Identification

Toxoplasmosis is a rare infectious disease during pregnancy, but it can be very serious especially if the infection occurs during the first trimester of pregnancy ^[1]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017.

The risk of maternal-foetal transmission varies according to the age of pregnancy at which primary infection occurs, being in a inversely proportional relationship ^[2]***. Congenital toxoplasmosis-Annual epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017` ^[3]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014. Thus, although the risk of transmission to the fetus is lower in the first trimester, the probability that it develops signs of congenital toxoplasmosis is greater ^[4]***. Congenital toxoplasmosis-Annual epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017 ^[5]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~.

When it happens in the last trimester of pregnancy, in most of the cases the child will make an asymptomatic, inapparent infection ^[6]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014| ^[7]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017. However, the untreated infection may lead to about 85% of the children lately infected in the course of pregnancy to present psychomotor retardation or corioretinită at birth distance until the age of 7 years ^[8]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014` <sup>[9]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017`.

There is often a reverse relationship between the risk of transmitting the infection and the severity of the disease ^[10]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014`’~'. The frequency of maternal-foetal transmission varies according to the age of pregnancy as follows: It is around 25% if the infection occurs in the first trimester of pregnancy, about 54% if the infection occurs in the second trimester of pregnancy and about 65% if the infection takes place at third trimester of pregnancy ^[11]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014′ ^[12]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017′.

Acute infection in pregnant women is generally asymptomatic ^[13]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017~ ^[14]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014~. The risk of infection for the fetus is not correlated with the absence or presence of symptoms in the mother, but with the time of infection ^[15]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017~' ^[16]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014~'. Women at risk are those that are infected during pregnancy, while those that were previously infected are generally protected from maternal-foetal transmission ^[17]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017~`' <sup>[18]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014~`'.

 

Clinical manifestations in pregnant

In more than 80% of cases the Primo-infection is asymptomatic ^[19]* * *. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017’`. ^[20]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014.”. ^[21]* * *. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017′.' ^[22]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014′.'. In about 20% of cases, when the infection is symptomatic, the woman may present:

• Fever, generally moderate;
• Polyadenopathies (inflammation of the lymph nodes) in particular cervical and occipital, which may persist for several weeks to more than 85% of patients;
• Headache;
• Myalgia (muscle pain);
• Arthralgia (joint pain);
• Eruption, etc. ^[23]* * *. Facts about … European Centre for Disease Prevention and Control. 2017 ^[24]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014.`. ^[25]* * *. Epidemiology and … factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017 ^[26]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014.).

Clinical manifestations in the case of congenital toxoplasmosis (in the fetus or newborn)

Most clinical signs and manifestations are non-specific and may mimic diseases caused by other microorganisms such as the herpes simplex virus, the Cytomegalovirus virus (CMV) and the Rubella virus ^[27]* * *. Facts about toxoplasmosis. European Centre for Disease … and Control. 2017 ^[28]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014). ^[29]* * *. Epidemiology and Risk … Toxoplasmosis. Centers for Disease Control and Prevention. 2017 ^[30]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014.)).

Congenital toxoplasmosis is manifested by the triad: intracerebral calcification , chorioretinitis (ocular impairment) and hydrocephalus (accumulation of cerebrospinal fluid). Very few children present the full triad at birth ^[31]* * *. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017)) ^[32]* * *. Congenital toxoplasmosis – Annual … Report 2016. European Centre for Disease Prevention and Control. 2017 ^[33]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014′)) ^[34]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014.~). May also present other events such as epilepsy, psychomotor retardation, anaemia, jaundice, rash, thrombocytopenia, encephalitis, pneumonia, microcephaly, diarrhea, hypothermia ^[35]* * *. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017)' ^[36]* * *. Congenital … Report 2016. European Centre for Disease Prevention and Control. 2017 ^[37]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014’`. <sup>[38]</sup>* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014′.`.

