Volume 90, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



is a leading cause of severe foodborne illness in the United States. Population-based studies have found infection to be more prevalent in racial/ethnic minority and socioeconomically disadvantaged groups. Soil contaminated with cat feces, undercooked meat, and congenital transmission are the principal sources of infection. Toxoplasmosis-associated illnesses include congenital neurologic and ocular disease; acquired illness in immunocompetent persons, most notably ocular disease; and encephalitis or disseminated disease in immunosuppressed persons. The association of infection with risk for mental illness is intriguing and requires further research. Reduction of in meat, improvements in hygiene and food preparation practices, and reduction of environmental contamination can prevent toxoplasmosis, but more research is needed on how to implement these measures. In addition, screening and treatment may help prevent toxoplasmosis or reduce the severity of disease in some settings.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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  1. Dubey JP, , 2010. Toxoplasmosis of Animals and Humans. Second edition. Boca Raton, FL: CRC Press.
  2. Jones JL, Dubey JP, , 2012. Foodborne toxoplasmosis. Clin Infect Dis 55: 845851.[Crossref]
  3. Roghmann MC, Faulkner CT, Lefkowitz A, Patton S, Zimmerman J, Morris JG, Jr, 1999. Decreased seroprevalence for Toxoplasma gondii in Seventh Day Adventists in Maryland. Am J Trop Med Hyg 60: 790792.
  4. Hill D, Coss C, Dubey JP, Wroblewski K, Sautter M, Hosten T, Muñoz-Zanzi C, Mui E, Withers S, Boyer K, Hermes G, Coyne J, Jagdis F, Burnett A, McLeod P, Morton H, Robinson D, McLeod R, , 2011. Identification of a sporozoite-specific antigen from Toxoplasma gondii . J Parasitol 97: 328337.[Crossref]
  5. Boyer K, Hill D, Mui E, Wroblewski K, Karrison T, Dubey JP, Sautter M, Noble AG, Withers S, Swisher C, Heydemann P, Hosten T, Babiarz J, Lee D, Meier P, McLeod R, Toxoplasmosis Study Group; , 2011. Unrecognized ingestion of Toxoplasma gondii oocysts leads to congenital toxoplasmosis and causes epidemics in North America. Clin Infect Dis 53: 10811089.[Crossref]
  6. Su C, Khan A, Zhou P, Majumdar D, Ajzenberg D, Dardé ML, Zhu XQ, Ajioka JW, Rosenthal BM, Dubey JP, Sibley LD, , 2012. Globally diverse Toxoplasma gondii isolates comprise six major clades originating from a small number of distinct ancestral lineages. Proc Natl Acad Sci USA 109: 58445849.[Crossref]
  7. Lindsay DS, Dubey JP, , 2011. Toxoplasma gondii: the changing paradigm of congenital toxoplasmosis. Parasitology 138: 18291831.[Crossref]
  8. McLeod R, Boyer K, Lee D, Mui E, Wroblewski K, Karrison T, Noble AG, Withers S, Swisher CN, Heydemann PT, Sautter M, Babiarz J, Rabiah P, Meier P, Grigg ME, Toxoplasmosis Study Group; , 2012. Prematurity and severity are associated with Toxoplasma gondii alleles (NCCCTS, 1981–2009). Clin Infect Dis 54: 15951605.[Crossref]
  9. Gilbert RE, Freeman K, Lago EG, Bahia-Oliveira LM, Tan HK, Wallon M, Buffolano W, Stanford MR, Petersen E, European Multicentre Study on Congenital Toxoplasmosis (EMSCOT); , 2008. Ocular sequelae of congenital toxoplasmosis in Brazil compared with Europe. PLoS Negl Trop Dis 2: e277.[Crossref]
  10. Shobab L, Pleyer U, Johnsen J, Metzner S, James ER, Torun N, Fay MP, Liesenfeld O, Grigg ME, , 2013. Toxoplasma serotype is associated with development of ocular toxoplasmosis. J Infect Dis 208: 15201528.[Crossref]
  11. Remington JS, McLeod R, Wilson CB, Desmonts G, Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA, , 2011. Toxoplasmosis, eds. Infectious Diseases of the Fetus and Newborn Infant. Seventh edition. Philadelphia, PA: Elsevier Saunders, 9181041.[Crossref]
