Toxoplasmosis in pregnancy – diagnosis,symptoms, treatment

Update: December 2018 Toxoplasmosis is a disease
who fear women planning pregnancy. Their fears
are justified, because this infection is a risk not
only for the mother’s body, but also for the health of her unborn baby.
Toxoplasmosis is a parasitic disease caused by
the simplest organisms – Toxoplasma.

The disease has varying degrees of severity, characterized by
polymorphism of symptoms and clinical manifestations. Toxoplasmosis
refers to TORCH infections (herpes, rubella, cytomegalovirus),
able to be activated in conditions of weakened immunity,
such infections are especially dangerous for the fetus undergoing
intrauterine development.

Toxoplasmosis: пути передачи

Many people believe that the carrier of the disease are
only cats, but this is not the case, the source of toxoplasmosis can be
other domestic and wild animals: dogs, guinea pigs, rabbits,
cows, sheep, pigs, some predators and even rodents. Infection
a healthy person can happen when eating badly
roasted and raw meat, food, which fell feces
animals, poor personal hygiene (rare,
poor-quality cleaning of the premises, no washing of hands when cleaning
toilets of sick animals, etc.). Transmission from
sick mother to the fetus in utero, as well as during transplantation
internal organs or blood transfusions.

Clinical manifestations of toxoplasmosis

There are several clinical forms of toxoplasmosis: acute,
chronic and latent. Toxoplasmosis может быть врожденным и
acquired. The disease is dangerous because it most often occurs
asymptomatic. Acute form with more severe symptoms
characteristic of persons with extremely weak immunity (see
Symptoms of toxoplasmosis – congenital and acquired).

When ingested, toxoplasmosis affects almost everything.
organs and systems, so it is peculiar to clinical polymorphism
manifestations. Symptoms of the disease depend on which organ
struck more than others. The main clinical manifestations
symptoms of toxoplasmosis during pregnancy can be:

  • increase in body temperature to high numbers (38 ° C and above),
    chills
  • appearance of weakness, headaches
  • loss of appetite, sleep disturbance, lethargy, drowsiness Toxoplasmosis
  • jaundice
  • skin rash
  • an increase in the size of the liver and spleen, an increase
    lymph nodes
  • decreased muscle tone
  • appearance of changes in the eyes (inflammatory processes,
    squint, etc.)
  • pneumonia
  • symptoms of CNS damage
  • appearance of memory disorders
  • emergence of feelings of fear, obsessive states

Acute toxoplasmosis is dangerous to human health and life.
has a severe course and does not pass without consequences. But at
timely detection of infection and adequate treatment, the patient may
get well

Diagnosis of toxoplasmosis in pregnant women

The disease is diagnosed according to the symptoms of the disease and
results of laboratory and instrumental methods of research.
Serological methods are the main diagnostic methods.
toxoplasmosis. What are the tests for toxoplasmosis with
pregnancy?

  • RNIF (reaction of indirect immunofluorescence)
  • CSC (complement fixation reaction)
  • ELISA (enzyme-linked immunosorbent assay)

The reaction of indirect immunofluorescence is sensitive, starting from
first week of illness. She peaks after 2-4 months
from the time of infection and is indicative throughout
many years (with the chronic form of the disease).

Complement fixation shows positive
results, starting from the second week, reaches maximum
manifestations to 2-4 months of illness. Further indicators may become
negative or slightly positive, which makes it difficult
diagnosis of chronic and latent forms.

The greatest value is a blood test by ELISA. With his
using immunoglobulins of the Igm and Igg class, thanks to which
можно выявить и дифференцировать все формы toxoplasmosis.

KP (skin allergy test) with toxoplasmin is
additional method of diagnosis of the disease. Usually she
becomes positive starting at 4-6 weeks of infection and
able to persist throughout life. Positive
the reaction to toxoplasmin is manifested:

  • general body reaction
  • increasing papules in size,
  • its hyperemia and soreness
  • увеличением lymph nodes и др.
  • For a pregnant woman and the fetus is the most dangerous primary
    infection with toxoplasmosis during pregnancy. When
    infection occurs before pregnancy, this indicates
    наличие  защитных антител Igg –  процент осложнений
    void
  • Detection of protective Igg antibodies is not an indication for
    treatment.
  • Sex partners of pregnant women, regardless of the results
    surveys of women do not need compulsory research on
    TORCH infection.

In general, the analysis of the patient’s blood by toxoplasmosis is noted
decrease in the number of leukocytes (leukopenia) or normal number
leukocytes with a relative increase in the lymphocyte fraction.

To instrumental diagnostic methods include:
x-ray, fundus diagnostics and biopsy
lymph nodes.

In patients with toxoplasmosis, intracerebral
calcifications in the parietal, frontal, occipital or temporal lobes
brain, calcifications can also be detected in the muscles.
When examining the fundus of the patient, scarring can be detected
changes (signs of chorioretinitis). Lymph node biopsy in
turn allows differentiation of toxoplasmosis from other
diseases.

Decoding the analysis of toxoplasmosis during pregnancy

The table provides a description of the interpretation of the analysis results.
for toxoplasmosis in a pregnant woman by ELISA to determine
Whether the woman contracted during or before pregnancy.
A negative result means that in the column of the laboratory form
the number of detected protective antibodies is less than normal.
A positive result is when this quantity is larger in comparison
with reference values.

