Toxoplasmosis - Cat Scratch Disease

by Dr. Y.L.M

My friend loves to eat sushi and sashimi. In fact, every time we go out for a meal, he always likes to go to a Japanese restaurant. Recently, he called me and said he contracted toxoplasmosis. I thought that was a disease brought on by cats?

Toxoplasmosis is a type of infection that is caused by a protozoa type of parasite called Toxoplasma gondii. It is also known as 'cat scratch disease'. Cats are the primary host of this parasite.

It is true that toxoplasmosis is most commonly associated with cats and contact with their faeces, but you can also acquire it with raw meat or undercooked meat.

Is it very common? Now I'm worried because not only do I love to eat sashimi, I have 3 cats in my house!

Toxoplasmosis is far more common that most people think. In fact, it is estimated that 5.2 million people in Malaysia are seroprevalent!

In the US, the CDC estimates that more than 60 million people carry the parasite! And in Europe, it is estimated that some countries have 90% of their populations as carriers.

If it is so common, then why don't more people know about this?

This is because very few people have symptoms. 80 to 90% of people who are seropositive for toxoplasma are completely unaware and display no symptoms.

They may carry the parasite around, but it rarely causes disease because our body's immune system keeps the parasite at bay.

Why do some people get toxoplasmosis then and not others?

You are more at risk to get toxoplasmosis if :

* You have contact with cats. Having a cat on its own is not a problem, but if you do not maintain high standards of hygiene when it comes to keeping cats, you are more at risk. Example, if you touch the cat's faeces during cleaning of its litter box and thereafter, you touch your hands to your mouth before washing up.

* If you like eating raw or partially cooked meat. Yes, Japanese raw food like sashimi or sushi is included. However, raw fish is not as risky as raw pork, raw lamb, or raw venison in transferring the toxoplasma parasite.

* If you prepare raw food and do not eat it yourself (such as preparing a meal for your pets), but touch your mouth before washing up.

* You may also acquire the toxoplasma parasite after an organ transplant or blood transfusion, though this is rare.

* A pregnant woman who has toxoplasmosis has a 40% chance of transmitting it to her baby. This has very dire consequences for the baby.

How will I know I have toxoplasmosis?

Most people who get toxoplasmosis are unaware they have the disease. But symptoms include flu-like symptoms such as mild fever, body aches, lethargy, headache, and also swollen lymph nodes that appear on both sides of your body (symmetrical).

This can last from several days to weeks. If your immune system is healthy and intact, there should be no problem and you will recover quickly. Once you get toxoplasmosis, you are immune to it for life if your immune system continues to be healthy.

People with a compromised immune system however are at severe risk. Your immune system can be compromised if you have AIDS, or are on chemotherapy or immuno-suppressive drugs (such as those patients who have had an organ transplant). Those with a compromised immune system can get toxoplasmosis again and again. Toxoplasmosis can then invade the eye (ocular toxoplasmosis), brain, lungs, and heart and severely damage the tissues.

Ocular toxoplasmosis is particularly dangerous because the toxoplasma cysts then become invasive, and cause the retina of your eye to be damaged, thus causing varying degrees of blindness.

Do babies who get toxoplasmosis from their mothers die?

It's possible, because the immune system of a foetus is not fully mature until after birth. But most infants do not get any symptoms after birth. A certain percentage do however, and the infants can have convulsions, cerebral palsy and spasticity, deafness, mental retardation and blindness.

The infant may also have a small head (microcephaly) or an abnormally large head due to increased fluid accumulation (hydrocephalus).

Is it treatable? Should I get rid of my cat?

Pyrimethamine plus sulphadiazine are used to treat toxoplasmosis. Clindamycin or azithromycin can also be used.

Of course you can keep your cat if you are a healthy person! But if you are immuno-compromised, then you should help prevent your cats from getting toxoplasmosis by feeding them dry or canned food only and keeping them indoors. Wear gloves when you change their litter box.

More info on TOXOPLASMOSIS here.

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