Toxoplasmosis during pregnancy can be dangerous to the unborn child. All facts about symptoms. Treatments for toxoplasmosis.
What is toxoplasmosis?
Toxoplasmosis is an infectious disease caused by special parasites: The pathogen is called Toxoplasma gondii and belongs to the unicellular organisms. Toxoplasmas reproduce in a complicated cycle and produce three distinct stages, all of which are important for infection in humans.
The final host for Toxoplasma gondii are cats, in whose intestine the parasites multiply. Therefore, toxoplasmosis is actually an animal disease. Humans – like other animals – serve only as intermediate hosts. Cats excrete certain stages of toxoplasma in large quantities in their feces – this is especially true of young cats. In the open air, the pathogens mature within two to four days, depending on temperature and humidity. After that they are infectious. They stick to the plants and farm animals, such as goats, sheep or poultry, can ingest Toxoplasma gondii. You can become infected by eating meat and sausages or by direct contact with cat feces.
Toxoplasma gondii is distributed worldwide. With increasing age, the number of people who have already had contact with the parasite increases. Doctors estimate that more than 70 percent of people over 70 have had contact with Toxoplasma gondii. With the adults it is on the average 50 per cent. The so-called contagion rate is much higher in Germany than, for example, in the Netherlands (26 percent) or in the USA (9 percent). As a reason experts suspect the different eating habits.
Toxoplasmosis and pregnancy: When is there a danger for the unborn child??
Toxoplasmosis in pregnancy is only dangerous to the unborn child if pregnant women have contracted the disease within the last six weeks before or during pregnancy first infection with Toxoplasma gondii. In most cases, toxoplasmosis is asymptomatic during pregnancy. However, the parasites can pass on to the unborn child and cause severe complications and malformations:
– Miscarriage is possible – especially if you get infected in the first trimester of pregnancy. – inflammation of the retina and choroid in the eye in babies (it sometimes shows up months or years later) – hydrocephalus – calcification of the brain vessels – enlarged liver and spleen
If you contract toxoplasmosis for the first time during pregnancy, the risk of infection for your unborn child depends on various factors, for example:
– Time of infection during pregnancy – Infection dose – Dangerousness of the pathogens – Immune competence of the expectant mother
The longer the pregnancy, the higher the risk that expectant mothers will transmit toxoplasmosis to the child via the placenta. In the first trimester of pregnancy, the transmission rate is about 15 percent; in the last trimester, it is about 60 percent. On the other hand, with increasing duration of pregnancy, the severity of the disease decreases.
Toxoplasmosis during pregnancy: frequency
The problem is that antibodies against Toxoplasma can only be detected in 26 to 54 percent of Central European women of childbearing age. This means that a large proportion of them have not yet had contact with the dangerous pathogens. If you were infected with toxoplasmosis before you became pregnant, your baby is protected from infection by your antibodies and immunity – so there is usually no risk to your baby. Doctors can use a toxoplasmosis test to determine whether or not you have antibodies to the toxoplasmas. According to the Institute for Risk Assessment (BfR), about 15 infections with toxoplasma acquired in the womb are reported each year. They are also called connatal infections because the infection occurs in the womb or at birth. However, doctors ame that the number of unreported cases is high.
Toxoplasmosis in pregnancy: treatment
Doctors treat an initial infection with toxoplasmosis during pregnancy with antibiotics (drugs against bacteria), antiparasitics (drugs against parasites), or a combination of the two. The following agents are available:
Spiramycin (antibiotic) for pregnant women up to 16. Week of pregnancy Pyrimethamine (antiparasitic drugs) plus Sulfadiazine (antibiotic): from week 16. Pregnancy for at least four weeks; concurrent treatment with Folinic acid (not folic acid!), so as not to impair the effectiveness of the treatment. If there is evidence of infection or damage to the embryo in the ultrasound, doctors carry out treatment with these three agents until the end of pregnancy. Important are regular blood-. possibly urine tests as well as the control of the liver function. Doctors also determine drug levels in your blood more frequently.
However, doctors controversially discuss the effectiveness of toxoplasmosis therapy for the initial infection during pregnancy. A recent study found evidence that treatment with pyrimethamine and sulfadiazine performed better than treatment with spiramycin within the first few weeks after infection. This applied with regard to the transmission rate of the pathogens via the placenta and brain damage in newborns.
Toxoplasmosis: Treatment of newborns
Doctors also treat a newborn child with toxoplasmosis with the combination of pyrimethamine, sulfadiazine, and folinic acid. The duration of therapy for newborns with symptoms depends on the severity of toxoplasmosis in the child and can be up to twelve months. Doctors continuously determine the level of the drug in the blood. In the case of infected babies without symptoms, in whom the infection is only detectable via laboratory values, doctors consider treatment for three to six months.
Toxoplasmosis in pregnancy – tips for protection
Pregnant women and women of childbearing potential should avoid initial infection during pregnancy at all costs! Be sure to ask your doctor for a toxoplasmosis test to find out whether you have already been in contact with toxoplasmas and have immunity – in this case, antibodies against the pathogen can be detected in the blood. Have your antibody status determined before or as early as possible in pregnancy. If you are not immune, get tested for toxoplasmosis regularly during pregnancy. But: The toxoplasmosis test is only covered by the statutory health insurance if there is a well-founded suspicion. Screening for toxoplasmosis does not (yet) exist in Germany.
If you have not had contact with Toxoplasma gondii before becoming pregnant, you do not have antibodies to the pathogen. Especially when handling cats in your household. Special protective measures are advisable outdoors as well as in the diet. They apply especially to pregnant women, but also to all other persons!
– Do not consume raw, inadequately heated/frozen sausage and meat products (z.B. Heat meat sufficiently. Fry it well. Cooking, frying, or pasteurizing will kill toxoplasmas. At temperatures above 67 °C, even permanent stages of the pathogens that encapsulate in cysts die within one to two minutes. Important: You must reach the high temperature evenly throughout the product – brief heating in the microwave is not suitable for this purpose! – Freezing food also kills Toxoplasma, but is not sufficient as a sole measure because some strains survive freezing. Freeze meat at -20°C for at least eight hours to kill toxoplasma. – Wash fruits and vegetables well before eating, peel or cook them. – Store soil-containing foods such as potatoes or carrots separately from other foods to avoid possible transmission of the parasites. – Wash your hands both before eating and after preparing raw meat. Clean all used kitchen utensils well afterwards. – Do not drink water from lakes, streams or other water sources when doing outdoor activities. – Do not feed your cat raw meat that may contain Toxoplasma gondii. It is better to use canned or dry food. – Pregnant women should have the litter box cleaned by others in the household. They should clean the feces box daily with hot water and dispose of the litter. – If you have visited sand playgrounds – wash your hands thoroughly afterwards. – Wear gloves when gardening, working in the fields or doing other earthwork. Again, wash your hands well afterwards. – Do not pet cats that are loose outside.