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Toxoplasmosis

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Toxoplasmosis

Definition

Toxoplasmosis in cats occurs with ocular sign only or with other generalized involvement of the liver, lung and meninges. Ocular sign may not be accompanied by systemic sign and are more common in cats than dogs.

Etiology
Toxoplasmosis is an infection caused by the obligate intracellular coccidian parasite, toxoplasma gondii. Toxoplasma gondii that infects nearly all mammals, Felidae the definitive hosts, all other warm-blooded animals are intermediate hosts.

Pathophysiology
Oral ingestion of tissue cysts or oocysts result spread of toxoplasma organism to extraintestinal organs via the bloods or lymph. Focal necrosis of the heart, eye, and brain result due to proliferation of toxoplasma gondii.

Clinical presentation/signs General Comments
The uveitis in cats is frequently documentas multiple foci of renitis or retinochoroiditis with varying degrees of anterior uveitis. In dogs, chorioretinitis, optic neuritis and less frequenly, anterior uveitis and inflamation of extraocular muscles are present.

Differential Diagnosis
Cats

Intraocular disease (anterior uveitis): Feline Infectious Peritonitis (FIP), Feline Leukemia Virus (FeLV), Feline Immunodeficiency Virus (FIV), immune mediated, trauma, lens induced, corneal ulceration with reflex uveitis
Dyspnea (respiratory signs): asthma, cardiogenic, pneumonia (bacterial, fungal, parasitic), neoplasia, heartworm disease, pleural disease (effusions), diaphragmatic hernia, chest wall injury
Neurologic (causes of meningoencephalitis), viral: (FIP, rabies , pseudorabies), fungal (cryptococcosis, blastomycosis, histoplasmosis ), parasitic (cuterebriasis, coenurosis, aberrant heartworm migration), bacterial: idiopathic disease (feline polioencephalomyelitis)

Dogs

Often associated with other immunosuppressive diseases.
Neurologic: usually in very young dogs, differentiate from Neospora caninum (both produce CNS and neuromuscular disease)
Consider other conditions causing multifocal signs, infectious or inflammatory toxicity and metabolic disease.

Diagnosis
The presumptive diagnosis of toxoplasmosis can be made in cats with sign uveitis and a positive serum titer, although ocular toxoplasmosis in cats is not association of IgM antibodies and toxoplasma antigens have been developed for diagnosis of toxoplasmosis. Fecal examination for toxoplasma oocyst can be useful to detemine if the cat is shedding and is potentially infectius for the animals or humans.

Treatment

Usually outpatient
Inpatient, severe disease; patient cannot maintain adequate nutrition or hydration.
Confine, patients with neurologic signs

Medications
Drugs of choice

Clindamycin: 25-50 mg/kg PO or IM daily, divided into two doses, for at least 2 weeks after clinical signs clear
1% prednisone drops, every 8 hours for 2 weeks for uveitis; use concurrently

Alternative Drugs

Sulfadiazine (30 mg/kg PO q12h) in combination with pyrimethamine (0.5 mg/kg PO q12h) for 2 weeks; can cause depression, anemia, leukopenia, and thrombocytopenia, especially in cats.
Folinic acid (5 mg/day) or brewer's yeast (100 mg/kg/day), correct bone marrow suppression caused by sulfadiazine/pyrimethamine therapy

Management/Prevention
Cats

Diet: prevent ingestion of raw meat, bones, viscera, or unpasteurized milk (especially goat's milk); or mechanical vectors (flies, cockroaches); feed only well-cooked meat.
Behavior: prevent free roaming to hunt prey (birds, rodents) or to enter buildings where food-producing animals are housed.

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