Resources for Clinicians

Pamphlets & Phone Numbers

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Useful Resources in the U.S.
Lab for PCR, Serology, Isolation
Toxoplasma Serology Laboratory
(part of the Palo Alto Medical Foundation)
Palo Alto, California
(650) 853-4828

For Treating Pregnant Women
Food and Drug Administration
obtaining Spiramycin

(301) 827-2335
(610) 454-8469
Food and Drug Administration
Public Health Advisory
(301) 594-3060
Support and Information
National Collaborative Congenital
Toxoplasmosis Treatment Group
University of Chicago
Chicago, Illinois
(773) 834-4131

Congenital Toxoplasmosis in Patients with AIDS
University of Miami
General Clinical Research Center

Dr. Gwendolyn Scott
(305) 243-6522
Useful Resources in Europe
Lab for Serology, Isolation, PCR
Institut de Puericulture et de Perinatalogie
Paris, France
(011) (33) 1-40-44-3941
Support and Information
The Toxoplasmosis Trust
(run by the baby charity Tommys)
London, UK
(011) (44) (087) 777-3060

Type of Infections and their Treatments

Infection of the Immunologically-Normal Older Child or Adult

Histopathology of Lymph Node

Often the infection goes unrecognized. Signs include enlarged lymph glands, fever, or, in rare cases, damage to the eye, brain, or other vital organs. Active infection is treated when there is damage to the vital organs. Further information is available in the following references.

* Beneson MW, ET Takafuji, SM Lemon, et al. Oocyst-Transmitted Toxoplasmosis Associated with Ingestion of Contaminated Water. New England Journal of Medicine. 307: 666-669, 1982.

* Desmonts G, J Couv reur, F Alison, et al. Étude Épidémiologique sur la Toxoplasmose: de L'influence de la Cuisson des Viandes de Boucherie sur la Fréquence de L’infection Humaine. Rev Fr Etud Clin Biol. 10: 952-958, 1965.

* Dorfman RF and JS Remington. Value of Lymph Node Biopsy in the Diagnosis of Acute Acquired Toxoplasmosis. New England Journal of Medicine. 289: 878-881, 1973.

* Greenlee JE, WD Johnson, JF Campa, et al. Adult Toxoplasmosis Presenting as Polymyositis and Cerebellar Ataxia. Annals of Internal Medicine. 82: 367-371, 1975.

* Kean BH, AC Kimball, and WN Christenson. An Epidemic of Acute Toxopasmosis. JAMA. 208: 1002-1004, 1969.

* Luft BJ, JS Remington. Acute Toxoplasma Infection Among Family Members of Patients with Acute Lymphadenopathic Toxoplasmosis. Archives of Internal Medicine. 144: 53-56, 1984.

* Montoya JG. Laboratory Diagnosis of Toxoplasma Gondii Infection and Toxoplasmosis. Journal of Infectious Diseases. 2002 Feb 15; 185 Suppl 1: S73-82.

* Montoya JG and JS Remington. Studies on the Serodiagnosis of Toxoplasmic Lymphadenitis. Clinical Infectious Diseases. 1995 Apr; 20 (4): 781-789.

* Remington JS and R McLeod. Toxoplasmosis. Infectious Diseases in Medicine and Surgery (3rd Edition). J Bartlett, S. Gorbach, N Blacklow (Eds). Lippincott Williams & Wilkins: Philadelphia, 2003.

* Teutsch SM, DD Juranek, A Sulzer, et al. Epidemic Toxoplasmosis Associated with Infected Cats. New England Journal of Medicine. 300: 695-699, 1979.

* Theologides A and BJ Kennedy. Toxoplasmic Myocarditis and Pericarditis (editorial). American Journal of Medicine. 47: 169- 174, 1969.

*Townsend JJ, JS Wolinsky, JR Baringer, and PC Johnson. Acquired Toxoplasmosis: A Neglected Cause of Treatable Nervous System Disease. Archives of Neurology. 32: 335-343, 1975.

Infection of the Pregnant Woman

Toxoplasmosis in the fetus
can be prevented and treated

Diagnosis, prevention of transmission, and treatment of the fetus in utero are very important. When a pregnant woman acquires the infection for the first time early in pregnancy, transmission to her fetus is uncommon; but when the parasite is transmitted at this time, the fetus often has substantial clinical disease. As pregnancy progresses, the likelihood of transmission increases and the severity of the disease at birth diminishes. Nonetheless, even if the infection is acquired by the mother very late in gestation and the baby appears normal, without detailed evaluation at birth, sequelae occurs later almost uniformly unless the baby is treated. Treatment in utero can reduce transmission and manifestation of the illness. Treatment during infancy can treat the disease and reduce sequeleace. Acquisition of the parasite before pregnancy does not usually result in transmission if the mother is immunologically normal. If a chronically infected mother is immunocompromised, transmission can occur. Further information is available in the following references.

