Thursday, January 12, 2012

Toxoplasmosis: Don't Pussyfoot Around the Kitties

  Who doesn't love a good pussy? Get your minds out of the gutter! I'm talking about kitty cats. God's four-footed furry feline friends. They're sweet (ha!). They are loveable (ha!). They are excellent companions (ha!). I'm allowed to be sarcastic about cats - I have five of them. We'll do a psychological evaluation of me in the future so we can determine why, In God's name, I would ever think 5 cats were a good idea.

Cats are all fine and good...until you're pregnant. If you've been a preggo who also harbors felines, then no doubt you've heard the constant warnings about how bad cats are for pregnant women. A lot of the fuss centers around a little parasite called toxoplasma gondii, which causes toxoplasmosis. Women are told many different things about handling cats during pregnancy - most of which are incorrect. The top "advice" is usually this:
  • Don't ever touch your cat or breathe the same air as your cat when pregnant.
  • Don't ever, ever change a litter box when you're pregnant. 
  • Get rid of all cats now that you're pregnant. 
 It's hogwash. Now, there is definite reason to fear toxoplasmosis It can cause miscarriage or stillbirth or it can cause birth abnormalities such as hydrocephalus or blindness. It is certainly dangerous if a pregnant woman is exposed. My issue is with the perceived risk and method of exposure when it concerns cats. If you listen to the mainstream advice, you would think that cats are the only way that you can become infected and that it's nearly certain that all cats carry this. Simply.Not.True.

 Before I get into some parasite particulars, I want to give you some background so you don't think I'm just someone with a bug up her butt about, well, butt bugs. In my real life, I am a Certified Veterinary Technician. No, I don't hold and cuddle puppies and kittens all day. I went through a 2.5 year college program, completed 15 weeks of externships, earned my Associates in Veterinary Technology, sat for a national board exam and passed and earned my license as a veterinary technician. I complete 16 hours of continuing education every two years in order to keep my license legal and up to date. I have twelve years of experience in veterinary medicine - 10 of those years licensed. I do get to pet puppies and kitties now and then, but I also take radiographs, draw blood, place IV catheters, administer medications and treatments, educate clients and the community, run laboratory tests such as routine and non-routine chemistries, urinalysis and other bloodwork such as CBCs. I administer and monitor anesthesia as well as assist doctors in surgery. Oh, there is so much more that we do.  Veterinary technicians are unsung heroes of the veterinary world. Anyway, one of my specialties is laboratory medicine. That is, I'm a wiz with things involving blood, pee, poop and other goodies from the body. I'm great friends with the microscope. Parasitology is one of my favorite things and, ahem, I'm dang good at it. What is it? It's the study of parasites. In my day to day life in the vet tech world, I obtain fecal samples, prepare them and look at them under the microscope where I identify all sorts of little buggers that shouldn't be there. Toxoplasma gondii is just one of those little bastards.

 T.gondii can infect any warm-blooded animal - including us humanfolk - and birds. The big fuss about cats comes from the fact that they are the only primary hosts. That is, they are the only animal that sheds the oocysts (zygotes wrapped in a comfy and protective shell) in their feces. Any mammal or bird can carry the oocysts, but those oocysts will only bump uglies with one another in the intestines of cats. It's a fun cycle. Little oocysts are hanging out in the soil or nature. An animal comes in contact with the oocyst and ingests it. Kitty eats the animal that ingested the oocyst. Or, baby kitty gets it from mama's milk. From there, the oocysts "hatch" in the kitty's intestine. They proceed to make love sweet parasite love and give birth to, you guessed it, more oocysts that are then passed into the cats poop. These little bastards are resilient. Cats will only pass them in their feces for a few weeks after their initial infection. In most cases, their bodies eventually get rid of the T. gondii invaders after those first few weeks. However, the oocysts can survive in soil for an average of 18 months, with many making it for several years. This brings us to the methods of infection for people...

