Toxoplasmosis in pregnancy - Revision history

Aidan: /* Prevention */

2020-09-20T16:24:16Z

Prevention

← Older revision		Revision as of 16:24, 20 September 2020
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	*Prevention mostly focusses on counselling around risk reduction:		*Prevention mostly focusses on counselling around risk reduction:
	**Wash hands after changing cat litter		**Wash hands after changing cat litter
			**Wear gloves in the garden and when changing cat litter
	**Cook meat thoroughly		**Cook meat thoroughly
	**Avoid raw eggs and unpasteurized dairy		**Avoid raw eggs and unpasteurized dairy
			**Wash fruits and vegetables
			**Do not obtain a new cat while pregnant

	[[Category:Obstetrical infections]]		[[Category:Obstetrical infections]]

Aidan at 12:30, 20 September 2020

2020-09-20T12:30:45Z

← Older revision		Revision as of 12:30, 20 September 2020
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	**Can also be done on fetal blood		**Can also be done on fetal blood
	*Serology		*Serology
	**Can check maternal IgM and IgG		**Can check maternal IgM and IgG, both of which appear within the first week after infection
	**IgM is not specific to recent infection, however, as it can be present for more than a year		**IgM is not specific to recent infection, however, as it can be present for more than a year
	**IgG avidity testing is used to determine recency of infection		**IgG avidity testing is used to determine recency of infection

Aidan at 12:32, 15 September 2020

2020-09-15T12:32:08Z

← Older revision		Revision as of 12:32, 15 September 2020
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	**Avoid raw eggs and unpasteurized dairy		**Avoid raw eggs and unpasteurized dairy

	[[Category:Infectious diseases]]
	[[Category:Obstetrical medicine]]
	[[Category:Obstetrical infections]]		[[Category:Obstetrical infections]]

Aidan at 12:31, 15 September 2020

2020-09-15T12:31:43Z

← Older revision		Revision as of 12:31, 15 September 2020
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	*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
			*Only half of women can identify a significant risk factor[[CiteRef::boyer2011un]]
			*Risk of transmission to fetus is with parasitemia associated with primary infection, so women who are seropositive are ''not'' at risk of having a child with congenital infection

	==Diagnosis==		==Diagnosis==
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	***Low avidity is unhelpful, as avidity can remain low for more than a year		***Low avidity is unhelpful, as avidity can remain low for more than a year
	***High avidity, on the other hand, suggests infected at least 3-4 months prior		***High avidity, on the other hand, suggests infected at least 3-4 months prior
	**Therefore, if infection is suspected in the first 16 weeks of gestation, avidity ~~testing~~ ~~may be able to rule~~ out infection during pregnancy		**Therefore, if infection is suspected in the first 16 weeks of gestation, high avidity effectively rules out infection acquired during pregnancy
	*Needs serial head ultrasound to monitor for hydrocephalus and intraparenchymal brain calcifications		*Needs serial head ultrasound to monitor for hydrocephalus and intraparenchymal brain calcifications
	**May also see hepatic calcifications, splenomegaly, and ascites		**May also see hepatic calcifications, splenomegaly, and ascites
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	\|}		\|}

			*In general, for highly suspected or confirmed infection, it is reasonable to start [[Is treated by::spiramycin]] while confirming the infection
	===Acute Infection===
		⚫	*If acute infection, such as IgM + / IgG – that converts to IgG +, or IgM + / low IgG avidity with compatible clinical picture, then rule out fetal infection with an amniocentesis after week 18