* Berrebi A, Bardou M, Bessieres MH, Nowakowka D, Castagna R, Rolland M, Wallon M, Franck J, Bongain A, Monnier- Barbarino P, Assouline C, Cassaing S. Outcome for children infected with congenital toxoplasmosis in the first trimester and with normal ultrasound findings: A study of 36 cases. Cur J Obstet Gynecol Reprod Biol. 2006 De.

* Couvreur J, G Desmonts, and P Thulliez. Prophylaxis of Congenital Toxoplasmosis. Effect of Spiramycin on Placental Infection. Jounral of Antimicrobial Chemotherapy. 22: 193-200, 1988.

* Daffos F, F Forestier, M Capella-Pavlovsky, et al. Prenatal Management of 746 Pregnancies at Risk for Congenital Toxoplasmosis. New England Journal of Medicine. 318: 271-275, 1988.

* Dannemann BR, WC Vaughan, P Thulliez, et al. The Differential Agglutination Test for Diagnosis of Recently Acquired Infection with Toxoplasma gondii. Journal of Clinical Microbiology. 28: 1928-1933, 1990.

* Grover CM, P Thulliez, JS Remington, et al. Rapid Prenatal Diagnosis of Congenital Toxoplasma Infection by Using Polymerase Chain Reaction and Amniotic Fluid. Journal of Clinical Microbiology. 28: 2297-2301, 1990.

* Hohlfeld P, T Daffos, JM Costa, et al. Prenatal Diagnosis of Congenital Toxoplasmosis with a Polymerase Chain Reaction Test on Amniotic Fluid. New England Journal of Medicine. 331: 695-699, 1994.

* Liesenfeld O, JG Montoya, S Kinney, C Press, and JS Remington. Effect of Testing for IgG Av idity in the Diagnosis of Toxoplasma gondii Infection in Pregnant Women: Experience in a US Reference Laboratory. Journal of Infectious Disease. 2001 Apr 15; 183 (8): 1248-1253.

* McCabe RE and JS Remington JS. Toxoplasmosis: The Time Has Come. New England Journal of Medicine. 318: 313-315, 1988.

* Montoya JG, R Jordan, S Lingamneni, K Boyer, D Hill, GJ Berry, and JS Remington. Toxoplasmic Myocarditis and Polymyositis in Patients with Acute Acquired Toxoplasmosis Diagnosed During Life. Clinical Infectious Diseases. 1997 Apr; 24 (4): 676-683.

* Remington JS, R McLeod, and G Desmonts. Toxoplasmosis. Infectious Diseases of the Fetus and Newborn Infant (5th Edition). J Remington, J Klein (Eds). WB Saunders: Philadelphia, 2001. Pages 205-346.

* Thiebaut R, Leproust S, Chene G, Gilbert R. Effectiveness of prenatal treatment for congenital toxoplasmosis: a metaanalysis of individual patients’ data. Lancet. 2007 Jan 13; 369(9556): 115+22.

* Wilson CB and JS Remington. What Can be Done to Prevent Congenital Toxoplasmosis? American Journal of Obstetrics Gynecology. 138: 357-363, 1980.

Infection of the Fetus or Newborn Infant

Newborn infant with
congenital toxoplasmosis

This may be subclinical, involve the brain and eye or any organ. Infection may be evident at birth or later in life. Infection in the fetus and infant (to one year of age) should always be treated with antimicrobial agents. Active infection later in life should be treated. Further information is available in the following references.

* Eichenwald HG. A Study of Congenital Toxoplasmosis with Particular Emphasis on Clinical Manifestations, Sequelae, and Therapy. 41-49. In Siim JC (ed): Human Toxoplasmosis. Munksgaard, Copenhagen, 1960.

* Guerina NG, HW Hsu, HC Meissner, et al, Neonatal Serologic Screening and Early Treatment for Congenital Toxoplasma Gondii Infection. New England Journal of Medicine. 33: 1858-1863, 1994.

* Hohlfeld P et al. Fetal Toxoplasmosis: Outcome of Pregnancy and Infant Follow-up after in utero Treatment. Journal of Pediatrics. 115, 765-769, 1989.

* Hohfeld P, F Daffos, P Thulliez, et al. Fetal Toxoplasmosis: Outcome of Pernancy and Infant Follow-up after in utero Treatment. Journal of Pediatrics. 115: 765-769, 1989.

