# [Toxoplasmosis in Cats](/knowledge/bacteria/pet-parasites/toxoplasmosis-cats-zoonotic-risk-pregnancy): Risks for Pregnant Women and Immunocompromised Hosts ## Key Takeaways - *Toxoplasma gondii*, an obligate intracellular protozoan, infects virtually all warm-blooded animals, with felids serving as definitive hosts capable of shedding environmentally resistant oocysts in feces for 1-3 weeks post-infection. - Seroprevalence in cats varies widely (6-70%+), with stray and semi-domesticated populations exhibiting higher rates, posing significant environmental contamination pressure. - Clinical toxoplasmosis in cats, though uncommon, can manifest as fever, lethargy, dyspnea, neurological signs (ataxia, seizures), and ocular lesions (iridocyclochoroiditis); immunosuppression is a major risk factor. - Diagnosis involves serology (MAT, IFAT, ELISA), molecular methods (PCR for DNA detection in blood, feces, CSF), and cytology/histopathology to identify tachyzoites or cysts. - The primary zoonotic risk is congenital toxoplasmosis in pregnant women and reactivation in immunocompromised individuals, acquired via ingestion of sporulated oocysts from contaminated environments or cat litter. - Prevention strategies include keeping cats indoors, feeding cooked food, daily litter box cleaning (oocysts require 1-5 days to sporulate), and strict hygiene for high-risk individuals. --- ## Etiology and Life Cycle [Toxoplasmosis](/knowledge/parasites/pet-parasites/toxoplasmosis-feline-transmission-public-health-clinical-management) is a zoonotic disease caused by the obligate intracellular apicomplexan protozoan *[Toxoplasma gondii](/knowledge/parasites/protozoa/toxoplasma-gondii-lifecycle-neurological-infection)* [1, 2]. The parasite infects virtually all warm-blooded animals, including birds and mammals [3, 4]. Felids, both domestic and wild, serve as the definitive hosts because they are the only species capable of excreting environmentally resistant oocysts in their feces [2, 3, 5]. The life cycle involves sexual reproduction in the feline intestinal epithelium, leading to the shedding of unsporulated oocysts, and asexual reproduction in intermediate hosts [2, 6]. Cats become infected by ingesting tissue cysts from infected prey or raw meat, or by ingesting sporulated oocysts from the environment [2, 5]. After ingestion, bradyzoites from tissue cysts or sporozoites from oocysts invade the intestinal epithelium and undergo schizogony and gametogony, culminating in oocyst formation [6, 7]. Oocyst shedding typically begins 3 to 10 days post-infection and can last for 1 to 3 weeks, during which a single cat can excrete millions of oocysts [2, 3]. Sporulation occurs in the environment within 1 to 5 days, rendering oocysts infectious to many hosts [2, 3]. ## Epidemiology and Prevalence *T. gondii* infection is distributed globally, with seroprevalence in cat populations varying widely by geographic region, management practices, and diagnostic methods [2, 3, 8]. Studies report seroprevalence rates ranging from 6% to over 70% depending on the population sampled [1, 3, 9, 10]. In a study from Kirikkale, Turkey, using immunochromatographic rapid test kits, a prevalence of 6% was found in 50 cats presented to a veterinary hospital [1]. In contrast, a serological survey in Espirito Santo, Brazil, using ELISA and indirect immunofluorescence (IFI), reported a prevalence of 15.2% and 7.6%, respectively [3]. Higher rates have been documented in stray and semi-domesticated populations. In Bangkok, Thailand, the prevalence in semi-domesticated cats was 11.5% compared to 1.5% in pet cats [8]. In Pakistan, a study using ELISA and PCR found an overall infection rate of 74.6% in stray cats versus 25.4% in pet cats [10]. In Izmir, Turkey, *T. gondii* DNA was detected in 14.37% of stray cat feces, with a seroprevalence of 37.84% [11]. A study in Greece