Chupis Vlada Kostyantynivna parasite and can excrete millions of

Student oocysts that survive in the

Bukovinian State Medical University environment for months. [1]
Makarenko Viktoriia Genadiivna
Student Symptomatic disease can be seen in
Bukovinian State Medical University patients who are
immunocompromised with
reactivation of latent infection or with
Toxoplasmosis in pregnansy acquisition of new infection. Primary
infection during pregnancy is often
Abstract
asymptomatic in the mother but can
Toxoplasmosis is an important result in congenital disease in the
infection, that can lead to serious fetus.[3]
negative consequences for the fetus.
Ehiology
Сongenital toxoplasmosis can result
in permanent neurological damage Cats are the definitive hosts for
and severe morbidity such as Toxoplasma gondii, shedding large
blindness. This study aimed to numbers of oocysts in their feces.
evaluate the clinical, laboratory and Humans are infected after eating
epidemiological data of pregnant undercooked meat (pork or lamb)
women with toxoplasmosis. Primary containing tissue cysts, or
prevention is key to preventing contaminated water or food.[5]
infection, so patient education is an This parasite can exist in three forms:.
important aspect of treatment. An
adequate therapy will help to reduce 1. Sporozoite – present in
the infection rates.[7] sporulated oocysts that are shed
from the alimentary canal and
Keywords: Toxoplasmosis, thus found in the feces of the
congenital toxoplasmosis, pregnancy, definitive hosts. [6]
fetal infection, prenatal diagnosis, risk 2. Tachyzoite – a rapidly dividing
groups. form observed during acute
Introduction infection. [6]
3. Bradyzoite – a slow growing
Toxoplasmosis is a parasitic infection,
form seen within tissue cysts.
caused by the protozoan Toxoplasma
[6]
gondii. Parasites remain in human
tissues lifelong. This disease is After ingestion of oocysts or
transmitted vertically, from mother to bradyzoites of the parasite, they are
fetus. Many times there are no spread by blood from the
symptoms, so serological screening in gastrointestinal tract through the
routine prenatal care is essential for human body in the form of
early detection of pregnant women. tachyzoites. Tachyzoites penetrate
Cats are the definitive hosts for the into the cells of various tissues,
causing strong inflammatory reaction  Brain problems [12]
and destruction of tissues.
Diagnosis
Tachyzoites encyst in tissues and
organs days after infection.[2] The diagnosis of toxoplasmosis is
Specific risk factors: typically made by serologic testing. A
test that measures immunoglobulin G
 working with meat; (IgG) is used to determine if a person
 having kittens; has been infected. If it is necessary to
 eating raw beef or lamb; try to estimate the time of infection,
 eating locally produced dried, which is of particular importance for
pregnant women, a test which
or smoked meat;
measures immunoglobulin M (IgM) is
 drinking unpasteurized milk; also used along with other tests such
 eating raw oysters.[7] as an avidity test.[12]
Сlinical symptoms:
Diagnosis of toxoplasmosis is usually
 Achy muscles made by detection of Toxoplasma-
 Fever specific IgG, IgM, IgA, or IgE
 Swollen glands antibodies. There are several tests
 Blurry vision available that detect these
 Headache immunoglobulin antibodies within
 Eye redness several weeks of infection:
 Fatigue[11]
 Dye test (DT)
These symptoms can last for a month  Indirect fluorescent antibody
or longer.[1] test (IFA)
The risk of transmitting the infection  Enzyme immunoassays
(ELISA, immunoblots)
to the child depends on the period of
 Agglutination test
your pregnancy when the infection
 Avidity test[8]
occurred. The later in pregnancy you
become infected, the more likely your anti-Toxoplasma IgA (serum)
baby will become infected as well.
But the earlier during pregnancy you • Most helpful for diagnosing
are infected, the more serious the congenital disease. [9]
problems for the child after birth can
• Demonstration of IgA in the serum
be. [14]
from the newborn at or after 10 days
Pregnancy complications: is diagnostic of congenital disease[9]
 Preterm birth IgA assays are more sensitive than
 Stillbirth assays for IgM in the diagnosis of
 Miscarriages congenital disease. Testing for both
 Blindness IgM and IgA will identify 75% of
congenital infections[9]
 Liver damage
Toxoplasma-specific IgG avidity (CSF), or other biopsy material. These
index (serum) techniques are used less frequently
because of the difficulty of obtaining
• Useful in pregnant women who have these specimens. Parasites can also be
detectable IgG and IgM as it identifies isolated from blood or other body
recent versus chronic infection. [10] fluids (for example, CSF) but this
process can be difficult and requires
• A high avidity result in the first 12 considerable time.[14]
to 16 weeks of pregnancy rules out
infection acquired during pregnancy. Sonogram of the fetus can also be
[10] performed to evaluate for ventricular
dilatation, intracranial calcifications,
• A low IgG avidity result should not ascites, and hepatomegaly[14]
be interpreted as an indication of
recent infection because the IgG
response can mature slowly over
several months in some people.[10]