It is understandable to assume that cats are your biggest risk since they are the primary host. This is incorrect. More than half of toxoplasmosis infection occur after handling raw meat. As I said, any mammal or bird can acquire toxoplasmosis. This includes the wide variety of animals that end up on our plates at the dinner table, especially lamb, venison and pork. Handling or consuming raw or undercooked meat is the biggest culprit in toxoplasmosis infections. To be safe, all meat should be cooked to 160 degrees (180 in poultry). I like jerky and I'm an advocate for raw milk, but both should be avoided during pregnancy due to the risk of transmission. Jerky is a risk because of the low heat typically used to create it. Raw milk, especially goat, is a risk as T. gondii is passed through mama milk. Most people won't even notice if they've become infected. Symptoms resemble a mild flu or even mononucleosis. Those most at risk are people with immuno-compromising conditions, including pregnancy. In those folks, the oocysts eventually settle in the tissues, especially the eyes and the brain in humans and the muscles in animals. In pregnant women, the oocysts can be transmitted to the baby via the placenta.

 Another method of transmission is contaminated soil. This is where the oocysts hang out after being passed through the cat's feces. Adults and children who dig around, garden or play in the dirt are susceptible. T. gondii can survive the harshest weather conditions, so the risk is still present even during a snowy winter. Their presence in the soil can also lead to contaminated water (more of an issue in developing countries) or fruits and vegetables. Thoroughly washing any fruits and vegetables is key to preventing transmission this way. It can also be present in children's sandboxes - your friendly neighborhood stray may enjoy using the sandbox as a litter box. Sandboxes - oh, having a parasitology background can just skeeve you - are a prime habitat for parasites like T. gondii and it's friends - roundworm and hookworm.

 Now it's time to talk about kitties. I've heard it all - I've heard people telling pregnant women that you can get it from petting cats, getting bit or being scratched. This is false. The primary source of infection is the cat's feces. You can't get it from bites, scratches or handling their urine or blood. This is the part where people tell you that if you're pregnant and you scoop litter you will just die right there on the spot. Seriously, I heard that once. Again, this is incorrect. When an infected cat poops, the oocysts are present in the poop. However, it takes anywhere from 24 hours to 5 days for those oocysts to sporulate - that is, they become infective to humans. If you're practicing proper kitty hygiene and scooping the litter box at least once a day then your chances of acquiring toxoplasmosis are about nil. If you let the poop sit in their for a few days until it gets to the point of being a bit dry then you up your chances of infection. Even then, you practically have to lick the poop to get it. There's no definitive research stating that you can get it through litter dust as you're scooping, so wearing a mask would be fine if it makes you comfortable.

But wait, is your cat even at risk? Cats at highest risk of carrying T. gondii are outdoor cats (that is, any cat who goes outside for any period of time - even if it's just to sit outside on the porch for 10 minutes)  as they hunt and eat little rodents and birds and they come in contact with infested soil. New kittens are also high risk as they could have gotten it from mama. Most of the time, new kittens come to us from shelters or rescues, so we don't know if mom was a street cat. Cats who spend all of their time indoors are at the lowest risk. Very low. Now, if you have little mice sharing your home and your cat eats them, his risk increases slightly. There is also a slight risk that you could track T. gondii into your home on your shoes and kitty could become infected if he licks your shoes or the carpet where you walked. This is so rare, but I'm putting it out there as many people assume their indoor only cats aren't at risk for anything (you can also track in coccidia, giardia, roundworm, whipworm and hookworm - in case you already weren't feeling icky. Tell that to Flylady next time she insists you wear your shoes in the house from sun up to sun down).

