Toxoplasmosis 73592 223016178 2008-07-02T05:12:14Z SJP 2716074 Reverted edits by [[Special:Contributions/24.220.214.190|24.220.214.190]] to last version by Trugster (using [[WP:HG|Huggle]]) {{DiseaseDisorder infobox | Name = Toxoplasmosis | Image = Toxoplasma gondii tachy.jpg | Caption = ''T. gondii'' [[tachyzoite]]s | DiseasesDB = 13208 | ICD10 = {{ICD10|B|58||b|50}} | ICD9 = {{ICD9|130}} | ICDO = | OMIM = | MedlinePlus = 000637 | eMedicineSubj = med | eMedicineTopic = 2294 | }} '''Toxoplasmosis''' is a [[parasitic disease]] caused by the [[protozoan]] ''[[Toxoplasma gondii]]''.<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = pp. 723&ndash;7 |publisher = McGraw Hill | year = 2004 | id = ISBN 0838585299 }}</ref> The parasite infects most [[warm-blooded]] animals, including humans, but the primary host is the [[Felidae|felid (cat) family]]. Animals are infected by eating infected meat, by ingestion of [[faeces]] of a [[cat]] that has itself recently been infected, or by transmission from mother to fetus. Cats have been shown as a major reservoir of this [[infection]].<ref name=Torda_2001>{{cite journal |author=Torda A |title=Toxoplasmosis. Are cats really the source? |journal=Aust Fam Physician |volume=30 |issue=8 |pages=743–7 |year=2001 |pmid=11681144}}</ref> Up to one third of the world's population is estimated to carry a Toxoplasma infection.<ref name=Montoya_2004>{{cite journal |author=Montoya J, Liesenfeld O |title=Toxoplasmosis |journal=Lancet |volume=363 |issue=9425 |pages=1965–76 |year=2004 |pmid=15194258 | doi = 10.1016/S0140-6736(04)16412-X}}</ref> The [[Centers for Disease Control and Prevention]] notes that overall [[seroprevalence]] in the United States as determined with specimens collected by the National Health and Nutritional Assessment Survey (NHANES) between 1999 and 2004 was found to be 10.8%, with seroprevalence among women of childbearing age (15 to 44 years) of 11%.<ref name=Jones_2007>{{cite journal |author=Jones JL, Kruszon-Moran D, Sanders-Lewis K, Wilson M |title=''Toxoplasma gondii'' infection in the United States, 1999-2004, decline from the prior decade |journal=Am J Trop Med Hyg |volume=77 |issue=3 |pages=405–10 |year=2007 |pmid=17827351}}</ref> During the first few weeks, the infection typically causes a mild [[flu]]-like illness or no illness. After the first few weeks of infection have passed, the parasite rarely causes any symptoms in otherwise healthy adults. However, people with a weakened [[immune system]], such as those infected with [[HIV]], and [[fetuses]], may become seriously ill, and it can occasionally be fatal. The parasite can cause [[encephalitis]] (inflammation of the brain) and [[neurologic disease]]s and can affect the [[heart]], [[liver]], and [[eye]]s ([[chorioretinitis]]). == History == The protozoan was first discovered by Nicolle & Manceaux, who in 1908 [[isolated]] it from the African rodent ''[[Gundi|Ctenodactylus gundi]]'', then in 1909 [[differentiated]] the disease from ''[[Leishmania]]'' and named it ''Toxoplasmosis gondii'' <ref name=Sukthana_2006>{{cite journal |author=Sukthana Y |title=Toxoplasmosis: beyond animals to humans |journal=TRENDS in Parisitology |volume=22 |issue=3 |pages=137 |year=2006 |doi=10.1016/j.pt.2006.01.007}}</ref>[http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6W7G-4J55654-3-3&_cdi=6626&_user=427455&_orig=search&_coverDate=03%2F31%2F2006&_sk=999779996&view=c&wchp=dGLbVzb-zSkzS&md5=10087511e28d0e025255efed0d310bdf&ie=/sdarticle.pdf]. The first recorded [[congenital]] case was not until 1923, and the first adult case not until 1940<ref name=Sukthana_2006/>. In 1948, a [[serological]] dye test was created by Sabin & Feldman, which is now the standard basis for diagnostic tests.<ref>[http://www.pamf.org/serology/clinicianguide.html#toxosero Toxoplasma Serology Laboratory: Laboratory Tests For The Diagnosis Of Toxoplasmosis A Guide For Clinicians<!