CEU Maternal Serologic Screening for Toxoplasmosis

Abstract

Congenital toxoplasmosis is a rare, but potentially serious, problem during pregnancy. Toxoplasmosis is caused by a protozoal parasite that can be found in warm-blooded animals (including humans); dried cat feces, contaminated soil, or contaminated water; and raw or undercooked meat containing infective tissue cysts. Although cats play a role in the epidemiology of the disease, there is no statistical correlation between toxoplasmosis infection and cat ownership. Toxoplasmosis can be transmitted to the fetus in utero through transplacental transmission. Both the incidence of placental transmission and severity of congenital disease depend on gestational age at which maternal seroconversion occurs. Although transmission rates from mother to fetus tend to be low early in pregnancy, fetal disease severity is highest when the fetus is infected early in gestation. Serological tests to determine maternal seroconversion are available, but their use can pose ethical and practical dilemmas. Universal maternal screening is not currently warranted in the United States because disease prevalence is low.

Toxoplasma gondii infection in pregnancy

“…According to research conducted in Paris, this association is effective in the reduction of the severity of the disease and in the improvement of fetal and neonatal prognosis (2% with severe onset compared to 21% in historical controls) [30]. It has also been observed, in longitudinal studies, that if the woman infected during pregnancy is properly treated and the newborn submitted, during a year, to a classic, specific antiparasitary treatment regime for toxoplasmosis, the possibilities of neuro-ocular alterations decrease from 50% to 8% [50].…”

“…Pinard et al [50] concluded that seropositive mother should be clinically examined until the end of gestation, and fetus diagnosis should be based on a combination of ultrasound, amniocentesis and cordocentesis exams. Improvement of PCR will permit, in the near future, a decrease in conflicting results, as well as a decrease in the use of invasive techniques [42].…”

Association of the presence of residual anti-Toxoplasma gondii IgM in pregnant women and their respective family groups in Miracema, Northwest Rio de Janeiro, Brazil

“…Toxoplasmosis infection is transmitted (1) by the ingestion of raw or undercooked meat, which contains tissue cysts of the parasite; (2) through the accidental ingestion of oocysts eliminated in the feces of infected cats; and (3) transplacentary due to the primary gestational infection (Frenkel et al 1970, Hutchinson et al. 1971, Aspinall et al 2003, Bahia-Oliveira et al 2003.The diagnosis of toxoplasmosis is based mainly on serological tests that detect anti-T.gondii IgM and IgG antibodies (Camargo 1995, Pinard et al 2003, that correspond to acute and chronic infections, respectively. Although IgM anti-T. gondii (IgMTg) tend to disappear, it can remain at low titers for a long period of time complicating the interpretation of the serological diagnosis of the acute phase in that case they are named residual IgM and correspond to the chronic phase of the disease (Bastien 2002, Remington et al 2004.…”

“…The diagnosis of toxoplasmosis is based mainly on serological tests that detect anti-T.gondii IgM and IgG antibodies (Camargo 1995, Pinard et al 2003, that correspond to acute and chronic infections, respectively. Although IgM anti-T. gondii (IgMTg) tend to disappear, it can remain at low titers for a long period of time complicating the interpretation of the serological diagnosis of the acute phase in that case they are named residual IgM and correspond to the chronic phase of the disease (Bastien 2002, Remington et al 2004.…”

Seroprevalence of Toxoplasmosis in Antenatal Women with Bad Obstetric History

“…Infection in an immunocompetent adult human is usually asymptomatic. Toxoplasma is most dangerous for immunocompromised patients and the fetus whose mother is infected during pregnancy (Pinard et al, 2003).…”