Baby with congenital toxoplasmosis

Congenital toxoplasmosis is a group of symptoms that occur when an unborn baby (fetus) is infected with the parasite Toxoplasma gondii.

Cause and incidence

During pregnancy if the mother becomes infected with toxoplasmosis the developing baby can become infected. The infection may spread to the developing baby during the pregnancy itself, or during labor or delivery through the placenta.

The toxoplasmosis infection in the mother is generally mild, and she may not be aware of it. Infection of the developing baby can cause severe problems. Infection in early pregnancy results in more severe problems than infection in later pregnancy.

Complications in the babies due to the infection

Half of the developing babies who get infected with toxoplasmosis during the pregnancy are born prematurely. Congenital toxoplasmosis can damage the baby’s eyes, nervous system, skin, and ears.

Complications include:

•   Enlarged liver and spleen

•   Vision problems: Eye damage from inflammation of the retina or other parts of the eye which can lead to blindness or severe visual disability.

•   Feeding problems

•   Hearing loss

•   Jaundice (yellow skin)

•   Low birth weight (intrauterine growth restriction)

•   Skin rash (tiny red spots or bruising) at birth

•   Hydrocephalus

Brain and nervous system damage ranges from very mild to severe, and may include:

•   Seizures

•   Severe mental retardation or other neurological problems

Signs of infection in the new born

The health care provider will examine the baby after birth. Often, there are signs of infection in the baby at birth. However, newborns with milder infections may not have symptoms or problems for months or even years. If the babies are not treated, they develop problems especially in the eyes when they become adolescents.

The baby may have:

•   Yellow skin (jaundice)

•   Inflammation of the eyes

•   Large head size (macrocephaly) or smaller-than-normal head size (microcephaly)

•   Diarrhea or vomiting

•   Fluid on the brain (hydrocephalus)

•   Swollen lymph nodes (lymphadenopathy)

•   Swollen spleen and liver

Tests done to detect infection in the fetus

An invasive prenatal testing, postnatal or neonatal screening is done to check the fetus.

Tests done during pregnancy to detect infection include:

•   Detection of infection by checking for the presence of antibody for Toxoplasma gondii in the mother by testing mother’s blood.

•   Amniotic fluid testing and fetal blood testing

•   Ultrasound of the abdomen

After birth, the following tests may be done on the baby:

•   Antibody studies on cord blood and cerebrospinal fluid

•   CT scan of the brain

•   MRI scan of the brain

•   Neurological exams

•   Standard eye exam

•   Toxoplasmosis test

Treatment

An infection in the baby can be very serious since a baby’s immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the body are very difficult to eradicate with anti-protozoans.

Spiramycin can treat infection in the pregnant mother. Pyrimethamine and sulfadiazine can treat fetal infection diagnosed during the pregnancy.

Treatment of infants with congenital toxoplasmosis typically includes pyrimethamine, sulfadiazine, and leucovorin for one year. Infants are also sometimes given steroids if their vision is threatened or if the protein level in the spinal fluid is high.

Calling your health care provider

Call for an appointment with your health care provider if you are pregnant and think you are at risk for toxoplasmosis. You are at high risk if you have a cat and your the person who cleans the litter box. Do not change the litter while your pregnant, ask some one else to do it.

Call for an appointment with your health care provider if you are pregnant and have not received any prenatal care.

Prevention

By following safe food preparation and hygiene practices pregnant women can prevent infection by toxoplasma. Your health-care provider should test for Toxoplasma infection before pregnancy or at your first prenatal visit. A simple blood test is performed and your doctor can determine if you are at risk for infection by toxoplasma.

Pregnant women who have pet cats are at increased risk of developing toxoplasmosis. They should avoid contact with any material that are potentially infected with cat feces. Cook meat until it is well done, and wash your hands after handling raw meat.

Treatment of pregnant women infected with toxoplasma is very important to prevent infection of the fetus.