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In the United States, toxoplasmosis following allogeneic hematopoietic stem transplant (allo‐HCT) is very rare with a rate only between 0.5% and 2%. The reported rates of hemophagocytic lymphohistiocytosis (HLH) following allo‐HCT range between 0.3% and 17%. Secondary HLH due to toxoplasmosis infection is extremely rare. Herein, we report a case of secondary HLH due to toxoplasmosis following allo‐HCT. The diagnosis was reached by a bone marrow biopsy and confirmed by DNA next generation sequencing and immunohistochemical (IHC) staining. The IHC staining included CD1a, a stain previously known to react with cells infected by Leishmania, here we show CD1a staining of macrophages infected with Toxoplasma gondii. Our report highlights the utility of bone marrow biopsy in diagnosing parasitic infection underlying HLH in post‐transplant settings. The pre‐transplant evaluation of patients from low endemic countries, is a great opportunity to obtain a travel history to determine the risks and the preventative measures against opportunistic infections including toxoplasmosis. [ABSTRACT FROM AUTHOR]

No new drugs for treatment of toxoplasmosis have been approved in over 60 years, despite the burden of toxoplasmosis on human society. The small selection of effective drugs is limited by important side effects, often limiting patient use. This perspective highlights promising late-stage drug candidates in the treatment of toxoplasmosis. Presently, drugs target the tachyzoite form of the parasite Toxoplasma gondii responsible for the acute infection but do not eradicate the tissue cyst form underlying chronic infection. Pyrimethamine - the first-line and only approved drug for treatment of toxoplasmosis in the United States - inhibits parasite DNA synthesis by inhibiting dihydrofolate reductase (DHFR). Two novel DHFR inhibitors with improved potency and selectivity for parasite DHFR over human DHFR are in clinical-stage development. One of the most advanced and promising therapeutic targets, demonstrating potential to treat both acute and chronic toxoplasmosis, is the calcium-dependent protein kinase 1 (CDPK1) which plays an essential role in the intracellular replicative cycle of the parasite, and has no direct mammalian homolog. Two CDPK1 inhibitor programs have identified potent and selective lead series, demonstrating acceptable systemic and CNS exposure, and in vivo efficacy in animal models of acute and chronic infection. Physicians need a better arsenal of parasiticidal drugs for the treatment of toxoplasmosis, particularly those active against tissue cysts. [ABSTRACT FROM AUTHOR]

Toxoplasmosis, a disease with diverse clinical manifestations, caused by infection with the Apicomplexan parasite, Toxoplasma gondii (T. gondii), is a major source of morbidity and mortality in the United States. Although toxoplasmosis prevalence and mortality have declined over the past two decades, the CDC considers this disease a neglected parasitic infection requiring public health action. Here, we overview the literature to bring attention to the prevalence of the disease in the United States, and high economic burden associated with the disease. The conclusions to be drawn are clear: there is low awareness and underestimation of the disease burden amongst healthcare professionals; a high economic burden associated with the disease; relapse rates to treatment represent additional mortality and morbidity and further costs for the healthcare system; and better treatments are necessary to combat this public health threat. [ABSTRACT FROM AUTHOR]

Toxoplasmosis in marine mammals is epidemiologically and clinically important. Toxoplasma gondii antibodies (by modified agglutination test, cut-off ≥1:25) were detected in serum of 65 of 70 (92.9%) northern sea otters ( Enhydra lutris kenyoni ) from Washington State, USA. Brains and/or muscles of 44 sea otters were bioassayed in mice (INF-γ knock-out [KO], Swiss Webster outbred [SW]) and viable T. gondii was isolated from 22 of 44 (50%); T. gondii strains were lethal to KO mice but not SW mice. These T. gondii isolates were further propagated in cell culture. Multi-locus PCR-RFLP genotyping of cell culture-derived tachyzoites revealed four different genotypes among 22 isolates including ToxoDB PCR-RFLP genotype #5 (14 isolates), #1 (three isolates), #3 (four isolates), and #167 (one isolate). PCR-DNA sequencing based genotyping using polymorphic gene GRA6 revealed one of four different alleles. Among the 14 RFLP genotype #5 strains, 10 have GRA6 sequences that match with the Type A, one match with the Type X, two strains did not generate sequence data, and one strain had double peaks at known polymorphic sites indicating a mixed infection. The seven strains belong to genotypes #1 and #3, all have identical sequences to T. gondii Type II reference isolate ME49. Genotype #167 strain has identical sequence to Type I reference strain. In summary, we observed high seroprevalence, and high rate of isolation of T. gondii from northern sea otters and predominant genotype #5 that has been previously reported a dominant and widespread strain among terrestrial wildlife in North America. GRA6 sequence analysis of the genotype #5 isolates indicated the dominance of Type A lineage in sea otters in Washington State. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that the use of proton pump inhibitors (PPIs) is associated with an increased risk of being diagnosed with toxoplasmic retinochoroiditis., Design: Retrospective, matched case-control study using data from 2000 to 2020., Participants: Patients with ocular toxoplasmosis and controls were matched 5:1 for age, sex, and race, with the eligibility date ± 3 months from the index date of exposed match. Patients aged < 18 years with congenital toxoplasmosis, having < 2 years in the insurance plan before the index date, and without ≥ 1 visit to an eyecare provider before the index date were excluded from the study., Methods: Patients with ocular toxoplasmosis were identified using the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, and PPI use or diseases highly associated with PPIs were identified using national drug codes from an administrative medical claims database., Main Outcome Measures: The primary outcome was defined as having a prescription for a PPI or histamine-2 (H2) blocker. Multivariable logistic regression analyses were performed, controlling for demographic and systemic health variables., Results: A total of 4069 cases and 19 177 controls met the eligibility criteria. Of the 4069 patients with ocular toxoplasmosis, 989 (24.3%) were on PPI/H2 blockers compared with 3763 of 19 177 (19.2%) controls. The adjusted logistic regression model demonstrated 1.28 greater odds of PPI/H2 blocker use in cases of ocular toxoplasmosis than matched controls (95% confidence interval, 1.17-1.40; P < 0.001)., Conclusions: Proton pump inhibitor/H2 blocker exposure was associated with an increased risk of being diagnosed with ocular toxoplasmosis, corroborating findings from a prior case series., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background. Toxoplasma gondii infection causes substantial morbidity and mortality in the United States, and infects approximately one-third of persons globally. Clinical manifestations vary. Seropositivity is associated with neurologic diseases and malignancies. There are few objective data concerning US incidence and distribution of toxoplasmosis. Methods. Truven Health MarketScan Database and International Classification of Diseases, Ninth Revision (ICD-9) codes, including treatment specific to toxoplasmosis, identified patients with this disease. Spatiotemporal distribution and patterns of disease manifestation were analyzed. Comorbidities between patients and matched controls were compared. Results. Between 2003 and 2012, 9260 patients had ICD-9 codes for toxoplasmosis. This database of patients with ICD-9 codes includes 15% of those in the United States, excluding patients with no or public insurance. Thus, assuming that demographics do not change incidence, the calculated total is 61 700 or 6856 patients per year. Disease was more prevalent in the South. Mean age at diagnosis was 37.5 ± 15.5 years; 2.4% were children aged 0-2 years, likely congenitally infected. Forty-one percent were male, and 73% of women were of reproductive age. Of identified patients, 38% had eye disease and 12% presented with other serious manifestations, including central nervous system and visceral organ damage. Toxoplasmosis was statistically associated with substantial comorbidities, including human immunodeficiency virus, autoimmune diseases, and neurologic diseases. Conclusions. Toxoplasmosis causes morbidity and mortality in the United States. Our analysis of private insurance records missed certain at-risk populations and revealed fewer cases of retinal disease than previously estimated, suggesting undercoding, underreporting, undertreating, or differing demographics of those with eye disease. Mandatory reporting of infection to health departments and gestational screening could improve care and facilitate detection of epidemics and, thereby, public health interventions. [ABSTRACT FROM AUTHOR]

