Vertical transmission of HIV and toxoplasma by reactivation in a chronically infected woman

Abstract

Prevention of mother-to-child transmission of HIV and Toxoplasma dual infections in the immunocompromised patient remains a healthcare challenge. We report a case of congenital toxoplasmosis resulting from reactivation of latent infection in a severely immunodepressed HIV-infected pregnant woman, who had poor adherence to therapy; this case illustrates the difficulties encountered in management of such a rare condition.

Toxoplasmosis in HIV/AIDS Patients - A Living Legacy

“…In this case, the combined Toxoplasma therapy (pyrimethamine and sulfadiazine) and HAART were benefitial not only to the mother but also prevented transmission to the fetus. Despite this evidence of success in most cases, there have been reports of poor outcomes when an HIVi n f e c t e d m o t h e r h a s C T d u r i n g p r e g n a n c y , w i t h v e r t i c a l t r a n s m i s s i o n o f o n e o r b o t h infections to the fetus and an increase of morbidity and mortality in the mother (Mitchell et al, 1990;O'Riordan & Farkas, 1998;Fernandes et al, 2009). Maternal-fetal transmission of toxoplasmosis due to reactivation of chronic infection during pregnancy occurs in mothers with a very low CD4 cell counts (Minkoff et al, 1997) or in the presence of other immunological disorders (Montoya & Liesenfeld, 2004).…”

“…Compliance to antiretroviral therapy is a medical challenge which led to a rare case of congenital toxoplasmosis from a severely immunosuppressed HIV-infected woman as a result of reactivation (Fernandes et al, 2009). Under this circumstance, prophylaxis is required in addition for strict adherence to therapy in pregnant women infected with HIV.…”

Toxoplasmosis-Serological Evidence and Associated Risk Factors among Pregnant Women in Southern Thailand

“…3 In South America, the estimated annual incidence of congenital toxoplasmosis varied from 9.5 to 10.6/1,000 live-births. 4 In Thailand, antibodies to T. gondii varied from 2.3% to 29.6% among pregnant women and 7.18% to 13.14% in newborns. [5][6][7][8] The risk of a congenital Toxoplasma infection in infants is directly related to their seropositive mothers.…”

Toxoplasma gondii antibody profile in HIV-1-infected and uninfected pregnant women and the impact on congenital toxoplasmosis diagnosis in Rio de Janeiro, Brazil

“…3 The fetal transmission of toxoplasmosis occurs predominantly when the mother is infected during pregnancy, a situation where the diagnosis is usually made through serological tests. However, congenital toxoplasmosis may also be associated with reactivation of a chronic maternal infection, especially in HIV-1-infected and immunosuppressed women, [4][5][6][7][8][9][10][11] or with reinfection by a different strain of Toxoplasma gondii. 12,13 The diagnosis of reactivated T. gondii infection during pregnancy has been the subject of much controversy.…”