How do you know if your cat has toxoplasmosis? In general, you don't. If your cat is healthy, he or she likely won't show any signs and will eventually rid their body of the toxoplasma. Young kittens and those with weaker immune systems are more susceptible. The most common signs would be a lack of appetite, lethargy and a fever. In severe cases, cats will show neurologic signs (changes in personality, dizziness, blindness, seizures...). You can test for toxoplasmosis. It takes from 3 days up to 2 weeks for it to show up in fecal and blood tests. Fecal tests are okay, but not preferred. While the cat sheds millions of the oocysts in their feces, they are often missed during fecal examinations. The oocysts look a lot like little air bubbles and even coccidia or giardia. Staff that isn't adequately trained or those using poor equipment may miss these little guys on the microscope. In addition, cats only shed the oocysts for a brief time during the infection, so they may not be present in the feces. The best test is a blood test that looks for antibodies - IgG and IgM. This test will indicate if your kitty has acquired toxoplasmosis and if he or she has an active infection or was exposed in the past and is now immune. If your kitty has it, the vet may tell you that he doesn't need treatment as most cats get through it just fine. However, as a preggo, you may opt for treatment. Treatment can include a few different drugs, the most common being the antibiotic Clindamycin, which acts as an anti-protozoan in this case.

So, to recap, you are most likely - here in America and in other developed nations - to acquire toxoplasmosis via the handling or consumption of raw and undercooked meats. Gardening or handling soil also puts you at risk. The hype about cats being a giant risk is just one big overinflated myth that has led to the unnecessary deaths of many cats (being put in shelters and then euthanized after owners become pregnant). Good hygiene is key to keeping yourself safe.

  • Always wash anything that comes into contact with raw and undercooked meats - your hands, all utensils and cookware, cutting surfaces and counters. 
  • Freezing your meats for 2 to 3 days before use can reduce, but not eliminate, your risk of toxoplasmosis.
  • Cook meats thoroughly to 160 F (180 F if it's poultry). Experts recommend letting the meat sit for three minutes after cooking to insure proper temperature distribution.
  • Wash your hands. Wash your hands. Wash your hands. 
  • Wear gloves when working in the garden. Wash hands afterwards.
  • Wash hands after handling soil.
  • Thoroughly wash all fruits and vegetables, including those that you grown on your own.
  • Use caution when handling kiddie sandboxes. If you own it, keep it covered when not in use in order to prevent neighborhood kitties from using it as a litter box.
  • Scoop cat litter daily. <------will also help eliminate kitty bathroom behavior problems.
  • Be careful not to touch your face while scooping the litter. Wash your hands after scooping the litter.
  • Wash your hands. Wash your hands. Wash your hands.
  • Do not lick the cat poop.
  • It's fine to wear gloves and/or a mask while scooping cat litter if that makes you feel more comfortable.
  • Keep your kitties indoors to lower their risk of infection. Be mindful of tracking soil through the house on your shoes.
  • Don't feed kitty an raw or undercooked meat.
  • Make sure kitty has a check up once a year at the veterinarian and ask for a fecal test. If you are extra concerned about toxoplasmosis, request an antibody test. 
  • Your midwife, family doctor, or OB can perform an antibody blood test for toxoplasmosis when you go in for your first check up. This will let you know if you've been exposed and if it's an older exposure or if it's an active infection. And older exposure would mean, in most cases, that you are immune.
  • Wash your hands. Wash your hands. Wash your hands. (with NON antibacterial soap)

 Finally, take my experience. I have worked in veterinary medicine for 12 years and have had 6 kitties in that time - 5 of whom are living today. I have changed and cleaned thousands of litter boxes. I have handled thousands of kitty poop samples. I have only seen toxoplasmosis (and I do know how to distinguish it from other parasites) three times in 12 years. Twice in cats and once in a monkey (yeah, monkey shit it the most vile substance on the planet, fyi). I get myself tested for toxoplasmosis during pregnancy and in between. I've never tested positive for it. That's been the experience of many of my fellow veterinary colleagues.

  I hope this takes away some of the fear regarding cats in pregnancy. I mean it when I say that a lot of cats have been given up and/or just plain euthanized when an owner becomes pregnant because there is so much misinformation out there. Now go hug your kitty.


Big Families Rock said...

Very awesome blog post, I have to say I have learned a lot

Anonymous said...

Thank you for this. Very, very informative. The part about inhaling the litter dust, though....I'm reading so many conflicting things on this! Are you sure that aerated spores are not a risk for preggos? That's what I worry about most. I am careful to wash my hands after scooping, but I've definitely breathed in my fair share of litter dust. Too bad the info on the web isn't clearer in this regard....

Funky Little Earthchild said...