⚫	*If acute infection, such as IgM + / IgG – that converts to IgG +, or IgM + / low IgG avidity with compatible clinical picture, then rule out fetal infection with an ~~mmniocentesis~~ after week 18
	**Likely start treatment with [[spiramycin]] while confirming infection
	*If infected < 14 weeks gestation, [[Is treated by::spiramycin]] 3 g/day until delivery		*If infected < 14 weeks gestation, [[Is treated by::spiramycin]] 3 g/day until delivery
	**However, it doesn't cross the placenta and it's unclear whether it affects outcomes in the baby		**However, it doesn't cross the placenta and it's unclear whether it affects outcomes in the baby
	**Likely most effective if given within 8 weeks of maternal infection		**Likely most effective if given within 8 weeks of maternal infection
			**[[Pyramethamine]] is contraindicated in pregnancy before 14 weeks gestation
	**Second-line would be monotherapy with [[Is treated by::sulfadiazine]] or [[Is treated by::clindamycin]]		**Second-line would be monotherapy with [[Is treated by::sulfadiazine]] or [[Is treated by::clindamycin]]
	*If age ≥ 14 weeks gestation and documented fetal infection by amniocentesis, or if suspected infection was ≥14 weeks gestation, use standard therapy		*If age ≥ 14 weeks gestation and documented fetal infection by amniocentesis, or if suspected infection was ≥14 weeks gestation, use standard therapy
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	**Therefore, if initially started on [[spiramycin]], then switch to standard therapy if amniotic fluid PCR is positive or ultrasound is abnormal		**Therefore, if initially started on [[spiramycin]], then switch to standard therapy if amniotic fluid PCR is positive or ultrasound is abnormal
	**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
			*If age ≥33 weeks gestation, then continue [[spiramycin]] and await a postnatal diagnosis

	===Prevention===		==Prevention==

	*Prevention mostly focusses on counselling around risk reduction:		*Prevention mostly focusses on counselling around risk reduction:

Aidan: /* Acute Infection */

2020-08-20T00:54:09Z

Acute Infection

← Older revision		Revision as of 00:54, 20 August 2020
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	== Clinical Manifestations ==		==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

	== Diagnosis ==		==Diagnosis==

	*Molecular		*Molecular
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	==Management==		==Management==
	{\| class="wikitable"		{\| class="wikitable"
	! IgM		!IgM
	! IgG		!IgG
	! Interpretation		!Interpretation
	! Management		!Management
	\|-		\|-
	\| +		\| +
	\| –		\|–
	\| acute primary infection or false positive		\|acute primary infection or false positive
	\| repeat serology in 2 to 3 weeks; if unchanged, then was false positive		\|repeat serology in 2 to 3 weeks; if unchanged, then was false positive
	\|-		\|-
	\| rowspan=2\| +		\| rowspan="2" \| +
	\| rowspan=2\| +		\| rowspan="2" \| +
	\| rowspan=2\| recent or prior infection		\| rowspan="2" \|recent or prior infection
	\| high IgG avidity: infection was >4 months ago so unlikely to be acute		\|high IgG avidity: infection was >4 months ago so unlikely to be acute
	\|-		\|-
	\| low IgG avidity: cannot determine when infection occurred		\|low IgG avidity: cannot determine when infection occurred
	\|-		\|-
	\| –		\|–
	\| +		\| +
	\| remote infection		\|remote infection
	\| no risk of transmission except rare cases of immunocompromise		\|no risk of transmission except rare cases of immunocompromise
	\|-		\|-
	\|–		\|–
	\|–		\|–
	\| no prior infection; at risk		\|no prior infection; at risk
	\| counsel on prevention of primary infection		\|counsel on prevention of primary infection
	\|}		\|}

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	*If acute infection, such as IgM + / IgG – that converts to IgG +, or IgM + / low IgG avidity with compatible clinical picture, then rule out fetal infection with an mmniocentesis after week 18		*If acute infection, such as IgM + / IgG – that converts to IgG +, or IgM + / low IgG avidity with compatible clinical picture, then rule out fetal infection with an mmniocentesis after week 18
			**Likely start treatment with [[spiramycin]] while confirming infection
	*If infected < 14 weeks gestation, [[Is treated by::spiramycin]] 3 g/day until delivery		*If infected < 14 weeks gestation, [[Is treated by::spiramycin]] 3 g/day until delivery
	**However, it doesn't cross the placenta and it's unclear whether it affects outcomes in the baby		**However, it doesn't cross the placenta and it's unclear whether it affects outcomes in the baby
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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

	=== Prevention ===		===Prevention===

	* Prevention mostly focusses on counselling around risk reduction:		*Prevention mostly focusses on counselling around risk reduction:
	** Wash hands after changing cat litter		**Wash hands after changing cat litter
	** Cook meat thoroughly		**Cook meat thoroughly
	** Avoid raw eggs and unpasteurized dairy		**Avoid raw eggs and unpasteurized dairy

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: /* Management */ rearranged table

