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Wednesday, November 22, 2023

Toxoplasmosis

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The topic of toxoplasmosis as a cause of abortion is a widely publicized topic but we will explain clearly and simply what you should know.

Toxoplasmosis is produced by a parasite, people generally associate it with cats, however, these kittens only cause infection in humans in 10% of cases, so the main cause of contamination is uncooked meat or undercooked (the famous 3/4 or medium-rare term that we order in restaurants). The other important thing is that in an ordinary patient, with a normal immune system, it does not produce any symptoms or health repercussions. It is also necessary to know that the prevalence of this parasitic infection is endemic throughout the world, that is, 90% of people have the infection.

Based on the above, it is logical to think that the chances of acquiring the infection during pregnancy are relatively low, but if they do occur, important alterations have been described and vary according to the trimester or months of pregnancy at the time of acquiring the infection. If the infestation occurs during the first three months it has been related to abortions, on the other hand, if it occurs after week 12 it has been associated with alterations of the fetal brain such as ventriculomegaly, stroke, agenesis of the corpus callosum, and other medical terms that do not have relevance in this publication, and if it occurs at the end of pregnancy it can be associated with the appearance of ocular toxoplasmosis that causes blindness.

Before the pregnancy, it’s possible to test for toxoplasmosis. This is done through two tests, the most well-known being the toxotest, where two antigens (IgG and IgM) are determined.

Positive IgG indicates that the infection has already occurred and that you should not worry about acquiring it during pregnancy since immunity was generated and you will not suffer it again, like chickenpox – it happens once without reoccurring.

Positive IgM indicates recent infection, so you have two options: perform the avidity test (which is not available in all countries) and confirm the infection or start treatment with pyrimethamine (it has to be prescribed by a specialist ) or clindamycin. In other countries, before starting treatment, they recommend performing amniocentesis to confirm the presence of antigens in the amniotic fluid, but it is a delicate process that can lead to loss of pregnancy, placental hematomas, fetal injury, and placental abruption. Your doctor should advise you on what is best for you.

Negative IgG, it means that you have never been exposed to the infection, so it is imperative to take extreme measures such as hand hygiene, proper cooking of meats, seafood, properly washing vegetables, etc. since by acquiring the infection during pregnancy you are at risk of having fetal alterations.

In case you have not planned the pregnancy and you have become pregnant without knowing your status against toxoplasmosis, your gynecologist will send you for tests during your first prenatal care appointments and in the second half of pregnancy.

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