Volume 91, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000–2010. A matched case–control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups.


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  1. Antinori A, Larussa D, Cingolani A, Lorenzini P, Bossolasco S, Finazzi MG, Bongiovanni M, Guaraldi G, Grisetti S, Vigo B, Gigli B, Mariano A, Dalle Nogare ER, De Marco M, Moretti F, Corsi P, Abrescia N, Rellecati P, Castagna A, Mussini C, Ammassari A, Cinque P, d'Arminio Monforte A, , 2004. Prevalence, associated factors, and prognostic determinants of AIDS-related toxoplasmic encephalitis in the era of advanced highly active antiretroviral therapy. Clin Infect Dis 39: 16811691.[Crossref] [Google Scholar]
  2. Jones JL, Hanson DL, Chu SY, Ciesielski CA, Kaplan JE, Ward JW, Navin TR, , 1996. Toxoplasmic encephalitis in HIV-infected persons: risk factors and trends. The Adult/Adolescent Spectrum of Disease Group. AIDS 10: 13931399.[Crossref] [Google Scholar]
  3. 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] [Google Scholar]
  4. Dubey JP, Jones JL, , 2008. Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38: 12571278.[Crossref] [Google Scholar]
  5. Ho YC, Sun HY, Chen MY, Hsieh SM, Sheng WH, Chang SC, , 2008. Clinical presentation and outcome of toxoplasmic encephalitis in patients with human immunodeficiency virus type 1 infection. J Microbiol Immunol Infect 41: 386392. [Google Scholar]
  6. Montoya JG, Liesenfeld D, , 2004. Toxoplasmosis. Lancet 363: 19651976.[Crossref] [Google Scholar]
  7. Fuentes I, Rubio JM, Ramírez C, Alvar J, , 2001. Genotypic characterization of Toxoplasma gondii strains associated with human toxoplasmosis in Spain: direct analysis from clinical samples. J Clin Microbiol 39: 15661570.[Crossref] [Google Scholar]
  8. Robert-Gangneux F, Dardé ML, , 2012. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 25: 264296.[Crossref] [Google Scholar]
  9. Falusi O, French AL, Seaberg EC, Tien PC, Watts DH, Minkoff H, Piessens E, Kovacs A, Anastos K, Cohen MH, , 2002. Prevalence and predictors of Toxoplasma seropositivity in women with and at risk for human immunodeficiency virus infection. Clin Infect Dis 35: 14141417.[Crossref] [Google Scholar]
  10. Bartelink ML, Hoek L, Freriks JP, Rutten GE, , 1998. Infections in patients with type 2 diabetes in general practice. Diabetes Res Clin Pract 40: 1519.[Crossref] [Google Scholar]
  11. Bretagne S, Costa JM, Foulet F, Jabot-Lestang L, Baud-Camus F, Cordonnier C, , 2000. Prospective study of Toxoplasma reactivation by polymerase chain reaction in allogeneic stem-cell transplant recipients. Transpl Infect Dis 2: 127132.[Crossref] [Google Scholar]
  12. Voegele L, Cheerva AC, Bertolone S, , 2013. Cerebral toxoplasmosis after tandem high-dose chemotherapy and autologous hematopoietic cell transplant for neuroblastoma. J Pediatr Hematol Oncol 35: e50e52.[Crossref] [Google Scholar]
  13. Jones JL, Roberts JM, , 2012. Toxoplasmosis hospitalizations in the United States, 2008, and trends, 1993–2008. Clin Infect Dis 54: e58e61.[Crossref] [Google Scholar]
  14. World Health Organization, 1992. International Classification of Diseases, 10th Revision. Available at: www.who.int/classifications/icd/en/. Accessed July 10, 2012. [Google Scholar]
  15. National Center for Health Statistics; Centers for Disease Control and Prevention (CDC); US Census Bureau, 2011. United States Bridged-Race Population Estimates 2010 - NCHS. Available at: http://www.cdc.gov/nchs/nvss/bridged_race.htm. Accessed October 10, 2013. [Google Scholar]
  16. United States Department of Health and Human Services, 2005. Protection of Human Subjects. Title 45 Code of Federal Regulations, Pt 46. Available at: http://www.hhs.gov/ohrp/documents/OHRPRegulations.pdf. Accessed April 29, 2014. [Google Scholar]
  17. National Center for Health Statistics, 2007. Bridged-Race Intercensal Estimates of the July 1, 2000–July 1, 2009. United States Resident Population from the Vintage 2006 Postcensal Series by Year, County, Age, Sex, Race, and Hispanic Origin, Prepared Under Collaborative Arrangement with the U.S. Census Bureau. Available at: www.cdc.gov/nchs/nvss/bridged_race.htm. Accessed April 29, 2014. [Google Scholar]
  18. National Center for Health Statistics, 2010. Life Expectancies for 2000–2010 Were Calculated Using a Revised Methodology and May Differ from Those Previously Published. National Vital Statistics Reports (NVSR), Deaths: Preliminary Data for 2008. Available at: http://www.census.gov/compendia/statab/2012/tables/12s0104.pdf. Accessed July 11, 2012. [Google Scholar]
