Drugs in pregnancy and lactation
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
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%).
Infections
C. Simon Herrington in Muir's Textbook of Pathology, 2020
The most common consequence is a subclinical latent infection, where tissue cysts reside in brain and muscle where they cause no significant pathology, but they may reactivate if the person becomes immunosuppressed. Acute acquired toxoplasmosis presents as fever, malaise, lymphadenopathy, and splenomegaly. As suspicion of lymphoma is common, lymph node biopsy is frequently performed in tandem with serology. Characteristically, the node shows reactive follicular hyperplasia and numerous small non-necrotic granulomas, but rarely – if ever – any detectable parasites. Congenital toxoplasmosis follows transplacental transmission in about 30% of women who acquire toxoplasma infection in pregnancy. During the first trimester this results in abortion, and as pregnancy progresses the risk of severe fetal disability declines. The classic tetrad is hydrocephalus or microcephaly, chorioretinitis, and cerebral calcification. Histologically, there is an encephalitic reaction against the parasites. Milder sequelae include learning disability and epilepsy.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
Infection by Toxoplasma gondii is commonly asymptomatic. It may be transmitted from mother to fetus, resulting in a congenital form, or it may be acquired postnatally by the ingestion of contaminated soil or undercooked meat. About 40% of cases of congenital toxoplasmosis are symptomatic with jaundice, hepatosplenomegaly, lymphadenopathy, fever, and retinochoroiditis as prominent manifestations.123 In acquired toxoplasmosis, a hepatitis-like picture with jaundice124, 125 or granulomatous hepatitis126127 may occur. A prolonged prodromal phase, which may be characterized by subfebrile temperature elevations and fatigue, and the presence of generalized lymphadenopathy may suggest toxoplasma hepatitis. Liver biopsy may disclose liver cell necrosis with an inflammatory infiltrate. A rising titer in the Sabin-Feldman dye test establishes the diagnosis.
Synthesis and biological evaluation of ursolic acid derivatives bearing triazole moieties as potential anti-Toxoplasma gondii agents
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2019
Tian Luan, Chunmei Jin, Chun-Mei Jin, Guo-Hua Gong, Zhe-Shan Quan
Toxoplasma gondii is an opportunistic pathogen that causes infection in human beings and various animals, thereby severely impairing their health. Congenital toxoplasmosis, caused by T. gondii, is especially harmful to pregnant women as the infection may result in abortion, stillbirth, and abnormality of foetus thinking barrier. The infection could also be fatal for immuno-compromised patients1. Owing to the complexity of T. gondii life cycle, its multifarious pathogenesis and different biological characteristics, no preventive and medicine-specific treatment exists currently. Traditional anti-T. gondii drugs have various disadvantages, such as the inability to completely kill the protozoa and oocysts, high toxicity, frequent recurrence, and failure in immuno-compromised individuals2,3. Considering the increasing percentage of natural product-based drugs in the market in the past years, researchers have now focussed their attention to plant-based compounds with anti-T. gondii activity. Moreover, several studies have shown natural products and their derivatives to exert strong anti-T. gondii effects, making these an attractive source of anti-T. gondii drugs4,5. In this regard, structural modifications of natural products to generate effective and less-toxic derivatives are considered to be very promising for the development of anti-T. gondii drugs.
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.
Rolling up the pieces of a puzzle: A systematic review and meta-analysis of the prevalence of toxoplasmosis in Iran
Published in Alexandria Journal of Medicine, 2018
Masoud Foroutan, Sahar Dalvand, Ahmad Daryani, Ehsan Ahmadpour, Hamidreza Majidiani, Shahram Khademvatan, Esmaeil Abbasi
Pregnant women are substantial targets of T. gondii infection and the seroprevalence of infection among this population in Iran has been assigned 41% (95% CI = 36–45). Congenital cases appear more frequently when infection occurs late in pregnancy causing drastic imperfections of eyes and hearing apparatus. However debilitating outcomes such as mental retardation, deafness, retinochoroiditis, microcephaly, and hydrocephaly mostly take place when infection is encountered in the first trimester. In this case there are plenty of documentations worldwide.6,10,13 Totally, seroprevalence rates of toxoplasmosis in pregnant women and those in childbearing age illustrated more endemicity in the Americas and Africa, ranging 6.1–77.5% and 25.3–75.2%, respectively. Additionally, in Europe and Asia the seroprevalence trend indicate a range scope between 8.2–63.2% and 0.8–63.9%, respectively.30 Moreover, in recent systematic review, annual incidence of congenital toxoplasmosis was reported 190,100 cases (95% CI = 179,300–206,300) from global perspective that impose 1.20 million DALYs (Disability-adjusted life year) (95% CI = 0.76–1.90). South America, some Middle Eastern and low-income countries had the highest burden of infection.6 Higher endemicity of toxoplasmosis in some regions implicates lower primary active infection in gestation period, since pregnant women have encountered T. gondii during their childhood or childbearing age, leading to the premunition or concomitant immunity in person’s body which extinguishes the pathogenicity of parasites.6
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