Listeriosis and toxoplasmosis are foodborne illnesses that can have long-term consequences when contracted during pregnancy. Listeriosis is implicated in stillbirth, preterm labor, newborn sepsis, and meningitis, among other complications. Toxoplasmosis is associated with blindness, cognitive delays, seizures, and hearing loss, among other significant disabilities. Healthcare providers who understand the fundamentals of Listeria and Toxoplasma infection will have the tools to identify symptoms and high-risk behaviors, educate women to make safer decisions, and provide anticipatory guidance if a pregnant woman would become infected with either of these foodborne illnesses. [ABSTRACT FROM AUTHOR]

Background: Toxoplasma gondii is an intracellular protozoan parasite with zoonotic potential that causes acute and chronic diseases, which has been associated with schizophrenia, depression, bipolar disorder, and suicidal behavior. Military personnel may be at increased risk for exposure to the parasite when deployed to countries with high prevalence rates.Methods: Women Veterans were recruited to participate in the study at an event to recognize women Veterans and later through e-mails. Blood samples were collected from 70 women Veterans (mean age: 47 years) and analyzed for T. gondii IgG titer. Participants completed a demographic instrument, Center for Epidemiologic Studies Depression scale, Profile of Mood States (POMS), and Post-Traumatic Stress Disorder Checklist-Military.Results: The infectivity rate was lower than the rate in the United States (11.4% [8 out of 70 were seropositive], but 6 of the 8 [75%] had been deployed outside the United States. Pearson correlations and t tests showed significant relationships between T. gondii seropositivity and Center for Epidemiologic Studies Depression score), POMS-depression, POMS-confusion, and POMS-anger subscale scores, and total mood disturbance score.Conclusions: This study is the first to describe biobehavioral relationships between chronic T. gondii infection, depression, and dysphoric moods in a military veteran population. [ABSTRACT FROM AUTHOR]

The article discusses issues concerning an increase in drug prices across the pharmaceutical industry of the U.S. It mentions categories in medication price increases such as calcium disodium versenate used for lead poisoning and pyrimethamine for toxoplasmosis; and offers suggestions for patients to reduce their medication costs. It also presents relative safety, tolerability, effectiveness and simplicity of new drugs.

The article offers information on the major neglected parasitic infections in the U.S. Details about the origin, prevalence, and treatment of the infections are discussed including toxocariasis, Chagas disease, and trichomoniasis. Also mentioned is information on the association of the diseases to the poverty rate of several states in the country.

Background: Toxoplasmosis is among the most widespread and prevalent zoonosis in the world. People can become infected through ingestion of oocysts shed by felids or of tissue cysts contained in meat from infected animals. Acute infection can result in a wide spectrum of consequences, including flu-like illness and retinitis, as well as congenital infection in pregnant women. Severe disease can occur, especially if people are immunocompromised. Frequency of human infection varies substantially by region due to ecological, social, and cultural factors. The most recent nationwide prevalence estimates in children from United States were 3.6% in 6-11 year olds and 5.8% in 12-19 year olds. Because of the limited knowledge of the occurrence of common zoonotic pathogens in children in the United States, the objective of this study was to estimate the sero-prevalence of T. gondii-specific antibodies in children from the Marshfield area in Wisconsin and to examine the association between sero-positivity and farm living. Methods: Banked sera from 342 Wisconsin children collected in 1997-1999, aged 2 to 18 years, were tested for Toxoplasma gondii-specific IgG antibodies using ELISA. Recorded information included age, sex, and whether the child resided on a farm. Impact of assay accuracy, sensitivity and specificity, on sero-prevalence was examined using Bayesian methods. Results: Observed prevalence of T. gondii-specific antibodies was 10.8% (37/347). Adjusting for sensitivity and specificity of the assays yielded a prevalence estimate of 8.0% (95% probability interval: 4% - 12.4%). Children living on a farm had a 5 times higher odds of T. gondii-specific antibodies than children not living on a farm (OR=5.08, 95% CI: 2.2 - 11.6). Conclusion: Results suggest that even in apparently low-risk populations, the true extent of the infection in children is significant. In this study population, children living on farms were differentially exposed, with earlier and higher infection risk than children not living on farms. Findings highlight the need to increase awareness about toxoplasmosis acquired early in life and to improve our understanding of the ecology of T. gondii in rural environments from developed and developing countries. [ABSTRACT FROM AUTHOR]

Highlights: [•] The annual environmental deposit of cat feces in the US is 1.2 million tons. [•] Toxoplasma gondii oocysts may remain viable for several years and thus accumulate. [•] In favored cat defecation sites, oocysts may accumulate in very high numbers. [•] The accumulation of T. gondii oocysts may be a major public health problem. [ABSTRACT FROM AUTHOR]