  19. Redelings MD, Wise M, Sorvillo F, , 2007. Using multiple cause-of-death data to investigate associations and causality between conditions listed on the death certificate. Am J Epidemiol 166: 104108.[Crossref] [Google Scholar]
  20. Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML, , 2008. Productivity costs of cancer mortality in the United States: 2000–2020. J Natl Cancer Inst 100: 17631770.[Crossref] [Google Scholar]
  21. Grosse SD, Krueger KV, Mvundura M, , 2009. Economic productivity by age and sex: 2007 estimates for the United States. Med Care 47: S94S103.[Crossref] [Google Scholar]
  22. Lipscomb J, Weinstein MC, Torrance GW, Gold MR, Siegel JE, Russell LB, Weinstein MC, , 1996. Time preference. , eds. Cost Effectiveness in Health and Medicine. New York, NY: Oxford University Press, 214246. [Google Scholar]
  23. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB, , 1996. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 276: 12531258.[Crossref] [Google Scholar]
  24. Halfhill TR, , 2012. Tom's Inflation Calculator, v7.5.3. Copyright 1997–2012. Available at: http://www.halfhill.com/inflation.html. Accessed October 1, 2012. [Google Scholar]
  25. Bristow BN, Casil J, Sorvillo F, Basurto-Dávila R, Kuo T, , 2013. Melanoma-related mortality and productivity losses in the USA, 1990–2008. Melanoma Res 23: 331335. [Google Scholar]
  26. Moschetti K, Barragan N, Basurto-Dávila R, Cummings PL, Sorvillo F, Kuo T, , 2014. Mortality and productivity losses from Alzheimer disease among U.S. adults aged 40 to 64 years, 1999 to 2010. Alzheimer Dis Assoc Disord, in press. [Google Scholar]
  27. Batz MB, Hoffman S, Morris JG, Jr, 2011. Ranking the Risks: The 10 Pathogen-Food Combinations with the Greatest Burden on Public Health. Gainesville, FL: Emerging Pathogens Institute, University of Florida. [Google Scholar]
  28. Centers for Disease Control and Prevention; Global Health–Division of Parasitic Diseases and Malaria, 2013. Parasites–Toxoplasmosis (Toxoplasma infection). Available at: www.cdc.gov/parasites/toxoplasmosis/prevent.html. Accessed June 22, 2014. [Google Scholar]
  29. 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. [Google Scholar]
  30. Dubey JP, Hill DE, Jones JL, Hightower AW, Kirckland E, Roberts JM, Marcet PL, Lehmann T, Vianna MC, Miska K, Sreekumar C, Kwok OC, Shen SK, Gamble HR, , 2005. Prevalence of viable Toxoplasma gondii in beef, chicken, and pork from retail meat stores in the United States: risk assessment to consumers. J Parasitol 91: 10821093.[Crossref] [Google Scholar]
  31. Jones JL, Sehgal M, Maguire JH, , 2002. Toxoplasmosis-associated deaths among human immunodeficiency virus-infected persons in the United States, 1992–1998. Clin Infect Dis 15: 1161.[Crossref] [Google Scholar]
  32. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H, Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Disease Society of America; , 2009. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 58: 1207. [Google Scholar]
  33. Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, Bourland DD, 3rd Uttamchandani R, Fuhrer J, Jacobson J, Morlat P, Vilde JL, Remington JS, , 1993. Toxoplasmic encephalitis in patients with acquired immune deficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team. N Engl J Med 329: 9951000.[Crossref] [Google Scholar]
  34. Dannemann B, McCutchan JA, Israelski D, Antoniskis D, Leport C, Luft B, Nussbaum J, Clumeck N, Morlat P, Chiu J, Vilde JL, Orellana M, Feigal D, Bartok A, Heseltine P, Leedom J, Remington J, , 1992. Treatment of toxoplasmic encephalitis in patients with AIDS: randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. The California Collaborative Treatment Group. Ann Intern Med 116: 3343.[Crossref] [Google Scholar]
  35. Nissapatorn V, , 2009. Toxoplasmosis in HIV/AIDS: a living legacy. Southeast Asian J Trop Med Public Health 40: 11581178. [Google Scholar]
  36. Hessol NA, Buchbinder SP, Colbert D, Scheer S, Underwood R, Barnhart JL, O'Malley PM, Doll LS, Lifson AR, , 1992. Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates. Am J Public Health 82: 561564.[Crossref] [Google Scholar]

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  • Received : 07 May 2014
  • Accepted : 25 Jul 2014
  • Published online : 05 Nov 2014

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