-- Bot generated title -->]</ref> == Transmission == [[Image:Toxoplasmosis LifeCycle.jpg|right|thumb|210px|Life cycle of ''Toxoplasma gondii''.]]Transmission may occur through: * Ingestion of raw or partly cooked meat, especially pork, lamb, or venison containing Toxoplasma cysts. Infection prevalence in countries where undercooked meat is traditionally eaten, such as [[France]], has been related to this transmission method. Oocysts may also be ingested during hand-to-mouth contact after handling undercooked meat, or from using knives, utensils, or cutting boards contaminated by raw meat.<ref name=CDC>{{cite web | url=http://www.dpd.cdc.gov/DPDx/HTML/Toxoplasmosis.htm | title=Toxoplasmosis | publisher=Centers of Disease Control and Prevention | date=2004-11-22 }}</ref> * Ingestion of contaminated cat faeces. This can occur through hand-to-mouth contact following gardening, cleaning a cat's [[litter box]], contact with children's sandpits, or touching anything that has come into contact with cat faeces. * Drinking water contaminated with Toxoplasma. * Transplacental infection [[Uterus|in utero]]. * Receiving an infected [[organ transplant]] or [[blood transfusion]], although this is extremely rare.<ref name=CDC /> The cyst form of the parasite is extremely hardy, capable of surviving exposure to freezing down to −12 degrees Celsius (10 degrees Fahrenheit), moderate temperatures and chemical disinfectants such as bleach, and can survive in the environment for over a year. It is, however, susceptible to high temperatures&mdash;above 66 degrees Celsius (150 degrees Fahrenheit), and is thus killed by thorough cooking, and would be killed by 24 hours in a typical domestic freezer.<ref>[http://www.ncagr.com/vet/ToxoplasmosisTxt.htm North Carolina Department of Agriculture & Consumer Services<!-- Bot generated title -->]</ref> Cats excrete the pathogen in their faeces for a number of weeks after contracting the disease, generally by eating an infected rodent. Even then, cat faeces are not generally contagious for the first day or two after excretion, after which the cyst 'ripens' and becomes potentially pathogenic. Studies have shown that only about 2% of cats are shedding oocysts at any one time, and that oocyst shedding does not recur even after repeated exposure to the parasite. Although the pathogen has been detected on the fur of cats, it has not been found in an infectious form, and direct infection from handling cats is generally believed to be very rare. === Pregnancy precautions === [[Congenital]] toxoplasmosis is a special form in which an unborn child is infected via the [[placenta]]. A positive antibody [[titer]] indicates previous exposure and immunity and largely ensures the unborn baby's safety. A simple blood draw at the first pre-natal doctor visit can determine whether or not the woman has had previous exposure and therefore whether or not she is at risk. If a woman receives her first exposure to toxoplasmosis while pregnant, the baby is at particular risk. A woman with no previous exposure should avoid handling raw meat, exposure to cat feces, and gardening (cat feces are common in garden soil). Most cats are not actively shedding [[oocyst]]s and so are not a danger, but the risk may be reduced further by having the litterbox emptied daily (oocysts require longer than a single day to become infective), and by having someone else empty the litterbox. However, while risks can be minimized, they cannot be eliminated. For pregnant women with negative antibody titer, indicating no previous exposure to T. gondii, as frequent as monthly serology testing is advisable as treatment during pregnancy for those women exposed to T. gondii for the first time decreases dramatically the risk of passing the parasite to the fetus. Despite these risks, pregnant women are not routinely screened for toxoplasmosis in most countries ([[France]]<ref name=Sukthana_2006/>, [[Austria]]<ref