Toxoplasma Gondii Infection In Pregnancy Research Articles

Indirect impact of SARS-CoV-2 pandemic on incidence of maternal primary cytomegalovirus and Toxoplasma gondii infection in pregnancy.

Public health interventions promoted during the SARS-CoV-2 pandemic to control viral spread have impacted the occurrence of other communicable disease. Yet no studies have focused on perinatal infections with the potential for neonatal sequelae, including cytomegalovirus (CMV) and Toxoplasma gondii (TG). Here we investigate whether incidence rates of maternal primary CMV and TG infection in pregnancy were affected by the implementation of pandemic-related public health measures. A retrospective study including all pregnant women with confirmed primary CMV or TG infection in pregnancy, managed between 2018 and 2021 at two university centers. The incidence rate was calculated as the number of CMV and TG infections per 100 consultations with a 95% confidence interval (CI). Data were compared between pre-pandemic (2018-2019) and pandemic (2020 and 2021) years. The Newcombe Wilson with Continuity Correction method was employed to compare incidence rates. The study population included 215 maternal primary CMV and 192 TG infections. Rate of maternal primary CMV infection decreased in 2021 compared with 2018-2019 (4.49% vs 6.40%, attributable risk [AR] 1.92, P = 0.019). By contrast, the rate of TG infection substantially increased in 2020 (6.95% vs 4.61%, AR 2.34, P = 0.006). Close contact with cats was more common among patients with TG infection in 2020 and 2021 than among pre-pandemic TG-infected women (26.3% and 24.4% vs 13.3%, P = 0.013). Pandemic-related public health interventions and associated behavioral and lifestyle changes exerted a divergent effect on the incidence of primary CMV and TG infection in pregnancy, likely due to modulation of exposure to risk factors for these infections.

Toxoplasma gondii Infection in Pregnancy - Recommendations of the Working Group on Obstetrics and Prenatal Medicine (AGG - Section on Maternal Disorders).

Aim The AGG (Working Group for Obstetrics and Prenatal Diagnostics, Section Maternal Diseases) has issued these recommendations to improve the detection and management of Toxoplasma gondii infection in pregnancy. Methods Members of the Task Force developed the recommendations and statements presented here using recently published literature. The recommendations were adopted after a consensus process by members of the working group. Recommendations This article focuses on the epidemiology and pathophysiology of Toxoplasma gondii infection in pregnancy and includes recommendations for maternal and fetal diagnosis, transmission prophylaxis, therapy, prevention, screening, and peripartum management.

Tryptophan metabolism and immune alterations in pregnant Hispanic women with chronic Toxoplasma gondii infection.

Pregnancy markedly modifies women's metabolism and immune functions. We hypothesized that pregnancy might alter the immune and metabolic responses to chronic Toxoplasma gondii infection in pregnancy. A population of 690 pregnant Hispanic women were screened for antibodies to T. gondii and 158 women were positive (23% positivity) with 83% showing high avidity indices. These seropositive women were followed through their pregnancies with four data collection time points and a postpartum collection at two clinics in Tampa, Florida. A T. gondii seronegative group (N=128) was randomly selected to serve as a control group and measured along pregnancy in the same way. Serum levels of tryptophan, kynurenine, and their ratio, phenylalanine, tyrosine and their ratio, neopterin, and nitrite were measured through pregnancy and the postpartum. A plasma cytokine panel (IFN-γ, TNFα, IL-2, IL-10, IL-12, IL-6, IL-17) was analyzed in parallel. The major findings suggest that indoleamine 2,3-dioxygenase (IDO-1) was less activated in T. gondii seropositive pregnant Hispanic women with chronic infection. Evidence for IDO-1 suppression was that tryptophan catabolism was less pronounced and there were lower levels of multiple inflammatory cytokines including IFN-γ, which is the major inducer of IDO-1, and higher nitrite concentration, a surrogate marker for nitric oxide, an inhibitor of IDO. Latent T. gondii infection was associated with higher plasma tryptophan levels, and lower inflammatory cytokines across pregnancy, suggesting suppression of the IDO-1 enzyme, and possible T cell exhaustion during pregnancy.