Congenital toxoplasmosis can also occur under the appearance of a normality (at birth and a few years later) with the occurrence of symptoms either at school age or in young adolescents/adult in the form of a neuropsychiatric pathology (convulsions, spastic paralysis, Hyperkinetic syndrome with attention deficit, myoclonus, psychomotor retardation, autism) or ocular (progressive reduction of vision, blindness) ^[39]* * *. Facts about … European Centre for Disease Prevention and Control. 2017. ^[40]* * *. Congenital toxoplasmosis – Annual epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017`~ <sup>[41]</sup>GL Popa. Medical parasitology. Bucharest: Renaissance; 2014`~ ^[42]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014`~. This form occurs in about 65% of the infection cases in the third trimester of pregnancy and in those reactivated, regardless of gestational age <sup>[43]</sup>* * *. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017`~ ^[44]* * *. Congenital toxoplasmosis – Annual epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017~” ^[45]GL Popa. Medical parasitology. Bucharest: Renaissance; 2014”~ ^[46]* * *. CDC – Toxoplasmosis – Disease. Centers for Disease Control and Prevention. 2014“~.

Diagnosis

Women’s testing must be carried out before the woman is pregnant or at the latest from her first visit to the pregnant women’s gynecologist to know the status of specific anti-Toxoplasma gondii antibodies (T. gondii) ^[47]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014|~. ^[48]Garcia LS. Clinical use and … for Toxoplasma gondii: approved guideline. NCCLS. Centers for Disease Control and Prevention. 2004.

The most common diagnosis is made by the determination of anti-gondii IgM and IgG antibodies ^[49]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014|~.| ^[50]Garcia LS. Clinical use and … for Toxoplasma gondii: approved guideline. NCCLS. Centers for Disease Control and Prevention. 2004′. Depending on the result obtained on a case-by-case basis, additional testing for elucidation ^[51]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.) ^[52]Garcia LS. Clinical use and interpretation of serological … guideline. NCCLS. Centers for Disease Control and Prevention. 2004 may be carried out. The diagnosis is based on clinical signs and results of serological tests and can be completed (in reference centres) by isolating the parasite on cell cultures or demonstrating the presence of the parasite in the tissues or fluids of the body by biopsy or necropsy ^[53]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014||~. ^[54]Garcia LS. Clinical use and … for Toxoplasma gondii: approved guideline. NCCLS. Centers for Disease Control and Prevention. 2004”.

At fetus the diagnosis can be done by PCR testing (Polymerase Chain Reaction) from the amniotic fluid ^[55]***. Congenital toxoplasmosis… epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017 ^[56]Garcia LS. Clinical use and interpretation … guideline. NCCLS. Centers for Disease Control and Prevention. 2004 ^[57]***. CDC-Toxoplasmosis-Diagnosis. Centers for Disease Control and Prevention. 2016|”..

The confirmation of congenital infection is by detection of Ig M and Ig anti toxoplasma antibodies in the newborn ^[58]***. Congenital toxoplasmosis… epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017` <sup>[59]</sup>Garcia LS. Clinical use and interpretation … guideline. NCCLS. Centers for Disease Control and Prevention. 2004` ^[60]***. CDC-Toxoplasmosis-Diagnosis. Centers for Disease Control and Prevention. 2016|’|’..

Increased levels of IgG anti toxoplasma antibodies may persist for years without any relationship with acute disease ^[61]***. Congenital toxoplasmosis… epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017`' <sup>[62]</sup>Garcia LS. Clinical use and interpretation … guideline. NCCLS. Centers for Disease Control and Prevention. 2004`' ^[63]***. CDC-Toxoplasmosis-Diagnosis. Centers for Disease Control and Prevention. 2016|’~’..

At European level there are no regulations regarding the screening of pregnant women, but differ according to the prevalence of toxoplasmosis and public health policies at national level. The United States of America (USA) does not practice screening for toxoplasmosis, but in France and Austria it is governed by law to facilitate the early diagnosis of recent infections. In France, Austria, Belgium, Norway and Italy, screening is carried out in the first 3 months, followed by a 3-month retest program, while in other countries there are no such programs. If screening tests are performed, it is advisable to do as early as possible to determine the serological status and avoid ambiguous situations as well as to provide information on prevention measures ^[64]***. Congenital toxoplasmosis… Report 2016. European Centre for Disease Prevention and Control. 2017’~| ^[65]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~~||. ^[66]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013~~||.