name=Sukthana_2006/> and [[Italy]]<ref name=Paschale_2008>[http://www.blackwell-synergy.com/doi/abs/10.1111/j.1469-0691.2007.01883.x De Paschale ''et al.'' (2008) Seroprevalence and incidence of Toxoplasma gondii infection in the Legnano area of Italy ''Clinical Microbiology and Infection'' '''14''' (2), 186–189]</ref> being the exceptions) for reasons of cost-effectiveness and the high number of [[false positives]] generated as the disease is so rare (an example of [[Bayesian statistics]]). As invasive [[prenatal]] testing incurs some risk to the [[fetus]] (18.5 pregnancy losses per toxoplasmosis case prevented<ref name=Sukthana_2006/>), [[postnatal]] or [[neonatal]] screening is preferred. The exceptions are cases where [[foetal]] abnormalities are noted, and thus screening can be targeted.<ref name=Sukthana_2006/> Some regional screening programmes operate in [[Germany]], [[Switzerland]] and [[Belgium]].<ref name=Paschale_2008/> Treatment is very important for recently infected [[pregnancy|pregnant]] women, to prevent infection of the fetus. Since a baby's immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the body are very difficult to eradicate with anti-protozoans, an infection can be very serious in the young. [[Transplacental]] transmission:(a) infection in 1st trimester - incidence of transplacental infection is low (15%) but disease in neonate is most severe. (b) infection in 3rd trimester - incidence of transplacental infection is high (65%) but infant is usually asymptomatic at birth.{{Fact|date=January 2008}} == Clinical manifestations == Infection has two stages: === Acute toxoplasmosis === During [[Acute (medical)|acute]] toxoplasmosis, symptoms are often [[influenza]]-like: swollen [[lymph node]]s, or muscle aches and pains that last for a month or more. Rarely, a patient with a fully functioning [[immune system]] may develop eye damage from toxoplasmosis. Young children and [[Immunodeficiency|immunocompromised]] patients, such as those with HIV/AIDS, those taking certain types of [[chemotherapy]], or those who have recently received an [[organ transplant]], may develop severe toxoplasmosis. This can cause damage to the brain or the eyes. Only a small percentage of infected newborn babies have serious eye or brain damage at birth. === Latent toxoplasmosis === Most patients who become infected with ''[[Toxoplasma gondii]]'' and develop toxoplasmosis do not know it. In most immunocompetent patients, the infection enters a latent phase, during which only [[bradyzoite]]s are present, forming [[cyst]]s in [[nervous tissue|nervous]] and [[muscle]] tissue. Most infants who are infected while in the womb have no symptoms at birth but may develop symptoms later in life.[http://www.futurepundit.com/archives/001675.html] === Treatment === Treatment is often only recommended for people with serious health problems, because the disease is most serious when one's immune system is weak. Medications that are prescribed for acute Toxoplasmosis are: * [[Pyrimethamine]] &mdash; an [[antimalarial medication]]. * [[Sulfadiazine]] &mdash; an [[antibiotic]] used in combination with pyrimethamine to treat toxoplasmosis. * [[clindamycin]] &mdash; an antibiotic. This is used most often for people with HIV/AIDS. * [[spiramycin]] &mdash; another antibiotic. This is used most often for pregnant women to prevent the infection of their child. (Other antibiotics such as [[minocycline]] have seen some use as a salvage therapy). In people with latent toxoplasmosis, the cysts are immune to these treatments, as the antibiotics do not reach the [[bradyzoite|bradyzoites]] in sufficient concentration. Medications that are prescribed for latent Toxoplasmosis are: * [[atovaquone]] &mdash; an antibiotic that has been used to kill Toxoplasma cysts inside [[AIDS]] patients. <ref> {{cite web | title=Toxoplasmosis - treatment key research | url=http://www.aidsmap.com/en/docs/659BAD5D-332A-4F8D-9F93-8D0F470B2D32.asp | date=2005-11-02 | publisher=NAM & aidsmap}} </ref> * [[clindamycin]] &mdash; an antibiotic which, in combination with atovaquone, seemed to optimally kill cysts in mice.