Congenital Toxoplasmosis

00:02 In this lecture, I’m going to discuss congenital infections of the infant.

00:07 So we often call these TORCH infections.

00:11 TORCH, the letters stand for the diseases.

00:14 T is toxoplasmosis.

00:17 O is unfortunately other, which includes syphilis, parvovirus, HIV, varicella.

00:23 R is rubella.

00:25 C is cytomegalovirus or CMV.

00:29 And H is herpes simplex virus or HSV.

00:33 I want to go through these infections one at a time.

00:37 So let’s start with toxoplasmosis.

00:40 Toxoplasmosis is caused by a parasite, Toxoplasma gondii, that’s found in animals.

00:47 In particular, you can find it in cat litter of cats, especially cat litter that’s been out for more than 24 hours.

00:54 And you may find raw or undercooked meat especially beef.

01:00 It’s mom’s first infection that confers risk.

01:04 So it should be her first infection during pregnancy.

01:08 Sometimes, patients will be tested for toxo in that they’ll be checked to see if they have antibodies already formed against toxo and if they do, they’re at lower risk conferring this to a child.

01:19 It’s the women who are not immune to toxo who get it first during pregnancy that can confer a risk to their infant.

01:28 Also, in immunocompromised parents, they may have a reactivation of their latent toxo infection and that can also confer a risk.

01:40 So, it’s the first infection during pregnancy or a reactivation in an immunocompromised mother that confers risk of toxo.

01:49 Toxo can present with a variety of symptoms including hydrocephalus, microcephaly, diffuse cerebral calcifications, chorioretinitis or hepatosplenomegaly.

02:02 This is one of the few congenital infections that causes microcephaly.

02:08 So keep that one in mind and the calcifications we see commonly.

02:13 So if we suspect toxoplasmosis, we generally would diagnose it by getting serology, serologic testing.

02:21 And we would treat it in the infant with medications similar to what we treat in older people with toxo, which is pyrimethamine, sulfadiazine, and leucovorin.

02:34 Sadly, the drug company that was making pyrimethamine was bought out by another drug company.

02:41 And so now, the cost of pyrimethamine went from what is 2 cents in say Brazil to $750 per pill.

02:51 This was purely a profit move.

02:54 So now, the cost of management of toxoplasmosis and treatment, which is a long term cost, is as much a $75,000 a month.

03:06 So toxoplasmosis prevention is what’s key.

03:11 Pregnant women should be tested if there’s a concern for risk of toxoplasmosis.

03:17 And pregnant women should avoid uncooked meat.

03:21 So steak tartare is forbidden during pregnancy.

03:25 Additionally, we recommend that pregnant women should change their cat litter at least daily or have someone else do it.

03:33 It takes a day for the form of the toxoplasmosis to become effective while outside of the cat’s body.

03:40 So rapid or frequent changing of kitty litter should be okay.