Toxoplasmosis, cats and pregnant women: what you need to know
We hear a lot about toxoplasmosis, but it is a disease that is not always well explained, whether you are a cat guardian or a pregnant woman. In this article, we will look at what causes this disease, its consequences for our health and our cats’ health, as well as how to prevent it.
Toxoplasmosis, what is it?
Toxoplasmosis is a disease caused by a small parasite invisible to the naked eye: Toxoplasma gondii. It is what we commonly call a zoonosis, because it is a disease transmitted by animals to humans, but it is not contagious between humans.
Toxoplasma gondii can be found in an inactive form, as cysts, in the tissues of most warm-blooded animals such as pigs, cattle, sheep, goats, and birds. These animals are intermediate hosts of Toxoplasma gondii and generally do not show any symptoms. The parasite can also be found in an active form, oocysts, which are found in the environment.
Cats, as well as other felines, are the definitive hosts, or final hosts, of the parasite Toxoplasma gondii. The parasite can reproduce in the cat’s intestine, where it takes an active form and produces oocysts. The cat then eliminates the oocysts in its feces. These oocysts are very resistant and can survive in a favorable environment for up to a year.
Humans can get toxoplasmosis if they ingest cysts or oocysts. Cysts are found in raw or undercooked meat. Oocysts are found in cat feces, but also in soil or water contaminated by cat feces, as well as on raw fruits and vegetables that grew in contaminated soil and were not properly washed.
Toxoplasmosis occurs during the first infection with the parasite. After that, although the parasite remains present in the body for many years, the immune system keeps it in an inactive form and it no longer causes symptoms, so you are then immune for life.
Thanks to improved hygiene and food safety practices, the prevalence of toxoplasmosis has decreased in many countries over the past decades, and fewer people are now immune than in the past. In France, 30% of the population was immune in 2020, compared with 80% in 1960. The prevalence is highest in South America and Africa, at 50 to 80%, while in North America, Europe, Asia, and Australia, it ranges from 10 to 40%. It remains a common infection worldwide, with prevalence varying greatly depending on the country and population. [1–4]
Is toxoplasmosis a serious disease?
It depends! In around 80% of the cases for a healthy adult, the first infection with toxoplasmosis goes unnoticed and is entirely asymptomatic. [1]
When illness does occur, it is usually mild, with symptoms such as a moderate fever, swollen
lymph nodes, fatigue, headaches, and joint or muscle pain.
Nevertheless, some vulnerable parts of the population can develop severe forms of toxoplasmosis, in particular pregnant women and immunocompromised people.
In fact, while pregnant women do not have symptoms in most cases, toxoplasmosis can cross the placental barrier and be transmitted to the fetus. Infection of the fetus can then cause congenital toxoplasmosis, which may lead to serious complications such as in utero death, premature birth, neurological problems, and visual impairment.
In 90% of cases, congenital toxoplasmosis is latent: the newborn has no symptoms at birth, but symptoms may appear later in life, such as ocular or neurological forms.
The further the pregnancy progresses, the higher the risk of transmission from the mother to the child, but the lower the risk of severe damage. The risk of transmission is estimated at 10% in the first trimester, 30 to 40% in the second trimester, and 60 to 70% in the third trimester. [1,5]
I am pregnant, do I have to give up my cat?
As we have just seen, pregnant women are particularly at risk when it comes to toxoplasmosis, and because cats play a role in the transmission of this disease, we still too often hear things like, “Madam, you are pregnant, you need to get rid of your cat,” and other variations going as far as recommending euthanasia of the cat.
Let’s look in more detail at the recommendations and the risks for pregnant women. First, depending on the country you live in, routine screening for toxoplasmosis may be part of the mandatory screening during pregnancy. This is the case in France, Italy, and Austria, for example. [6,7]
In that case, there are then two possible situations depending on the result of the blood test:
You are already immune to toxoplasmosis because your serology is positive: you do not need to take any precautions regarding your cats or toxoplasmosis. However, this does not protect you against other infections and bacteria that lead to dietary restrictions during pregnancy, such as listeria.
You are not immune to toxoplasmosis because your serology is negative. In this case, precautions must be taken to reduce the risk of contamination. The serology might be repeated every month until delivery to check that you have not contracted toxoplasmosis during pregnancy, depending on your country's policies.
Now, if you are in the second situation and need to be careful about toxoplasmosis during your pregnancy, or if you do not know your serology status, does that mean you need to get rid of your cat?
