Gastrointestinal parasites are often diagnosed in companion animals; they affect the health and well-being of dogs and cats, and some of them are also of public health interest. Therefore, epidemiological studies are important in continuously updating data regarding prevalence and associated risk factors for parasitic diseases. Regardless of the presence or absence of digestive symptoms, the overall prevalence of GI parasites in owned cats from this study was high (52.6%), and four zoonotic parasites were identified (Giardia spp., Toxoplasma-like, T. cati, and hookworms). T. cati was the most prevalent GI parasite (40.2%), and significantly more prevalent in symptomatic (53.3%), than in asymptomatic owned cats (14.9%). Different studies have been identified T. cati as the most frequently found parasite in domestic cats [13,24]. In Europe, T. cati prevalence varies between 7.2% and 83.3% with an average prevalence of 17.8% [11,24-26]. The prevalence of T. cati in household/owned and asymptomatic cats in Romania lies in the reported average for Europe according to this study and a previous one (20.3%) . However, the prevalence of T.cati positive cats may differ depending on geographical regions, rural or urban areas, and exposure to risk factors. In western European countries are reported lower prevalences comparing with southern, central, and eastern European countries [24,25].
Numerous studies aimed to establish the correlation between exposure to different risk factors and infection with T. cati in cats. In the current study, outdoor access and lack of deworming were identified as the main risk factors, but also the age and presence of digestive clinical signs.
Cats with outdoor access were 13.82 times more susceptible of being T. cati positive than indoor cats. This emphasizes the possibility of free-roaming and predatory behaviour significantly increasing the risk for infection also for cats with owners. This risk factor was assessed also by other authors [24,27,28] and a positive correlation was observed between the time a cat spends outdoor and the probability of a T. cati patent infection to occur . Cats without an anthelmintic treatment in the last three months before sample collection were 15.9 more likely to be infected with T. cati. Prevalence of patent infection decreases if the frequency of anthelmintic treatment per year increases as shown in the study of Beugnet et al. . Other studies did not find a positive association between patent T. cati infection and the time past from the last deworming of the cats, but suggest further investigations in this direction . The European Scientific Council Companion Animal Parasites (ESCCAP) recommends a deworming frequency of four times a year and faecal examinations, but also a prevention and control management that can be adapted to individuals depending on exposure to risk factors. Kittens should start receiving deworming treatment every two weeks starting at three weeks of age until two weeks after weaning and monthly until they are six months. Moreover, for adult cats exposed to the infection through paratenic hosts from free roaming and outside access, a monthly treatment is recommended .
Cats of all ages are prone to patent infections with T. cati, therefore have the potential to be sources of contamination . Nevertheless, in the current study, young age (0-2 years) represented a risk factor, with an increased rate of infection in kittens (51.5%). This is similar with the results obtain in other studies [13,27,31]. However, cats over 2 years should not be neglected as a potential reservoir for T. cati as the prevalence was still high (18.8%) probably due to the predatory behaviour of outdoor cats (40%) . T. cati larvae that harbor in different tissues or organs of the paratenic hosts, such as small mammals or birds  once ingested by the definitive host, they develop and reach adult stages in the small intestines . Gender was not found to be a risk factor and the same results were obtained by others [11,33].
Multiparasitism has significant relevance for the course of the disease, and also gives information about which antiparasitic medication should be chosen according to the cat’s age and risks of exposure. T. cati was found in 16 out of 17 cases of mixed infections, and the most prevalent mixed infection was between T. cati and Cystoisospora spp in outdoor kittens.
Clinical signs are one of the main reasons of owners concerns and therefore for a vet consult. Few studies were made on correlations between gastrointestinal symptoms and various pathogens in feline populations. Their results are of both epidemiological and clinical importance since they can give the proper tools for veterinarians in establishing the most appropriate diagnostic and therapeutic protocols based on risk factors and clinical aspects of each individual. In this study, the involvement of parasites, especially of T. cati in cats with or without digestive symptoms was assessed. Parasitic pathogens were involved in a high percentage of cats with digestive symptoms (67.8%). Increased prevalence of parasites in cats with gastrointestinal symptoms was also found by others .
More than half of the cats (53.3%) that were brought with gastrointestinal signs were positive for T. cati infection. Contrary, in other studies Giardia spp. was more frequently found in cats with diarrheic faeces [6,34]. However, a higher prevalence of T. cati (5-30%) was found in unowned cats with diarrhoea coming from different settlements . In this study, the presence of digestive symptoms and associated risk factors for feline toxocarosis (young age, outdoor access, lack of deworming) strongly suggests the infection with T. cati in cats. It was observed that regardless of the age of cats, diarrhoea can be significantly linked to T. cati patent infection. Besides the clinical and therapeutic implications that this correlation has, it can be assumed that zoonotic potential may be increased in cats with diarrhoea. A high prevalence of toxocarosis was seen also in cats with inappetence, therefore, this symptom can also be suggestive for T. cati. Furthermore, the involvement of the parasite increased with the number of associated digestive symptoms. Although age can be a risk factor, the implication of T. cati as a pathogen involved in digestive symptoms was not influenced by the cat’s age. That emphasizes that the parasite should not be excluded from the list of differential diagnoses in gastrointestinal disturbances even for older cats.
An overall high percentage of parasitic pathogens were found in cats, but more importantly, in ones with digestive symptoms. Some of the identified parasites represent a concern in both animal and human health. Identifying correlations between patent infections with T. cati, clinical manifestations and various associated factors in cats is of real interest for establishing the proper diagnosis and developing efficient measures for treatment and control for feline infection, environmental contamination, and most importantly the zoonotic risk that this parasitic disease represents.
The results of this study confirm the high rate of infection with T. cati and involvement of other parasitic enteropathogens in the aetiology of gastrointestinal symptoms in cats. Faecal testing is highly recommended as a routine examination in clinically healthy animals and as an important diagnostic tool in individuals with digestive signs, that could also reduce environment and human contamination.