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Toxoplasmosis is a disease caused by the protozoan toxoplasmosis (intracellular parasite) that can be found in the tissues of the human body as well as in many animals, especially cats, mice and dogs. Treatment of toxoplasmosis should only be carried out under the supervision of a physician. What does toxoplasmosis look like in pregnancy? How to prevent toxoplasmosis?
Toxoplasmosis is a parasitic disease that is considered to be the most common in humans. It is caused by Toxoplasma gondii, which was detected in 1908.
A case of congenital toxoplasmosis in humans was described a little later. The least infected with toxoplasmosis is recorded in northern Europe and Southeast Asia. In the past, many cases of toxoplasmosis in pregnant women were reported in our country. Screening in this area is currently being carried out in Europe in pregnant women.
Whether a patient is infected is determined by immunofluorescence and color tests as well as a positive serological test. These tests are necessary to recognize the presence of human toxoplasmosis.
The development cycle of the protozoan toxoplasmosis
In the development cycle of the toxoplasmosis protozoa, sexual and asexual reproduction takes place (a large number of animal species). It has two forms, the first is tachyzoite, which is observed in the acute phase of infection. The second form of bradyzoites is characterized by slow growth in tissue cysts.
The sexual development cycle takes place in the cat’s digestive tract and its final stage – oocysta it is excreted with the faeces to the outside. During a primary infection, a cat may secrete millions of oocysts each day for 1 to 3 weeks.
Oocysts are very resistant to environmental conditions and when excreted from the host’s organism, they may be infectious for over a year (especially in a warm and dry environment). All three of the mentioned forms of protozoa are infectious to humans, while the cysts of the parasite can live in the human body until the end of the infected individual’s life.
Toxoplasmosis-pathways of infection
1. The alimentary path – infection with toxoplasmosis occurs by eating undercooked or raw meat, usually beef, pork or mutton, which contains tissue cysts. In addition, it is possible to become infected due to ingestion of oocysts that are present in an environment contaminated with the feces of an infected cat. Drinking contaminated / contaminated water, contact with contaminated soil, and eating fruits and vegetables raw are also important.
The cat expels oocysts, which are very resistant to any unfavorable environmental conditions and chemical action. Their invasiveness in soil may persist for up to a year, and in water for up to several years. Despite the excretion of a large amount of oocysts, a cat becomes ill only once for two weeks, while oocysts acquire infectious properties only after about 2-5 days after expulsion.
2. Bearing – toxoplasmosis can cross the placenta to the fetus when the mother has congenital toxoplasmosis.
3. Blood transfusion – infection with toxoplasmosis can occur due to transfusion of contaminated blood or during transplantation of infected organs.
Read more on: Blood transfusion – indications, procedure, complications
Types of toxoplasmosis
- Acquired toxoplasmosis
In humans, there is a form of acquired toxoplasmosis (acute and chronic), which is a typical zoonotic disease, and a congenital form, which is a consequence of infection through the placenta.
Sharp figure Acquired toxoplasmosis characterized by the occurrence of a symptom such as increased body temperature. There are also symptoms from the organs affected by the disease.
- Toxoplasmosis węzłowa
In nodal toxoplasmosis, one, several or a large number of lymph nodes are enlarged. Typically, the lymph nodes in the neck, in front of or behind the ears, or on the nape of the neck are enlarged. The inguinal and axillary nodes are less frequently enlarged. Moreover, the lesions may be located in the mediastinum or in retroperitoneal lymph nodes.
Sometimes, with the involvement of the mesenteric lymph nodes, abdominal pains appear that resemble appendicitis. Lymphadenopathy is accompanied by headaches, throat, muscle and joint pain, as well as a feeling of progressive weakness and general malaise.
In addition, there may be a skin rash and symptoms of gastroenteritis. Sometimes, as a result of the primary nodal infection passing to the central nervous system, limb paresis, cranial nerve involvement, convulsions, and mental disorders such as apathy, distraction or dementia may occur.
- Generalized toxoplasmosis
It may be related to the entry of the parasite into the central nervous system, giving the picture of encephalitis. Then, the patient develops headaches, dizziness, problems with balance, nystagmus, apathy, and various symptoms that depend on the location of the parasite in the brain tissue. Other forms of generalized toxoplasmosis can lead to: pneumonia, hepatitis, inflammation of the meninges and the brain and myocarditis.
- Eyeball toxoplasmosis
It leads to problems with proper vision, scotomas in front of the eyes, pain and photophobia. There may also be lacrimation of the affected eyeball as an indication of ongoing choroidal retinitis. Ocular toxoplasmosis is chronic and tends to come back.
- Chronic toxoplasmosis
It is characterized by nonspecific symptoms in the form of inflammation of: the retina of the eye, the liver, the choroid of the eye, or the respiratory tract. Moreover, in chronic toxoplasmosis, there are periodic low-grade fever and fever, as well as headaches and pain in the joints and muscles of the limbs. It happens that in some people the infection is asymptomatic, but it is especially dangerous in pregnant women.
Pregnant women infected with toxoplasmosis are more prone to miscarriage, premature birth or stillbirth with birth defects. Failure with one pregnancy does not mean that the next pregnancy will end the same, but medical care and prior treatment are important.
