Toxoplasmosis in Pregnancy

Parasitology Department FK USU

PATHOGENESIS
Tissue

cysts form as early as 7 days after infection and remain for the lifespan of the host They produce little or no inflammatory response but cause severe disease in immunocompromised patients or chorioretinitis in congenitally infected older children

PATHOGENESIS
When a mother acquires the infection during pregnancy, the parasite may be disseminated hematogenously to the placenta If the mother gets the infection in the first trimester and the infection is not treated, approximately 17% of fetuses are infected, and disease in the infant is usually severe If the mother acquires infection in the third trimester and the infection is not treated, approximately 65% of fetuses are infected, and involvement is mild or unapparent at birth

PATHOGENESIS & PATHOLOGY

Toxoplasma may infect the maternal side of the placenta in the course of acute primary disease and if the parasite penetrates to the fetal side. Fetuses infected in early pregnancy are at a higher risk of manifesting clinical signs of infection.

PATHOGENESIS & PATHOLOGY Tachyzoites are found in all organs in acute infections, most prominently in muscle, including heart, liver, spleen, lymph nodes and CNS In the human host, rapidly multiplying tachyzoites are responsible for the tissue damage

PATHOGENESIS & PATHOLOGY

Tachyzoite, Intest. mucosal bradyzoite, oocyst. (epithelial cell) reinfection tachyzoite tachyzoite damage fetus nucleated cell and tissue blood stream

(reactivation)

bradyzoit

destroyed

damage

DIAGNOSIS
of T. gondii antigen in blood or body fluids by enzyme-linked immunosorbent assay (ELISA) technique indicates acute infection The results from a double-sandwich IgM ELISA are more sensitive and specific than the results from other IgM tests The results of the IgG avidity test may help discriminating those with acute infection from those with chronic infections better than alternative assays, such as assays that measure IgM antibodies
Detection

DIAGNOSIS
As is true for IgM antibody tests, the

avidity test is most useful when performed early in gestation because a long-term pattern occurring late in pregnancy does not exclude the possibility that the acute infection may have occurred during the first months of gestation Isolation of T. gondii from amniotic fluid is diagnostic of congenital infection by mice inoculation

REFERENCE
Beaver, P.C., Jung, R.C. 1984. Clinical parasitology. 9th ed. Philadelphia, Lea & Febringer. p.162-164 Gillespie, S., Pearson, R.D. 2001. Principle and practice of clinical parasitology.John Wiley & Son Ltd. p.113-133 Schimidt, G.D., Roberts, L.S. 2005. Foundation of parasitology. 7th ed. Mc Graw Hill. p. 134-138