Toxoplasma In Pregnancy

Question 1

What is the incidence of maternal infection with toxoplasma?

Answer 1

2/ 1000 pregnancies

Question 2

How can toxoplasmosis be acquired?

Answer 2

By ingestion of toxoplasma cysts in undercooked meat from infectious oocytes which are exerted by cats
OR contaminated water

Question 3

What are the features of maternal infection with toxoplasma?

Answer 3

60 - 70 % asymptomatic
Some women suffer from:
Malaise _ fever _ lymphadenopathy

Question 4

What is the fetal risk of transmission with toxoplasma?

Answer 4

The risk increases with gestational age
< 1% before 4 w
4 - 15 % at 13 w
60% at 36 w

Question 5

What is the risk of congenital toxoplasmosis abnormality in pregnancy?

Answer 5

Greatest when the infection occurs during the 1st trimester
Early pregnancy 85 %
Late pregnancy 10 - 80 %

Question 6

When is the combined risk of having an affected fetus ( by toxoplasmosis) highest? Why?

Answer 6

Middle of pregnancy
13 - 28 w
[ the risk of transmission is higher in late pregnancy and the risk of abnormalities is higher in early pregnancy]

Question 7

What is the toxoplasmosis triad ?

Answer 7

1- intracerebral calcification
2- hydrocephalus
3- chorioretinitis
ℹ UNCOMMON IN UTERO OR AT BIRTH

Question 8

What are the features of congenital toxoplasmosis?

Answer 8

1- CNS : ventriculomegaly - hydrocephalus- convulsions
2- eye : chorioretinitis - blindness
3- hepatospleenomegaly: anaemia- rash - jaundice
4- pneumonitis
[ ear and heart are NOT affected]

Question 9

How is maternal infection with toxoplasma diagnosed?

Answer 9

1- seroconversion of IgG
2 - IgM +ve / IgG +,ve / low AVIDITY index ( < 30%)

Question 10

What are the US features of congenital toxoplasmosis?

Answer 10

1- ventriculomegaly
2- hydrocephalus
3- microcephaly
4- intracerebral calcification
5- cataract formation
6- ascites

Question 11

What is the treatment in confirmed maternal infection with toxoplasma?

Answer 11

Spirsmycin 1 g , 3 times/ day

Question 12

What is the treatment of confirmed fetal infection with toxoplasma?

Answer 12

Confirmed by amniocentesis
1- spirsmycin 1g 3 times/ d
* alternated weekly with:
2- pyrimethamine 50 mg/once a day
3- sulfadiazine 1 g / 3 times/ d
4- folinic acid 50 mg weekly
ℹ weekly CBC when taking pyrimethamine ( folate antagonist)