According to the observations, infection with the protozoan toxoplasmosis, unlike other parasites, causes permanent immunity to reinfestation.
- Congenital toxoplasmosis
During the course of congenital toxoplasmosis, characteristic symptoms appear in the form of: hydrocephalus, retinitis, uveitis and intracerebral calcifications. In addition, patients with toxoplasmosis may develop jaundice, enlargement of the liver and spleen. The clinical form and the course of the disease depend on the period of pregnancy in which the fetus was infected.
During infection in the first and second trimesters of pregnancy, the fetal damage is severe, the following may occur: hydrocephalus or microcephaly, small eyes, eyeball atrophy, ailment in the form of cataracts or atrophy of the optic nerve and intracerebral calcifications.
With prenatal infection, the baby is born with acute symptoms of toxoplasmosis. This may result in severe muscle tension, jaundice, skin rash, high temperature, convulsions, hepatitis, eye lesions, paralysis, myocarditis or interstitial pneumonia. Even if the children survive, the eye and the brain are damaged.
The long-term consequences of congenital toxoplasmosis in children are: epilepsy, speech disorders, amblyopia, strabismus, mental retardation and blindness.
Toxoplasmosis in pregnant women
Infection with toxoplasmosis in pregnant women occurs as a result of primary infection of the pregnant woman and after the parasite has passed through the placenta to the fetus. If a woman had a disease before pregnancy, she acquired high immunity and only when her immunity is significantly impaired may the infection reactivate and the fetus becomes infected.
The consequence of infection may be death of the fetus inside the uterus or serious complications in the newborn and the child. The most serious complications are infected with toxoplasmosis at an early stage of pregnancy, as retinitis and hydrocephalus may develop. However, in late pregnancy, the infection causes jaundice, pneumonia, enlargement of the spleen and liver, and encephalitis. Fortunately, most babies infected with intrauterine disease do not have any overt clinical symptoms after delivery, but they should be under the constant supervision of a physician, as neurological disorders may develop even after many years.
Serological tests are the basis for the diagnosis of toxoplasmosis in pregnant women. They are based on the determination of IgG and IgM antibodies by means of an ELISA test for toxoplasmosis. It is best to perform this type of examination as early as possible (preferably during the first visit to the gynecologist), and after obtaining a negative result – repeat it at least once in each trimester of pregnancy. Interpretation of serological test results is difficult and should be performed only by specialists.
The disclosure of the presence of antibodies during a single examination is not an indication for treatment implementation. After three weeks, another test (check-up) should be performed, which is crucial, or the results should be verified in the laboratory.
After the examination for the presence of the protozoan toxoplasmosis, the first stage of treatment should be implemented as soon as possible. The time from the first examination for infection until the initiation of therapy is important. The so-called The “therapeutic window” is very short-lived.
The goal of treating toxoplasmosis in pregnant women is to prevent transmission of the infection to the fetus. For this purpose, the doctor orders the patient to take an antibiotic (spiramycin), which is a safe drug and does not cause congenital malformations in the fetus. Despite doubts, this drug helps to inhibit transmission to the fetus, spiramycin should be taken until delivery at a dose of 1,0 g (3 MU) every 8 hours.
If, nevertheless, the fetus becomes infected, spiramycin should be replaced (after 18 weeks of pregnancy) with pyrimethamine with folic acid and sulfadiazine – they cross the placenta and fight the disease in the fetus.
After delivery, newborns are serologically tested to confirm or rule out congenital toxoplasmosis. Women treated during pregnancy usually do not show serious clinical signs during childbirth.
See more information on: Baby Development – Development Calendar, First Six Months
Testing pregnant women for toxoplasmosis is easily available. Undoubtedly, they have financial resources to decide to conduct such tests, because the National Health Fund does not cover the costs of the test (unless the clinic and the laboratory have an agreement with the National Health Fund), due to the low interest and unprofitability of the universal toxoplasmosis detection program.
According to the Polish Gynecological Society, tests for detecting toxoplasmosis are recommended, but not obligatory. The decision to conduct such tests may be made by the doctor in charge of the pregnancy or by the patient herself.
Are you interested in the subject of tests that a pregnant woman should undergo? Read more: Pregnancy tests
Prevention of toxoplasmosis is difficult due to the high prevalence of this parasite and the presence of long asymptomatic periods in cases of chronic infections. It is possible and necessary, especially for pregnant women, by:
- reducing contact with animals that may be the source of infection;
- exclusion of eating raw meat and drinking unpasteurized milk (meat suitable for consumption should be prepared at the right temperature);
- observing the basic rules of personal hygiene and everyday life (e.g. after preparing raw meat, wash your hands thoroughly with soap and water);
- avoiding eating unwashed fruits and vegetables;
- using rubber gloves during any work on the plot or in the garden;
- feeding cats with food, not raw meat, in addition, you should clean the litter box with rubber gloves every day (remember to wash your hands thoroughly after cleaning);
- avoiding drinking raw water.
What is daily hygiene? Read: Personal hygiene – the basics, intimate hygiene, oral hygiene
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