Toxoplasma gondii infection in pregnancy

Toxoplasmosis is a worldwide spread infection, caused by the parasite Toxoplasma gondii, acquired through ingestion of contaminated food or water, or consuming infected undercooked meat. Despite the fact that in healthy, non-pregnant population, this infection is predominantly asymptomatic and self-limited, in pregnancy it requires special care to minimize the risks to the fetus by vertical transmission. Congenital toxoplasmosis can result in permanent neurological impairment and even blindness. Once diagnosed in pregnancy, this infection needs prompt medical therapy to prevent fetal complications. Primary prevention of the toxoplasmosis consists of dietary and lifestyle changes with the purpose to limit the contact with the parasite. Secondary prevention includes the screening of the pregnant women. Screening programs are implemented in various countries depending on the prevalence of the parasite in the respective areas. The purpose of this article is to make a review of the medical literature concerning the management of Toxoplasma gondii infection in pregnancy. For this purpose, scientific research in databases and online medical publications such as Medline, PubMed, Elsevier and The Lancet was conducted.

Pregnancy and Toxoplasmosis: should screening be a routine practice?

Because infectious agents can reach the fetus through the placenta, pregnancy is regarded as a particular period for contagious diseases. Identification of infections during pregnancy and appropriate treatment can prevent fetal disorders. For this purpose, to avoid their harmful effects on fetus and newborn, various infectious diseases are screened during pregnancy. Toxoplasma gondii infection in pregnancy is transmitted through the transplacental pathway leading to severe neurological sequelae such as fetal abortion, stillbirth, intrauterine growth retardation, cranial calcifications, blindness, deafness, and mental retardation. This can lead to serious social and economic problems for the family and the infant, as well as society. To prevent these sequelae, infections during pregnancy need to be identified and appropriately treated. There are different opinions and practices in the world regarding the screening of T. gondii during pregnancy follow-up. This review aimed to assess the seroprevalence of T. gondii infection during gestation in Turkey and the world, its effects on the fetus, ways of protection, and suggestions about screening in the world and in Turkey in light of the literature, so that this becomes a guide for clinical practice for physicians.

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women attending antenatal care in Kigali, Rwanda

Background: Toxoplasma gondii infection in pregnancy, if left untreated, is associated with spontaneous abortions, low birth weight babies, congenital deformities and intrauterine deaths. The infection is also associated with human immune deficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In Rwanda, the burden and risk factors of T. gondii infection among pregnant women and among HIV infected pregnant women is largely unknown. This cross-sectional study aimed at determining the seroprevalence of T. gondii infections and their risk factors among pregnant women in Kigali, Rwanda.Methods: Pregnant women aged 18 years and above who were attending antenatal care at four clinics in Kigali City, between April and August 2014 were screened for IgG and IgM antibodies against T. gondii using ELISA technique. Information on their HIV status and CD4+ cell count was obtained from their medical records. Participants were also interviewed on selected behaviours that predispose individuals to T. gondii infection.Results: A total of 384 pregnant women were involved in the study. The overall T. gondii seroprevalence was 12.2%. Of the 384 pregnant women studied, 37 (9.6%) were positive for anti-T. gondii-specific IgG antibodies, indicating past infection and 15 (3.9%) had positive IgM results indicating recent infection. Drinking untreated water and eating undercooked meat were identified as important risk factors for T. gondii infection respectively at 22.4% and 22.3% [OR=3.95, CI:2.09-7.49; p<0.001 and OR=3.27, 95% CI: 1.75-6.09; p<0.001].Conclusion: Although the seroprevalence of T. gondii antibodies is relatively low, institution of interventional measures is desirable.

Toxoplasma Ig M positive in pregnancy: what does it mean from the perspective of the gynecologists?

