Updated: 12/31/2021

Congenital Toxoplasmosis

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  • 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

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