Abstract: Toxoplasmosis, caused by Toxoplasma gondii, is one of the most common parasitic infections of humans and other warmblooded animals. It has been found worldwide and nearly one-third of humans have been exposed to the parasite. Congenital infection occurs when a woman becomes infected during pregnancy and transmits the parasite to the foetus. Besides congenital infection, humans become infected by ingesting food or water contaminated with sporulated oocysts from infected cat faeces or through ingestion of tissue cysts in undercooked or uncooked meat. Food animals (pigs, chickens, lambs and goats) become infected by the same routes, resulting in meat products containing tissue cysts, which can then infect consumers. Toxoplasma infection is common in food animals in the United States. Implementation of management factors such as biosecure confinement housing are important in reducing the levels of infection in animals destined for human consumption. [Copyright &y& Elsevier]

Purpose: To describe eight patients with toxoplasma retinochoroiditis following exposure to wild game., Methods: Retrospective, multicenter case series., Results: Eight men, aged 29 to 71 (mean, 56 years), developed toxoplasmic retinochoroiditis after hunting and/or consuming wild game in the United States, including seven deer and one bear. Five patients developed the disease after eating undercooked game meat, while three developed ocular findings after cleaning hunted animals. Seven patients were healthy prior to exposure. LogMAR visual acuity at presentation was 0.697 ± 0.745, improving to 0.256 ± 0.335 by last follow-up. Disease complications developed in five (62.5%) patients, of which recurrence of retinochoroiditis was the most common., Conclusions: Contact with wild game is a potential source of primary ocular toxoplasmosis in immunocompetent adults. Hunters and consumers of rare game are at risk of serious ocular disease and appropriate contact precautions and cooking may reduce this complication.

Background. Toxoplasmosis-related hospitalizations often occur in persons with human immunodeficiency virus (HIV) infection and other causes of immunosuppression. Methods. Using the National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project, we examined trends in toxoplasmosis-related hospitalizations by HIV infection status from 1993 through 2008, and rates by sex and race or ethnicity in 2008. The NIS is designed to represent a 20% sample of US community hospitals and currently includes information on up to 8 million discharges per year from 1000 hospitals. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes 130-130.9 for toxoplasmosis and 042-044/795.8/795.71/V08 for HIV infection. Results. Estimated HIV-associated toxoplasmosis hospitalizations increased from 9395 in 1993 to 10 583 in 1995 (P =.0002), then dropped to 3643 in 2001 (P < .0001), with similar levels thereafter. The rate of HIV-associated toxoplasmosis hospitalizations among all HIV-related hospitalizations decreased from 3.33% in 1993 to 1.25% in 2008 (P <.0001). Estimated non-HIV-associated toxoplasmosis hospitalizations were less variable from 1993 to 2008 (range, 386-819; 0.0020% in 1993, 0.0015% in 2008). In 2008, the rates of both HIV- and non- HIV-associated toxoplasmosis hospitalizations were higher in Hispanic persons than in white persons. Conclusions. HIV-associated toxoplasmosis hospitalizations dropped markedly after 1995 when highly active antiretroviral therapy was introduced; however, hospitalizations decreased relatively little after 2000, suggesting late diagnosis of some HIV-infected persons or antiretroviral therapy failure. Non-HIV-associated toxoplasmosis hospitalizations have been more stable. The rates of toxoplasmosis-related hospitalizations varied markedly among racial and ethnic groups. [ABSTRACT FROM AUTHOR]

After 30 years of the human immunodeficiency virus (HIV) epidemic, parasites have been one of the most common opportunistic infections (OIs) and one of the most frequent causes of morbidity and mortality associated with HIV-infected patients. Due to severe immunosuppression, enteric parasitic pathogens in general are emerging and are OIs capable of causing diarrhoeal disease associated with HIV. Of these, Cryptosporidium parvum and Isospora belli are the two most common intestinal protozoan parasites and pose a public health problem in acquired immunodeficiency syndrome (AIDS) patients. These are the only two enteric protozoan parasites that remain in the case definition of AIDS till today. Leismaniasis, strongyloidiasis and toxoplasmosis are the three main opportunistic causes of systemic involvements reported in HIV-infected patients. Of these, toxoplasmosis is the most important parasitic infection associated with the central nervous system. Due to its complexity in nature, toxoplasmosis is the only parasitic disease capable of not only causing focal but also disseminated forms and it has been included in AIDS-defining illnesses (ADI) ever since. With the introduction of highly active anti-retroviral therapy (HAART), cryptosporidiosis, leishmaniasis, schistosomiasis, strongyloidiasis, and toxoplasmosis are among parasitic diseases reported in association with immune reconstitution inflammatory syndrome (IRIS). This review addresses various aspects of parasitic infections in term of clinical, diagnostic and therapeutic challenges associated with HIV-infection. [ABSTRACT FROM AUTHOR]

Objective: To determine a cost-minimizing option for congenital toxoplasmosis in the United States. Methodology/Principal Findings: A decision-analytic and cost-minimization model was constructed to compare monthly maternal serological screening, prenatal treatment, and post-natal follow-up and treatment according to the current French (Paris) protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. One- and two-way sensitivity analyses are used to evaluate robustness of results. Universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, following the French protocol, is found to be cost-saving, with savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, and to bivariate analysis of test costs and incidence of primary T. gondii infection in pregnancy. Given the parameters in this model and a maternal screening test cost of $12, screening is cost-saving for rates of congenital infection above 1 per 10,000 live births. If universal testing generates economies of scale in diagnostic tools—lowering test costs to about $2 per test—universal screening is cost-saving at rates of congenital infection well below the lowest reported rates in the United States of 1 per 10,000 live births. Conclusion/Significance: Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities. Author Summary: We constructed a decision-analytic and cost-minimization model to compare monthly maternal serological screening for congenital toxoplasmosis, prenatal treatment, and post-natal follow-up and treatment according to the current French protocol, versus no systematic screening or perinatal treatment. Costs are based on published estimates of lifetime societal costs of developmental disabilities and current diagnostic and treatment costs. Probabilities are based on published results and clinical practice in the United States and France. We use sensitivity analysis to evaluate robustness of results. We find that universal monthly maternal screening for congenital toxoplasmosis with follow-up and treatment, following the French (Paris) protocol, leads to savings of $620 per child screened. Results are robust to changes in test costs, value of statistical life, seroprevalence in women of childbearing age, fetal loss due to amniocentesis, incidence of primary T. gondii infection during pregnancy, and to bivariate analysis of test costs and incidence of primary T. gondii infection. Given the parameters in this model and a maternal screening test cost of $12, screening is cost-saving for rates of congenital infection above 1 per 10,000 live births. Universal screening according to the French protocol is cost saving for the US population within broad parameters for costs and probabilities. [ABSTRACT FROM AUTHOR]

