What are the other Names for this Condition? (Also known as/Synonyms)

• Congenital Toxoplasma Infection
• Fetal Toxoplasmosis
• Prenatal Toxoplasmosis

What is Congenital Toxoplasmosis? (Definition/Background Information)

• Infection by Toxoplasma gondii, which is a common microorganism (classified as protozoa), causes toxoplasmosis. This condition is generally caused by consuming meat that is contaminated by the parasitic microorganism. The contamination can occur even during the cooking or preparation stage
• Women, who are exposed to the protozoa, during or just before pregnancy, may pass on the infection to the baby in the womb. This causes Congenital Toxoplasmosis, a condition that can lead to serious complications, congenital defects, and spontaneous abortion (in some cases)
• Cats are host to the microorganism; cat feces are a possible source of the protozoa. An accidental ingestion of the same, can also cause toxoplasmosis
• The infected fetus may suffer nervous system development problems and other growth defects, or it may not be affected at all. This depends on the stage of pregnancy at the time of onset of the infection
• The earlier the stage of infection during pregnancy (1st trimester), the more severe is the effect of Congenital Toxoplasmosis infection, as the fetus is still in its early development phase. A fully developed and healthy fetus may only be mildly affected (or not affected at all)

Who gets Congenital Toxoplasmosis? (Age and Sex Distribution)

• According to CDC (US, Centers for Disease Control and Prevention) statistics, only around 15% of women in their reproductive phase, are immune to toxoplasmosis infection
• A (recently infected) pregnant woman can infect the baby in the womb through the placenta. This transplacental vertical infection from mother to the developing fetus can cause damaging affects in the unborn child. The risk of the fetus contracting Congenital Toxoplasmosis is the highest, during the 3rd trimester

What are the Risk Factors for Congenital Toxoplasmosis? (Predisposing Factors)

The risk factors of Congenital Toxoplasmosis include:

• Women, who are infected by toxoplasmosis, either shortly before or during their pregnancy, have a high risk of transmitting it to their unborn offspring
• Pregnant women on immunosuppressant drugs, for various reasons, might cause the protozoa (which they carry) to be reactivated

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Congenital Toxoplasmosis? (Etiology)

• Toxoplasmosis infection is caused by a parasite called toxoplasma gondii. Congenital transmission of the infection takes place from an infected mother to the infant child, causing Congenital Toxoplasmosis
• This can happen any time during pregnancy or immediately on delivery, if the mother is infected

What are the Signs and Symptoms of Congenital Toxoplasmosis?

Manifestation of Congenital Toxoplasmosis may occur during the fetal stage or shortly after the baby’s birth. Spontaneous abortions may also take place, or the infant could be stillborn (and preterm). Following a birth of the child, the signs and symptoms of Congenital Toxoplasmosis that may be observed are:

• Hearing and vision loss, eye damage
• Irregular head size, fluid in the brain (hydrocephalus)
• Swollen lymph nodes
• Diarrhea and/or vomiting
• Jaundice (pale yellow skin), enlarged spleen or liver may also be noted
• Premature birth, low birth weight
• Feeding difficulties
• Mental growth delays, seizures or convulsions

Growth abnormalities in the fetal stage and congenital defects (at birth) may be noted, which include damage to the nervous system, eye, ear, and skin.

How is Congenital Toxoplasmosis Diagnosed?

Some healthcare providers conduct toxoplasmosis screening for women in the period immediately following a pregnancy (during the first few visits). However, if any associated signs and symptoms are observed, and/or if the individual has a weak immune system, then screening becomes essential. A prompt diagnosis of toxoplasmosis is vital to protect the unborn child and the mother.

The exams and tests that could be conducted to diagnose toxoplasmosis during pregnancy include:

• Physical exam and evaluation of medical history of the pregnant woman
• Blood samples are examined, to detect the presence of the IgG and IgM antibodies against the microorganism. This blood test may be repeated after an interval of time, to determine the status of infection. Some other blood tests include:
  • Polymerase chain reaction (PCR)
  • ELISA test for toxoplasma
  • Sabin-Feldman dye test
• Cordocentesis: A test to check, if toxoplasmosis infection occurred during pregnancy
• Testing of amniotic fluid and blood of the fetus
• Abdominal ultrasound scan

After birth, a physical examination of the baby for the presence of clinical signs of Congenital Toxoplasmosis is performed, by the pediatrician, in suspected cases. Some of the diagnostic tests are:

• CT scan of head
• MRI scan of the brain
• Study of the cerebrospinal fluid
• Umbilical cord blood or fluid test
• Eye examination
• Examination for neurological defects

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Congenital Toxoplasmosis?