There aren't any conclusive studies on aerated spores. I usually tell people that the best bet is to wear a mask to make them feel more comfortable. Now, cleaning the litter box on a daily basis is a must to keep the possibility of spores down as they require at least 24 hours to develop and do their thing.

Litter dust poses it's own set of problems, especially if it's clay litter. If possible, you might prefer a less dusty litter such as wheat, pine or corn-based brands. :-)

Kate991 said...

I'm 4mos pregnant and very concerned about toxo. I have done extensive research on it but can't find any sure info on an incident I'm most recently worried about. Hoping you have some input.

I work at a veterinary clinic and set my phone down right on the counter top next to the microscope where thousands of cat fecal tests have been done, right in the same spot that feces is usually sat. I didn't think much of it until later when I was eating in my car and realized I hadn't washed my hands after picking my phone up from the counter. Yikes. Do you know if toxo can live on a surface such as counter, doorknob, faucet, etc if there is no actual feces visible to the eye? Could my phone have been infected by touching the counter and then infected my hand when picking it (phone) up? Basically, does toxo live outside of visible feces? Help!

Funky Little Earthchild said...

Hi Kate -

Toxoplasmosis is VERY hardy and can survive outside of feces for over a year.

The chances are slim that any of the feces contained toxo, especially if it was fresh poo (which is what clients should be bringing for fecals, but I know some people bring old poo). Does the poop come in direct contact with the counter? Toxoplasmosis is hard to find via microscope examination, but check with the tech doing the fecals if anyone came up positive.

Talk to your midwife and doctor about it. It takes 3 weeks (I think 23 days specifically) for it to show up in your bloodwork after initial infection. Now, you may already have been exposed prior to pregnancy, which is perfectly safe, and that could result in a positive titer. If that happens, your midwife or GP will order more tests to see if your toxo antibodies are rising, which would indicate a recent infection.

In all likelihood you should be safe, but definitely have bloodwork run in a few weeks just to be safe.


Anonymous said...

Thanks for this post. I admit I am freaking out a bit. We adopted an adorable kitten from a local shelter when I was about 10 weeks pregnant. DH has been in charge of the litter box and changed it daily or at most every other day. But at yesterday's vet appointment the vet noted that our little guy was treated for coccidia up until the day we got him (antibiotics). No more specifics were given, but I leaned that toxoplasmosis is a type of coccidia and I got very worried. Again, I have never touched the litter box but my kitten has been all over me since day one. And I know I don't wash my hands every time I pet him- I'd live at the sink. How worried should I be?

Funky Little Earthchild said...

I'm not a doctor or midwife, so I can't say for certain if you would be in the clear. I recommend talking to your midwife or doctor to be sure.

That being said, there are MANY forms of coccidia. Coccidia tends to be species specific - meaning it will not thrive in an animal other than it's preferred host. The most common form of coccidia in cats is called Isospora. It is species specific and it's seen in cats way more than toxoplasmosis. Your veterinarian or whoever diagnosed the cat should have information on the type of coccidia that was seen. Also, Isospora coccidia is usually treated with a sulfa drug (usually TM-P or Albon). Toxoplasmosis is treated with Clindamycin.

There is also a possibility that kitty had another form of coccidia that does not thrive in cats. Often cats (and dogs) will ingest other animals, such as rodents, that are infected with species specific coccidia. The coccidia does not infect the cat, it just passes through the intestines and will show up in a fecal sample. This does not require any treatment, but there are some vets who, irresponsibly, give antibiotics for it anyway. Again, your veterinarian should have information about the type of coccidia found in your cat.

Another note, toxoplasmosis is never reported as coccidia by any responsible veterinarian. Even though it is a coccidia, it is reported as toxoplasmosis because it IS zoonotic and to differentiate from the other forms of coccidia. :-)

Hope that helped!

Anonymous said...

Yes- that actually helps a lot. The vet notes from the shelter actually say "albon" so it looks like it was probably Isospora. I thought "Albon" was the vet's name! So it looks like my kitten is in the clear and he will be an indoor cat, so hopefully he will stay that way.