Background. Late diagnosis of human immunodeficiency virus (HIV) infection remains common despite advances in therapy and prognosis. The southeastern United States is a rapidly growing Latino settlement area where ethnic disparities may contribute to late presentation to care. Methods. We assessed demographic and clinical factors between racial/ethnic groups at the time of HIV care initiation in the University of North Carolina Center for AIDS Research Clinical Cohort. We identified independent predictors of late presentation, defined as a CD4+ T lymphocyte (CD4) count <350 cells/mm3 or an AIDS-defining event (ADE), using log-linear binomial regression. Results. During the period 1999-2009, 853 patients initiated HIV care, of whom 11% were Latino, 28% were white, and 61% were black. Median initial CD4 counts were lower for Latino patients (186 cells/mm3) than white patients (292 cells/mm3; P 5 .006) and black patients (302 cells/mm3; P = .02). Latino persons were more likely to be late presenters than white or black persons (76% vs 58%; P < .001) and accounted for 86%, 75%, and 50% of all presenting cases of active tuberculosis, histoplasmosis, and toxoplasmosis, respectively. Latino ethnicity, older age, male sex, and earlier entry year were independently associated with late presentation (P < .05 for all). In multivariable analyses, Latino persons were 1.29 times more likely to present to care late than white or black persons (95% confidence interval, 1.15-1.45). Conclusions. Latinos are more likely to initiate HIV care later in the course of illness than are black and white persons and account for a majority of several ADEs. Strategies to improve earlier HIV testing among Latinos in new settlement areas are needed. [ABSTRACT FROM AUTHOR]

Toxoplasmosis, a disease described worldwide, which is caused by the protozoan Toxoplasma gondii, commonly involves the retina. The disease has a higher impact in immunocompromised individuals and in congenital infection because of the severity of central nervous system involvement. Although simple prophylactic measures could reduce transmission, T. gondii seroprevalence is still high, especially in South America. Educational campaigns and the development of new drugs to prevent primary infection could potentially reduce the burden of the disease. [ABSTRACT FROM AUTHOR]

Toxoplasmosis in allo-SCT patients is rare in the United States but has a mortality of 60-90%. In this retrospective study, we identified patients with definite and probable toxoplasmosis after allo-SCT at our institution from 1994 to 2009 using ICD-9 codes and the pathology database. Of 3626 patients who underwent allogeneic SCT, we identified 8 with definite toxoplasmosis and 1 with probable toxoplasmosis, an incidence of 0.25%. International patients had a significantly higher incidence of toxoplasmosis than did US patients (1.6 versus 0.15% (P=0.002)). Three patients presented with toxoplasmosis <30 days after transplantation and six developed toxoplasmosis within 100 days of starting high-dose corticosteroids. Two patients were diagnosed postmortem. Six of the remaining seven patients died despite 2 weeks of therapy. Co-morbidities, particularly infections, were the primary cause of death in one case and a contributing factor in the remaining six cases. On the basis of these results, we conclude that all allo-SCT patients from countries with high Toxoplasma seropositivity and seropositive patients from the United States should undergo serial PCR screening during the first month after transplantation and during corticosteroid use. All patients who test positive should undergo preemptive therapy. [ABSTRACT FROM AUTHOR]

Acute infection with Toxoplasma gondii during pregnancy and its potentially tragic outcome for the fetus and newborn continue to occur in the United States, as well as worldwide, despite the fact that it can be prevented. The infection can be acquired through ingestion of infected, undercooked meat or contaminated food or water. Transmission to the fetus occurs almost solely in women who acquire their primary infection during gestation and can result in visual and hearing loss, mental and psychomotor retardation, seizures, hematological abnormalities, hepatosplenomegaly, or death. Systematic education and serological screening of pregnant women are the most reliable and currently available strategies for the prevention, diagnosis, and early treatment of the infection in the offspring; this is largely because toxoplasmosis in pregnant women most often goes unrecognized. Treatment of the infection in the fetus and infant during the first year of life has been demonstrated to significantly improve the clinical outcome. [ABSTRACT FROM AUTHOR]

Toxoplasma gondii infections in zoo animals are of interest because many captive animals die of clinical toxoplasmosis and because of the potential risk of exposure of children and elderly to T. gondii oocysts excreted by cats in the zoos. Seroprevalence of T. gondii antibodies in wild zoo felids, highly susceptible zoo species, and feral cats from 8 zoos of the midwestern United States was determined by using the modified agglutination test (MAT). A titer of 1:25 was considered indicative of T. gondii exposure. Among wild felids, antibodies to T. gondii were found in 6 (27.3%) of 22 cheetahs (Acynonyx jubatus jubatus), 2 of 4 African lynx (Caracal caracal), 1 of 7 clouded leopards (Neofelis nebulosa), 1 of 5 Pallas cats (Otocolobus manul), 12 (54.5%) of 22 African lions (Panthera leo), 1 of 1 jaguar (Panthera onca), 1 of 1 Amur leopard (Panthera pardus orientalis), 1 of 1 Persian leopard (Panthera pardus saxicolor), 5 (27.8%) of 18 Amur tigers (Panthera tigris altaica), 1 of 4 fishing cats (Prionailurus viverrinus), 3 of 6 pumas (Puma concolor), 2 of 2 Texas pumas (Puma concolor stanleyana), and 5 (35.7%) of 14 snow leopards (Uncia uncia). Antibodies were found in 10 of 34 feral domestic cats (Felis domesticus) trapped in 3 zoos. Toxoplasma gondii oocysts were not found in any of the 78 fecal samples from wild and domestic cats. Among the macropods, antibodies were detected in 1 of 3 Dama wallabies (Macropus eugenii), 1 of 1 western grey kangaroo (Macropus fuliginosus), 1 of 2 wallaroos (Macropus robustus), 6 of 8 Bennett's wallabies (Macropus rufogriseus), 21 (61.8%) of 34 red kangaroos (Macropus rufus), and 1 of 1 dusky pademelon (Thylogale brunii). Among prosimians, antibodies were detected in 1 of 3 blue-eyed black lemurs (Eulemur macaco flavifrons), 1 of 21 ring-tailed lemurs (Lemur catta), 2 of 9 red-ruffed lemurs (Varecia variegata rubra), and 2 of 4 black- and white-ruffed lemurs (Varecia variegata variegata). Among the avian species tested, 2 of 3 bald eagles (Haliaeetus leucocephalus) were seropositive. Among 7 possible risk factors, sex, freezing meat temperature (above -13 C vs. below -13 C), washing vegetables thoroughly, frequency of feral cat sightings on zoo grounds (occasionally vs. frequently), frequency of feral cat control programs, capability of feral cats to enter hay/grain barn, and type of animal exhibit, exhibiting animals in open enclosures was the only factor identified as a significant risk (OR 3.22, P - 0.00). [ABSTRACT FROM AUTHOR]