2020-07-30T17:17:05Z

Management: rearranged table

← Older revision		Revision as of 17:17, 30 July 2020
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	==Management==		==Management==
	{\| class="wikitable"		{\| class="wikitable"
		⚫	! IgM
	!IgG		! IgG
⚫	!IgM
	!Interpretation		! Interpretation
	!Management		! Management
	\|-		\|-
	\|–		\| +
	\|–		\| –
	\|no ~~prior~~ infection; at ~~risk~~		\| acute primary infection or false positive
		⚫	\| repeat serology in 2 to 3 weeks; if unchanged, then was false positive
⚫	\|counsel on prevention of primary infection
	\|-		\|-
			\| rowspan=2\| +
⚫	\|–
			\| rowspan=2\| +
		⚫	\| rowspan=2\| recent or prior infection
		⚫	\| high IgG avidity: infection was >4 months ago so unlikely to be acute
		⚫	\|-
			\| low IgG avidity: cannot determine when infection occurred
			\|-
			\| –
	\| +		\| +
	\|~~acute~~ ~~primary~~ infection ~~or false positive~~		\| remote infection
		⚫	\| no risk of transmission except rare cases of immunocompromise
⚫	\|repeat serology in 2 to 3 weeks; if unchanged, then was false positive
	\|-		\|-
	\| +
	\|–		\|–
		⚫	\|–
	\|prior infection		\| no prior infection; at risk
⚫	\|no risk of transmission except rare cases of immunocompromise
		⚫	\| counsel on prevention of primary infection
⚫	\|-
	\| +
	\| +
⚫	\|recent or prior infection
⚫	\|do ~~avidity~~ ~~testing: if high~~ avidity, infection was >4 months ago so unlikely to be acute~~; if low avidity, uncertain~~
	\|}		\|}

Aidan: moved relevant contents from congenital infection

2020-07-30T17:13:01Z

moved relevant contents from congenital infection

@@ Line 1: / Line 1: @@
-== Management ==
+== Clinical Manifestations ==
 {| class="wikitable"
 !IgG
@@ Line 9: / Line 32: @@
 |–
 |no prior infection; at risk
-|counsel on prevention of primary infection (handwashing after litter, cook meat well, no raw eggs or unpasteurized dairy
+|counsel on prevention of primary infection
 |-
 |–
@@ Line 27: / Line 50: @@
 |}
-=== Acute Infection ===
+===Acute Infection===
-** Amniocentesis after week 18
+** Wash hands after changing cat litter
 [[Category:Infectious diseases]]

Aidan: Created page with "== Management == {| class="wikitable" !IgG !IgM !Interpretation !Management |- |– |– |no prior infection; at risk |counsel on prevention of primary infection (handwashing..."

2020-07-30T17:05:21Z

Created page with "== Management == {| class="wikitable" !IgG !IgM !Interpretation !Management |- |– |– |no prior infection; at risk |counsel on prevention of primary infection (handwashing..."

New page

== Management ==
{| class="wikitable"
!IgG
!IgM
!Interpretation
!Management
|-
|–
|–
|no prior infection; at risk
|counsel on prevention of primary infection (handwashing after litter, cook meat well, no raw eggs or unpasteurized dairy
|-
|–
| +
|acute primary infection or false positive
|repeat serology in 2 to 3 weeks; if unchanged, then was false positive
|-
| +
|–
|prior infection
|no risk of transmission except rare cases of immunocompromise
|-
| +
| +
|recent or prior infection
|do avidity testing: if high avidity, infection was >4 months ago so unlikely to be acute; if low avidity, uncertain
|}

=== Acute Infection ===

* If acute infection, such as IgM + / IgG – that converts to IgG +, or IgM + / low IgG avidity with compatible clinical picture
** Amniocentesis after week 18
*** If PCR positive, treat with [[pyrimethamine]] and [[sulfadiazine]] plus [[folinic acid]], until delivery
*** If PCR negative, continue prophylaxis with [[spiramycin]] 1 g po TID
* Choice of antiparasitic
** [[Spiramycin]] does not cross the placenta, while [[pyrimethamine]] and [[sulfadiazine]] do
** However, [[pyrimethamine]] is teratogenic before 14 weeks gestation

[[Category:Infectious diseases]]
[[Category:Obstetrical medicine]]
[[Category:Obstetrical infections]]