Toxoplasmosis in pregnancy
Toxoplasmosis is a zonootic disease results from toxoplasma gondi infection.It is a parasite not bacteria which presents in cat fecal matter .Domestic cats and other felids are the definitive hosts (DHs). All non-feline animals, including dogs and humans, are intermediate hosts (IHs). Also it may present in contaminated meat and water and presents world wide.
Toxoplasma gondi:
Toxoplasma gondi is one unicellular parasite (protozoa).It is practically infect warm blooded animals .But cats are known as host that parasite make its sexual reproduction.
Toxoplasmosis in humans:
There are three types of infection:
1-Acute toxoplasmosis in humans:
Some cases are asymptomatic .But people who develop the symptoms show:
- Headache
- Fever
- Fatigue
- Swollen lymph nod
- Muscle aches
- Seizures
- Lung problem
- Confusion
- Poor coordination
- Blurred vision (sever inflammation of retina due to toxoplasmosis eye)
2-Latent toxoplasmosis in humans:
Because of no or mild symptoms (flu like symptoms )of toxoplasma gondi ,the disease may enter a latent phase that tissue cyst are present .The infection happens in retinas (toxoplasmosis eye ) ,lung, heart , central nervous system ( in brain and preset for human life ) and skeletal muscle.
3-Cutaneous toxoplasmosis in humans:
This type seldom happens.But it appears in acquired infection.It appears as roseola and erythema multiforme-like eruptions, prurigo-like nodules, urticaria, and maculopapular lesions.Newborns may have punctate macules, ecchymoses, or "blueberry muffin" lesions.
Toxoplasmosis in pregnancy:
Toxoplasma infection before pregnancy has few or no danger to baby except in case of infection three months before conception .
Toxoplasma can cause many defects in fetus such as :
- Hydrocephalus.
- Microcephaly.
- Intracranial calcifications.
- Retinochoroiditis.
- Strabismus.
- Blindness.
- Epilepsy.
- Psychomotor and mental retardation.
- Petechiae due to thrombocytopenia.
- Anemia.
Toxoplasmosis in early pregnancy causes a small risk for baby transmission (less than 6%), rates of transmission range from 60% to 81% in 3rd trimester.
T gondii transmission through breastfeeding or from man to man has no evidence.
Toxoplasmosis in dogs:
Dogs mostly suffer from toxoplasmosis as a secondary disease.Most cases related to immunodeficiency and absence of vaccination against canine distemper virus. Toxoplasmosis symptoms appear as neurological signs including :
- Seizures
- Cranial nerve deficits
- Tremors
- Ataxia
- Paresis or paralysis within encephalomyelitis.
Other symptoms are reported such as :
- Noise sensitivity.
- Myositis.
- Ocular disease described as necrotizing conjunctivitis.
- Anterior uveitis.
- Endophthalmitis.
- Chorioretinitis.
Cutaneous toxoplasmosis in dogs:
In general, it related to corticoid therapy and transplantation. The infection appeared as erythematous epidermal nodules, pyogranulomatous and necrotizing dermatitis, and panniculitis, with multifocal vasculitis and vascular thrombosis.
Toxoplasma infection in cats more sever in case of vertical transmission .It progresses to pneumonia, and encephalitis hepatitis or cholangiohepatitis, and other symptoms appear such as :
- Ascites.
- Lethargy.
- Dyspnea.
- Extra-intestinal enteritis.
- Inflammatory intestinal disease.
- Thickening of the gastric wall due to eosinophilic fibrosing gastritis.
- Regional lymphadenopathy.
In adults, there are no clinical symptoms appear.In case of generalized infection of toxoplasma gondi pneumonia appears . Acute respiratory distress syndrome and septic shock may happen.
Toxoplasmosis eye observed in cats with no generalized clinical symptoms.But other symptoms appeared like :
- Aqueous flare.
- Keratic precipitate.
- Lens luxation.
- Glaucoma.
- Retinal detachment
Some diseases happen in low frequant like :
- Myocarditis with echocardiographic changes.
- Diarrhea with oocysts.
- Pyogranulomatous cystitis after renal transplantation.
Toxoplasmosis diagnosis:
when the doctor suspect toxoplasma infection ,he will make a serological test (blood test ) to looking for antibodies for toxoplasma.These antibodies appear after infection or foreign material enter the body. These antibodies are specific to the type of infection .So doctors can determine toxoplasmosis infection from antibodies.
Toxoplasma gondi test result:
In some cases false negative result appears.In this case the patient is in early stage of infection and antibodies don't appear yet so the doctor may ask you to repeat the test several weeks later.
In case of positive result , this means that you are actively infected with toxoplasma .Also, it may mean that you have infected with toxoplasma before and this antibodies from previous infection.
Testing your baby:
Pregnant woman with toxoplasmosis infection can check her baby to know if he also infected or not . Tests including:
Amniocentesis:
This test has done safely after fifteen weeks of pregnancy, the doctor uses a fine needle to remove a small amount of fluid from the fluid-filled sac that surrounds the fetus (amniotic sac). This fluid is checked for presence of toxoplasmosis. Amniocentesis carries a slight risk of miscarriage and minor complications, such as cramping, leaking fluid or irritation where the needle was inserted.
Ultrasound scan:
This test uses to detect any abnormality in fetus.
Treatment of toxoplasmosis:
Treatment will be different in case of pregnancy according to whether your baby infected or not.Mostly he will prescribe antibiotic according to your case . Spiramycin is an antibiotic which mostly recommended in the 1st and early 2nd trimester. A combination of pyrimethamine/sulfadiazine and leucovorin is mostly recommended within the late 2nd and 3rd trimesters.
If your baby has toxoplasmosis during pregnancy , pyrimethamine and sulfadiazine may be considered as a treatment. But they have significant side effects on pregnant and the baby and are used only as a last resort.
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