Congenital toxoplasmosis - Revision history

Aidan at 16:22, 20 September 2020

2020-09-20T16:22:36Z

← Older revision		Revision as of 16:22, 20 September 2020
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	[[Category:Congenital infections‏‎]]		[[Category:Congenital infections‏‎]]
	[[Category:Pediatrics]]

Aidan at 12:29, 20 September 2020

2020-09-20T12:29:32Z

@@ Line 3: / Line 3: @@
 *Can be acquired during maternal parasitemia associated with primary infection
 **However, it is possible to acquire from reactivation of latent toxoplasmosis in an HIV-infected mother
-*Risk of transplacental infection of fetus is lowest in first trimester and highest in third
+*Risk of transplacental infection of fetus is lowest in first trimester and highest in third, but the risk of severe disease is highest if infected in first trimester and lowest in third trimester[[CiteRef::2007ef]]
 *See also [[toxoplasmosis in pregnancy]]
 ==Clinical Manifestations==
 *At birth, 85% of infected babies are asymptomatic and only 15% are symptomatic
-**Risk of infection is related to trimester of infection: 6% in first, 40% in second, and 72% in third
+**Risk of infection is related to trimester of infection: 6-15% in first, 30-40% in second, and 60-72% in third
 **Risk of signs of congenital infection is inversely related to trimester of infection: 61% in first, 25% in second, and 9% in third
 *Classic triad of [[Causes::chorioretinitis]] (most common), [[Causes::intraparenchymal cerebral calcifications]], and [[Causes::hydrocephalus]]
 *Others: [[Causes::thrombocytopenia]], [[Causes::hepatitis]], [[Causes::hepatosplenomegaly]], [[Causes::cataracts]], [[Causes::strabismus]], [[Causes::microphthalmia]]
 ==Diagnosis==

Aidan at 12:04, 20 September 2020

2020-09-20T12:04:56Z

← Older revision		Revision as of 12:04, 20 September 2020
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	**However, it is possible to acquire from reactivation of latent toxoplasmosis in an HIV-infected mother		**However, it is possible to acquire from reactivation of latent toxoplasmosis in an HIV-infected mother
	*Risk of transplacental infection of fetus is lowest in first trimester and highest in third		*Risk of transplacental infection of fetus is lowest in first trimester and highest in third
			**First trimester: 10%
			**Second trimester: 25%
			**Third trimester: 80%
	*See also [[toxoplasmosis in pregnancy]]		*See also [[toxoplasmosis in pregnancy]]

Aidan at 18:16, 20 August 2020

2020-08-20T18:16:21Z

← Older revision		Revision as of 18:16, 20 August 2020
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	*For prevention, refer to [[Toxoplasmosis in pregnancy#Management\|the management of toxoplasmosis in pregnancy]]		*For prevention, refer to [[Toxoplasmosis in pregnancy#Management\|the management of toxoplasmosis in pregnancy]]

	[[Category:~~Obstetrical~~ infections‏‎]]		[[Category:Congenital infections‏‎]]
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Parasites]]

Aidan: /* In pregnancy */

2020-07-30T17:11:13Z

In pregnancy

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-21T21:29:43Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 21:29, 21 July 2020
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	* Risk of transplacental infection of fetus is lowest in first trimester and highest in third		* Risk of transplacental infection of fetus is lowest in first trimester and highest in third

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Often no history of illness during pregnancy		* Often no history of illness during pregnancy
	** Symptoms, if present, tend to be mild with low-grade fever, malaise, and lymphadenopathy		** Symptoms, if present, tend to be mild with low-grade fever, malaise, and lymphadenopathy

Aidan: /* In children */

2020-05-17T18:37:50Z

In children

← Older revision		Revision as of 18:37, 17 May 2020
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	=== In children ===		=== In children ===
	* Postnatal treatment is with standard therapy for at least 12 months		* Postnatal treatment of neonates is with standard therapy for at least 12 months
	** [[Is treated by::Sulfadiazine]] 50 mg/kg q12h		** [[Is treated by::Sulfadiazine]] 50 mg/kg q12h
	** [[Is treated by::Pyrimethamine]] 1 mg/kg q12h for 2 days (load), followed by 1 mg/kg for 2 to 6 months, followed by 1 mg/kg qMWF		** [[Is treated by::Pyrimethamine]] 1 mg/kg q12h for 2 days (load), followed by 1 mg/kg for 2 to 6 months, followed by 1 mg/kg qMWF
	** [[Folinic acid]] 10 mg PO thrice weekly until 1 week after [[pyrimethamine]] is stopped		** [[Folinic acid]] 10 mg PO thrice weekly until 1 week after [[pyrimethamine]] is stopped
			* Treatment of congenital infection in older children is standard therapy until 1 to 2 weeks after resolution of signs or symptoms
			** [[Is treated by::Pyrimethamine]] 1 mg/kg q12h (max 50 mg) for 2 days, followed by 1 mg/kg/day (max 25 mg)
			** [[Is treated by::Sulfadiazine]] 75 mg/kg load, followed by 50 mg/kg q12h (max 4 g/day)
			** [[Folinic acid]] 10-20 mg po thrice weekly
			** Can add [[prednisone]] for severe chorioretinits at 1 mg/kg/day divided bid (max 40 mg/day), followed by a rapid taper
	* Serial evaluations with a clinical assessment, neuroradiology, ophthalmology, and CSF analysis		* Serial evaluations with a clinical assessment, neuroradiology, ophthalmology, and CSF analysis

