An infective disorder, sporadic in nature, that leads
to chorioretinitis and cerebral calcification. Transplacental infection may
occur with devastating results for fetal development.
Toxoplasma gondii; T. gondii;
Many adults demonstrate antibodies to Toxoplasma gondii, the
causative organism; consequently, subclinical infection is probably common. In the
United States, it is demonstrated that 3-70% of healthy adults are serologically
positive for T. gondii. In general, the incidence of the infection varies with the
population group and the geographical area studied. T. gondii infection affects more
than 3500 newborns in the United States each year. T. gondii seropositivity rates
among HIV-infected patients vary from 10-45%. Toxoplasmic encephalitis (TE) has been
reported in 1-5% of AIDS patients. Internationally, the seropositivity prevalence rate
is as high as 75% by the fourth decade of life, in countries such as France and El Salvador.
As many as 90% of adults in Paris are seropositive. Approximately 50% of the adult
population in Germany is infected. Women of childbearing age in much of Western Europe,
Africa, and South and Central America have seroprevalence rates of greater than 50%.
This syndrome was described by A.B. Sabin and H.A.
Feldman, American epidemiologists.
T. gondii oocysts are shed in animal feces and may be
ingested in dust form by humans.
Fever, headache, lymphadenopathy, myalgia, anorexia, and
arthralgia are the most common presenting features in adults and children
infected with toxoplasmosis. A minority of patients develop visual symptoms,
however about half of patients show characteristic lesions in the retina on
Patients with toxoplasmosis should
be treated as potentially contagious to the operating room personnel. In view of the serious
consequences of transplacental spread, patient contact with pregnant personnel must
be avoided. Patients should be assessed to determine the degree of
involvement. Dehydration may be a feature of the acute illness. As these
patients are infected, arrangements must be made to use disposable
anesthetic and surgical equipment or to protect nondisposable equipment from bacterial
There are no reports of anesthesia with this
medical condition. The presence of cerebral calcification might be associated with seizures
and potentially a change in the intracranial dynamic, i.e., intracranial pressure. The
antiepileptic medications must be continued until the morning of surgery. Antibiotic must
be given before anesthesia and elective surgical procedures should be delayed in patients
with active infections.
No agents are indicated or contraindicated, except in the presence of seizure activities,
triggering anesthetic agents should be avoided. In the case of ophthalmic disease
occurring subsequent to acute infection, treatment may involve steroid administration and
preoperative steroid stress doses may be necessary. Antibiotics may be administered and
any possible drug interaction should be considered.
Teutsch SM, Juranek DD, Sulzer M et al: Epidemic toxoplasmosis associated
with infected cats. N Engl J Med