This site does not extensively treat the laboratory diagnosis of Toxoplasma gondii infection. Those interested may ask questions or consult additional specialist materials.

The infectious agent

Toxoplasmosis is caused by a parasite-Toxoplasma gondii (TG) that develops intracellularly and has as its final host the cat, the man intervening in the TG cycle as intermediate host ^[67]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017~.~ ^[68]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014|`|. ^[69]***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017.

Generally, the disease is asymptomatic and benign in the imunocompentent adult , but represents an important hazard for imunodeppressed patients and pregnant women ^[70]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017~~. ^[71]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014||’. ^[72]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017~`.

 

Incidence and prevalence

Toxoplasmosis is a widespread infection in the world, but its prevalence varies from one country to another according to food habits in that country and compliance with hygiene rules (including contact with soil, unfiltered water or raw meat, washing of hands and vegetables) ^[73]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014_.' ^[74]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017_’.. The incidence is very high in poor countries and in developing countries.

The Center for Disease Control (CDC, Centers for Disease Control and Prevention) based in Atlanta, USA reports that 22.5% of the population over the age of 12 years is infected with TG, and the incidence is higher in hot and humid climates and low altitudes ^[75]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014`| <sup>[76]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017“. It is estimated that, annually, the US are born between 500 and 5,000 children with congenital toxoplasmosis <sup>[77]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014“ <sup>[78]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017|`. Although the majority of children seem healthy at birth, sequelae of congenital disease may occur tardy ^[79]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014|` <sup>[80]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017`~. The prevalence of congenital toxoplasmosis is estimated at 1/3.030 of births with symptomatic cases 1/29.000 of births ^[81]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014`~ <sup>[82]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017`|.

 

Source

Final hosts of T. Gondii are cats and other felines, which acquire the infection, mainly by eating other mammals (especially rodents) or birds, and probably by oocysts from contaminated soil with cat feces, through licking/cleaning ^[83]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~`~ <sup>[84]</sup>***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~`~. Only felines host the parasite in their intestinal tract, where the sexual stage of the protozoan life cycle occurs, causing the excretion of oocysts in the feces for 10-20 days, rarely more ^[85]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~`~` ^[86]***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~`~`.

The intermediate hosts of T. gondii include sheep, goats, rodents, pigs, cattle, chickens and other birds ^[87]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~“ ^[88]***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~“. All these can be carriers of the infectant stage of T. gondii in the tissues, especially in the muscles and the brain ^[89]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~`' <sup>[90]</sup>***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~`'. Tissue cysts remain viable for long periods, possibly throughout the lifetime. Cattle appear to be only minimally affected by natural infection with T. gondii ^[91]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014~`| <sup>[92]</sup>***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~`|.

 

Method of transmission

Man can be contaminated by:

