testing, you probably won't know you've been infected. The vast majority of infected people with healthy immune systems don't have any symptoms at all. If you do, you may have painless swollen lymph glands and other generally mild symptoms, like muscle aches, fatigue, headache, fever, and possibly a sore throat or a rash.
Only rarely do more serious symptoms arise in otherwise healthy people. Sometimes toxoplasmosis is suspected when certain fetal abnormalities are picked up during a prenatal ultrasound, though most infected babies appear normal.
Will I be screened for toxoplasmosis immunity or infection?
The American College of Obstetricians and Gynecologists (ACOG) doesn't recommend screening pregnant women, with the exception of those who are HIV-positive or when infection is suspected.
Talk about the pros and cons of testing with your doctor or midwife, and together you can make a decision that's right for you. And be sure to call your caregiver if you have swollen glands or other reasons to suspect you've been infected.
If it seems as though you might be infected, your blood will be tested to measure your levels of two antibodies. Depending on the results, you may need to be tested again in two to three weeks and have your blood sent to a toxoplasmosis "reference lab." This is done both to confirm the initial results and to help determine approximately when you might have become infected.
What will happen if I do get toxoplasmosis?
If test results suggest that you got toxoplasmosis while pregnant, your practitioner may begin treating you with an antibiotic that may lower your risk of transmitting the infection to your baby.
And since not all maternal infections are transmitted to the baby, you may have an amniocentesis to determine whether your baby also has the infection. (The lab will do a special DNA test on your amniotic fluid to check for the presence of the parasite.) You'll also have a series of ultrasounds throughout your pregnancy to look for abnormalities in your developing baby.
What could happen if my baby gets toxoplasmosis and how will he be treated?
The consequences for your baby can range from mild to severe, and the infection may result in miscarriage, stillbirth, or death shortly after birth.
If your amniotic fluid shows that your baby has been infected or an ultrasound shows a problem, you'll probably be referred to a specialist for care, and you may also want to talk to a genetic counselor about the risks to your baby. Depending on your baby's gestational age, you'll be given the option to end the pregnancy.
If you continue the pregnancy, you'll be given other antibiotics to take beginning sometime in the second trimester to try to reduce your baby's risk of problems.
Congenital toxoplasmosis can affect your baby's brain, causing problems such as mental or motor developmental delays, cerebral palsy, and epilepsy. It can affect other organs too, most commonly the eyes, leading to visual impairment and sometimes blindness.
Will my baby show signs of toxoplasmosis as soon as he's born?
Some babies will have signs of toxoplasmosis at birth, which may include an enlarged liver and jaundice, an enlarged spleen, a low platelet count, a rash, a heart or lung infection, and enlarged lymph nodes. However, the vast majority of babies with congenital toxoplasmosis, particularly those infected later in pregnancy, seem normal at birth but may develop serious problems months or even years later.
If your baby tests positive for toxoplasmosis at birth, he'll be treated with antibiotics for about a year, even if he has no symptoms. Special hearing and eye exams will be done, as well as a sonogram or CAT scan of his head and other tests as needed. Studies show that although treatment after birth may not reverse all the damage that occurred before birth, it will greatly reduce a baby's risk of developing new problems during infancy and beyond.