* Koppe JG, GJ Kloosterman, H deRoever-Bonnet, et al. Toxoplasmosis and Pregnancy: with a Long-term Follow-up of the Children. European Journal of Obstetrics and Gynecology Reproductive Biology. 413: 101-110, 1974.

* Liesenfeld O, JG Montoya, NJ Tathineni, M Dav is, BW Brown Jr, KL Cobb, J Parsonnet, and JS Remington. Confirmatory Serologic Testing for Acute Toxoplasmosis and Rate of Induced Abortions Among Women Reported to hav e Positiv e Toxoplasma Immunoglobulin M Antibody Titers. American Journal Obstetrics Gynecology, 2001. 184 (2): 140-145.

* McAuley JB, KM Boyer, D Patel, R McLeod, et al. Early and Longitudinal Ev aluations of Treated Infants and Children and Untreated Historical Patients with Congenital Toxoplasmosis: The Chicago Collaborative Treatment Trial. Clinical Infectious Diseases. 18: 38-72, 1994.

* McGee T, C Wolters, L Stein, K Boyer, N Roizan, C Swisher, P Meier, and R McLeod. Absence of Sensorineural Hearing Abnormalities in Treated Infants with Congenital Toxoplasmosis. Archives of Otolaryngology Head and Neck Surgery. 106: 75-80, 1992.

* McLeod R, D Mack, R Foss, et al. Lev els of Pyrimethamine in Sera and Cerebrospinal and Ventricular Fluids from Infants Treated for Congenital Toxoplasmosis. Antimicrobial Agents Chemotherapy. 36: 1040-1048, 1992.

* Mitchell CD, SS Erlich, MT Mastrucci, et al. Congenital Toxoplasmosis Occurring in Infants Perinatally Infected wi Human Immunodeficiency Virus 1. Pediatric Infectious Disease Journal. 9: 512-518, 1990. th

* Patel DV, E Holfels, N Vogel, et al. Resolution of Intracerebral Calcifications in Children with Treated Congenital Toxoplasmosis. Radiology. 199: 433-440, 1996.

* Roberts F, R McLeod, and K Boyer. Toxoplasmosis in Infectious Diseases of Children. Krugman's Infectious Diseases of Children (10th Edition). SL Katz, A Gershon, P Hotez (Eds). Mosby: St. Louis, 2002.

* Roizen N, C Swisher, K Boyer, et al. Neurologic and Dev elopmental Outcome in Treated Congenital Toxoplasmosis. Pediatrics, 1995, 95: 11-20.

* Saxon SA, N Knight, DW Reynolds, et al. Intellectual Deficits in Children Born with Subclinical Congenital Toxoplasmosis: A Preliminary Report. Journal of Pediatrics. 82: 792-797, 1973.

Infection of the Eye

Active infection

Eye disease occurs as a sequel of infection acquired in utero. It rarely occurs during acute infection of older children and adults. It also occurs in immunocompromised individuals. Active retinochoroditis is treated with animicrobial agents. Further information is available in the following references.

* Binquet C, Wallon M, Quantin C, Kodjikian L, Garweg J, Fleury J, Peyron F, Abrahamowicz M. Prognostic factors for the long-term development of ocular lesions in 327 children with congenital toxoplasmosis. Epidemiol Infect. 131: 57-68, 2003.

* Brezin AP, et al. Ocular Toxoplasmosis in the Fetus. Immunohistochemistry Analysis and DNA Amplification. Retina. 14: 19-26, 1994.

* Couvreur J and P Thulliez. Toxoplasmose Acquise a Localisation Oculaire Ou Neurologique. Presse Med. 25: 438-442, 1996.

* Garweg JG, Kodjikian L, Peyron F, Binquet C, Fleury J, Grange JD, Quantin C, Wallon M. [Congenital ocular toxoplasmosis--ocular manifestations and prognosis after early diagnosis of infection]. Klin Monatsbl Augenheilkd. 222: 721-7, 2005. German.

* Garweg JG, Scherrer J, Wallon M, Kodjikian L, Peyron F. Reactivation of ocular toxoplasmosis during pregnancy. BJOG. 112: 241-2, 2005

* Glasner PD, et al. An Unusually High Prev alence of Ocular Toxoplasmosis in Southern Brazil. American Journal of Ophthalmology. 114: 136-144, 1992.

* Hogan MJ. Ocular Toxoplasmosis. Columbia University Press, New York. 86, 1951.

* Holland GN, et al. Ocular Toxoplasmosis in Patients with the Acquired Immunodeficiency Syndrome. American Journal of Ophthalmology. 106: 653-674, 1988

* Kodjikian L, Wallon M, Fleury J, Denis P, Binquet C, Peyron F, Garweg JG. Ocular manifestations in congenital toxoplasmosis. Graefes Arch Clin Exp Ophthalmol. 244: 14-21, 2006.