• Ingestion of contaminated raw vegetables and water (unfiltered) ^[93]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017|`| <sup>[94]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.`~ ^[95]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017|~| ^[96]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014|’| ^[97] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017
• Ingestion of raw, uncooked goat milk ^[98]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017|“| ^[99]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.“~ ^[100]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017|~`| <sup>[101]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014|’` ^[102] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017`
• Direct contact with cat litter <sup>[103]</sup>***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017|`’| ^[104]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.’`~ <sup>[105]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017|~’| <sup>[106]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014|”| <sup>[107]</sup> CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017~
• Ingestion of raw or insufficiently prepared meat of sheep or swine, containing cysts, much rarer by beef or horse <sup>[108]</sup>***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017|`*| ^[109]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.`*~ <sup>[110]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017|*~| <sup>[111]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014|’*| <sup>[112]</sup> CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017“ . Overall, this method of transmission represents about 30-63% of infections <sup>[113]</sup>***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017||`^[114]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.~`~<sup>[115]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017||~<sup>[116]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014||' <sup>[117]</sup> CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017`'. Cysts are destroyed by preparing meat at 67 Celsius degrees or by freezing at low temperatures (-)20 Celsius degrees ^[118]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017(-|^[119]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.(-^[120]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017(-^[121]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014(- ^[122] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017”. They resists at cold up to -7 Celsius degrees and heat, it takes 10 minutes for example at temperatures of 50 Celsius degrees to destroy them ^[123]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017-)^[124]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.-)^[125]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017-)^[126]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014-) ^[127] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017(-.
• Transplacental passage if the maternal infection occurs during pregnancy. The frequency of maternal-foetal transmission varies according to the age of pregnancy as follows: around 25% if the infection occurs in the first trimester of pregnancy, about 54% if the infection occurs in the second trimester of pregnancy and about 65% if the infection takes place in the third trimester of pregnancy ^[128]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014”~. ^[129]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017.).
• The transmission linked to a reactivation of an older gondii infection during the pregnancy period was described only in HIV infected women ^[130]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017(*) ^[131]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.(*) ^[132]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017(*) ^[133]***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014(*). ^[134] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017-)
• Much rarer infection can occur by transplant (e.g. cardiac transplant) or blood transfusion ^[135]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017(*`) <sup>[136]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.(*`) ^[137]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017(*`) <sup>[138]</sup>***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014(*`). ^[139] CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017-`).

Risk groups

• Pregnant women – risk of maternal-foetal transmission if the infection occurs during pregnancy ^[140]***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.' ^[141]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.+ ^[142]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013`.
• Women with diseases affecting immunity (HIV infection, immunosuppressive treatments, etc.) – May reactivate the parasite if they have been infected before they become pregnant <sup>[143]</sup>***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.` ^[144]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014+ ^[145]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013`-*.

 

Incubation period

From 10 to 23 days after ingestion of insufficient prepared meat, from 5 to 20 days after contact with the infected cat ^[146]***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.`' <sup>[147]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.`+ ^[148]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013“.

 

Infectiousness Period

There is no transmission from one person to another, except for intrauterine transmission, from mother to fetus ^[149]***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.” ^[150]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.’+ ^[151]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013`'. The oocysts that are removed from cats sporulate and become infectant within 1-5 days and may remain infectious in water or into wet soil for one year <sup>[152]</sup>***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.~' <sup>[153]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.+~ <sup>[154]</sup>***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013~`. Cysts from meat of infected animals remains infectious as long as the meat is edible and insufficiently prepared by heat ^[155]***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.’| ^[156]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.+| ^[157]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013`|.

 

Prophylaxis

Hygiene measures

Hygiene measures are essential in avoiding infection with TG ^[158]***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.|' ^[159]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.|+ ^[160]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013|`.

Early treatment is not associated with a reduction in the risk of fetal malformations ^[161]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014`’~ <sup>[162]</sup>***. CDC-Toxoplasmosis. Treatment. Centers for Disease Control and Prevention. 2016.. For this reason, the prevention of infection is crucial <sup>[163]</sup>***. Congenital toxoplasmosis-Annual … Report 2016. European Centre for Disease Prevention and Control. 2017.’|- <sup>[164]</sup>Popa GL. Medical parasitology. Bucharest: Renaissance; 2014.+|* <sup>[165]</sup>***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013`|-.

1. Food/Nutrition associated risk reduction ^[166]Popa GL. Medical parasitology. Bucharest: Renaissance, 2014’` ^[167]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017-* ^[168]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013”

• Meat cooking at appropriate temperatures;
• Freezing of meat for a few days at temperatures below 0 ˚ C to reduce the risk of infection;
• The cleansing and persistent cleaning of fruit and vegetables;
• Cleaning of utensils with hot water and detergent after contact with raw meat or with unwashed fruit and vegetables;
• Persistent washing of hands before, during and after preparation of food and before meals;

2. Environmental risk reduction ^[169]Popa GL. Medical parasitology. Bucharest: Renaissance, 2014`' <sup>[170]</sup>***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017`-* ^[171]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013’`'

• Avoiding the consumption of untreated/unfiltered water;
• Wearing of gloves at gardening and any contact with soil that can be contaminated with TG infected cat fecal;
• Careful washing of hands after contact with the cat;
• Educating children about the importance of hand washing in the prevention of infections;
• Feeding the cat only with dry food, special for cats or cooked food, not sufficiently heat-prepared;
• Changing the litter of the cat daily (the parasite becomes infected 1-5 days after the removal in the cat’s feces), but not by the pregnant woman;
• Avoiding stray cats;
• Do not adopt a new cat during pregnancy.