reported a 20.8% seroprevalence using IFAT, with older age and history of cat-fight trauma identified as risk factors [12]. In Slovakia, a seroprevalence of 37.4% was found in owned and shelter cats [9]. These data underscore the high environmental contamination pressure posed by feline populations, particularly free-roaming and stray cats [3, 8, 11]. ## Clinical Signs in Cats Clinical [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/cat-toxoplasmosis-neonatal) is relatively uncommon despite high seroprevalence, but when it occurs, it can be severe and multisystemic [4, 13]. The most frequently reported clinical signs include fever, anorexia, lethargy, dyspnea, and abdominal discomfort [4, 13, 14]. In a retrospective analysis of 100 histologically confirmed cases, 73% of cats had fever (40.0 to 41.7 degrees Celsius), and dyspnea and polypnea were common [13]. Neurological signs, such as ataxia, seizures, and behavioral changes, are also documented, particularly in cases with encephalitis [4, 13, 15]. Ocular [toxoplasmosis](/knowledge/parasites/pet-parasites/toxoplasmosis-feline-transmission-public-health-clinical-management) is a frequent manifestation, with multifocal iridocyclochoroiditis being the most common lesion, observed in 81.8% of cats with ophthalmitis in one study [4, 13, 16]. Pulmonary [toxoplasmosis](/knowledge/parasites/pet-parasites/toxoplasmosis-feline-transmission-public-health-clinical-management) presents as interstitial pneumonia, while abdominal forms can involve hepatitis, pancreatitis, and lymphadenopathy [4, 13]. Neonatal [toxoplasmosis](/knowledge/parasites/pet-parasites/toxoplasmosis-feline-transmission-public-health-clinical-management), acquired transplacentally, can result in stillbirth, neonatal death, or severe multisystemic disease in kittens [4, 17]. Immunosuppression, whether due to concurrent infections (e.g., feline leukemia virus, [feline immunodeficiency virus](/knowledge/viruses/pet-viruses/feline-immunodeficiency-virus)) or therapeutic immunosuppression, is a major risk factor for the development of clinical disease [4, 18]. ## Pathology and Tissue Distribution Histopathological examination reveals necrosis and inflammation in affected organs, with *T. gondii* tachyzoites and tissue cysts identifiable in multiple tissues [13, 19]. In a large case series, *T. gondii* was identified in 80% of brains, 70% of livers, 76.7% of lungs, 64.4% of pancreata, and 62.7% of hearts from infected cats [13]. In zoo animals, systemic disease with involvement of heart, liver, lungs, brain, spleen, and lymph nodes is common [19]. In Pallas' cats, encephalitis is a prominent feature, while ring-tailed lemurs frequently show lymphoid tissue involvement [19]. The genotype of *T. gondii* can influence pathogenicity; for example, ToxoDB genotype #4, commonly found in wildlife, was associated with overwhelming disseminated [toxoplasmosis](/knowledge/parasites/pet-parasites/toxoplasmosis-feline-transmission-public-health-clinical-management) in two littermate kittens [5]. In China, genotype #9 (Chinese 1) is widely prevalent in cats and has been linked to clinical outbreaks in pigs and humans [2]. ## Diagnostics Diagnosis of [feline toxoplasmosis](/knowledge/parasites/pet-parasites/cat-toxoplasmosis-symptoms-in-humans) relies on a combination of serological, molecular, and cytological methods [1, 2, 4, 20]. Serological tests detect anti-*T. gondii* IgG and IgM antibodies. Common platforms include the modified agglutination test (MAT), indirect fluorescent antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA), and Sabin-Feldman dye test [1, 2, 20, 21]. The MAT using formalin-preserved tachyzoites is considered highly sensitive and specific for detecting chronic infection in cats [21]. Recombinant antigens such as GRA7 have shown superior sensitivity compared to SAG2 and GRA6 for serodiagnosis