Toxoplasmosis in pregnancy

Question 1

What is toxoplasmosis in pregnancy (RF)

Answer 1

Protozoan- toxoplasma gondii
parasite excretes inc at faces, incubation 5-23d)
transmission faoco oral (infected meat, cat faeces)

Chance of vertical transmission increased with age - 1st trim 1%, 80% 3rd
Chance of CONGENITAL toxo reduced with age 1st trim 60-80%, 5% 3rd

RF- cat in households, some rural areas of France

Question 2

Sx and Ix of toxoplasmosis in pregnancy

Answer 2

Sx -
Mother – asymptomatic (occasional, fever, malaise, arthalgia)

Child
60% asympto at birth - develop deafness, low IQ, microcephaly

40% sympto at borth - Classic 4c’s of toxo
Chorioretinitis
hydroCephalus
Convulsion
Intracranial Calcifications (scattered in brain, unlike CMV)

hepatomegaly/jaundice

N.B. any condition with chorioretinitis can progress to cataracts (it’s just rubella is most commonly associated

Ix -
Sabin Feldman dye test
Bloods - IgM can persist for years. IgG immunity
USS - foetal anomaly scan
Amniocentesis and PCR for foetal infection (if USS rise suspicion)

Question 3

Mx of toxoplasmosis in pregnancy

Answer 3

always ask preg mother to avoid raw meat and handling cat litter

Toxoplasm +ve in mum, -ve in baby (no vertical yet) - SPiramycin 3w - prevents

Toxoplasm PCR +ve mum, +ve baby -Pyrimethamine + sulfadizaine for up to 1 year post delivery
can add prenisolone