Funky Little Earthchild said...

Yay! Yep, they wouldn't give Albon for toxoplasmosis. Enjoy the new little kitten! :-)

Aubree said...

So, is it for certain that toxoplasmosis can live on surfaces in your house? Wouldn't that mean that any shoes you wear indoors could bring it in? My husband is a letter carrier and walks all over creation in his shoes, then comes home and walks to the back bedroom to change them. If that were the case, wouldn't many more people test positive for toxoplasmosis? If my husband changes the litterbox and then turns on the sink to wash his hands, do the oocysts live on the faucet, or are they only hardy in soil?

Funky Little Earthchild said...

They are hardy pretty much anywhere, though they prefer warm and moist environments to "activate" so to speak. Yes, it's possible to track them in the house. It's advised to remove shoes as soon as you get into the house for several reasons, not just toxoplasmosis. There are two other parasites that are of concern in the soil - roundworms and hookworms. Both can be tracked in on shoes. Both can cause problems in humans. Both can infect pets in the house as well. Shoes bring in all sorts of nasties such as those parasites, pesticides, herbicides, fungus - it can make you crazy to think about it. Maybe have him get in the habit of removing his shoes once he comes through the door. We do that in my family. I have a little shoe rack right by the front door. My husband is the worst offender.

Yes, if he changes the litter box and comes in contact with oocysts then he can transfer them to the faucet when washing his hands. Wiping down the faucet will prevent them from staying on the surface.

Toxoplasmosis is not routinely screened for in people other than pregnant women, so there may be more people walking around with it than we know.

Again, the biggest risk of infection comes from raw and undercooked meat, not from cats. :-)

Anonymous said...

Hi, thanks for writing this. Some sites on the internet are so inacurate. Im 4months pregnant i have 3 cats 1 outdoors 2 in. I never clean the litter tray my husband has always done it. The outdoor cat does not use the litter tray at all. I was wondering can you catch toxoplasmosis from a cat sneezing or breathing in your face. Thanks

Funky Little Earthchild said...

You cannot catch it from the cat sneezing or breathing on you. :)

Anonymous said...

Thanks for the awesome blog post. I'm 2mo pregnant and have been instructed to avoid raw meat, fish etc, which is not a problem. But my doc told me not to eat any salad or raw veggies/fruits that cannot be peeled. I'm very frustrated about that because I love salads and strawberries, plums, peaches etc and I always wash them carefully. Do you know, does vinegar kill toxoplasmosis? Maybe if I first wash the fruits with vinegar and then water, or toxo is too resilient?

Funky Little Earthchild said...

Anon - soaking in water or a vinegar solution (or straight vinegar) is believed to kill off the spores. Some people soak them for about 10 to 15 minutes.

There was a recent study in the Journal of Food Safety about it. I can't access the direct article at the moment, but the abstract has the info as well:

Standard disclaimer: I'm not a doctor, so this blog does not take the place of medical advice from a licensed healthcare professional. Gotta say that nowadays. :)

Anonymous said...

Million thanks for your reply! Of course I ask my doc also about this, plus about the idea of pouring some boiling water on them, that should work too. ;) Thanks again!

Anonymous said...

We have seen adult, neighborhood cats laying in our flowerbeds before, although we have never seen cat feces in the flowerbeds ever. I am 5 months pregnant and was pulling weeds with no gloves on. I didn't think anything of it since I didn't ever see feces. I did put gloves on when digging holes for flowers and other plants but I'm sure I put my hand/glove to my face to wipe the sweat, move my hair from my forehead, or scratch my nose. So now I am freaking out that I could have toxoplasmosis. I did wash my multiple times after I was finished. Any insight on the chances me being infected? Am I overreacting? I thought I was being careful but now I don't know. Thoughts?

Anonymous said...

Will a steam mop kill the bugs walked in through the house ? Also walking through a street with lots of stray cats on one area , one eating a raw chicken Wing , could I get toxoplasmas by breathing in the air as its a pretty shady area with lots of trees ? I'm 24 weeks should I get tested ?

Anonymous said...