Women who have been diagnosed with acute infection are advised not to get pregnant less than 6 months after diagnosis, although there are no studies to establish a clear safety period ^[172]Popa GL. Medical parasitology. Bucharest: Renaissance, 2014’`- ^[173]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017- ^[174]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013”-.

Vaccination

There’s no vaccine.

Birth to the infected woman

There are no special recommendations.

 

Breastfeeding

There are no special recommendations.

 

Treatment

The treatment of pregnant women is problematic. The treatment is performed at the indication of the doctor with Sulphamids, spiramycin or pyrimethamine depending on the time of diagnosis in relation to the age of pregnancy. Spiramycin is usually used to prevent placenta infection; Pyrimethamine and Sulfadiazine should be considered if the fetal infection is confirmed either by ultrasound or by PCR tests from the amniotic fluid ^[175]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014(/) ^[176]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017(/) ^[177]***. CDC-Toxoplasmosis. Treatment. Centers for Disease Control and Prevention. 2016(/). Pyrimethamine is considered to have teratogenic effect, not given during the first 16 weeks of pregnancy ^[178]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014(/.) ^[179]***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017(/.) ^[180]***. CDC-Toxoplasmosis. Treatment. Centers for Disease Control and Prevention. 2016(/.).

 ******************

            Question:

Do I have to give up the cat if I’m pregnant?

No, but you must follow the following tips during pregnancy ^[181]***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017”.| ^[182]***. Congenital … Report 2016. European Centre for Disease Prevention and Control. 2017 ^[183]Popa GL. Medical parasitology. Bucharest: Renaissance; 2014′.~ ^[184]***. Epidemiology … factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017 ^[185]***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013’`~:

• Avoid cat litter cleaning as much as possible.
• If there is no one else who can perform this task, you must wear gloves and wash your hands rigorously with soap and water after cleaning the cat litter.
• You must make sure that the cat litter is changed daily. Toxoplasma does not become infectious until after 1-5 days after the oocysts has been eliminated through the cat’s feces.
• Feed the cat with dry or canned commercial food, not raw or insufficiently prepared meat.
• Hold the cat in the house.
• Avoid contact with stray kittens and do not purchase a new cat when you are pregnant.
• If you store out the cat litter, hold it closed.
• Wear gloves when you come into contact with soil or sand, because it can be contaminated with cat feces.
• Wash your hands thoroughly with soap and water after activities such as gardening.

Bibliography

1. ***. Facts about toxoplasmosis. European Centre for Disease Prevention and Control. 2017
2. ***. Congenital toxoplasmosis-Annual epidemiological Report 2016. European Centre for Disease Prevention and Control. 2017
3. Popa GL. Medical parasitology. Bucharest: Renaissance; 2014
4. ***. Epidemiology and Risk factors. Toxoplasmosis. Centers for Disease Control and Prevention. 2017
5. ***. CDC-Toxoplasmosis-Disease. Centers for Disease Control and Prevention. 2014
6. Garcia LS. Clinical use and interpretation of serological tests for Toxoplasma gondii: approved guideline. NCCLS. Centers for Disease Control and Prevention. 2004
7. ***. CDC-Toxoplasmosis-Diagnosis. Centers for Disease Control and Prevention. 2016
8. ***. CDC-Toxoplasmosis-Prevention and Control. Centers for Disease Control and Prevention. 2013
9. ***. CDC-Toxoplasmosis-biologist. Centers for Disease Control and Prevention. 2017
10. ***. CDC-Toxoplasmosis. Treatment. Centers for Disease Control and Prevention. 2016