<ref> {{cite journal | author = Djurković-Djaković O, Milenković V, Nikolić A, Bobić B, Grujić J | title = Efficacy of atovaquone combined with clindamycin against murine infection with a cystogenic (Me49) strain of Toxoplasma gondii. | journal = J Antimicrob Chemother | volume = 50 | issue = 6 | pages = 981–7 | year = 2002 | pmid = 12461021 | doi = 10.1093/jac/dkf251 | url=http://jac.oxfordjournals.org/cgi/reprint/50/6/981.pdf | format=PDF}} </ref> However, in latent infections successful treatment is not guaranteed, and some subspecies exhibit resistance. == Biological modifications of the host == The parasite itself can cause various effects on the host body, some of which are not fully understood. === Reproductive changes === A recent study <ref>Jaroslav Flegr. Women infected with parasite ''Toxoplasma'' have more sons, Naturwissenschaften, August 2006. [http://www.natur.cuni.cz/~flegr/pdf/toxosons.pdf full text]</ref> has indicated Toxoplasmosis correlates strongly with an increase in boy births in humans. According to the researchers, ''depending on the antibody concentration, the probability of the birth of a boy can increase up to a value of 0.72 ... which means that for every 260 boys born, 100 girls are born.'' The study also notes a mean rate of 0.60 to 0.65 (as opposed to the normal 0.51) for Toxoplasma positive mothers. === Behavioral changes === It has been found that the parasite has the ability to change the behavior of its host: infected [[rat]]s and mice are less fearful of cats &mdash; in fact, some of the infected rats seek out cat-urine-marked areas. This effect is advantageous to the parasite, which will be able to sexually reproduce if its host is eaten by a cat.<ref>Berdoy M, Webster J, Macdonald D (2000). Fatal Attraction in Rats Infected with Toxoplasma gondii. ''Proceedings of the Royal Society of London, B267:1591-1594''. PMID 11007336</ref> The mechanism for this change is not completely understood, but there is evidence that toxoplasmosis infection raises [[dopamine]] levels and concentrates in the [[amygdala]] in infected mice. The findings of behavioral alteration in rats and mice have led some scientists to speculate that toxoplasma may have similar effects in humans, even in the latent phase that had previously been considered [[asymptomatic]]. Toxoplasma is one of a number of parasites that may alter their host's behaviour as a part of their life cycle.<ref name="dailym">{{cite news | title='Cat Box Disease' May Change Human Personality And Lower IQ | publisher=The Daily Telegraph | date=April 8, 2000 }}</ref> The behaviors observed, if caused by the parasite, are likely due to infection and low-grade [[encephalitis]], which is marked by the presence of cysts in the [[brain]], which may produce or induce production of a neurotransmitter, possibly dopamine,<ref name="incrisk1">{{cite journal | author = Flegr J, Havlíček J, Kodym P, Malý M, Šmahel Z | title = Increased risk of traffic accidents in subjects with latent toxoplasmosis: a retrospective case-control study. | journal = BMC Infect Dis | volume = 2 | issue = | pages = 11 | year =2002 | pmid = 12095427 | doi= 10.1186/1471-2334-2-11 }}</ref> therefore acting similarly to [[dopamine reuptake inhibitor]] type [[antidepressants]] and [[stimulants]]. <blockquote> "In populations where this parasite is very common, mass personality modification could result in cultural change. [Variations in the prevalence of ''Toxoplasma gondii''] may explain a substantial proportion of human population differences we see in cultural aspects that relate to ego, money, material possessions, work and rules." &mdash; Kevin Lafferty<ref name="Kevin Lafferty press release"> Kevin