Congenital toxoplasmosis

Congenital toxoplasmosis is a group of symptoms caused by infection of the unborn baby (fetus) with the parasite Toxoplasma gondii.

The fetus can become infected with toxoplasmosis if the mother is infected with toxoplasmosis, or if she has a history of toxoplasmosis during previous pregnancies.

For the mother the disease is generally mild and may not be evident. Infection of the fetus, however, can cause severe problems. Infection early in pregnancy results in more severe problems than later infection.

Congenital toxoplasmosis can damage the baby's eyes, nervous system, skin, and ears.

Symptoms include:

• Anemia
• Enlarged liver and spleen
• Eye damage from inflammation of the retina
• Jaundice
• Low birth weight
• Prematurity
• Skin rash (petechiae or ecchymosis) at birth

The physical examination may show signs of:

• Anemia
• Cerebral calcifications
• Chorioretinitis
• Hydrocephalus
• Lymphadenopathy
• Macrocephaly or microcephaly

Signs and symptoms that occur late in the disease include:

• Hearing loss
• Mental retardation
• Seizures
• Neurological problems
• Visual impairment

Prenatal tests include:

• Amniotic fluid testing and fetal blood testing
• Antibody titer
• Ultrasound of the abdomen

Postnatal diagnosis:

• Antibody studies on cord blood and cerebrospinal fluid
• CT scan of the brain
• MRI scan of the brain
• Neurological exams
• Standard eye exam
• TORCH screen

Spiramycin can treat infection in the pregnant mother.

Pyrimethamine and sulfadiazine can treat fetal infection (diagnosed during the pregnancy).

Treatment of infants with congenital toxoplasmosis typically includes pyrimethamine, sulfadiazine, and leucovorin for one year. Infants are also sometimes given steroids if their vision is threatened or if the protein level in the spinal fluid is high.

The outcome depends on the severity of the congenital toxoplasmosis.

• Blindness or severe visual disability
• Severe mental retardation or other neurological problems

Call for an appointment with your health care provider if you are pregnant and think you are at risk for toxoplasmosis (for example, if you have a cat and are the person who cleans the litter box).

Call for an appointment with your health care provider if you are pregnant and have not received any prenatal care.

Prospective or expectant mothers can be tested to find out if they are at risk for toxoplasmosis.

Pregnant women who have cats as house pets may be at increased risk of developing toxoplasmosis. They should avoid contact with any materials that are potentially infected with cat feces, or that could be contaminated by insects exposed to cat feces (cockroaches, flies, etc.).

Cook meat until it is well done, and wash your hands after handling raw meat.

Cohen J, Powderly WG. Infectious Diseases. 2nd ed. New York, NY: Elsevier; 2004.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th ed. London: Churchill Livingstone; 2005.