| Toxoplasmosis (Toxo)
What is Toxo?
Toxo (Toxoplasmosis) is a disease caused by a parasite called toxoplasma
gondii. Toxo usually infects the brain, but can also infect other
areas of the body, particularly the eyes and lungs. Toxo causes
lesion in the brain that are very serious. There are good treatments
for toxo, but it is a very serious disease and must be treated quickly.
How do you catch Toxo?
About 50% of Americans are infected with the toxo parasite. In most
people, infection with the toxo parasite causes no harm because
it remains "asleep" inside their bodies. However, if a person is
infected with both toxo and HIV, then toxo can "wake up" or reactivate
and cause serious illness. People with HIV can develop toxo if they
(a) have been infected with the toxo parasite, and (b) have seriously
weakened immune systems. Most people who get toxo have fewer than
200 T-cells.
Most people get the toxo parasite by eating rare ("under-cooked")
meat. All meat should be cooked completely through (that is until
no pink is showing). Contact with cat litter may also transmit toxo.
If you have a cat, you should wash your hands thoroughly after cleaning
the litter box. You can also have your cat tested to see if it is
infected with toxo.
How can I find out if I have been infected with Toxo?
Your doctor can perform a blood test (a "Toxoplasma Antibody Test")
to see if you have been infected with the toxo parasite. If you
have been infected with the toxo parasite, this does not mean you
have active toxo disease. It does mean, however, that you could
develop active toxo disease in the future.
All people with HIV should have a toxo antibody test to determine
if they have been infected with the toxo parasite. It is best to
have this test when you are healthy and your T-cells are above 200.
Ask your doctor about this blood test.
What are the symptoms of Toxo?
Toxo can cause many different kinds of symptoms. Sometimes the symptoms
are so slight that you may overlook them at first. Symptoms include
one-sided weakness or numbness, difficulty walking and talking,
mood and personality changes, changes in vision (such as double
vision, increased sensitivity to light, or loss of vision altogether),
muscle spasms, seizures, and severe headaches that do not get better
with aspirin or Tylenol. These symptoms will get worse and progress
to paralysis, coma and death unless the infection is properly treated.
How can a doctor tell if I have Toxo?
Diagnosing toxo can sometimes be difficult. If you have signs or
symptoms of a brain infection, usually a doctor will do a scan of
your brain (called either a CT scan or MRI) or a brain biopsy. A
brain biopsy means inserting a needle into your skull, which can
be painful, but in most cases, is very safe. While the diagnosis
is being considered, the doctor will treat you with medications
for toxo.
Can Toxo be prevented?
Yes, many cases of toxo can now be prevented. Preventive medication
is recommended for anyone with less than 100 T-cells, who has tested
positive for the toxo parasite.
TMP/SMX (also called Bactrim or Septra), a preventive treatment
for PCP also prevents toxo most of the time. Many people have allergic
reactions to Bactrim, including rashes, itching, and nausea. However,
many doctors are now "desensitizing" patients to Bactrim by giving
small amounts of the drug and building up the amount over time.
This seems to help many people who thought that they could not take
Bactrim. Other drug alternatives include Dapsone (alone or in combination
with pyrimethamine also called Daraprim) and atovaquone (Mepron).
Ask your doctor about taking medication to prevent toxo and PCP.
If you are not infected with the toxo parasite, you can reduce
your risk of becoming infected by eating only well-cooked meats
and washing your hands frequently especially after changing cat
litter or doing garden work. There is no need to get rid of your
cat.
Can Toxo be treated?
Yes, toxo can be treated with a variety of drugs. However, the medicines
do not kill the toxo parasite, they only keep it under control.
Once you get toxo disease you must keep taking your medicine forever,
otherwise the disease will come back. Because toxo is so serious,
it usually requires at least two drugs. Your doctor will give you
drugs that are right for you:
Sulfadiazine and pyrimethamine used together are the most common
drugs for treating toxo. But sulfadiazine can cause serious allergic
reactions in many people, including rashes, itching and nausea.
If you cannot take sulfadiazine, your doctor will usually give you
clindamycin (Cleocin) instead. Clindamycin can cause diarrhea in
some people. Pyrimethamine can cause low white blood counts in some
people. To counter the possible side effects of pyrimethamine on
the bone marrow, another drug called Leucovorin (or folinic acid)
is given along with pyrimethamine.
Other drugs used less often to treat toxo include: azithromycin
(Zithromax), clarithromycin (Biaxin), and doxycycline (Vibramycin).
Ask your doctor about these treatments if standard treatments are
not working or are making you sick.
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