Lafferty [http://newswire.ascribe.org/cgi-bin/behold.pl?ascribeid=20060803.110303&time=11%2035%20PDT&year=2006&public=0] </ref> </blockquote> Correlations have been found between latent ''Toxoplasma'' infections and various characteristics:<ref name="Zimmer1Aug2006">Carl Zimmer, The Loom. [http://scienceblogs.com/loom/2006/08/01/a_nation_of_cowards_blame_the.php ''A Nation of Neurotics? Blame the Puppet Masters?''], 1 Aug. 2006 </ref> * Decreased novelty-seeking behaviour<ref name="Flegr2007">{{cite journal | author =Jaroslav Flegr | title = Effects of Toxoplasma on Human Behaviour | journal = [[Schizophrenia Bulletin]] | volume = 33 | issue = 3 | pages = 757–760 | year = 2007 | month = Jan | id = | doi = 10.1093/schbul/sbl074 | pmid = 17218612 }}</ref> * Slower reactions * Lower rule-consciousness and jealousy (in men)<ref name="Flegr2007">{{cite journal | author = Jaroslav Flegr | title = Effects of Toxoplasma on Human Behaviour | journal = [[Schizophrenia Bulletin]] | volume = 33 | issue = 3 | pages = 757–760 | year = 2007 | month = Jan | id = | doi = 10.1093/schbul/sbl074 | pmid = 17218612 }}</ref> * More warmth and conscientiousness (in women)<ref name="Flegr2007">{{cite journal | author = Jaroslav Flegr | title = Effects of Toxoplasma on Human Behaviour | journal = [[Schizophrenia Bulletin]] | volume = 33 | issue = 3 | pages = 757–760 | year = 2007 | month = Jan | id = | doi = 10.1093/schbul/sbl074 | pmid = 17218612 }}</ref> The evidence for behavioral effects on humans is relatively weak. There have been no [[randomized controlled trial|randomized clinical trials]] studying the effects of toxoplasma on human behavior. Although some researchers have found potentially important associations with toxoplasma, it is possible that these associations merely reflect factors that predispose certain types of people to infection (e.g., people who exhibit risk-taking behaviors may be more likely to take the risk of eating undercooked meat). Studies have found that toxoplasmosis is associated with an increased car accident rate, roughly doubling or tripling the chance of an accident relative to uninfected people.<ref name="incrisk1"/><ref name="incrisk4">{{cite journal | author =Yereli K, Balcioglu IC, Ozbilgin A. | title = Is Toxoplasma gondii a potential risk for traffic accidents in Turkey? | journal = Forensic Sci Int | volume = | issue = | pages = | year =2005 | month=Dec 2 | pmid = 16332418 }}</ref> This may be due to the slowed reaction times that are associated with infection.<ref name="incrisk4"/> "If our data are true then about a million people a year die just because they are infected with toxoplasma," the researcher Jaroslav Flegr told ''The Guardian''.<ref name="guar1">{{cite news | title=Can a parasite carried by cats change your personality? | publisher=The Guardian | date=September 25, 2003 | url=http://www.guardian.co.uk/life/thisweek/story/0,12977,1048642,00.html }}</ref> The data shows that the risk decreases with time after infection, but is not due to age.<ref name="incrisk1"/> Ruth Gilbert, medical coordinator of the European Multicentre Study on Congenital Toxoplasmosis, told ''BBC News Online'' these findings could be due to chance, or due to social and cultural factors associated with toxoplasma infection.<ref name="bbcgilb">{{cite news | title=Dirt infection link to car crashes | publisher=BBC News | date=August 10, 2002 | url=http://news.bbc.co.uk/1/hi/health/2176548.stm }}</ref>However there is also evidence of a delayed effect which increases reaction times.