A few complications of Congenital Toxoplasmosis are:

• The fetus may develop growth abnormalities and mental disorders
• Toxoplasmosis could affect the brain and cause behavioral changes
• In some cases, the infant may appear normal at birth, but develop severe illnesses later (after a few years or even after some decades)
• Miscarriage and stillbirth, or death of the infant following its birth, are other severe results

How is Congenital Toxoplasmosis Treated?

• Pregnant women with toxoplasmosis require prompt and early treatment with antibiotic medication, to prevent Congenital Toxoplasmosis by blocking the spread of infection to the fetus. The fetus is also periodically checked using diagnostic imaging (ultrasound), for any defects
• The infants are administered antibiotics for almost a year, if the mother had had the infection. This is an important step in treating Congenital Toxoplasmosis
• If severe eye or spinal cord abnormalities are seen, then steroids may be administered

How can Congenital Toxoplasmosis be Prevented?

The likelihood of the fetus being affected is significant, if toxoplasmosis infection in mother is contracted prior to or during the period following pregnancy (in the 1st trimester). Infection of fetus during first trimester can lead to severe organ damage, because the main organs in fetus, start forming during this period.

The transmission of infection from mother to child is the highest during the 3rd trimester. However, since vital organs have already formed and considerable fetal development taken place by then, the risk to major organs in the fetus is minimized.

The onus is on every pregnant women (or women planning a child) to ensure that they are generally well-informed of the infection by their healthcare provider. The expectant mothers should be aware of certain preventive measures and precautions to be taken, as outlined below:

• To reduce the incidence of Congenital Toxoplasmosis, proper precautions have to be taken to prevent transmission of the harmful protozoa, via food and water. This has to be considered, even while traveling to other countries and cities
• Avoid undercooked food (mainly meat) and contaminated water; always drink water that is clean and from a reliable source
• Follow basic rules while cooking and consuming food, such as:
  • Carefully washing food items (like meat and vegetables)
  • Washing food vessels, cutting boards, etc. before use
  • Cooking meat to the required temperatures, to kill any microorganism
  • Keeping food items covered, stored properly
  • Washing hands before eating, or immediately after handling raw meat
• Sample tasting of meat, while it is being cooked (or while still undercooked), is to be avoided
• Fruits and vegetables have to be washed and cleaned well, particularly if they are to be consumed raw
• Completely avoid handling cat feces and cleaning cat litter boxes. Nevertheless, do ensure that the litter boxes are cleaned regularly (by others)
• Garden soil may be contaminated with Toxoplasma found in cat feces - ensure that you wash your hands thoroughly with soap and water after being in contact with the soil (due to activities, such as gardening or backyard cleaning)
• If you belong to any of the high-risk groups, such as working at a vet clinic, a pet store, or having a weak immune system; then, do ensure that you take adequate safety precautions while handling cats (or other pets), also avoid touching or playing with stray cats

What is the Prognosis of Congenital Toxoplasmosis? (Outcomes/Resolutions)

• Prompt treatment of the condition is necessary, if pregnant women are infected, especially during the first trimester. An infection of toxoplasmosis during weeks 10-24, poses a maximum threat of the fetus being born with congenital defects. Aggressive treatment may help avoid Congenital Toxoplasmosis and the prognosis is good, in such cases
• A healthy pregnant woman usually recovers from toxoplasmosis within a few days, even if no treatment is given and only certain basic self-care steps are followed (like drinking enough fluids, getting adequate rest). Nevertheless, during pregnancy, the fetus has to be constantly monitored for any abnormalities or infection
• Infected pregnant women may suffer a miscarriage, or the child may be stillborn, or die after birth, if the condition is serious, left untreated, or if it remains undetected. The prognosis of Congenital Toxoplasmosis can be very poor, in such cases

Additional and Relevant Useful Information for Congenital Toxoplasmosis:

• It is best not to get pregnant, if you have had a recent infection of toxoplasmosis. It is advisable to consult your gynecologist to plan your child, in such cases
• Individuals with weak immune systems should wait for a period of time and recover completely from their illness, before planning for a child
• The management (prevention and treatment) of toxoplasmosis can be accomplished to a good extent through mass-education. This should include providing information on proper hygiene, maintaining good food preparation practices, and following outlined preventive measures (mentioned above)