Toxoplasma gondii infection in pregnancy occurs with maternal ingestion of cysts in undercooked meat or with maternal ingestion of oocysts found in water, food and soil (1). Contaminated under cleaned green salads (like garden rocket, parsley) and water may be important sources for women in Turkey. Although routine screening for toxoplasmosis in pregnancy is not recommended, this is not the case in daily practice and due to unnecessary screening and confounding test results, gynecologists should be also familiar with patients having the results of Toxoplasma IgM(+). One key-point for evaluation the toxoplasmosis-suspected pregnant woman is to know that congenital infection risk for the fetus is higher in third trimester; however, the risk of the injury for the fetus is greater in the first trimester (2). Pregnant women with IgM(+)/IgG(-) should be screened in 1 to 3 weeks again. If seroconversion in Ig G occurs, then infection is probably acquired during pregnancy and there is risk for congenital infection (3). Treatment is to be initiated with Spiramycin. Amniocentesis for amniotic fluid PCR should be performed after 16 weeks. A detailed fetal ultrasonography should be also performed. In case of IgM(+)/IgG(+), the results should be confirmed. Toxoplasma Gondii avidity testing is reasonable at this stage (4). High-avidity IgG antibodies are detected at least 12-16 weeks after infection, so high-avidity IgG results show that the infection was started 16 weeks before. Low-avidity results may persist for a long period (even more than one year after acute infection), so only avidity tests should not be used (1, 5). In our daily practice, we account the gestational week, the Ultrasonograhic findings with maternal serum results into account. In case of IgM(+)/IgG(+); we also perform IgG avidity test. We initiate medical treatment and repeat the tests in 3 weeks. A significant increase in IgG titers (3-4 times) together with low-avidity IgG is suggestive for an acute infection. Fetal infection should be checked with amniocentesis

Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study

Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.

Risk Factors for Toxoplasma gondii Infection in Pregnancy

From 1992 to 1994, a prospective case-control study designed to identify preventable risk factors for Toxoplasma gondii infection in pregnancy was conducted in Norway. Case-patients were identified through a serologic screening program encompassing 37,000 pregnant women and through sporadic antenatal testing for Toxoplasma infection. A total of 63 pregnant women with serologic evidence of recent primary T. gondii infection and 128 seronegative control women matched by age, stage of pregnancy, expected date of delivery, and geographic area were enrolled. The following factors were found to be independently associated with an increased risk of maternal infection in conditional logistic regression analysis (in order of decreasing attributable fractions): 1) eating raw or undercooked minced meat products (odds ratio (OR) = 4.1, p = 0.007); 2) eating unwashed raw vegetables or fruits (OR = 2.4, p = 0.03); 3) eating raw or undercooked mutton (OR = 11.4, p = 0.005); 4) eating raw or undercooked pork (OR = 3.4, p = 0.03); 5) cleaning the cat litter box (OR = 5.5, p = 0.02); and 6) washing the kitchen knives infrequently after preparation of raw meat, prior to handling another food item (OR = 7.3, p = 0.04). In univariate analysis, travelling to countries outside of Scandinavia was identified as a significant risk factor, but this variable was not independently associated with infection after data were controlled for factors more directly related to the modes of infection.

Risk Factors for Toxoplasma gondii Infection in Pregnancy: Results of a Prospective Case-Control Study in Norway

From 1992 to 1994, a prospective case-control study designed to identify preventable risk factors for Toxoplasma gondii infection in pregnancy was conducted in Norway. Case-patients were identified through a serologic screening program encompassing 37,000 pregnant women and through sporadic antenatal testing for Toxoplasma infection. A total of 63 pregnant women with serologic evidence of recent primary T. gondii infection and 128 seronegative control women matched by age, stage of pregnancy, expected date of delivery, and geographic area were enrolled. The following factors were found to be independently associated with an increased risk of maternal infection in conditional logistic regression analysis (in order of decreasing attributable fractions): 1) eating raw or undercooked minced meat products (odds ratio (OR) = 4.1, p = 0.007); 2) eating unwashed raw vegetables or fruits (OR = 2.4, p = 0.03); 3) eating raw or undercooked mutton (OR = 11.4, p = 0.005); 4) eating raw or undercooked pork (OR = 3.4, p = 0.03); 5) cleaning the cat litter box (OR = 5.5, p = 0.02); and 6) washing the kitchen knives infrequently after preparation of raw meat, prior to handling another food item (OR = 7.3, p = 0.04). In univariate analysis, travelling to countries outside of Scandinavia was identified as a significant risk factor, but this variable was not independently associated with infection after data were controlled for factors more directly related to the modes of infection.