TOXOPLASMOSIS IN
PREGNANCY
TOXOPLASMOSIS
• Parasitic infection
• Caused by protozoa: Toxoplasma Gondii
• Toxoplasma Gondii exists oin three forms:
• 1. Trophozoite
• 2. Tissue cysts
• 3. Oocysts
FREQUENCY OF TOXOPLASMA
ANTIBODY IN WOMEN IN IND
• Year No IgG % pos IgM % pos
• 1996 568 52,3 12,9
• 2000 3236 51,3 5,2
• 2001 8565 53,0 5,4
TOXOPLASMA GONDII
• Trophozoite:
• Requires in intracellular habitat to survive
and multiply
• Reproduction is endogenous
• During the acute phase, it invades every
type of cell
• After invasion the organisms multiply until
cell cytoplasm is so filled that the cell is
disrupted
TOXOPLASMA GONDII
• Tissue cysts:
• Formed within the host cells as early as
eight day of an acute infection
• Probably persist throughout the life of the
host
• Skeleton, heart muscle and brain are the
most common sites for latent infections
TOXOPLASMA GONDII
• Oocyst:
• Produced in the small intestine of the cat
• One shed, the oocyte sporulates in 1 to 5 days
and become infectious
• Under appropriate condition it remain infectious
for more than 1 year
• The parasite transmitted by direct handling of
contaminated soil and cat feces
• All form of parasite are destroyed by adequate
freezing and heating
MATERNAL INFECTION
• Transmission of toxoplasma to human occurs
through the ingestion of under-cooked meat
• Through other foods contaminated with oocyte,
or by transfusion of whole blood.
• Syndrome including: fatigue, malaise, cervical
lymphadenopathy and atypical lymphocytosis
• Placental and fetal infection occur during the
spreading phase of the parasitemia
• Fetal infection 30-40%, increase with gestational
age
FETAL INFECTION
• During 1st trim, the rate of transmission is
approximately 15%, the rate of 2nd trim is
approximately 30 % and 3rd trim is 60 %
• Fetal morbidity and mortality rate are higher
after early transmission
• Infected neonates often have evidence of
disease: LBW. Hepatosplenomegaly, icterus,
anemia, hydrocephalus, intracranial calcification
• Sequelae vision loss, psychomotor and mental
retardation, hearing loss and chorioretinitis
PREVENTION
• Primary prevention: information about the
way of infection (cat, raw meet) to avoid
ingestion, inhalation, important for all
pregnant women are”seronegative”
• Secondary prevention: detection of
infected women during pregnancy to start
treatment before fetus gets infected
• Tertiary prevention: treatment of infected
children to reduced/avoid symptom
HYGIENIC AND DIETITIC
EDUCATION
• Avoid eating raw or uncooked meat
• Wash salads, vegetables, fruits and berries
• Have good kitchen hygiene
• Avoid contact with cat feces (kittens)
• Wash hands after contact with sand and
soil
• Use gloves when gardening
DIAGNOSIS OF CONGENITAL
TOXOPLASMOSIS
• Search for the parasite: seldomly used
• Serological test: measure antibodies
• Detection of the symptoms:
• - prenatal ultrasound
• - cranial ultrasound
• Amniocentesis: to look for DNA of parasite
by PCR-technique
SEROLOGICAL TEST
• Being infected leads to some weeks of
parasitemia, can be passed on to the fetus
• The body starts to produced antibodies
• They fight againt the parasite, control the
disease, no more parasite circle in blood
• Some group of Ig: IgG, IgM, IgA, IgE
• For diagnosis of toxoplasmosis usually IgG
dan IgM are measured
Continue
• Before happened an infection IgG -, IgM –
• When an infection happens, IgG +, IgM +
• IgM + during acute infection and stay + in limited
time 6 months – 1 year
• IgG rise during acute infection, sink slowly
again, but stay +, protect against another
parasitemia, protect to the fetus
• If stable IgG and no IgM: infection long ago,
protection, “latent infection”
• Early pregnancy – and + testing later
“seroconversion” acute infection
• If IgG+ IgM +,infection happened short time ago
SEROLOGICAL TEST
• Interpretation of toxoplasmosis serology
results:
• IgM IgG Interpratation
• + - Possible acute infection, IgG
• titers reassed in several weeks
• + + Possible acute infection
• - + Remote infection
• - - Susceptible, uninfected
THANK YOU