Aidan: /* Management */ added children

2020-05-17T18:34:34Z

Management: added children

← Older revision		Revision as of 18:34, 17 May 2020
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	** However, it is teratogenic until 14 weeks gestation so [[spiramycin]] is used until then		** However, it is teratogenic until 14 weeks gestation so [[spiramycin]] is used until then

			=== In children ===
			* Postnatal treatment is with standard therapy for at least 12 months
			** [[Is treated by::Sulfadiazine]] 50 mg/kg q12h
			** [[Is treated by::Pyrimethamine]] 1 mg/kg q12h for 2 days (load), followed by 1 mg/kg for 2 to 6 months, followed by 1 mg/kg qMWF
			** [[Folinic acid]] 10 mg PO thrice weekly until 1 week after [[pyrimethamine]] is stopped
			* Serial evaluations with a clinical assessment, neuroradiology, ophthalmology, and CSF analysis

			[[Category:Obstetrical infections‏‎]]
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Parasites]]		[[Category:Parasites]]

Aidan at 17:48, 17 May 2020

2020-05-17T17:48:35Z

@@ Line 5: / Line 5: @@
 == Clinical Presentation ==
 * Classic triad of [[Causes::chorioretinitis]] (most common), [[Causes::intraparenchymal cerebral calcifications]], and [[Causes::hydrocephalus]]
 * Others: [[Causes::thrombocytopenia]], [[Causes::hepatitis]], [[Causes::hepatosplenomegaly]], [[Causes::cataracts]], [[Causes::strabismus]], [[Causes::microphthalmia]]
 == Diagnosis ==
 * Molecular
-** Definitive diagnosis is based on PCR of amniotic fluid or fetal blood
+** Definitive diagnosis is based on PCR of amniotic fluid around 18 months, usually done after maternal serology to confirm intrauterine infection
 * Serology
 ** Can check maternal IgM and IgG
 *** Low avidity is 35-50% and high is >60%
-*** High avidity suggests infected at least 4 months prior
+*** Low avidity is unhelpful, as avidity can remain low for more than a year
 [[Category:Pediatrics]]

Aidan: Created page with "== Background == * Can be acquired during maternal parasitemia associated with primary infection ** However, it is possible to acquire from reactivation of latent toxoplasmosi..."

2020-02-09T01:24:34Z

Created page with "== Background == * Can be acquired during maternal parasitemia associated with primary infection ** However, it is possible to acquire from reactivation of latent toxoplasmosi..."

New page

== Background ==
* Can be acquired during maternal parasitemia associated with primary infection
** However, it is possible to acquire from reactivation of latent toxoplasmosis in an HIV-infected mother
* Risk of transplacental infection of fetus is lowest in first trimester and highest in third

== Clinical Presentation ==
* 85% of infected babies are asymptomatic at birth; 15% symptomatic
** Symptom severity increases is highest in first trimester and lowest in third
* Classic triad of [[Causes::chorioretinitis]] (most common), [[Causes::intraparenchymal cerebral calcifications]], and [[Causes::hydrocephalus]]
* Others: [[Causes::thrombocytopenia]], [[Causes::hepatitis]], [[Causes::hepatosplenomegaly]], [[Causes::cataracts]], [[Causes::strabismus]], [[Causes::microphthalmia]]

== Diagnosis ==
* Molecular
** Definitive diagnosis is based on PCR of amniotic fluid or fetal blood
* Serology
** Can check maternal IgM and IgG
** Avidity testing
*** Low avidity is 35-50% and high is >60%
*** High avidity suggests infected at least 4 months prior
* Needs serial head ultrasound to monitor for hydrocephalus and calcifications

[[Category:Pediatrics]]
[[Category:Parasites]]