in cats [20]. Immunochromatographic rapid test kits offer a practical, cost-effective option for point-of-care screening [1]. Molecular diagnostics, particularly PCR and real-time PCR, are used to detect *T. gondii* DNA in blood, feces, cerebrospinal fluid, or tissue samples [10, 11]. PCR is especially valuable for detecting active infection and for confirming oocyst shedding in feces [11]. Cytological examination of tracheal aspirates, bronchoalveolar lavage fluid, or pleural fluid can reveal tachyzoites in acute cases [4, 13]. Histopathology with immunohistochemical staining remains the gold standard for postmortem diagnosis [13, 19]. ## Treatment Treatment of clinical [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/cat-toxoplasmosis-pregnancy-infant-risk) is aimed at reducing tachyzoite replication and controlling inflammation. The primary antiprotozoal agents include clindamycin, which is the most commonly used drug [4, 22, 23]. Clindamycin is administered at 10 to 12 mg/kg orally every 12 hours for 2 to 4 weeks [4]. However, a paradoxical effect has been observed in experimental acute toxoplasmosis, where clindamycin treatment led to increased mortality in some cats, possibly due to endotoxin release from lysed organisms [22]. Despite this, clindamycin remains the first-line therapy in clinical practice [4]. In Pallas' cats, prophylactic clindamycin significantly reduced juvenile mortality associated with toxoplasmosis [23]. Other treatment options include trimethoprim-sulfonamide combinations and pyrimethamine, though these are less commonly used in cats due to potential adverse effects [4]. Supportive care, including fluid therapy, nutritional support, and anti-inflammatory doses of corticosteroids for ocular or neurological inflammation, is often necessary [4]. ## [Zoonotic Risk](/knowledge/parasites/pet-parasites/zoonotic-risk-humans-get-parasites-from-pets) and the "[Cat Toxoplasmosis Baby](/knowledge/bacteria/pet-parasites/toxoplasmosis-cats-zoonotic-risk-pregnancy)" Concern The primary zoonotic concern regarding [feline toxoplasmosis](/knowledge/parasites/pet-parasites/feline-toxoplasmosis-cat-parasite-reference) is the risk of primary infection in pregnant women and immunocompromised individuals [2, 9, 24]. The phrase "[cat toxoplasmosis baby](/knowledge/parasites/pet-parasites/cat-toxoplasmosis-neonatal)" reflects the well-documented risk of congenital toxoplasmosis, which occurs when a woman acquires a primary *T. gondii* infection during pregnancy [2, 24]. Transplacental transmission of tachyzoites can lead to fetal infection, resulting in miscarriage, stillbirth, or severe neonatal disease including chorioretinitis, hydrocephalus, and intracranial calcifications [2, 24]. Cats are central to this risk because they are the only hosts that shed oocysts into the environment [2, 3, 11]. Humans become infected by accidentally ingesting sporulated oocysts from contaminated soil, water, or food, or by handling contaminated [cat litter](/knowledge/veterinary-medicine/clinical-methods/cat-litter) [3, 11, 24]. Immunocompromised individuals, such as those with HIV/AIDS, organ transplant recipients, or patients on immunosuppressive therapy, are at risk of reactivation of latent toxoplasmosis, which can cause life-threatening encephalitis or disseminated disease [2, 4, 24]. Stray and free-roaming cats pose a higher risk due to their greater likelihood of shedding oocysts [8, 10, 11]. In a study from Izmir, over 14% of stray cats were shedding *T. gondii* DNA in feces, indicating a significant potential for environmental contamination [11]. The seroprevalence of nearly 40% in cats from Slovakia further underscores the non-negligible risk of human infection [9]. ## Prevention and Control Prevention of zoonotic transmission requires a multi-faceted approach targeting both feline and human behaviors [2, 24, 25]. Key recommendations include: - Keeping cats indoors to prevent hunting and scavenging [2, 8]. - Feeding cats only commercial cooked or canned food, never raw or undercooked meat [2, 5]. - Daily cleaning of litter boxes, as oocysts require 1 to 5 days to sporulate and become infectious [2, 3]. - Pregnant women and immunocompromised individuals should avoid cleaning litter boxes; if unavoidable, disposable gloves and hand washing are essential [2, 24]. - Covering sandboxes and garden areas to prevent cat defecation [3, 26]. - Controlling stray cat populations and implementing rodent control programs [2, 19]. - Vaccination of cats is not widely available, but experimental live attenuated vaccines (e.g., RHΔompdcΔuprt) have shown promise in reducing oocyst shedding in cats [27]. The following decision tree summarizes the clinical approach to managing a cat with suspected toxoplasmosis in the context of [zoonotic risk](/knowledge/parasites/pet-parasites/zoonotic-risk-humans-get-parasites-from-pets). ```mermaid graph TD A["Cat presents with clinical signs consistent with toxoplasmosis"] --> B{"Perform serology and/or PCR"} B --> C["Positive for T. gondii"] B --> D["Negative for T. gondii"] C --> E{"Assess clinical severity"} E --> F["Mild or subclinical"] E --> G["Moderate to severe"] F --> H["Monitor; consider treatment if immunocompromised"] G --> I["Initiate antiprotozoal therapy (e.g., clindamycin)"] I --> J["Provide supportive care"] D --> K["Consider alternative diagnoses"] C --> L["Assess household risk"] L --> M["Pregnant or immunocompromised person in household"] L --> N["No high-risk individuals"] M --> O["Implement strict hygiene: daily litter box cleaning, gloves, hand washing"] N --> P["Standard hygiene precautions"] O --> Q["Educate on zoonotic risk and prevention"] P --> Q ``` ## Conclusion [Toxoplasmosis in cats](/knowledge/parasites/pet-parasites/feline-toxoplasmosis-neonatal-risks) represents a significant veterinary and public health concern due to the unique role of felids in the life cycle of *T. gondii* [2, 3]. While clinical disease in cats is relatively uncommon, the potential for massive oocyst shedding makes cats a critical source of environmental contamination [2, 11]. The risk of congenital toxoplasmosis in humans, often summarized by the search term "[cat toxoplasmosis baby](/knowledge/parasites/pet-parasites/cat-toxoplasmosis-pregnancy-infant-risk)," is a well-established consequence of primary maternal infection during pregnancy [2, 24]. Immunocompromised individuals are also at increased risk of severe disease [4, 24]. Effective prevention relies on responsible cat ownership, including indoor housing, feeding cooked food, and meticulous litter box hygiene [2, 25]. Veterinary clinicians play a key role in diagnosing feline infections, managing clinical cases, and educating clients about zoonotic risks [1, 4]. Continued research into diagnostics, treatment, and vaccination is essential to reduce the burden of this globally distributed parasite [2, 20, 27]. ## References [1] Parlatir Y, Senel Y, Kara E. Determination of the Prevalence of [Toxoplasmosis in Cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cat-life-cycle) with Immunochromatographic Rapid Tests Kits in Kirikkale University Veterinary Faculty Animal Hospital. Research and Practice in Veterinary and Animal Science. 2025. URL: https://www.semanticscholar.org/paper/247f3db5fd827af96d636da4d3164d751074874f [2] Dubey JP, Cerqueira-Cezar CK, Murata F, et al. All about [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cat-love): the last decade. Veterinary Parasitology. 2020. URL: https://www.semanticscholar.org/paper/f0acbbba7cd9f8c048d5d0764bbf9a13fc7c158b [3] Fux B, Covre K, Lopes R, et al. Seroprevalence of [Toxoplasmosis in Cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-baby-risk) in Espirito Santo State, Brazil. Current Developments in Nutrition. 