Toxoplasmosis in Germany: Epidemiology, Diagnosis, Risk Factors, and Treatment

Abstract

Background: With approximately 30% of the world population infected, Toxoplasma gondii is one of the most widespread pathogenic parasites in both humans and animals and a major problem for health economics in many countries.Methods: This review is based on the findings of individual studies, meta-analyses, and Cochrane Reviews retrieved by a selective literature survey of the Medline and Google Scholar databases.Results: Current data indicate a high rate of Toxoplasma gondii infection in Germany, ranging from 20% to 77% depending on age (95% confidence interval for 18-to 29-year-olds [17.0; 23.1]; for 70-to 79-year-olds [72.7; 80.5]). Male sex, caring for a cat, and a body mass index of 30 or more are independent risk factors for seroconversion. Postnatally acquired (food-related) infection is predominant, but maternal-to-fetal transmission still plays an important role. While most infections are asymptomatic, congenital toxoplasmosis and reactivated Toxoplasma encephalitis in immunosuppressed persons (transplant recipients and others) are sources of considerable morbidity. Toxoplasma gondii infection of the retina is the most common cause of infectious uveitis in Germany. The diagnosis and treatment of this type of parasitic infection are particular to the specific organs involved in the individual patient. Conclusion:Desirable steps for the near future include development of an effective treatment for the cystic stage and identification of biomarkers to assess the risk of reactivation and predict the disease course.

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

“…Seropositivity varied considerably between the different pathogens in our study. While this had an impact on the interpretability of results for highly prevalent pathogens, seropositivity values were generally in line with previous literature (Franck et al 2017 ; Korr et al 2017 ; Lachmann et al 2018 ; Pleyer et al 2019 ).…”

Screening for common eye diseases in the elderly with Optos ultra-wide-field scanning laser ophthalmoscopy: a pilot study with focus on ocular toxoplasmosis

“…Moreover, while the conversion rate has risen in several regions of the world, a decline in seroconversion has been observed in several nations, such as France [ 9 ], the Netherlands [ 10 ] and the USA [ 6 , 7 , 11 ]. Furthermore, Germany has a seroprevalence of 50%, figures that in an international context should be regarded as a relevant threat to public health [ 12 ]. Remarkably, recent data indicate not only that seroprevalence increases with age [ 8 , 13 , 14 ] but that gender and body mass index may correlate as potential risk factors for seropositivity [ 10 ].…”

Sulfadiazine plasma concentrations in women with pregnancy-acquired compared to ocular toxoplasmosis under pyrimethamine and sulfadiazine therapy: a case–control study

“…Against the backdrop of a long controversy on the efficacy of prenatal Toxoplasma therapy with regard to clinical outcomes in newborns, we need to clarify how these concentrations can be explained and to what extend the observed lower-end ranges of plasma levels for PY and SA in pregnant women and a plasma concentration one-third of the maternal level in the foetus [ 35 ] may influence the efficacy of the drugs in the foetus and newborn in future studies. Systematic measurements of plasma drug concentrations are an important option to objectively control for compliance, as well as for other factors of influence and relevant for adopting the treatment regime [ 37 ]. Prospectively used, these may hold promise to close the gap between expected and observed outcomes of pregnancy in human PT.…”