While giving birth my cat pooped on our sheets and a pile of clean cloths/towels I had on the bed. She smeared it everywhere. I some of the towels were white so I can bleach them, though I've heard bleach doesn't kill toxoplasMosis. Is this true? The cloths and sheets are colored so I can't bleach them. Any suggestions for how to disinfect them? Thanks!!

Funky Little Earthchild said...

If there is any worry about exposure, have your midwife or doctor do a blood test. The limits to the blood test are that a positive result doesn't tell you if you were infected before pregnancy or after. If it's negative, you can breathe a little. :)

I would wash clothing as normal. Bleach what you can. The water and detergent should wash and nasties away. Remember, it does take quite a few hours for feces to completely dry before the toxoplasmosis can send out those spores. It's not likely that anyone would get it by breathing the air on a normal day outside. The top three methods are from gardening, eating raw meat and changing litter boxes with older poo and litter. A steam mop may take care of some critters. Others, such as flea pupae, won't be killed.

Standard disclaimer - I am not a medical doctor. None of this information can replace advice from a qualified healthcare professional.

Anonymous said...

Thank you for the post. I'm 33 weeks pregnant and work with dogs at the shelter, walking, cuddling, feeding. Do you know if there's a risk in this. I know that dogs can carry these parasites on their surface but I'm not sure if how long they can stay attached to dogs.

Thank You

Jen C said...

Hi, just wondering if you have any experience with cloth diapers and toxoplasmosis. My 3 year old is still in cloth, but the diapers are shared with my 1 year old. My 3 yo. has the toxoplasmosis, and we have been told that the whole family would likely have it then. I am wondering if it is best to (I already clean my cloth diapers with vinegar every 3 or 4 washes), clean them with something else, or just switch to disposables? LMK what you think, as I am also worried our clothes might carry the eggs (if they can live 18 months in soil, maybe they are alive all over my house!) I have to get rid of them because my child is immuno-compromised. Any comments are appreciated (and we don't have a cat but are vegetarian so we may have picked it up from root vegetables).

Anonymous said...

Hi .. I know this is an old post but I was wondering if you could help me with a question ..
When on the go ....y husband kept the emptied litter box in the car and since he had no soap he wipes his hand with antibacterial gel. would that be nuff to get rid of toxo? cuz he then touched my Phone and I am now freaking out.

Funky Little Earthchild said...

Sorry I missed these last few comments!

If the litter wasn't old in the car, I wouldn't worry. I do not believe there is any evidence that antibacterial wipes will do anything to the toxo....depends on what is in them.

Jen C - I do not know about human to human transmission. You can test positive for it in that you've been exposed, but you're not actively infested, especially if you've been treated for it. It is treatable. It would likely be the same in cats...requiring the poop to dry for a day or so before it can form spores and spread.

Funky Little Earthchild said...

And just a reminder, I'm not a doctor, so please don't use my blog in place of medical advice. :)

Anonymous said...

I have a question! I think I just ate some butter that my cat licked (my husband told me AFTER I ate it that he thought the cat licked it earlier) could I get toxo from this?

Funky Little Earthchild said...

No toxo from shared butter. But your cat might get the shits. ;)

Anonymous said...

Hi FLE, thank you so much for your blog! it's very informative. i'm 5 months pregnant and have a part time helper who works for two other families that have cats with one family that lets their cat outdoors. My helper works at my home on different days than the two cat families. I'm wondering what the chances are that my helper will transfer toxo to me? Thanks very much!

Funky Little Earthchild said...

Anon - it would be next to impossible for your worker to transfer toxoplasmosis to you. :)

Anonymous said...

Thank you very much for this information. My interest in this is not because of pregnancy, but about the risk Toxo poses to our native animals here in Australia. I wanted to make pouches for rescued wildlife; I admitted to them that I had indoor cats but not sure if they're infected. They don't think it's safe for me to make pouches for them. My question to you is, would washing the knitted and material pouches make them safe enough?

Lexy Schoenefeld said...

If my cat walked or sat on the counter and it wasnt cleaned after that and food touched it could I get toxo

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