Human contact with cats, dogs, and other pets results in several million infections each year in the United States, ranging from self-limited skin conditions to life-threatening systemic illnesses. Toxoplasmosis is one of the most common pet-related parasitic infections. Although toxoplasmosis is usually asymptomatic or mild, it may cause serious congenital infection if a woman is exposed during pregnancy, particularly in the first trimester. Common pet-borne fungal infections include tinea corporis/capitis (ringworm); campylobacteriosis and salmonellosis are among the most common bacterial infections associated with pet ownership. Less commonly, pets can transmit arthropod-borne and viral illnesses (e.g., scabies, rabies). Infection in a pet can provide sentinel warning of local vectors and endemic conditions, such as Lyme disease risk. Treatment is infection-specific, although many infections are self-limited. Prevention involves common sense measures such as adequate hand washing, proper disposal of animal waste, and ensuring that infected animals are diagnosed and treated. Special precautions are indicated for immunocompromised persons. Increased communication between primary care physicians and veterinarians could improve treatment and prevention of these conditions. [ABSTRACT FROM AUTHOR]

Toxoplasma gondii is an important pathogen in both veterinary and human medicine. Infection during pregnancy can result in fetal transmission and a congenital infection syndrome. In immune-compromised hosts reactivation of latent infection can result in encephalitis. It has been estimated that as many as one-third of the human population harbours this zoonosis. The Seventh International Congress on Toxoplasmosis, organised by Louis M. Weiss and Kami Kim (Albert Einstein College of Medicine, Bronx, NY) was held on 23–27 May 2003 in Tarrytown, New York. At this meeting 133 investigators from 14 countries presented 102 papers on research involving this model Apicomplexan parasite. The presented research covered the epidemiology, immunology, cellular biology and molecular biology of this pathogen. [Copyright &y& Elsevier]

Infection with Toxoplasma gondii can cause severe illness when the organism is contracted congenitally or when it is reactivated in immune-suppressed persons. To determine the prevalence of T. gondii infection in a representative sample of the US population, the authors tested sera from participants in the Third National Health and Nutrition Examination Survey (1988–1994) for immunoglobulin G antibodies to T. gondii. Of 27,145 persons aged ≥12 years, 17,658 (65%) had sera tested. The overall age-adjusted seroprevalence was 22.5% (95% confidence interval (CI): 21.1, 23.9); among women aged 15–44 years, seroprevalence was 15.0% (95% CI: 13.2, 17.0). Age-adjusted seroprevalence was higher in the Northeast (29.2%) than in the South (22.8%), Midwest (20.5%), or West (17.5%) (p < 0.05). In multivariate analysis, risk for T. gondii infection increased with age and was higher among persons who were foreign-born, persons with a lower educational level, those who lived in crowded conditions, and those who worked in soil-related occupations, although in subset analyses risk categories varied by race/ethnicity. Nearly one quarter of adults and adolescents in the United States have been infected with T. gondii. Most women of childbearing age in the United States are susceptible to acute infection and should be educated about ways to minimize exposure to T. gondii. [ABSTRACT FROM PUBLISHER]

We tested all samples from patients with ocular toxoplasmosis sent to the Palo Alto Medical Foundation Toxoplasma Reference Laboratory from June 2004 through August 2010 for serologic evidence of recent Toxoplasma gondii infection. Of 205 patients aged 10–96 years, 11.7% had recent infection. Many people develop ocular disease soon after T. gondii infection. [ABSTRACT FROM PUBLISHER]

Toxoplasmosis is an infection caused by the protozoan parasite, Toxoplasma gondii. It has been reported as the fourth leading cause of hospitalization and second leading cause of death among 31 major foodborne pathogens in the United States. Humans are infected through consumption of raw or undercooked meat containing T. gondii tissue cysts or ingestion of food, soil, or water contaminated by T. gondii oocysts. People often lack knowledge about how to prevent T. gondii infection, especially the risks associated with eating or handling raw or undercooked meat. Current available data on cooking or low temperature storage for whole cuts of meat are not sufficient to validate inactivation of T. gondii. The objectives of the present study were to estimate the relationship of time and temperature with the survival rate of T. gondii during cooking and low temperature storage of fresh cut meats. We used different statistical sampling techniques such as bootstrap resampling and Gibbs sampling to establish those relationships. Monte Carlo simulation was used to estimate the safe temperature for cooking and storing meats. The results showed no detection of T. gondii in fresh meats when the internal temperature reached above 64 °C (147.2 °F) and below −18 °C (0 °F). The tissue cysts can remain viable at least up to 30 days at 4 °C (39 °F) and about 3.3% cysts survived at 62.8 °C (145 °F). This study can provide helpful information in improving the risk models to further mitigate the public health burden of toxoplasmosis. • T. gondii was unable to survive at internal cooking temperature above 64 °C in meat. • T. gondii can remain viable up to a month at refrigerated temperature (4 °C). • Freezing fresh meats below −18 °C for 24 h can inactivate T. gondii tissue cysts. [ABSTRACT FROM AUTHOR]