<ref>J. Havlícek, Z. Gašová, A. P. Smith, K. Zvára and J. Flegr, [http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=82691 Decrease of psychomotor performance in subjects with latent ‘asymptomatic’ toxoplasmosis], Parasitology (2001), 122: 515-520</ref> Other studies suggest that the parasite may influence personality. There are claims of toxoplasma causing antisocial attitudes in men and promiscuity<ref name="timescats">{{cite news | title=Dangerrrr: cats could alter your personality | publisher=Times Online | date=June 23, 2005 | url=http://www.libertypost.org/cgi-bin/readart.cgi?ArtNum=99546 }}</ref> (or even "signs of higher intelligence"<ref name="guar2">{{cite news | title=Can a parasite carried by cats change your personality? | publisher=The Guardian | date=September 25, 2003 | url=http://www.guardian.co.uk/life/thisweek/story/0,12977,1048642,00.html }}</ref> ) in women, and greater susceptibility to [[schizophrenia]] and [[manic depression]] in all infected persons.<ref name="timescats" /> A 2004 study found that toxoplasma "probably induce[s] a decrease of novelty seeking." <ref name="bmc">{{cite journal | author = Novotná M, Hanusova J, Klose J, Preiss M, Havlicek J, Roubalová K, Flegr J | title = Probable neuroimmunological link between Toxoplasma and cytomegalovirus infections and personality changes in the human host. | journal = BMC Infect Dis | volume = 5 | issue = | pages = 54 | year =2004 | month=Jul 6 | pmid = 16000166 | doi= 10.1186/1471-2334-5-54 }}</ref> According to Sydney University of Technology infectious disease researcher Nicky Boulter in an article that appeared in the January/February 2007 edition of Australasian Science magazine, Toxoplasma infections lead to changes depending on the sex of the infected person. <ref name="SMH Parasite article"> AAP, SMH [http://www.smh.com.au/news/national/parasite-makes-men-dumb-women-sexy/2006/12/26/1166895290973.html ''Parasite makes men dumb, women sexy''], 26 Dec. 2006 </ref> The study suggests that male carriers have lower IQs, a tendency to achieve a lower level of education and have shorter [[attention span]]s, a greater likelihood of breaking rules and taking risks, and are more independent, anti-social, suspicious, jealous and morose. It also suggests that these men are deemed less attractive to women. Women carriers are suggested to be more outgoing, friendly, more promiscuous, and are considered more attractive to men compared with non-infected controls. The results are shown to be true when tested on mice, though it is still inconclusive. ==== Toxoplasma's role in schizophrenia ==== The possibility that toxoplasmosis is one cause of schizophrenia has been studied by scientists since at least 1953. <ref name="pmid14725265">{{cite journal |author=Torrey EF, Yolken RH |title=Toxoplasma gondii and schizophrenia |journal=Emerging Infect. Dis. |volume=9 |issue=11 |pages=1375–80 |year=2003 |pmid=14725265 |doi=}}[http://www.cdc.gov/ncidod/EID/vol9no11/03-0143.htm free full text] </ref> These studies had attracted little attention from U.S. researchers until they were publicized through the work of prominent psychiatrist and advocate [[E. Fuller Torrey]]. In 2003, Torrey published a review of this literature, reporting that almost all the studies had found that schizophrenics have elevated rates of toxoplasma infection.<ref name="pmid14725265"/> A 2006 paper has even suggested that prevalence of toxoplasmosis has large-scale effects on national culture. <ref name="Lafferty">{{cite journal | journal=Proceedings of the Royal Society B: Biological Sciences | id=ISSN 0962-8452 (Paper) 1471-2954 (Online) | issue=FirstCite Early Online Publishing | doi=10.1098/rspb.2006.3641 | title=Can the common brain parasite, Toxoplasma gondii, influence human culture? | first=Kevin D. | last= Lafferty | year=2006 | url=http://www.journals.royalsoc.ac.uk/(dm021s45towy3pzbec3vjfez)/app/home/contribution.asp?referrer=parent&backto=issue,9,15;journal,8,316;linkingpublicationresults,1:102024,1 | volume = 273 | pages = 2749 }}</ref> These types of studies are suggestive but cannot confirm a causal relationship (because of the possibility, for example, that schizophrenia increases the likelihood of toxoplasma infection rather than the other way around).