To help in the diagnosis of acute

infection, new tests like IgG avidity
test have come up. It measures the
strength of IgG antibody binding to T.
gondii. If the infection is recent, the
avidity of binding of IgG antibodies is
low, and it takes about 5–6 months for Treatment
the avidity to become high. Thus,
In general, spiramycin is
patients with recent/acute infection
will have a low avidity whereas recommended for women whose
patients who had acquired infection infections were acquired and
previously will show a high IgG diagnosed before 18 weeks gestation
avidity index. The sensitivity of IgG and infection of the fetus is not
avidity can be up to 100% [13] documented or suspected. Spiramycin
acts to reduce transmission to the
IgG or IgM Immunoblot (serum) fetus and is most effective if initiated
within 8 weeks of seroconversion.[9]
• Used in diagnosis of congenital
disease. [14] Pyrimethamine, sulfadiazine and
leucovorin are recommended for
• Most useful in newborns with no infections acquired at or after 18
demonstrable IgM and/or IgA by weeks gestation or infection in the
conventional serologic methods, born fetus is documented or suspected.
to mothers with confirmed or highly
PCR is often performed on the
suspected acute infection
amniotic fluid at 18 gestation weeks
Diagnosis can be made by direct
observation of the parasite in stained to determine if the infant is
tissue sections, cerebrospinal fluid infected[15]
 Prevention of vertical transmission: To prevent risk of toxoplasmosis and
o Early pregnancy/first trimester, if other infections from food:
mother found to seroconvert
Spiramycin 1g every 8hr, does not Cook food to safe temperatures. A
cross the placenta, not used for fetal food thermometer should be used to
treatment.[16] measure the internal temperature of
o Beyond 1st trimester (≥ 18wks) or cooked meat.[17]
confirmed fetal infection (e.g., by
PCR): For Whole Cuts of Meat (excluding
Pyrimethamine 50 mg twice daily poultry)
x 2d then 50 mg per day Cook to at least 145° F (63° C) as
+ sulfadiazine 75 mg/kg/d in two measured with a food thermometer
divided doses x 2d then 50 mg/kg placed in the thickest part of the meat,
twice daily + leucovorin 10-20 then allow the meat to rest for three
mg daily.[16] minutes before carving or consuming.
[18]
Congenital disease For Ground Meat (excluding
The goal of treatment is to prevent or poultry)
limit pathology in the CNS and eye. Cook to at least 160° F (71° C);
ground meats do not require a rest
Treatment that is started early (before
time.[18]
2.5 months of age) and that is
continued for 12 months appears to For All Poultry (whole cuts and
result in more favorable outcomes, in ground)
particular reducing the likelihood of Cook to at least 165° F (74° C). [18]
sensorineural hearing loss.Infected
newborns should be treated for 1 year Peel or wash fruits and vegetables
with pyrimethamine plus sulfadiazine thoroughly before eating.[18]
plus leucovorin[17]
Avoid eating cured meats such as
prosciutto and salami[18]

Wash cutting boards, dishes, counters,

utensils, and hands with soapy water
after contact with raw meat, poultry,
seafood, or unwashed fruits or
vegetables.[18]

Avoid drinking untreated water.[18]