Cats are important in the epidemiology of Toxoplasma gondii infection because they are the only hosts that can excrete the environmentally resistant oocysts in the environment. Although exposure is common (approximately 30% of cats in the USA), clinical toxoplasmosis is relatively rare. Here, we report overwhelming disseminated toxoplasmosis in two litter mate 8-week-old kittens, thought to have acquired toxoplasmosis postnatally. Five domestic shorthair kittens, approximately 2–3 weeks of age, and the queen were found in upstate New York by a rescue group in spring of 2018. The kittens and queen were placed in a foster home for approximately 4–5 weeks and then transferred to a shelter. Two kittens died unexpectedly following a short illness. Postmortem examination of the two deceased kittens revealed overwhelming toxoplasmosis and the presence of entero-epithelial stages in small intestine, suggestive of recent ingestion of infected tissues. Antibodies to T. gondii were found in the deceased kittens and the queen but not in the three asymptomatic littermate kittens. No obvious cause of immunosuppression was demonstrated. Genetic typing of T. gondii from DNA extracted from liver and lungs of both kittens revealed Toxo DB #4 genotype, commonly found in wildlife. Owners and veterinarians should be aware of dangers of feeding raw meat to cats and contact with infected cat feces. Procedures to safely handle T. gondii infected feces in hospital setting are outlined. Unlabelled Image • Disseminated toxoplasmosis was diagnosed in 2 of 5 littermate kittens. • Schizonts and gamonts were found in enterocytes, indicating recently acquired infection. • Molecular characterization of DNA from lungs and liver of both kittens revealed Toxo DB genotype #4. [ABSTRACT FROM AUTHOR]

There is a paucity of pediatric-specific data to guide consensus recommendations for the prevention of Pneumocystis jirovecii pneumonia (PCP) and toxoplasmosis after solid organ transplantation. We surveyed pediatric transplantation providers and found considerable variability in prophylaxis strategies, despite current guideline recommendations that are based primarily on adult data., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

To assess the role of white-tailed deer (Odocoileus virginianus, WTD) in the epidemiology of toxoplasmosis, we conducted a national survey of WTD across the USA for Toxoplasma gondii infection. To do this, we combined serology with parasite isolation to evaluate the prevalence and genetic diversity of T. gondii in this game species. From October 2012 to March 2019, serum and tissues were collected from 914 WTD across the USA. Serum samples were screened for antibodies to T. gondii, and then the tissues of seropositive WTD were bioassayed in mice. Antibodies were detected in 329 (36%) of 914 WTD tested by the modified agglutination test (positive reaction at 1:25 or higher). Viable T. gondii was isolated from the heart of 36 WTD from 11 states. Three of the 36 isolates were pathogenic but not highly virulent to outbred Swiss Webster mice and all 36 isolates could be propagated further in cell culture and were genotyped. For genotyping, DNA extracted from cell culture-derived tachyzoites was characterized by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using the genetic markers SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico. Genotyping revealed seven ToxoDB PCR-RFLP genotypes, including 24 isolates for genotype #5 (haplogroup 12), four isolates for #2 (type III, haplogroup 3), three isolates for genotypes #1 (type II, haplogroup 2), two isolates for genotypes #3 (type II, haplogroup 2) and one isolate each for #39, #221 and #224. Genotype #5 was the most frequently isolated, accounting for 66.6% (24 of 36) of the isolates. Combining the 36 isolates from this study with previously reported 69 isolates from WTD, 15 genotypes have been identified. Among these, 50.4% (53/105) isolates belong to genotype #5. Our results indicate moderate genetic diversity of T. gondii in WTD. The results also indicate that undercooked venison should not be consumed by humans or fed to cats.

Feral swine are known reservoirs of various pathogens, including Toxoplasma gondii. Here, we report the first national survey of viable T. gondii in feral swine in the USA. We paired serological surveys with parasite isolation and bioassay to evaluate the prevalence and genetic diversity of these parasites. From 2012-2017, sera and tissues from 1517 feral swine across the USA were collected for the isolation of viable T. gondii. Serum samples were initially screened for antibodies to T. gondii, and then the tissues of seropositive feral swine were bioassayed in mice. Antibodies were detected in 27.7% of feral swine tested by the modified agglutination test (1:25 or higher). Antibody positive rates increased significantly with age, with 10.1% of juveniles, 16.0% of sub-adults and 38.4% of adults testing seropositive. Myocardium (50 g) from 232 seropositive feral swine was digested in pepsin and bioassayed in mice. Viable T. gondii was isolated from 78 feral swine from 21 states. Twelve of the 78 isolates were pathogenic to outbred Swiss Webster mice and 76 of the 78 isolates could be propagated further in cell culture and were genotyped. For genotyping, deoxyribonucleic acid extracted from cell culture-derived tachyzoites was characterized by polymerase chain reaction restriction fragment length polymorphism using the genetic markers SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1 and Apico. Genotyping revealed 15 ToxoDB genotypes, including 43 isolates for genotype #5 (haplogroup 12), 11 isolates for #24, four isolates for #2 (haplogroup 3), two isolates for each of genotypes #3 (haplogroup 2), #4 (haplogroup 12), #216, #221, #289 and #297 and one isolate for each of genotypes #1 (haplogroup 2), #39, #66, #260, #261 and #299. Genotype #5 was the most frequently isolated, accounted for 57% (43/76) of the isolates, followed by #24, accounted for 14% (11/76). Genotypes #260, #289, #297 and #299 are new types. Genotype #289 was highly virulent to mice and originated from feral swine collected in Louisiana on the same day at the same location. Genotype #216 was previously demonstrated to be highly virulent to mice. Our results indicate moderate genetic diversity of T. gondii in feral swine in the USA, with the genotype #5 (haplogroup 12) dominant in the continental USA, whereas genotype #24 (10/14) was dominant in Hawaii, suggesting different population structures of the parasites among the two distinct geographical locations.

Introduction : Infection with Toxoplasma gondii ( T. gondii ) causes the disease toxoplasmosis in humans and animals. Oral transmission alone may not explain the widespread distribution of this parasite over large species of host animals and geographic areas. Areas covered : Limited studies indicate the potential role of ticks in the distribution of T. gondii . The possibility of transmission of T. gondii has been demonstrated in Dermacentor variabilis, Dermacentor andersoni, Amblyomma americanum, Dermacentor reticulatus, Ixodes ricinus, Ixodes amblyomma, Amblyomma cajennense, Ornithodorus moubata and Haemaphysalis longicornis . Tick transmission of T. gondii , spread of ticks and pathogens by migratory birds and presence in the United States (US) of tick vectors of human and animal disease like Haemaphysalis longicornis indigenous to other parts of the world provide a possible mechanism for the widespread distribution of T. gondii , and a potentially expanding disease threat. Expert opinion : The evidence indicates that T. gondii is potentially an unrecognized tick-borne pathogen spreading toxoplasmosis, and that clinicians might consider toxoplasmosis in the differential diagnosis of tickborne diseases.