* Mcmenamin PG, et al. The Ultrastructural Pathology of Congenital Toxoplasmic Retinochoroiditis. Part 1: The Localization and Morphology of Toxoplasma Cysts in the Retina. Exp Eye Res. 43: 529-543, 1986.

* Mets M, E Holfels, KM Boyer, Et Al. Eye Manifestations of Congenital Toxoplasmosis. American Journal of Ophthalmology. 122: 309-324, 1996.

* Montoya JG, S Parmley, O Liesenfeld, GJ Jaffe, and JS Remington. Use of the Polymerase Chain Reaction for Diagnosis of Ocular Toxoplasmosis. Ophthalmology. 1999 Aug; 106 (8): 1554-1563.

* Montoya JG and JS Remington. Toxoplasmic Chorioretinitis in the Setting of Acute Acquired Toxoplasmosis. Clinical Infectious Diseases. 1996 Aug; 23 (2): 277-282.

* Nicholson DH and EB Wolchok. Ocular Toxoplasmosis in an Adult Receiv ing Long-term Corticosteroid Therapy. Archives of Ophtalmology. 94: 248-254, 1976.

* O'connor GR. Factors Related to the Initiation and Recurrence of Uv eitis. XL Edward Jackson Memorial Lecture. American Journal of Ophthamology. 96: 577-599, 1983.

* Perkins ES. Ocular Toxoplasmosis. British Journal of Ophthalmology. 57: 1-17, 1973.

* Roberts F and R McLeod. Pathogenesis of Toxoplasmic Retinochoroiditis. Parasitology Today. 15: 51-75, 1999.

* Roberts F, MB Mets, DJP Ferguson, R O'grady, C O'grady, P Thulliez, A Brezin, and R Mcleod. Histopathology of Congenital Ocular Toxoplasmosis in the Human Infant and Fetus. Archives of Ophthalmology. 119: 51-58, 2001.

* Wallon M, Kodjikian L, Binquet C, Garweg J, Fleury J, Quantin C, Peyron F. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics. 113:1567-72, 2004.

Infection of the Immunocompromised Individual

Toxoplasmic encephalitis
Toxoplasmic encephalitis
in Transplant Receipients

Infection in immunocompromised individuals may affect the brain, eye, or any organ and may be rapidly fatal for patients with transplantation (solid organ or bone marrow), cancer and its therapy, auto immune disease and its therapy, and AIDS. Treatment arrests disease. Further information is available in the following references.

* Dannemann B, JA Mccutchan, D Israelski, et al. Treatment of Toxoplasmic Encephalitis in Patients with AIDS: A Randomized Trial Comparing Pyrimethamine plus Clindamycin to Pyrimethamine plus Sulfonamides. Annals of Internal Medicine. 116: 33-43, 1992.

* Deleze M, G Mintz, and MC Mejia. Toxoplasma Gondii Encephalitis in Systemic Lupus Erythematosus: A Neglected Cause of Treatable Nerv ous System Infection. Journal of Rheumatology. 12: 994-996, 1985.

* Derouin F, A Devergie, and P Auber. Toxoplasmosis in Bone Marrow-transplant Recipients: Report of Seven Cases and Review. Clinical Infectious Disease. 15: 267-270, 1992.

* Luft BJ and JS Remington. Toxoplasmic Encephalisis in Patients with AIDS. Clinical Infectious Disease. 15: 211-222, 1992.

* Luft BJ, Y Naot, FG Araujo, et al. Primary and Reactivated Toxoplasma Infection in Patients with Cardiac Transplant: Clinical Spectrum and Problems in Diagnosis in a Defined Population. Annals of Internal Medicine. 99: 27-31, 1983.

* Ryning FW, R McLeod, J Maddox, et al. Probable Transmission of Toxoplasma Gondii by Organ Transplantations. Annals of Internal Medicine. 90: 47-49, 1979.

* Ström J. Toxoplasmosis Due to Laboratory Infection in Two Adults. Acta Med Scand. 139: 244-252, 1951.

* Suzuki Y, SY Wong, FC Grumet, J Fessel, JG Montoya, AR Zolopa, A Portmore, F Schumacher-perdreau, M Schrappe, S Koppen, B Ruf, BW Brown, and JS Remington. Ev idence for Genetic Regulation of Susceptibility to Toxoplasmic Encephalitis in AIDS Patients. Journal of Infectious Disease. 1996 January; 173 (1): 265-268.

Toxoplasmosis Research
Institute and Center

Chicago, IL