Snapshot A male neonate is born to a G2P2 mother who works at an animal shelter. She constantly interacted with cats, dogs, and rabbits. The neonate is noted to be jaundiced with hepatosplenomegaly. An ultrasound of his head shows hydrocephalus, and a subsequent CT scan shows intracranial calcifications. Out of concern for a congenital infection, his blood is sent for serologic testing for Toxoplasma. Introduction Overview toxoplasmosis is caused by Toxoplasma gondii protozoa, associated with cat feces/litter box handlind, eating raw meat, or drinking raw milk Epidemiology Demographics higher rates of infection in Europe, Central and South America, and Central Africa Risk factors contact with cats/litter box raw goat’s milk eating uncooked meat ETIOLOGY Pathogenesis mechanism Toxoplasma can survive in the environment for over a year primary transplacental transmission occurs when the mother is infected, particularly after the first trimester Presentation History mother has a history of past interaction with cats Symptoms common symptoms mild mononucleosis-like symptoms Physical exam triad chorioretinitis intracranial calcifications hydrocephalus may also see intrauterine growth retardation jaundice hepatosplenomegaly may have a blueberry muffin rash Imaging Fetal ultrasound findings may show hydrocephalus CT head findings intracranial calcifications, ventriculomegaly, and hydrocephalus Studies Serum labs toxoplasma IgG and IgM levels polymerase chain reaction (PCR) Differential ToRCHeS differential ToRCHeS Congenital Infections Toxoplasmosis Hydrocephalus, intracranial calcifications, and chorioretinitis +/- blueberry muffin rash Rubella Blueberry muffin rash, cataracts, deafness, and cardiac defects CMV Sensorineural deafness, microcephaly, periventricular calcifications, seizures, and petechial rash with thrombocytopenia Herpes Vesicular rash, keratoconjunctivitis, and acute meningoencephalitis Syphillis Facial abnormalities (such as rhagades, or linear scars at the oral commissure, saddle nose, and notched teeth), saber shins, and deafness Stillbirth Treatment Medical pyrimethamine + sulfadiazine indications all patients folinic acid indications administered with pyrimethamine and sulfadiazine to prevent bone marrow suppression Complications Death Severe neurologic sequelae Prognosis Mortality is high with congenital toxoplasmosis