  12. Koppe JG, Loewer-Sieger DH, De Roever-Bonnet H, , 1986. Results of 20-year follow-up of congenital toxoplasmosis. Am J Ophthalmol 101: 248249.[Crossref]
  13. Faucher B, Garcia-Meric P, Franck J, Minodier P, Francois P, Gonnet S, L'Ollivier C, Piarroux R, , 2012. Long-term ocular outcome in congenital toxoplasmosis: a prospective cohort of treated children. J Infect 64: 104109.[Crossref]
  14. Kodjikian L, Wallon M, Fleury J, Denis P, Binquet C, Peyron F, Garweg JG, , 2006. Ocular manifestations in congenital toxoplasmosis. Graefes Arch Clin Exp Ophthalmol 244: 1421.[Crossref]
  15. Peyron F, Garweg JG, Wallon M, Descloux E, Rolland M, Barth J, , 2011. Long-term impact of treated congenital toxoplasmosis on quality of life and visual performance. Pediatr Infect Dis J 230: 597600.[Crossref]
  16. Torrey EF, Bartko JJ, Lun ZR, Yolken RH, , 2007. Antibodies to Toxoplasma gondii in patients with schizophrenia: a meta-analysis. Schizophr Bull 33: 729736.[Crossref]
  17. Pearce BD, Kruszon-Moran D, Jones JL, , 2012. The relationship between Toxoplasma gondii infection and mood disorders in the third national health and nutrition survey. Biol Psychiatry 72: 290295.[Crossref]
  18. Arling TA, Yolken RH, Lapidus M, Langenberg P, Dickerson FB, Zimmerman SA, Balis T, Cabassa JA, Scrandis DA, Tonelli LH, Postolache TT, , 2009. Toxoplasma gondii antibody titers and history of suicide attempts in patients with recurrent mood disorders. J Nerv Ment Dis 197: 905908.[Crossref]
  19. Pedersen MG, Mortensen PB, Norgaard-Pedersen B, Postolache TT, , 2012. Toxoplasma gondii infection and self-directed violence in mothers. Arch Gen Psych 69: 11231130.[Crossref]
  20. Gajewski PD, Falkenstein M, Hengstler JG, Golka K, , 2014. Toxoplasma gondii impairs memory in infected seniors. Brain Behav Immun 36: 193199.[Crossref]
  21. Torrey EF, Yolken RH, , 2013. Toxoplasma oocysts as a public health problem. Trends Parasitol 29: 380384.[Crossref]
  22. Wilson M, Remington JS, Clavet C, Varney G, Press C, Ware D, , 1997. Evaluation of six commercial kits for detection of human immunoglobulin M antibodies to Toxoplasma gondii. The FDA Toxoplasmosis Ad Hoc Working Group. J Clin Microbiol 35: 31123115.
  23. Centers for Disease Control and Prevention, 2012. DPDx, Diagnostic Findings for Toxoplasmosis. Available at: http://www.cdc.gov/dpdx/toxoplasmosis/dx.html. Accessed April 7, 2014.
  24. Lappalainen M, Koskela P, Koskiniemi M, Ammälä P, Hiilesmaa V, Teramo K, Raivio KO, Remington JS, Hedman K, , 1993. Toxoplasmosis acquired during pregnancy: improved serodiagnosis based on avidity of IgG. J Infect Dis 167: 691697.[Crossref]
  25. Robert-Gangneux F, Dardé ML, , 2012. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 25: 264296.[Crossref]
  26. Montoya JG, Liesenfeld O, , 2004. Toxoplasmosis. Lancet 363: 19651976.[Crossref]
  27. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed April 2, 2014.
  28. Montoya JG, Remington JS, , 2008. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 47: 554566.[Crossref]
  29. Jones JL, Kruzon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB, , 2001. Toxoplasma gondii in the United States, seroprevalence and risk factors. Am J Epidemiol 154: 357365.[Crossref]
  30. Jones JL, Kruszon-Moran D, Sanders-Lewis K, Wilson M, , 2007. Toxoplasma gondii infection in the United States, 1999–2004, decline from the prior decade. Am J Trop Med Hyg 77: 405410.
  31. Jones JL, Kruszon-Moran D, Won K, Wilson M, Schantz PM, , 2008. Toxoplasma gondii and Toxocara spp. co-infection. Am J Trop Med Hyg 78: 3539.
