Management of Toxoplasmosis & Chickenpox in Pregnancy

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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DTOGIMED03_016

تاریخ نمایه سازی: 26 بهمن 1398

Abstract:

One of the major consequences of pregnant women becoming infected by Toxoplasma gondii & orChickenpox is vertical transmission to the fetus. Although rare, congenital infection can cause severeneurological, ocular or pulmonary disease as well as cardiac and cerebral anomalies.Recommendations of Toxoplasmosis Management in pregnancy:1. Routine universal screening should not be performed for pregnant women at low risk. Serologicscreening should be offered only to pregnant women considered to be at risk for primaryToxoplasma gondii infection (II-3E).2. Suspected recent infection in a pregnant woman should beconfirmed before intervention by having samples tested at a toxoplasmosis reference laboratory,using tests that are as accurate as possible and correctly interpreted (II-2B). 3. If acute infection issuspected, repeat testing should be performed within 2 to 3 weeks, and consideration given tostarting therapy with spiramycin immediately, without waiting for the repeat test results (II-2B). 4.Amniocentesis should be offered to identify Toxoplasma gondii in the amniotic fluid by polymerasechain reaction (a) if maternal primary infection is diagnosed, (b) if serologic testing cannot confirmor exclude acute infection, or (c) in the presence of abnormal ultrasound findings (intracranialcalcification, J Obstet Gynaecol Can 2013;35(1 eSuppl A): microcephaly, hydrocephalus, ascites,hepatosplenomegaly, or severe intrauterine growth restriction) (II-2B).5. Amniocentesis should not be offered for the identification of Toxoplasma gondii infection at lessthan 18 weeks’ gestation and should be offered no less than 4 weeks after suspected acute maternalinfection to lower the occurrence of false-negative results (II-2D). 6. Toxoplasma gondii infectionshould be suspected and screening should be offered to pregnant women with ultrasound findingsconsistent with possible TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes, and other)infection, including but not limited to intracranial calcification, microcephaly, hydrocephalus,ascites, hepatosplenomegaly, or IUGR. 7. Each case involving a pregnant woman suspected of havingan acute Toxoplasma gondii infection acquired during gestation should be discussed with an expertin the management of toxoplasmosis (III-B).8. If maternal infection has been confirmed but the fetusis not yet known to be infected, spiramycin should be offered for fetal prophylaxis (to preventspread of organisms across the placenta from mother to fetus) (I-B).9. A combination of pyrimethamine, sulfadiazine, and folinic acid should be offered as treatment forwomen in whom fetal infection has been confirmed or is highly suspected (usually by a positiveamniotic fluid polymerase chain reaction) (I-B). 10. Anti-toxoplasma treatment inimmunocompetent pregnant women with previous infection with Toxoplasma gondii should not benecessary (I-E).11. Women who are immunosuppressed or HIV-positive should be offered screening because of therisk of reactivation and toxoplasmosis encephalitis (I-A).12. A non-pregnant woman who has beendiagnosed with an acute Toxoplasma gondii infection should be counselled to wait 6 months beforeattempting to become pregnant. Each case should be considered separately in consultation with anexpert(III-B).13. Information on prevention of Toxoplasma gondii infection in pregnancy should bemade available to all women who are pregnant or planning a pregnancy (III-C).

Authors

Mostafa Alavi-Moghaddam

MD, MPH, AFSA, MS