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Toxoplasmosis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Corina N. Schoen, Elizabeth A. Morgan
Human infection starts with ingestion of cysts from uncooked/undercooked meat of infected animals (e.g., pork, lamb and mutton) orcontact with oocysts from infected cats or feces-contaminated soil, unwashed vegetables and fruit, and water. The average incubation period is 7 days [4–18]. Very few cases of congenital toxoplasmosis transmitted by mothers who were infected prior to conception have been reported; they can be attributed to either reinfection with a different strain or to reactivation of chronic disease. This reactivation is rare but can occur especially in an immunocompromised woman. Immunocompetent women with prior toxoplasmosis can be reassured that the risks to the subsequent fetus/neonate are exceedingly rare, especially >9 months after infection [4].
Toxoplasmosis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Foulon et al. (65) evaluated the reduction in the incidence of congenital toxoplasmosis using a primary prevention scheme (education) and a secondary prevention scheme (screening and treatment). Among the 11,286 consecutive pregnant women, primary prevention reduced the seroconversion rate by 63% (p = 0.013). Of 76 women determined to be at risk for delivering a child with congenital toxoplasmosis, 8 (11%) infected fetuses were detected by prenatal fetal diagnosis. Of these, secondary prevention (antibiotics) reduced the incidence of congenital toxoplasmosis by an additional 40%. Unfortunately, a recent meta-analysis of randomized trials showed poor design quality and no benefit in reducing the incidence congenital toxoplasmosis. Regardless, given the benefit of the Foulon et al. study and the low cost of behavioral interventions, the author recommends their continued use (66).
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Congenital toxoplasma infection is defined by the transmission of the parasite to the fetus and is dependent on the time of acquisition of maternal infection during pregnancy. The later maternal infection is acquired, the more frequently parasites are transmitted to the fetus, reaching 90% of transmission during the last weeks before delivery [20]. Congenital toxoplasmosis is defined by the clinical manifestations of the disease in the newborn. It is subclinical, mild or severe and depends on the age of the fetus at the time of transmission. The period of highest risk is between 10 and 24 weeks. It is known that the majority of infants with congenital toxoplasmosis have major sequelae. In the early 1950s, at a time when treatment was not undertaken, the major sequelae among 105 children less than five years of age, were mental retardation (96%), convulsions (84%), impaired vision (61%) and deafness (15%).
Anophthalmia and microphthalmia in children: associated ocular, somatic and genetic morbidities and quality of life
Published in Ophthalmic Genetics, 2022
Cecilia Fahnehjelm, Eva Dafgård Kopp, Josephine Wincent, Evin Güven, Mattias Nilsson, Monica Olsson, Kristina Teär Fahnehjelm
Three patients had epilepsy, five were either deaf or had hearing impairment, one had cerebral palsy and one had both ADHD and autism (Figure 4). Congenital toxoplasmosis was diagnosed in one patient prenatally. A TORCH panel test was checked in three other patients and was found to be negative, whereas four additional patients had negative cytomegalovirus serology tests. MRI or CT of the brain were performed in 19 cases and 1 case, respectively. Pathology was demonstrated in 14/20 with combinations of corpus callosum dysgenesis (6), microcephaly (3), vermis hypoplasia (2), affected pituitary gland (1), aquaeductus stenosis and calcifications (2), ventricular dilation (2) and polymicrogyria (1). Brain ultrasound was performed in four additional cases and were normal in all.
Disease of the Year 2019: Ocular Toxoplasmosis in HIV-infected Patients
Published in Ocular Immunology and Inflammation, 2020
Alejandra de-la-Torre, Jorge Gómez-Marín
There are multiple clinical manifestations of congenital toxoplasmosis, varying from fetal death to asymptomatic babies. A Brazilian study reported three cases of congenital fetal toxoplasmosis in which the mothers were HIV positive and had chronic toxoplasmosis. The first case ended with second-trimester fetal death. Autopsy revealed hepatosplenomegaly, pericarditis, anasarca, and myocarditis. In the second case, the infant presented with intracranial calcifications (identified on computed tomography imaging), retinochoroidal scars, and neurodevelopment delay. In the third case, the newborn was asymptomatic.47 Similarly, hydrocephalus, anemia, jaundice, rash, pneumonitis, seizures, microcephaly, and thrombocytopenia may be seen in cases of congenital toxoplasmosis.48
Quality-of-Life and Psychosocial Aspects in Patients with Ocular Toxoplasmosis: A Clinical Study in a Tertiary Care Hospital in Brazil
Published in Ocular Immunology and Inflammation, 2020
Aristofanes Mendonça Canamary, Isabela Ribeiro Monteiro, Monique Kling Mangeon Machado Silva, Caio Vinícius Saito Regatieri, Luci Meire Pereira Silva, Ricardo P. Casaroli-Marano, Cristina Muccioli
In a large cohort of younger patients diagnosed with congenital toxoplasmosis, a different evaluation methodology has been used.48 Surprisingly, unlike our study, only 25% of bilateral cases have been described, which could be explained by the difference of T. gondii genotype prevalence in the European continent.49 Furthermore, in a similar way to our cohort, women presented worse QoL, both in the toxoplasmosis group and in the control group.48 Although considering the overall score, congenital toxoplasmosis had little effect on the QoL and visual function of those affected,48 most likely due to a question of adaptation from childhood. In our cohort, we have also observed a statistical significance for women in relation to the “general health” variable. Although women didn’t have a grater number of legal blindness and ocular comorbidities cases but a larger number of bilateral cases, besides that, it has been verified that women not only give more importance to health than men but also took more care and greater use of health system. Taking together, these facts lead to more awareness of their deficiencies and thus major concern, and this could explain the significance for women.