Toxoplasmosis in Pregnancy

PATHOGENESIS
Tissue

cysts form as early as 7 days after infection and remain for the lifespan of the host They produce little or no inflammatory response but cause severe disease in immunocompromised patients or chorioretinitis in congenitally infected older children When a mother acquires the infection during pregnancy, the parasite may be disseminated hematogenously to the placenta

PATHOGENESIS
If the mother gets the infection in the first trimester and the infection is not treated, approximately 17% of fetuses are infected, and disease in the infant is usually severe If the mother acquires infection in the third trimester and the infection is not treated, approximately !% of fetuses are infected, and involvement is mild or inapparent at birth

PATHOGENESIS & PATHOLOGY

Toxoplasma

may infect the maternal side of the placenta in the course of acute primary disease and if the parasite penetrates to the fetal side" #etuses infected in early pregnancy are at a higher ris$ of manifesting clinical signs of infection"

PATHOGENESIS & PATHOLOGY

Tachy%oites

are found in all organs in acute infections, most prominently in muscle, including heart, liver, spleen, lymph nodes and &'( In the human host, rapidly multiplying tachy%oites are responsible for the tissue damage

PATHOGENESIS & PATHOLOGY

Tachyzoite, Intest. mucosal bradyzoite, oocyst. (epithelial cell) reinfection tachyzoite tachyzoite damage fetus nucleated cell and tissue bradyzoit blood stream

(reactivation)

destroy

damage

DIAGNOSIS
)etection of T. gondii antigen in blood or body

fluids by en%yme*lin$ed immunosorbent assay +,-I(./ technique indicates acute infection The results from a double*sand0ich Ig1 ,-I(. are more sensitive and specific than the results from other Ig1 tests The results of the Ig2 avidity test may help discriminate those 0ith acute infection from those 0ith chronic infections better than alternative assays, such as assays that measure Ig1 antibodies

DIAGNOSIS
.s is true for Ig1 antibody tests, the

avidity test is most useful 0hen performed early in gestation because a long*term pattern occurring late in pregnancy does not exclude the possibility that the acute infection may have occurred during the first months of gestation Isolation of T. gondii from amniotic fluid is diagnostic of congenital infection by mice inoculation

REFERENCE

Beaver, P.C., Jung, R.C. 1984. Clinical parasitology. 9th ed. Philadelphia, Lea & e!ringer. p.1"#$1"4 %illespie, &., Pearson, R.'. #((1. Principle and practice o) clinical parasitology.John *iley & &on Ltd. p.11+$1++ &chi,idt, %.'., Ro!erts, L.&. #((-. oundation o) parasitology. .th ed. /c %ra0 1ill. p. 1+4$1+8