This study evaluated the usefulness of adding the Toxoplasma gondii IgA antibody enzyme-linked immunosorbent assay (ELISA) to the serologic panel of tests done for the diagnosis of acute toxoplasmosis in pregnant women in a reference laboratory in the United States. We conducted a retrospective study of 690 consecutive pregnant women with positive T. gondii IgG antibody test results who also had T. gondii IgA and IgM antibody tests performed. Patients were defined as acutely or chronically infected with T. gondii based on a panel of serologic tests performed at the Palo Alto Medical Foundation Toxoplasma Serology Laboratory (PAMF-TSL). Among the 81 women who were positive by T. gondii IgA antibody ELISA testing, 61 (75.3%) were acutely infected with T. gondii , while of the 547 who were negative by IgA testing, only 24 (4.4%) were acutely infected ( P  < 0.001). Among the 71 women who were positive by both IgA and IgM antibody tests, 61 (85.9%) were acutely infected, whereas 24 (19.2%) of the 125 women who were positive by only the IgM ELISA were acutely infected ( P  < 0.001). These results demonstrate that pregnant women with T. gondii IgA antibodies are more likely than pregnant women without T. gondii IgA antibodies to have had a recent infection with T. gondii IgA antibody testing can therefore improve the accuracy of a serologic panel for the diagnosis of acute toxoplasmosis during pregnancy. Physicians who ordered testing only for Toxoplasma IgA antibody testing can therefore improve the accuracy of a serologic panel for the diagnosis of acute toxoplasmosis during pregnancy. Physicians who ordered testing only for T. gondii IgG and IgM should also request additional testing for IgA and IgG avidity, if both IgG and IgM are positive. This further testing should, ideally, be performed in a reference laboratory., (Copyright © 2019 Olariu et al.)

Toxoplasmosis causes substantial morbidity and mortality in the United States (US). Clinical manifestations to toxoplasmosis vary and there is limited information on incidence or treatment patterns in the US. Treatment pathways for pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) for toxoplasmosis hospitalizations were investigated using the Vizient Health Systems inpatient and outpatient data. Between January 1 st , 2011 and December 31 st , 2017, 10,273 hospital visits from 4,736 unique patients received a primary or secondary ICD-9/ICD-10 diagnosis for toxoplasmosis. The projected annual hospital visits with a diagnosis of toxoplasmosis was 68,821, corresponding to a total annual incidence of 9,832 comprising ocular toxoplasmosis of 2,169, toxoplasmic encephalitis of 1,399, unspecified toxoplasmosis of 4,368, congenital toxoplasmosis of 381, multisystemic toxoplasmosis of 69 and other toxoplasmosis of 1,446. Only 16.3% of the study population received treatment with pyrimethamine-based regimens or TMP-SMX. Pyrimethamine-based regimens were used significantly more often than TMP-SMX in toxoplasmic encephalitis (88.7% vs 79.6%, p = 0.01), other toxoplasmosis (85.0% vs 79.2%, p = 0.04), and unspecified toxoplasmosis (87.6% vs 77.9%, p = 0.03) in hospitals with 300 beds or more. A significantly higher percentage of visits with TMP-SMX as first-line treatment switched to pyrimethamine-based regimens compared to visits initiated on pyrimethamine-based treatments (26.7% vs 4.1%, p < .001). Ocular toxoplasmosis patients receiving pyrimethamine-based therapy were more likely to be discharged home compared to TMP-SMC at rates of 72.4% and 55.2%, respectively. Our analysis of commercial insurance records suggest toxoplasmosis is undertreated. Overall, pyrimethamine-based regimens are favored over TMP-SMX, have higher rates of discharge home, and have lower switch rates.

The intracellular parasite Toxoplasma gondii (Nicolle et Manceaux, 1908) infects humans resulting in acute toxoplasmosis, an infection that in immunocompetent people is typically mild but results in persistent latent toxoplasmosis. In that T. gondii appears to affect dopamine synthesis and because addicting drugs affect midbrain dopamine transmission, latent toxoplasmosis could influence substance use. Using both the third and continuous National Health and Nutrition Examination Surveys from the US Centers for Disease Control and Prevention, we used logistic regression to test for associations between T. gondii seropositivity and subject self-report of having ever used tobacco, alcohol, marijuana, cocaine, heroin, or methamphetamine. In the third NHANES dataset, which included data for tobacco, alcohol, marijuana and cocaine, T. gondii seropositivity was associated with a reduced likelihood of self-reported marijuana (OR = 0.71 [95% CI: 0.58; 0.87]; p = 0.001) and cocaine use (OR = 0.72 [95% CI: 0.56; 0.91]; p = 0.006). In the continuous National Health and Nutrition Examination Surveys dataset, which included data for all six substances, T. gondii seropositivity was associated with a reduced likelihood of self-reported tobacco (OR = 0.87 [95% CI: 0.76; 1.00]; p = 0.044), marijuana (OR = 0.60 [95% CI: 0.50; 0.72]; p < 0.001), heroin (OR = 0.60 [95% CI: 0.42; 0.85]; p = 0.005) and methamphetamine use (OR = 0.54 [95% CI: 0.38; 0.77]; p = 0.001). We observed interactions between sex and T. gondii seropositivity in the prediction of self-reported use of tobacco and alcohol. Further, T. gondii seropositivity appeared to remove the protective effect of education and economic status against self-reported cigarette smoking. These findings suggest that T. gondii seropositivity may be inversely associated with some but not all types of substance use in US adults.