  32. Scallan E, Hoekstra RM, Angulo FJ, Tauxe RV, Widdowson MA, Roy SL, Jones JL, Griffin PM, , 2011. Foodborne illness acquired in the United States–major pathogens. Emerg Infect Dis 17: 715.[Crossref]
  33. Batz MB, Hoffmann S, Morris JG, Jr, 2012. Ranking the disease burden of 14 pathogens in food sources in the United States using attribution data from outbreak investigations and expert elicitation. J Food Prot 75: 12781291.[Crossref]
  34. Jones JL, Holland GN, , 2010. Annual burden of ocular toxoplasmosis in the United States. Am J Trop Med Hyg 82: 464465.[Crossref]
  35. Lum FL, Jones JL, Holland GN, Liesegang TJ, , 2005. Survey of ophthalmologists about ocular toxoplasmosis. Am J Ophthalmol 140: 724726.[Crossref]
  36. Jara M, Hsu HW, Eaton RB, Demaria A, Jr, 2001. Epidemiology of congenital toxoplasmosis identified by population-based newborn screening in Massachusetts. Pediatr Infect Dis J 20: 11321135.[Crossref]
  37. Neto EC, Rubin R, Schulte J, Giugliani R, , 2004. Newborn screening for congenital infectious diseases. Emerg Infect Dis 10: 10681073.[Crossref]
  38. Lopez A, Dietz VJ, Wilson M, Navin TR, Jones JL, , 2000. Preventing congenital toxoplasmosis. MMWR Recomm Rep 49: 5775.
  39. Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R, , 1999. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counseling. Lancet 353: 18291833.[Crossref]
  40. Guerina NG, Hsu HW, Meissner HC, Maguire JH, Lynfield R, Stechenberg B, Abroms I, Pasternack MS, Hoff R, Eaton RB, Grady GF, New England Regional Toxoplasma Working Group; , 1994. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. N Engl J Med 330: 18581863.[Crossref]
  41. Gilbert RE, Thalib L, Tan HK, Paul M, Wallon M, Petersen E, European Multicentre Study on Congenital Toxoplasmosis; , 2007. Screening for congenital toxoplasmosis: accuracy of immunoglobulin M and immunoglobulin A tests after birth. J Med Screen 14: 813.[Crossref]
  42. Naessens A, Jenum PA, Pollak A, Decoster A, Lappalainen M, Villena I, Lebech M, Stray-Pedersen B, Hayde M, Pinon JM, Petersen E, Foulon W, , 1999. Diagnosis of congenital toxoplasmosis in the neonatal period: a multicenter evaluation. J Pediatr 135: 714719.[Crossref]
  43. Lebech M, Andersen O, Christensen NC, Hertel J, Nielsen HE, Peitersen B, Rechnitzer C, Larsen SO, Nørgaard-Pedersen B, Petersen E, , 1999. Feasibility of neonatal screening for Toxoplasma infection in the absence of prenatal treatment. Danish Congenital Toxoplasmosis Study Group. Lancet 353: 18341837.[Crossref]
  44. Kimball AC, Kean BH, Fucks F, , 1971. Congenital toxoplasmosis: a prospective study of 4,048 obstetric patients. Am J Obstet Gynecol 111: 211218.[Crossref]
  45. Alford CA, Stagno S, Reynolds DW, , 1974. Congenital toxoplasmosis: clinical, laboratory, and therapeutic considerations, with special reference to subclinical disease. Bull N Y Acad Med 50: 160181.
  46. Stillwaggon E, Carrier CS, Sautter M, McLeod R, , 2011. Maternal serologic screening to prevent congenital toxoplasmosis: a decision-analytic economic model. PLoS Negl Trop Dis 5: e1333.[Crossref]
  47. Cornu C, Bissery A, Malbos C, Garwig R, Cocherel C, Ecochard R, Peyron F, Wallon M, , 2009. Factors affecting the adherence to an antenatal screening programme: an experience with toxoplasmosis screening in France. Euro Surveill 14: 2125.
  48. Sagel U, Kremer A, Mikolajczyk RT, , 2011. Incidence of maternal Toxoplasma infection in pregnancy in Upper Austria, 2000–2007. BMC Infect Dis 11: 348.[Crossref]
  49. Peyron F, Wallon M, Liou C, Garner P, , 2000. Treatments for toxoplasmosis in pregnancy. Cochrane Database Syst Rev CD001684.
