Toxoplasmosis

The causative agent of toxoplasmosis is Toxoplasma gondii, a parasite that usually infects rodents. Based on serologic studies, approximately one third of reproductive-age women have had toxoplasmosis. In the United States, maternal infection is thought to occur in about 0.5%. Congenital toxoplasmosis can only occur when active infection occurs during pregnancy. Recognizable damage to newborns is estimated to occur in about 1 in 10,000 births; incidence of infected but asymptomatic newborns is unknown. Maternal infections that occur in the first trimester are more likely to cause abortion and significant fetal damage. Infections later in pregnancy tend to be asymptomatic at birth.

A pregnant woman can contract toxoplasmosis by eating raw meat containing the cysts of the organism or by fecal-oral transmission of the oocytes from an infected cat. Cats that are fed cooked or canned food are most often not infectious. Those that obtain rodents from the wild are more at risk. Pregnant women should avoid changing cat litter and handling cats, particularly those cats allowed to roam outdoors. Maternal toxoplasmosis may be asymptomatic or may present as a mononucleosis-like syndrome. Congenital disease ranges from overwhelming, including seizures, microcephaly or hydrocephaly, chorioretinitis, hepatosplenomegaly, jaundice, microphthalmia, and cataracts, to less symptomatic, which usually involves chorioretinitis. Prenatal ultrasound or postnatal brain scan can also show intracranial calcifications. The placenta should be examined pathologically for cysts of T. gondii (Beasley and Egerman, 1998).

The diagnosis of toxoplasmosis is serologic, looking for immunoglobulin G (IgG) and IgM by enzyme-linked immunosorbent assay (ELISA). Some assays have a high level of false-positive results. Laboratories well versed in performing these serologic tests should be used. Pyrimethamine and sul-fadiazine can treat women who acquire the infection prena-tally. Effectiveness of treatment protocols for prevention of congenital infection appears variable (Wallon et al., 1999). Screening of all pregnant women is not recommended at this time.

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