2020. URL: https://www.semanticscholar.org/paper/c8a06a7c2da069a70425a4ee3b10947240fb5aca [4] Calero-Bernal R, Gennari SM. Clinical Toxoplasmosis in Dogs and Cats: An Update. Frontiers in Veterinary Science. 2019. URL: https://www.semanticscholar.org/paper/85289202e785e3bc73f8f5115e9316d859714c0c [5] Crouch EEV, Mittel L, Southard T, et al. Littermate cats rescued from a shelter succumbed to acute, primary toxoplasmosis associated with TOXO DB genotype #4, generally circulating in wildlife. Parasitology International. 2019. URL: https://www.semanticscholar.org/paper/d461f809816133d61ed266a5eae6e08c1a3dec5c [6] Dubey JP, Frenkel JK. Cyst-induced [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-clinical-signs-diagnosis-zoonotic-risk). The Journal of Protozoology. 1972. URL: https://www.semanticscholar.org/paper/12d02c2160648955e5516f3c6df5f8ca6fc8d0c9 [7] Dubey JP. [Toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-fecal-shedding-zoonotic-risk-diagnostics). 1986. URL: https://www.semanticscholar.org/paper/2d40c71cd859696150a18a7a02da5c18e19cb9f6 [8] Inpankaew T, Sattasathuchana P, Kengradomkij C, et al. Prevalence of toxoplasmosis in semi-domesticated and pet cats within and around Bangkok, Thailand. BMC Veterinary Research. 2021. URL: https://www.semanticscholar.org/paper/9d019b6566281c83eacd73785646da54fbe4f464 [9] Selyemova D, Antolova D, Mangova B, et al. Cats as a sentinel species for human infectious diseases, toxoplasmosis, trichinellosis, and COVID-19. Current Research in Parasitology and Vector-Borne Diseases. 2024. URL: https://www.semanticscholar.org/paper/ce0b02c41d9424f9078cf916d5152566094d337a [10] Majid A, Ahmad N, Haleem S, et al. Detection of toxoplasmosis in pets and stray cats through molecular and serological techniques in Khyber Pakhtunkhwa, Pakistan. BMC Veterinary Research. 2021. URL: https://www.semanticscholar.org/paper/8d881c294db66470f8cb1039711b82f9beddee6c [11] Karakavuk M, Can H, Selim N, et al. Investigation of the role of stray cats for transmission of toxoplasmosis to humans and animals living in Izmir, Turkey. Journal of Infection in Developing Countries. 2021. URL: https://www.semanticscholar.org/paper/d4034b4469c570f968226bd0f2428a8841127668 [12] Kokkinaki KG, Saridomichelakis M, Mylonakis M, et al. Seroprevalence of and Risk Factors for [Toxoplasma gondii](/knowledge/parasites/protozoa/toxoplasma-gondii-lifecycle-neurological-infection) Infection in Cats from Greece. Animals. 2023. URL: https://www.semanticscholar.org/paper/2bbbd583a9ac38d15c1b6f98ccf07981157adf83 [13] Dubey JP, Carpenter JL. Histologically confirmed clinical [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-fecal-shedding-zoonotic-risk-diagnostics): 100 cases (1952-1990). Journal of the American Veterinary Medical Association. 1993. URL: https://www.semanticscholar.org/paper/d52209abc2a6337a4c9d08f712a537010200385e [14] Bastan I. Clinical and some laboratory findings in cats with Toxoplasmosis. 2018. URL: https://www.semanticscholar.org/paper/22a23aba5dc5ed1ccad8996586a2a1622e64a857 [15] Cucos C, Ionascu I, Mocanu J, et al. Neurological and ocular form of [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-fecal-shedding-zoonotic-risk). 2015. URL: https://www.semanticscholar.org/paper/aa122640585a7963211031f376cc4dfc5aad4bb2 [16] Vainisi SJ, Campbell LH. Ocular [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-indoor-diagnosis-public-health). 1969. URL: https://www.semanticscholar.org/paper/249b39e2a160380e0392f576ba6c852d4525e72d [17] Dubey JP, Mattix ME, Lipscomb TP. Lesions of Neonatally Induced [Toxoplasmosis in Cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-indoor-diagnosis-public-health). Veterinary Pathology-Supplement. 