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Toxoplasmosis Pregnancy

One of the most common infectious diseases, toxoplasmosis results from the protozoa Toxoplasma gondii. Distributed worldwide, it's less common in cold or hot arid climates and at high elevations. It usually causes localized infection but may produce significant generalized infection, especially in immunodeficient patients or neonates.

Congenital toxoplasmosis, characterized by lesions in the central nervous system, may result in stillbirth or serious birth defects.

Causes

T. gondii exists in trophozoite forms in the acute stages of infection and in cystic forms (tissue cysts and oocysts) in the latent stages. Ingestion of tissue cysts in raw or undercooked meat (heating, drying, or freezing destroys these cysts) or fecal-oral contamination from infected cats transmits toxoplasmosis.

However, toxoplasmosis also occurs in vegetarians who aren't exposed to cats, so other means of transmission may exist.

Congenital toxoplasmosis follows transplacental transmission from a chronically infected mother or one who acquired toxoplasmosis shortly before or during pregnancy.

Signs and symptoms

The following signs and symptoms characterize congenital toxoplasmosis and acquired toxoplasmosis.

Congenital toxoplasmosis

Toxoplasmosis acquired in the first trimester of pregnancy often results in stillbirth. About one-third of neonates who survive have congenital toxoplasmosis. The later in pregnancy maternal infection occurs, the greater the risk of congenital infection in the neonate.

Obvious signs of congenital toxoplasmosis include retinochoroiditis, hydrocephalus or microcephalus, cerebral calcification, seizures, lymphadenopathy, fever, hepatosplenomegaly, jaundice, and rash. Other defects, which may become apparent months or years later, include strabismus, blindness, epilepsy, and mental retardation.

Acquired toxoplasmosis

Acquired toxoplasmosis may cause localized (mild lymphatic) or generalized (fulminating, disseminated) infection. Localized infection produces fever and a mononucleosis-like syndrome (malaise, myalgia, headache, fatigue, sore throat) and lymphadenopathy.

Generalized infection produces encephalitis, fever, headache, vomiting, delirium, seizures, and a diffuse maculopapular rash (except on the palms, soles, and scalp). Generalized infection may lead to myocarditis, pneumonitis, hepatitis, and polymyositis.

Diagnosis

Treatment

Acute disease is treated with sulfon­amides and pyrimethamine for about 4 weeks and, possibly, folinic acid to control adverse effects. In patients who also have acquired immunodeficiency syndrome, treatment continues indefinitely.

In healthy older children who develop serious toxoplasmosis infections, treatment usually lasts for 4 to 6 weeks (or at least 2 weeks after symptoms are gone). Kids with weakened immune systems often need to be hospitalized when they develop toxoplasmosis, and those with AIDS may need to take anti-toxoplasmosis medication for life.

Prevention

Here are some tips to help you avoid exposure to toxoplasma during your pregnancy:

• Do not allow your cat to go outside your home where it may come into contact with toxoplasma. If possible, have someone else take care of your cat while you are pregnant.
• If possible, use a vegetable soap to wash fruits and vegetables, especially if you're eating them raw. Otherwise, scrub them carefully.
• After preparing raw meat, thoroughly wash cutting boards, knives and other kitchen utensils in hot, soapy water to prevent cross-contamination of other foods. Wash your hands carefully after handling raw meat.
• Use work gloves when gardening and wash your hands afterwards. Cover children's sandboxes when not in use (cats like to use them as litter boxes).
• Disposing of cat feces daily, because the oocysts do not become infective until after 24 hours