<ref name="pmid14725265"/> * Acute ''Toxoplasma'' infection sometimes leads to psychotic symptoms not unlike schizophrenia. * Some anti-psychotic medications that are used to treat schizophrenia, such as [[Haloperidol]], also stop the growth of ''Toxoplasma'' in cell cultures. * Several studies have found significantly higher levels of ''Toxoplasma'' antibodies in schizophrenia patients compared to the general population.<ref name=Wang_2006>{{cite journal |author=Wang H, Wang G, Li Q, Shu C, Jiang M, Guo Y |title=Prevalence of Toxoplasma infection in first-episode schizophrenia and comparison between Toxoplasma-seropositive and Toxoplasma-seronegative schizophrenia |journal=[[Acta Psychiatrica Scandinavica]] |volume=114 |issue=1 |pages=40–8 |year=2006 |doi= 10.1111/j.1600-0447.2006.00780.x |pmid=16774660}}</ref> * ''Toxoplasma'' infection causes damage to [[astrocyte]]s in the brain, and such damage is also seen in schizophrenia {{Fact|date=March 2008}}. == Human prevalence == The U.S. NHANES (1999-2004) national probability sample found that 10.8% of U.S. persons 6-49 years of age, and 11.0% of women 15-44 years of age, had Toxoplasma-specific [[IgG]] antibodies, indicating that they had been infected with the organism. <ref name=Jones_2007>{{cite journal |author=Jones JL, Kruszon-Moran D, Sanders-Lewis K, Wilson M |title=''Toxoplasma gondii'' infection in the United States, decline from the prior decade |journal=Am J Trop Med Hyg |volume=77 |issue=3 |pages=405–410 |year=2007 |pmid=17827351}}</ref> This prevalence has significantly decreased from the NHANES III (1988-1994). <ref name=Jones_2001>{{cite journal |author=Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB |title=''Toxoplasma gondii'' infection in the United States: seroprevalence and risk factors |journal=Am J Epidemiol |volume=154 |issue=4 |pages=357–65 |year=2001 |pmid=11495859 | doi = 10.1093/aje/154.4.357}}</ref> <ref name=Jones_2004>{{cite journal |author=Jones J, Kruszon-Moran D, Wilson M |title=Toxoplasma gondii infection in the United States, 1999-2000 |journal=Emerg Infect Dis |volume=9 |issue=11 |pages=1371–4 |year=2003 |url=http://www.cdc.gov/ncidod/EID/vol9no11/03-0098.htm |pmid=14718078}}</ref> It is estimated that between 30% and 65% of all people worldwide are infected with Toxoplasmosis. However, there is large variation countries: in France, for example, around 88% of the population are carriers, probably due to a high consumption of raw and lightly cooked meat. <ref>David Adam, Guardian Unlimited. [http://www.guardian.co.uk/life/thisweek/story/0,12977,1048642,00.html ''Can a parasite carried by cats change your personality?''], 25 Sep. 2003 </ref> Germany, the Netherlands and Brazil also have high prevalences of around 80%, over 80% <ref>Toxoplasmosis in the Netherlands by the Laboratory for Diagnoses for Infectious Diseases and Screening; RIVM Bilthoven [http://www.nvkc.nl/tijdschrift/content/1999/nr%201/p65/1999-1-p65.pdf]</ref> and 67% respectively. In Britain, about 22% are carriers, and South Korea's rate is only 4.3%.<ref name="Zimmer1Aug2006" /> Two risk factors for contracting toxoplasmosis are: * Infants born to mothers who became infected with ''Toxoplasma'' for the first time during or just before pregnancy. * Persons with severely weakened immune systems, such as those with AIDS. Illness may result from an acute Toxoplasma infection or reactivation of an infection that occurred earlier in life. == Animal prevalence == A [[University of California, Davis]] study of dead [[sea otter]]s collected from 1998 to 2004 found that toxoplasmosis was the cause of death for 13% of the animals.<ref name=Conrad_2005>{{cite journal |author=Conrad P, Miller M, Kreuder C, James E, Mazet J, Dabritz H, Jessup D, Gulland F, Grigg M |title=Transmission of Toxoplasma: clues from the study of sea otters as sentinels of ''Toxoplasma gondii'' flow into the marine environment |journal=Int J Parasitol |volume=35 |issue=11-12 |pages=1155–68 |year=2005 |pmid=16157341 | doi = 10.1016/j.ijpara.2005.07.002}}</ref> Proximity to freshwater outflows into the ocean were a major risk factor. Ingestion of [[oocysts]] from cat faeces is considered to be the most likely ultimate source.