  50. Peckham C, , 2011. Screening for Toxoplasmosis. Expert Review for United Kingdom Policy. Available at: http://www.screening.nhs.uk/policydb_download.php?doc=138. Accessed August 5, 2013.
  51. UK National Screening Committee. Policy on Toxoplasmosis Screening in Pregnancy (Updated December 2011). Available at: http://www.screening.nhs.uk/toxoplasmosis. Accessed August 5, 2013.
  52. Rudin C, Boubaker K, Raeber PA, Vaudaux B, Bucher HC, Garweg JG, Hoesli I, Kind C, Hohlfeld P, , 2008. Toxoplasmosis during pregnancy and infancy, a new approach for Switzerland. Swiss Med Wkly 138 (Suppl 168): 18.
  53. Röser D, Nielsen HV, Petersen E, Saugmann-Jensen P, Nørgaard-Pedersen PB, , 2010. Congenital toxoplasmosis: a report on the Danish neonatal screening programme 1999–2007. J Inherit Metab Dis 33 (Suppl 2): S241S247.[Crossref]
  54. Paquet C, Yudin MH, , 2013. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Can 35: 7879.[Crossref]
  55. Miron D, Raz R, Luder A, , 2002. Congenital toxoplasmosis in Israel: to screen or not to screen. Isr Med Assoc J 4: 119122.
  56. American College of Obstetricians and Gynecologists, 2002. ACOG practice bulletin. Perinatal viral and parasitic infections. Int J Gynaecol Obstet 76: 95107.
  57. Desmonts G, Couvreur J, , 1974. Congenital toxoplasmosis. A prospective study of 378 pregnancies. N Engl J Med 290: 11101116.[Crossref]
  58. Thiébaut R, Leroy V, Alioum A, Binquet C, Poizat G, Salmi LR, Gras L, Salamon R, Gilbert R, Chêne G, , 2006. Biases in observational studies of the effect of prenatal treatment for congenital toxoplasmosis. Eur J Obstet Gynecol Reprod Biol 124: 39.[Crossref]
  59. Thiébaut R, Leproust S, Chêne G, Gilbert R, SYROCOT (Systematic Review on Congenital Toxoplasmosis) Study Group; , 2007. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patients' data. Lancet 369: 115122.[Crossref]
  60. Gilbert R, Gras L, European Multicentre Study on Congenital Toxoplasmosis; , 2003. Effect of timing and type of treatment on the risk of mother to child transmission of Toxoplasma gondii . BJOG 110: 112120.[Crossref]
  61. Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon JM, Jenum PA, Hedman K, Naessens A, , 1999. Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol 180: 410.[Crossref]
  62. Gilbert RE, Gras L, Wallon M, Peyron F, Ades AE, Dunn DT, , 2001. Effect of prenatal treatment on mother to child transmission of Toxoplasma gondii: retrospective cohort study of 554 mother-child pairs in Lyon, France. Int J Epidemiol 30: 13031308.[Crossref]
  63. Gras L, Wallon M, Pollak A, Cortina-Borja M, Evengard B, Hayde M, Petersen E, Gilbert R, European Multicenter Study on Congenital Toxoplasmosis; , 2005. Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres. Acta Paediatr 94: 17211731.[Crossref]
  64. Wallon M, Peyron F, Cornu C, Vinault S, Abrahamowicz M, Bonithon Kopp C, Binquet C, , 2013. Congenital Toxoplasma infection: monthly prenatal screening diseases transmission rate and improves clinical outcome at 3 years. Clin Infect Dis 56: 12231231.[Crossref]
  65. Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W, Malm G, Salt A, Freeman K, Petersen E, Gilbert RE, European Multicentre Study on Congenital Toxoplasmosis (EMSCOT); , 2010. Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS Med 7: e1000351.[Crossref]
  66. Kieffer F, Wallon M, Garcia P, Thulliez P, Peyron F, Franck J, , 2008. Risk factors for retinochoroiditis during the first 2 years of life in infants with treated congenital toxoplasmosis. Pediatr Infect Dis J 27: 2732.[Crossref]
  67. Jones JL, Ogunmodede F, Scheftel J, Kirkland E, Lopez A, Schulkin J, Lynfield R, , 2003. Toxoplasmosis-related knowledge and practices among pregnant women in the United States. Infect Dis Obstet Gynecol 11: 139145.[Crossref]