Igm Igg Interpretation of blood analysis by ELISA What to do
The woman has no protective antibodies, there was no infection, she
относится  к серонегативным беременным и группе риска, каждый
trimester should be screened (at week 22 and before
childbirth)
Precautions should be taken very strictly during
беременности – ограничить контакт с собаками, кошками, грызунами,
rabbits, carefully wash salads, fruits, do not eat badly
cooked meat, meat products subjected to prolonged thermal
processing.
+ Most likely toxoplasma infection occurred, no more than 2
months ago.
A woman should consult an infectious disease specialist, a gynecologist for
conducting more thorough research because of the high
probability of primary infection with toxoplasma. Should pass
blood and urine PCR tests, repeat tests after 2 weeks
Igg и Igm. Если Igg +, и ДНК методом ПЦР также +, то назначается
treatment. If DNA is not detected, neg. Igg, следовательно анализ Igm
was false positive.
+ + The woman has been infected with toxplasm for the last 2-6
months.
A woman should consult an infectious disease specialist, a gynecologist for
conducting more thorough research. Perhaps this is primary
инфицирование, но следует помнить, что Igm сохраняется + от 3 мес
up to 2 years after suffering a disease with toxoplasmosis.
Recommended urine and blood analysis by PCR and analysis (avidity
test – авидность Igg) остроты инфекции, который поможет определить
time of infection.
+ A pregnant woman has protective antibodies, which indicates either
on latent, chronic process, or on non-sterile
immunity.
It does not pose a serious danger to the fetus and course.
pregnancy, as the result indicates persistent
lifelong immunity. If a woman has been diagnosed
For the first time during pregnancy, you can additionally make
urine and blood analysis by PCR, a negative result will prove
that immunity was acquired before pregnancy and further
diagnosis and treatment should not be carried out.

Treatment of toxoplasmosis

Drug treatment of pregnant women is possible only during
second trimester of pregnancy (after 12 – 16 weeks). It’s connected with
the fact that drugs that are used against Toxoplasma are capable
have a negative effect on the body of the fetus.

Self-medication for toxoplasmosis is unacceptable. Latent flow
absence of clinical manifestations and positive results
serological tests do not need treatment

If a severe form of the disease is predicted, the woman
offer to terminate a pregnancy, because chemotherapy is dangerous for
the body of the fetus. If she wants to keep the pregnancy, she has
берут письменное согласие на лечение toxoplasmosis.

Treatment of acute toxoplasmosis is carried out by pyrimethamine and
sulfa drugs or spiramycin in combination with
sulfonamides. To eliminate the side effects of drugs
concurrently prescribed folic acid. Also for treatment
toxoplasmosis drugs may be given to pregnant women
macrolide groups (rovamycin).

For accurate diagnosis of fetal infection
amniocentesis – puncture of the fetal bladder with taking for analysis
amniotic fluid. It should be remembered that the toxoplasma in them
detected only one month after infection of the pregnant
women. An enlarged liver may indicate a disease in the fetus.
and spleen, the appearance of intracranial calcifications, expansion
ventricles of the brain, a thickening of the placenta detected by ultrasound
infected fetus.

Чем опасен токсоплазмоз во время pregnancy?

If a pregnant woman is infected, the parasites through the blood can
enter the body of the fetus. The effects of toxoplasmosis are
that a pregnancy can end in a spontaneous abortion,
premature birth, stillborn or infected birth
baby

According to statistics, 12% of women are infected in
gestation period. Чем опасен токсоплазмоз при pregnancy?
Самое трагичное для матери – это риск развития врожденной инфекции
у baby Congenital Toxoplasmosis occurs in 30–40% of children
born to women who were sick during
of pregnancy.

  • If infection of the mother occurred in early pregnancy.
    (1-2 trimester; see calculator of pregnancy)
    intrauterine infection of the fetus is less common than with
    infection of the mother at a later date. However, the disease
    it is harder to infect a woman in the early stages, the risk
    miscarriage and premature birth is 10-15%, and congenital
    toxoplasmosis in a child with severe pathologies 15-25%.
  • If the infection occurred in the third trimester of pregnancy,
    then the risk of congenital disease in a child reaches 90%, but how
    usually in most cases the disease proceeds
    asymptomatic.
  • If a woman became infected long before the onset of pregnancy (6
    months and more), the infection is transmitted to the child in isolated cases,
    а если срок составляет меньше, чем за 6 месяцев – риск передачи
    pathogen to the fetus will be higher.

Congenital токсоплазмоз у ребенка проявляется общими симптомами,
to which can join: hydrocephalus, orioretinitis,
hepatosplenomegaly, thrombocytopenia, convulsions and microphthalmia
(small size of eyeballs).

Disease prevention

Prevention of toxoplasmosis during pregnancy is especially important.
для женщин, имеющих слабый immunity. Must with caution
work with the land, especially in the garden and in the flower beds. With
earthworks must wear protective gloves
(through small cracks in the skin, toxoplasma can enter the body
person).

It is necessary to thoroughly wash vegetables and fruits, wash hands after harvesting.
animal toilets, cell cleaning and after handling raw meat.
Do not eat poorly roasted meat, especially steak with blood and
dishes like him. It is not recommended to kiss pets, their
saliva may contain parasites.

If you are plagued by doubts about whether your
animal toxoplasmosis, hand over animal feces for analysis, and if
it will be healthy, do not let him eat raw meat and not
let go outside so that it does not get infected by the sick
animals.

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