1996. URL: https://www.semanticscholar.org/paper/1254e6ad6e3a8af547409537637842df2c9baaf2 [18] Munhoz AD, Hage SB, Cruz R, et al. [Toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-life-cycle-zoonotic-risk-prevention) in northeastern Brazil: Frequency, associated factors and coinfection with Neospora caninum, [feline immunodeficiency virus](/knowledge/viruses/pet-viruses/feline-immunodeficiency-virus) and feline leukemia virus. Veterinary Parasitology: Regional Studies and Reports. 2017. URL: https://www.semanticscholar.org/paper/7c8a2fdd2e9561c2569bc4e98397bbe347e630a2 [19] Denk D, De Neck S, Khaliq S, et al. Toxoplasmosis in Zoo Animals: A Retrospective Pathology Review of 126 Cases. Animals. 2022. URL: https://www.semanticscholar.org/paper/f5f5a29bf97f0304e6bbe2e206c484ebdc9df2e3 [20] Sabukunze S, Gu H, Zhao L, et al. Comparison of the performance of SAG2, GRA6, and GRA7 for serological diagnosis of [Toxoplasma gondii](/knowledge/parasites/protozoa/toxoplasma-gondii-lifecycle-neurological-infection) infection in cats. Frontiers in Veterinary Science. 2024. URL: https://www.semanticscholar.org/paper/9f5d168c43119aed8d92f0b3115eb05d8db3dc99 [21] Dubey JP, Thulliez P. Serologic diagnosis of [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-neurological-symptoms-cytology-pregnancy-veterinary-care) fed [Toxoplasma gondii](/knowledge/parasites/protozoa/toxoplasma-gondii-lifecycle-neurological-infection) tissue cysts. Journal of the American Veterinary Medical Association. 1989. URL: https://www.semanticscholar.org/paper/ee22536cb0d4e9d5bd35bdcff522943c207f2843 [22] Davidson MG, Lappin MR, Rottman JR, et al. Paradoxical effect of clindamycin in experimental, acute [toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-neurological-symptoms-cytology-pregnancy-veterinary-care). Antimicrobial Agents and Chemotherapy. 1996. URL: https://www.semanticscholar.org/paper/3c33146daf33215dac6e658719c1d07bb266fdf7 [23] Girling SJ, Pizzi R, Naylor A, et al. USE OF CLINDAMYCIN IN PALLAS' CATS [OTOCOLOBUS (FELIS) MANUL] TO REDUCE JUVENILE TOXOPLASMOSIS-ASSOCIATED MORTALITY RATES. Journal of Zoo and Wildlife Medicine. 2020. URL: https://www.semanticscholar.org/paper/4feb70d4897b80c8cd1cfacfe59755a6bcd4c598 [24] Hasan MF, Harun A, Hossain D, et al. Toxoplasmosis in animals and humans: a neglected zoonotic disease in Bangladesh. Journal of Parasitic Diseases. 2024. URL: https://www.semanticscholar.org/paper/da821e8fdfc168e67c0410f9698f8797db223dfc [25] Frenkel JK. [Toxoplasmosis in cats](/knowledge/parasites/pet-parasites/toxoplasmosis-cats-perinatal-transmission-public-health): diagnosis, treatment and prevention. Comparative Immunology, Microbiology and Infectious Diseases. 1978. URL: https://www.semanticscholar.org/paper/83342586a02084c5abca00f2f74a7c8eaed91493 [26] Zakaria R, Ardiansyah S. Potential Analysis Of Toxoplasmosis Distribution In Wild Cats (Felis silvestris) In Some Markets Of Sidoarjo District Through Microscopic Identification Of [Toxoplasma gondii](/knowledge/parasites/protozoa/toxoplasma-gondii-lifecycle-neurological-infection). Medicra (Journal of Medical Laboratory Science/Technology). 2020. URL: https://www.semanticscholar.org/paper/82acd479c09d814fba86964b3561af044fa1539a [27] Shen Y, Zheng B, Sun H, et al. A live attenuated RHΔompdcΔuprt mutant of Toxoplasma gondii induces strong protective immunity against toxoplasmosis in mice and cats. Infectious Diseases of Poverty. 2023. URL: https://www.semanticscholar.org/paper/2c0eccd9ce92a1acbb4617baa6621f2d56e59c8e ## Related Clinical & Scientific Guides * [Tick-Borne Diseases in Dogs: Pathogens, Clinical Signs, Diagnosis, and Prevention](/knowledge/parasites/general/tick-borne-diseases-dogs) * [Toxoplasmosis in Cats and the Risk of Brain Infection in Humans](/knowledge/parasites/general/toxoplasmosis-cats-brain-infection-humans) * [Dog Heartworm and Tick-Borne Disease Prevention](/knowledge/parasites/general/dog-heartworm-and-tick-borne-disease-prevention)