Toxoplasmosis in pregnancy
From IDWiki
Management
| 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
- Amniocentesis after week 18
- Choice of antiparasitic
- Spiramycin does not cross the placenta, while pyrimethamine and sulfadiazine do
- However, pyrimethamine is teratogenic before 14 weeks gestation
References
- ^ K. Boyer, D. Hill, E. Mui, K. Wroblewski, T. Karrison, J. P. Dubey, M. Sautter, A. G. Noble, S. Withers, C. Swisher, P. Heydemann, T. Hosten, J. Babiarz, D. Lee, P. Meier, R. McLeod. Unrecognized Ingestion of Toxoplasma gondii Oocysts Leads to Congenital Toxoplasmosis and Causes Epidemics in North America. Clinical Infectious Diseases. 2011;53(11):1081-1089. doi:10.1093/cid/cir667.
