# Food and Drinking Water as Sources of Pathogenic Protozoans: An Update
## 6 _Toxoplasma gondii_
### Involvement of Food and Drinking Water in T. gondii Infections
These results confirmed those obtained in a study in England and Wales, in which beef consumption, hand-washing habits before food preparation, and cross-contamination of food via sources other than food were identified as causes of infection [159]. In a meta-analysis it was observed that individuals who eat raw or undercooked meat have, respectively, 1.2-1.3 times the risk of _T. gondii_ infection compared to those who thoroughly cook meat [161]. Marine mammals such as whales, dolphins, and seals are parasitized by _T. gondii_. In June 2020, in a suspected food poisoning case reported in Tokyo, Japan, five of nine people who ingested the raw meat of a common minke whale (_Balaeoptera actorostrata_) not previously frozen before consumption showed symptoms such as diarrhea and fever up to 39 \({}^{\circ}\)C from 12 h to 5 days post-ingestion. The anti-_Toxoplasma_ antibodies could not be investigated in the patients due to a lack of cooperation. However, molecular and histopathological examinations of whale meat indicated _Sarocysts_ spp. and _T. gondii_ of the atypical type II genotype. The latter belonged to the ToxoDB genotype #39 isolated from sea otters, sheep, and goats in the USA. Occurrence of _T. gondii_ has already been reported in marine mammalians, namely, genotype ToxOB-RFLP genotype #300 in [PERSON]'s whale (_Balaeoptera edeni_) in Brazil, and type II strain in fin whales (_B. physalus_) in Italy. Minke whales in Scotland were positive for _T. gondii_ serum antibodies, and 60% seroprevalence of _T. gondii_ was found in Inuits in Canada and linked to the consumption of seal meat [173]. According to a systematic review, the published up to March 2018 showed that 44.1% of the outbreaks documented worldwide wereocyst-related. Waterborne infections gave rise to large-scale outbreaks sinceocysts can survive exposure to sodium hypochlorite and chlorine. _T. gondii_ocysts were found in soil in 28 out of 34 studies; in water in 25 out of 40 studies; in fresh produce comprising leafy greens and non-leafy vegetables, including roots, herbs, and fruits in 13 out of 23 studies; and bivalve mollus in 19 out of 22 studies. For soil and water, some studies reported a 100% detection rate, while for fresh produce and bivalve molluss, the maximum detection rates were 46% and 50%, respectively. In 13 of the selected articles, the One Health concept was applied to establish links between soil, water, and food contamination with infection cases. These mostly regarded North and South America [11]. Recent monitoring in the Emilia-Romagna region, Italy, highlighted a prevalence of human toxoplasmosis between 20.0% and 20.8%, higher than reported for other European countries. Over three years, 22.3% of women tested positive for toxoplasmosis in early pregnancy, with a frequency of active toxoplasmosis of 0.39% and a higher likelihood of infection for women of African, Asian, Eastern European, or South American origin compared to Italian women. Acute infection was diagnosed in 161 patients, of whom 113 were pregnant women [165]. In a cross-sectional study on pregnant women the overall seroprevalence of anti-_T. gondii_ antibodies (IgG and IgM) was 21.2%, and a significant association of the infection with raw vegetable consumption was found [174].