Unrecognized ingestion of toxoplasma gondii oocysts leads to congenital toxoplasmosis and causes epidemics in North America

Kenneth Boyer, Dolores Hill, Ernest Mui, Kristen Wroblewski, Theodore Karrison, J. P. Dubey, Mari Sautter, A. Gwendolyn Noble, Shawn Withers, Charles Swisher, Peter Heydemann, Tiffany Hosten, Jane Babiarz, Daniel Lee, Paul Meier*, Rima McLeod

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

103 Scopus citations

Abstract

(See the Editorial Commentary by Linn, on pages 1090-1.)Background. Congenital toxoplasmosis presents as severe, life-altering disease in North America. If mothers of infants with congenital toxoplasmosis could be identified by risks, it would provide strong support for educating pregnant women about risks, to eliminate this disease. Conversely, if not all risks are identifiable, undetectable risks are suggested. A new test detecting antibodies to sporozoites demonstrated that oocysts were the predominant source of Toxoplasma gondii infection in 4 North American epidemics and in mothers of children in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS). This novel test offered the opportunity to determine whether risk factors or demographic characteristics could identify mothers infected with oocysts.Methods.Acutely infected mothers and their congenitally infected infants were evaluated, including in-person interviews concerning risks and evaluation of perinatal maternal serum samples.Results.Fifty-nine (78%) of 76 mothers of congenitally infected infants in NCCCTS had primary infection with oocysts. Only 49%of these mothers identified significant risk factors for sporozoite acquisition. Socioeconomic status, hometown size, maternal clinical presentations, and ethnicity were not reliable predictors.Conclusions.Undetected contamination of food and water by oocysts frequently causes human infections in North America. Risks are often unrecognized by those infected. Demographic characteristics did not identify oocyst infections. Thus, although education programs describing hygienic measures may be beneficial, they will not suffice to prevent the suffering and economic consequences associated with congenital toxoplasmosis. Only a vaccine or implementation of systematic serologic testing of pregnant women and newborns, followed by treatment, will prevent most congenital toxoplasmosis in North America.

Original languageEnglish (US)
Pages (from-to)1081-1089
Number of pages9
JournalClinical Infectious Diseases
Volume53
Issue number11
DOIs
StatePublished - Dec 1 2011

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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