  68. Foulon W, Naessens A, Derde MP, , 1994. Evaluation of the possibilities for preventing congenital toxoplasmosis. Am J Perinatol 11: 5762.[Crossref]
  69. Foulon W, Naessens A, Ho-Yen D, , 2000. Prevention of congenital toxoplasmosis. J Perinat Med 28: 337345.[Crossref]
  70. Breugelmans M, Naessens A, Foulon W, , 2004. Prevention of toxoplasmosis during pregnancy: an epidemiologic survey over 22 consecutive years. J Perinat Med 32: 211214.[Crossref]
  71. Carter AO, Gelmon P, Wells GA, Toepell AP, , 1989. The effectiveness of a prenatal education programme for the prevention of congenital toxoplasmosis. Epidemiol Infect 103: 539545.[Crossref]
  72. Pawlowski ZS, Gromadecka-Sutkiewicz M, Skommer J, Paul M, Rokossowski H, Suchocka E, Schantz PM, , 2001. Impact of health education on knowledge and prevention behavior for congenital toxoplasmosis; the experience in Poznan, Poland. Health Educ Res 16: 493502.[Crossref]
  73. Gollub EL, Leroy V, Gilbert R, Chêne G, Wallon M, European Toxoprevention Study Group (EUROTOXO); , 2008. Effectiveness of health education on Toxoplasma-related knowledge, behavior, and risk of seroconversion in pregnancy. Eur J Obstet Gynecol Reprod Biol 136: 137145.[Crossref]
  74. Di Mario S, Basevi V, Gagliotti C, Spettoli D, Gori G, D'Amico R, Magrini N, , 2013. Prenatal education for congenital toxoplasmosis. Cochrane Database Syst Rev CD006171.
  75. Frenkel JK, Pfefferkorn ER, Smith DD, Fishback JL, , 1991. Prospective vaccine prepared from a new mutant of Toxoplasma gondii for use in cats. Am J Vet Res 52: 759763.
  76. Buxton D, Innes EA, , 1995. A commercial vaccine for ovine toxoplasmosis. Parasitology 110: S11S16.[Crossref]
  77. Bader TJ, Macones GA, Asch DA, , 1997. Prenatal Screening for toxoplasmosis. Obstet Gynecol 90: 457464.[Crossref]
  78. Mittendorf R, Pryde P, Herschel M, Williams MA, , 1999. Is routine antenatal toxoplasmosis screening justified in the United States? Statistical considerations in the application of medical screening tests. Clin Obstet Gynecol 42: 163173.[Crossref]
  79. Khoshnood B, De Vigan C, Goffinet F, Leroy V, , 2007. Prenatal screening and diagnosis of congenital toxoplasmosis: a review of safety issues and psychological consequences for women who undergo screening. Prenat Diagn 27: 395403.[Crossref]
  80. Remington JS, Thulliez P, Montoya JG, , 2004. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 42: 941945.[Crossref]
  81. Petersen E, , 2007. Toxoplasmosis. Semin Fetal Neonatal Med 12: 214223.[Crossref]
  82. McAuley JB, Jones JL, Singh AK, Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, , 2011. Toxoplasma. eds. Manual of Clinical Microbiology. Tenth edition. Washington, DC: American Society for Microbiology Press, 22172238.
  83. Holland GN, , 2004. Ocular toxoplasmosis: a global reassessment. Part II: disease manifestations and management. Am J Ophthalmol 137: 117.
  84. de-la-Torre A, Stanford M, Curi A, Jaffe GJ, Gomez-Marin JE, , 2011. Therapy for ocular toxoplasmosis. Ocul Immunol Inflamm 19: 314320.[Crossref]
  85. Jones JL, Krueger A, Schulkin J, Schantz PM, , 2010. Toxoplasmosis prevention and testing in pregnancy, survey of obstetrician-gynaecologists. Zoonoses Public Health 57: 2733.[Crossref]
  86. Jones JL, Schulkin J, Maguire JH, , 2005. Therapy for common parasitic diseases in pregnancy in the United States: a review and a survey of obstetrician/gynecologists' level of knowledge about these diseases. Obstet Gynecol Surv 60: 386393.[Crossref]
  • Received : 10 Dec 2013
  • Accepted : 31 Jan 2014

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