<ref name="npr1">{{cite web | title=Treating Disease in the Developing World. | work=Talk of the Nation Science Friday | date=December 16, 2005 | publisher=National Public Radio | url = http://www.npr.org/templates/story/story.php?storyId=5058325 17:30-22:00}}</ref> According to an article in the ''[[New Scientist]]'', the parasites have also been found in dolphins and whales. Researchers Black and Massie believe that anchovies, which travel from estuaries into the open ocean, may be helping to spread the disease. Michael Grigg of the US National Institute of Health mentioned that a new type of ''T. gondii'', type X, has been found which is responsible for the large deaths of sea otters, and may be "poised to sweep the world".<ref>Brahic, Catherine. (2008). [http://www.newscientist.com/channel/life/dn14037-the-worlds-most-successful-bug-hits-dolphins.html The world's most successful bug hits dolphins.]</ref> ==Notable people with toxoplasmosis == * [[Sebastian Coe]] (British middle distance runner) * [[Martina Navrátilová]] (tennis player) retired from a competition in 1982 with symptoms of a mystery 'virus' that were later found to be due to toxoplasmosis<ref>[http://www.parsa.ac.za/parasite.htm Parasite of the month<!-- Bot generated title -->]</ref> * [[Arthur Ashe]] developed neurological problems from toxoplasmosis (and was later found to be HIV-positive)<ref>[http://www.aegis.com/news/ads/1993/ad930239.html Arthur Ashe, Tennis Star, is Dead at 49<!-- Bot generated title -->]</ref> * [[Leslie Ash]] contracted toxoplasmosis in the second month of pregnancy<ref>[http://news.bbc.co.uk/1/hi/health/1109818.stm BBC News | HEALTH | Pregnancy superfoods revealed<!-- Bot generated title -->]</ref> * [[François, comte de Clermont]], Dauphin of France and [[House of Orléans|Orléans]] pretender to the French throne. Both he and his younger sister, Princess Blanche, are mentally disabled due to congenital toxoplasmosis.{{Fact|date=December 2007}} * [[Louis Wain]] was a prominent cat artist who later developed schizophrenia, which some believe was due to toxoplasmosis resulting from his prolonged exposure to cats.<ref>{{cite web | url=http://www.k-state.edu/parasitology/classes/625protozoa33.html | title=Topic 33. Coccidia and Cryptosporidium spp. | work=Biology 625: Animal Parasitology | accessdate=2006-10-14 | date=October 24, 2005 | publisher=[[Kent State]] Parasitology Lab }} Includes a list of famous victims. </ref> == References == <!-- --------------------------------------------------------------- See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a discussion of different citation methods and how to generate footnotes using the <ref> & </ref> tags and the {{Reflist}} template -------------------------------------------------------------------- --> {{Reflist|2}} <!-- [http://www.forumplanet.com/gamespy/topic.asp?fid=2726&tid=1654270] --> == External links == * Parts of this article are taken from the public domain [http://www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/factsht_toxoplasmosis.htm CDC factsheet: Toxoplasmosis] {{Protozoal diseases}} {{Cat nav}} [[Category:Cat diseases]] [[Category:Apicomplexa]] [[Category:Parasitic diseases]] [[Category:Zoonoses]] {{Link FA|fr}} [[ar:مقوسات]] [[cs:Toxoplazmóza]] [[de:Toxoplasmose]] [[el:Τοξοπλάσμωση]] [[es:Toxoplasmosis]] [[fr:Toxoplasmose]] [[hr:Toksoplazmoza]] [[id:Toksoplasmosis]] [[it:Toxoplasmosi]] [[he:טוקסופלזמוזיס]] [[hu:Toxoplazmózis]] [[ms:Toxoplasmosis]] [[nl:Toxoplasmose]] [[ja:トキソプラズマ症]] [[no:Toksoplasmose]] [[pl:Toksoplazmoza]] [[pt:Toxoplasmose]] [[ru:Токсоплазмоз]] [[sk:Toxoplazmóza]] [[fi:Toksoplasmoosi]]