Wear gloves when gardening and

during any contact with soil or sand
because it might be contaminated with
Prevention cat feces that contain Toxoplasma. [3]
Wash hands with soap and water after
gardening or contact with soil or sand. 1 Sensini A. Toxoplasma gondii
[6] infection in pregnancy: opportunities
and pitfalls of serological diagnosis.
Ensure that the cat litter box is Clin Microbiol Infect.
changed daily. The Toxoplasma
parasite does not become infectious 2 Gras L, Gilbert RE, Wallon M,
until 1 to 5 days after it is shed in a Peyron F, Cortina-Borja M. Duration
cat’s feces.[5] of the IgM response in women
acquiring Toxoplasma gondii during
Avoid changing cat litter if possible.
pregnancy: implications for clinical
If no one else can perform the task,
practice and cross-sectional incidence
wear disposable gloves and wash your
hands with soap and water afterwards. studies. Epidemiol Infect
[5] 3 Gilbert RE. Congenital
toxoplasmosis: scientific background,
Keep cats indoors to prevent them
clinical management and control. In:
from hunting and reduce the chances
Petersen E, Amboise-Thomas P,
they will become infected
with Toxoplasma.[5] editors. Epidemiology of infection in
pregnant women. 1st ed. Paris:
If you visit a farm, wash your hands Springer; 2000.
thoroughly after contact with sheep
4 Remington JSMR, Wilson CB,
and avoid handling newborn lambs[5]
Desmonts G. Toxoplasmosis. In:
Conclusion Remington JSKJ, editor. Infectious
diseases of the fetus and newborn
Toxoplasma infection in a pregnant infant. 7th ed. Philadelphia:
woman may results in congenital Saunders/Elsevier; 2011.
toxoplasmosis (CT) of the neonate;
worldwide, 400–4000 children are 5 Cook AJ, Gilbert RE, Buffolano W,
born with congenital toxoplasmosis et al. Sources of § infection in
every year. 90% of the infected pregnant women: European
woman are asymptomatic but the rate multicentre case-control study.
of vertical transmission is 40% which European research network on
increases with advancing gestational congenital toxoplasmosis. BMJ.
age. Most common features of 2000;321:142
congenital toxoplasmosis include
hydrocephalus, chorioretinitis, and 6 Paquet C, Yudin MH. Society of
intracranial calcifcations. Prevention obstetricians and gynaecologists of
of maternal toxoplasma by health Canada. Toxoplasmosis in pregnancy:
education and routine screening of prevention, screening, and treatment.
women living in areas with high J Obstet Gynaecol Can. 2013;35:78.
prevalence is of paramount
importance. 7 Hohlfeld P, MacAleese J, Capella-
Pavlovski M, et al. Fetal
toxoplasmosis: ultrasonographic
signs. Ultrasound Obstet Gynecol. for diagnosis of toxoplasmosis. J Clin
1991;1:241. Microbiol. 2004 Mar;42(3):941-5
8 Kaye A. Toxoplasmosis: diagnosis, 16 Derouin F, Pelloux H, ESCMID
treatment, and prevention in Study Group on Clinical Parasitology.
congenitally exposed infants. J Pediatr Prevention of toxoplasmosis in
Health Care. 2011;25(06):355–64. transplant patients. Clin Microbiol
Infect. 2008 Dec;14(12):1089-101.
9 Di Mario S, Basevi V, Gagliotti C,
et al. Prenatal education for 17 Guerina NG, Hsu HW, Meissner
congenital toxoplasmosis. Cochrane HC, et al. Neonatal serologic
Database Syst Rev. 2013;CD006171. screening and early treatment for
congenital Toxoplasma gondii
10 Petersen E. Epidemiology,
infection. N Engl J Med. 1994 Jun
diagnostics, and chemotherapy. In:
30;330(26):1858-63.
Ajioka JW, Soldati D, eds.
Toxoplasma molecular and cellular 18 Mandelbrot L, Kieffer F, Sitta R, et
biology. Norfolk, UK: Horizon al. Prenatal therapy with
Bioscience; 2007:chapter 3 pyrimethamine + sulfadiazine vs
spiramycin to reduce placental
11 Montoya JG, Liesenfeld O.
transmission of toxoplasmosis: a
Toxoplasmosis. Lancet. 2004 Jun
multicenter, randomized trial. Am J
12;363(9425):1965-76.
Obstet Gynecol. 2018
12 Desmonts G. Couvreur J. Oct;219(4):386.e1-386.e9
Congenital toxoplasmosis: a
prospective study of 378 pregnancies.
N Eng J Med. 1974 May
16;290(20):1110-6
13 Dunn D, Wallon M, Peyron F, et
al. Mother-to-child transmission of
toxoplasmosis: risk estimates for
clinical counseling. Lancet. 1999 May
29;353(9167):1829-33.
14 Pfaff AW, Liesenfeld O, Candolfi
E. Congenital toxoplasmosis. In:
Ajioka JW, Soldati D, eds.
Toxoplasma molecular and cellular
biology. Norfolk, UK: Horizon
Bioscience; 2007:chapter 5
15 Remington JS, Thulliez P,
Montoya JG. Recent developments