Pamphlets & Phone Numbers
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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-
*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,
* 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
* 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
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
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,
* 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
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,
* 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.