Toxoplasmosis during pregnancy can have severe consequences. The use of sensitive and specific serological and molecular methods is extremely important for the correct diagnosis of the disease. We compared the ELISA and ELFA serological methods, conventional PCR (cPCR), Nested PCR and quantitative PCR (qPCR) in the diagnosis of Toxoplasma gondii infection in pregnant women without clinical suspicion of toxoplasmosis (G1=94) and with clinical suspicion of toxoplasmosis (G2=53). The results were compared using the Kappa index, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. The results of the serological methods showed concordance between the ELISA and ELFA methods even though ELFA identified more positive cases than ELISA. Molecular methods were discrepant with cPCR using B22/23 primers having greater sensitivity and lower specificity compared to the other molecular methods., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Prior research has suggested an association between exposure to infectious disease and neurocognitive function in humans. While most of these studies have explored individual viral, bacterial, and even parasitic sources of infection, few have considered the potential neurocognitive burden associated with multiple infections. In this study, we utilized publically available data from a large dataset produced by the Centers for Disease Control and Prevention that included measures of neurocognitive function, sociodemographic variables, and serum antibody data for several infectious diseases. Specifically, immunoglobulin G antibodies for toxocariasis, toxoplasmosis, hepatitis A, hepatitis B, and hepatitis C, cytomegalovirus, and herpes 1 and 2 were available in 5662 subjects. We calculated an overall index of infectious-disease burden to determine if an aggregate measure of exposure to infectious disease would be associated with neurocognitive function in adults aged 20-59 years. The index predicted processing speed and learning and memory but not reaction time after controlling for age, sex, race-ethnicity, immigration status, education, and the poverty-to-income ratio. Interactions between the infectious-disease index and some sociodemographic variables were also associated with neurocognitive function. In summary, an index aggregating exposure to several infectious diseases was associated with neurocognitive function in young- to middle-aged adults., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The neurotropic parasite Toxoplasma gondii infects one third of the world population, but its effect on memory remains ambiguous. To examine a potential relationship of the infection with immediate and delayed memory, a population-based study was conducted in 4485 participants of the Third National Health and Nutrition Examination Survey aged 60years and older. Serum anti-Toxoplasma IgG antibodies were measured by enzyme immune assay and verbal memory was assessed using the Mini-Mental State Examination and the East Boston Memory Test. The prevalence of latent toxoplasmosis was 41%; in one way analysis of variance, anti-Toxoplasma IgG antibody levels significantly differed across tertiles for immediate (P=0.006) but not delayed memory scores (P=0.22). In multinomial logistic regression adjusting for covariates, Toxoplasma seropositivity was associated with lower immediate memory performance (OR: 0.65, 95% CI: 0.44, 0.97 for medium tertile and OR: 0.61, 95% CI: 0.37, 0.98 for highest tertile in reference to the lowest tertile), especially in non-Hispanic Whites (OR: 0.56, 95% CI: 0.36, 0.88 for medium tertile and OR: 0.51, 95% CI: 0.30, 0.87 for highest tertile in reference to the lowest tertile). However, no relationship with delayed memory was observed. In conclusion, latent toxoplasmosis is widespread in older adults and may primarily affect immediate rather than delayed memory, particularly in White Americans., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The article discusses the paper "Toxoplasma Gondii Infection in the United States, 1999-2004, Decline from the Prior Decade" by J. L. Jones, D. Kruszon-Moran, K. Sanders-Lewis and M. Wilson, that was published in the "American Journal of Tropical Medicine & Hygiene." In the paper, Jones and colleagues listed several reasons why the seroprevalence of Toxoplasma infection in U.S. have decreased significantly. This article argues, that though the findings of Jones and colleagues paper are encouraging, these results still suggest that the risk of symptomatic toxoplasmosis remains in U.S. and that risk will continue, so it is important for the public to take extra precautions to prevent this disease.

Purpose: To investigate the number of patient visits to ophthalmologists in the United States that are associated with ocular toxoplasmosis, and to assess ophthalmologists’ knowledge and treatment practices with regard to the disease. Design: Written survey. Methods: A random sample of 1000 US ophthalmologists was surveyed by mail in early 2002 by a questionnaire that was developed to collect information about physician demographics, and with regard to toxoplasmosis, number of patients seen, management practices, and knowledge about pathogenesis and risk factors. Results: Among 478 respondents (48%), 261 (55%) indicated that they had seen one or more patients thought to have active toxoplasmic retinochoroiditis in the prior 2 years, and 445 (93%) indicated that they had seen one or more patients with inactive retinochoroidal scars thought to be inactive toxoplasmosis in the prior 2 years. There was a diversity of opinions regarding topics, including the timing of infection and risk factors for ocular involvement. Many ophthalmologists expressed uncertainty about questions regarding the disease. Conclusions: Ocular toxoplasmosis is associated with a substantial number of patient visits in the United States each year. A variable understanding of the disease indicates a need for continuing medical education regarding ocular toxoplasmosis. [Copyright &y& Elsevier]

This article focuses on a study which reports that congenital toxoplasmosis affects as many as 5000 newborns annually in the U.S., and its outcome can be devastating. In this study, investigators retrospectively surveyed mothers of 122 infants with confirmed congenital Toxoplasma gondii infection who were referred within 1 month of life to the Chicago Collaborative Treatment Trial over a 20-year period. Twenty-five percent of the mothers recalled a conceivable exposure, and 25% did not. Only 39% could recall a specific exposure to cat litter or raw meat, and 48% recalled an illness that could have been toxoplasmosis. It is difficult to identify the fetus or newborn at risk for congenital toxoplasmosis from historical data, but the effectiveness of serologic screening for this condition is not yet proven.

Describes the campaign launched by the Humane Society of the United States to debunk myths about toxoplasmosis. Brochures being handed out to obstetricians and gynecologists as part of the HSUS Pets for Life program.

In North America (NA) and Europe, the majority of toxoplasmosis cases are benign and generally asymptomatic, whereas in South America (SA) toxoplasmosis is associated with much more severe symptoms in adults and congenitally infected children. The reasons for these differences remain unknown; currently, there is little information from patients in either region on how the immune system responds to infection with Toxoplasma gondii. Here, we report the relative abundance of 51 serum cytokines from acute and chronic toxoplasmosis cohorts of pregnant women from the United States, where approximately one-half of clinical isolates are Type II, and Colombia, where clinical isolates are generally "atypical" or Type I-like strains. Surprisingly, the results showed notably lower levels of 23 cytokines in acutely infected patients from the United States, relative to uninfected US controls. In acutely infected Colombian patients, however, only 8 cytokine levels differed detectably with 4 being lower and 4 higher relative to uninfected controls. Strikingly, there were also differences in the cytokine profiles of the chronically infected patients relative to uninfected controls in the US cohort. Hence, Toxoplasma appears to specifically impact levels of circulating cytokines, and our results may partly explain region-specific differences in the clinical spectrum of toxoplasmosis., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

We investigated 32 families of persons with acute toxoplasmosis in which > or = 1 other family member was tested for Toxoplasma gondii infection; 18 (56%) families had > or = 1 additional family member with acute infection. Family members of persons with acute toxoplasmosis should be screened for infection, especially pregnant women and immunocompromised persons.