From the Guidelines
Toxoplasmosis is a significant risk for pregnant women and immunocompromised individuals, and prevention measures should be taken seriously to avoid infection. This parasitic infection, caused by Toxoplasma gondii, can be transmitted through contact with cat feces, particularly when cleaning litter boxes 1. Pregnant women should avoid changing cat litter entirely if possible, as infection during pregnancy can lead to congenital toxoplasmosis in the fetus, potentially causing severe birth defects, brain damage, or vision problems.
Key Prevention Measures
- Having someone else clean the litter box daily (the parasite takes 1-5 days to become infectious)
- Wearing gloves if you must clean it yourself
- Washing hands thoroughly afterward
- Keeping cats indoors
- Not feeding them raw meat
- Avoiding gardening without gloves in areas where cats may defecate
- Thoroughly washing fruits and vegetables
- Cooking meat to safe temperatures as toxoplasmosis can also be contracted through contaminated soil and undercooked meat 1. Some key points to consider for prevention include:
- Meat should be cooked up to at least 63 C (145 F) for whole cut meat (excluding poultry), up to at least 71 C (160 F) for ground meat (excluding poultry), and up to at least 74 C (165 F) for all poultry (whole cuts and ground) 1
- Meat should be frozen at –20 C (–4F) for at least 48 hours 1
- Contact with mucous membranes should be avoided when handling raw meat, and gloves should be worn when handling raw meat 1
- Kitchen surfaces and utensils should be thoroughly washed after contact with raw meat 1
- Drinking unpasteurized goat milk should be avoided, and eating raw oysters, clams, or mussels should be avoided 1
- Skinning or butchering animals without gloves should be avoided 1
- Untreated water, including that from wells, or water with potential contamination by feces from domestic or wild cats should be avoided 1 If infection is suspected, physicians typically prescribe pyrimethamine combined with sulfadiazine and leucovorin for treatment, with dosages adjusted based on individual factors and duration determined by clinical response. It is essential to note that prevention is key, and following these guidelines can significantly reduce the risk of toxoplasmosis in pregnant women and immunocompromised individuals 1.
From the FDA Drug Label
Women of childbearing potential who are taking pyrimethamine should be warned against becoming pregnant. Pyrimethamine has been shown to be teratogenic in rats when given in oral doses 2.5 times the human dose for treatment of toxoplasmosis. There are no adequate and well-controlled studies in pregnant women. Pyrimethamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus Concurrent administration of folinic acid is strongly recommended when used during pregnancy.
The drug pyrimethamine is used to treat toxoplasmosis.
- Pregnant women: Pyrimethamine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Immunocompromised individuals: The label does not provide specific warnings for immunocompromised individuals, but it does recommend concurrent administration of folinic acid when used for the treatment of toxoplasmosis in all patients 2. It is recommended to exercise caution when using pyrimethamine in pregnant women and potentially in immunocompromised individuals.
From the Research
Toxoplasmosis in Cats and its Impact on Pregnant Women and Immunocompromised Individuals
- Toxoplasmosis, caused by Toxoplasma gondii, is a protozoal zoonosis with high sanitary risk for pregnant women and immunocompromised people 3.
- Felids, including domestic cats, are the only definitive hosts of T. gondii, shedding oocysts that become infectious for a wide range of animals, including humans 3.
- A study found that 20.7% of domestic cats living in households with women of childbearing age were seropositive for anti-T. gondii antibodies, indicating a risk of infection for these women 3.
Risk of Toxoplasmosis Transmission to Pregnant Women
- The risk of mother-to-fetus transmission of T. gondii infection can be reduced with appropriate treatment, such as the combination of spiramycin and trimethoprim-sulfamethoxazole 4, 5.
- A study found that the combination of spiramycin and trimethoprim-sulfamethoxazole was more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to spiramycin alone 4.
- Another study found that the treatment based on spiramycin/cotrimoxazole had significant efficacy in reducing maternal-fetal transmission of T. gondii when compared with pyrimethamine/sulfonamide and particularly with spiramycin alone 5.
Treatment Options for Toxoplasmosis
- Various treatment options are available for toxoplasmosis, including spiramycin, azithromycin, traditional Chinese medicine, pyrimethamine-sulfadiazine, trimethoprim-sulfamethoxazole, and pyrimethamine-clindamycin 6, 7.
- A systematic review and meta-analysis found that the pooled negative conversion rate and cure rate for these treatment options were similar, with no statistical difference between them 7.
- Trimethoprim-sulfamethoxazole has been shown to be effective in treating toxoplasmosis, with good therapeutic results observed in patients with lymphoglandular toxoplasmosis 6.