As we have seen previously, cats are the final host of toxoplasmosis, and they can therefore shed oocysts in their stools, which is a risk factor.
However, cats shed oocysts only during their first contamination with the parasite, for a period of one to three weeks. It is therefore estimated that, at any given time, only 1% of cats are actively shedding oocysts. [8,9]
Moreover, once shed, oocysts become infectious, or active, only after sporulating, that is 1 to 5 days after being excreted. If you clean your cat’s litter box daily, this drastically reduces the risk.
Finally, a cat that does not have access to the outdoors and that is fed an exclusively cooked diet (kibble, wet food, or a cooked homemade diet) presents no risk of contamination, because it cannot catch toxoplasmosis.
Contaminated feces are the only means of transmission. A cat cannot transmit toxoplasmosis through bites, scratches, saliva, or petting. [10]
To summarize, although cats are a risk factor for toxoplasmosis, the risk of transmission is low if you follow hygiene rules, and it is therefore not necessary to give up your cat!
The most important thing is to follow hygiene rules:
Remove feces from litter boxes every day and, if possible, have the litter boxes cleaned by another member of your household.
Wash the litter boxes regularly with hot water (above 70 °C). The use of bleach is not necessary.
Wash your hands after cleaning the litter boxes, after petting your cat, and before eating.
Though, as we will see in the next section, there are other risk factors for toxoplasmosis, mainly related to diet.
What are the main risk factors of toxoplasmosis?
Several studies have shown that, in humans, infection with toxoplasmosis is mainly linked to the consumption of raw or undercooked meat, as well as contaminated raw vegetables or fruits, rather than to the presence of a cat. [8,11–16]
The consumption of raw shellfish is also a source of contamination. Indeed, bivalve mollusks such as oysters, mussels, clams, or cockles filter water and can accumulate oocysts if the water is contaminated.
Because soil can be contaminated by cat feces and therefore by oocysts, gardening, and contact with soil in general, is also a route of contamination.
For the same reasons, untreated or unfiltered water can also be an important source of contamination, particularly in countries where access to drinking water and sanitation infrastructure is limited.
In addition to the recommendations related to cats, here are the dietary and hygiene recommendations to reduce the risk of toxoplasmosis:
Eat meat cooked to above 67 °C
Do not consume raw shellfish: oysters, mussels, clams, etc.
Do not consume raw milk, whether goat’s or cow’s milk
Drink filtered or treated water
Wash raw fruits and vegetables with water before eating them raw. The use of white vinegar is not necessary
Wear gloves when gardening and wash your hands carefully afterwards
Wash your hands with soap before eating or preparing a meal, after handling raw meat or raw vegetables, and after gardening
After handling raw meat or raw vegetables, wash the surfaces and utensils you used
Is toxoplasmosis dangerous for my cat?
Like for us, toxoplasmosis is asymptomatic in 80% of cases in healthy adult cats, but some cats can sometimes show clinical signs.
Indeed, immunocompromised cats, with a weakened immune system, for example in the case of FIV or FeLV, or because of a treatment, may develop symptoms such as:
Fever
Lethargy
Loss of appetite
And in the most severe cases:
Respiratory involvement: coughing, shortness of breath
Neurological involvement: seizures, tremors
Ocular involvement
Jaundice
Cats can become infected by eating raw meat containing cysts, whether through wild prey they hunt or as part of a raw diet. They can also become infected by ingesting oocysts, for example in contaminated water.
Raw feeding cats and toxoplasmosis: what are the risks?
Because meat can contain parasite cysts in its tissues, feeding a raw diet carries a risk of toxoplasmosis for your cat.
To reduce this risk, there are options:
Switching to a cooked homemade diet: indeed, cooking through to 67 °C destroys the cysts. [17]
Freezing the meat for at least 3 days at -20 °C inactivates the cysts. [17–19]
Nevertheless, as we have seen, this disease is not very dangerous for the majority of healthy cats, and outdoor access could be a more important risk factor for contamination. [16]
To summarize, although toxoplasmosis is mild for the majority of the population, it can be serious for pregnant women. That is why dietary and hygiene measures are essential for pregnant women who have not had toxoplasmosis before their pregnancy. Nevertheless, contrary to what we can still too often read, extreme measures such as giving up your cat during pregnancy are absolutely not necessary.
I hope this article will have been useful and will help you better understand this disease.
Sources
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