The first signs of toxoplasmosis in pregnant women. Toxoplasmosis in pregnant women. Prenatal diagnosis of toxoplasmosis

Toxoplasmosis is included in the list of TORCH infections (those that are transmitted in utero). Practically safe for the average person, toxoplasmosis during pregnancy leads to malformations in the fetus.

No symptoms Examination Signs
Method of treatment pregnant level
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What is it and what is the threat?

• cold symptoms - headache and muscle pain, weakness, fever, swollen lymph nodes (this goes away after a week);
• very rarely, with severely weakened immunity (including AIDS), various organs are affected - the brain, eyes, muscular system, heart;
• in very severe cases, infectious and inflammatory diseases of the brain develop, for example, meningoencephalitis.

Presents with headache and fever

The form of toxoplasmosis determines the symptoms and signs, including during pregnancy:

• acute is manifested by enlarged lymph nodes, fever (more than 38 degrees), muscle pain;
• cerebral - headache, numbness, paralysis, coma;
• congenital, received from the mother, manifested by rashes, deafness, underdevelopment, increased or reduced head size;
• eye - pain in the eyes, decreased visual acuity, blindness.

During pregnancy, chronic toxoplasmosis can develop, in which myocarditis, impaired functioning of the digestive and nervous systems, and memory impairment are observed.

Difficult to detect in the early stages

According to statistics, only one fetus out of a thousand is affected by the disease. Considering how dangerous toxoplasmosis is, it is still better to prevent infection with it during pregnancy.

Prevention and examinations

Cats are, of course, the main carriers of the infection. But this is not a reason to get rid of a pet that has been living in the house for several years, which has become practically a member of the family. Most likely, everyone has already been ill and received immunity. This can be easily checked by donating blood (your own and a cat's) for analysis.

Regular check-up of the expectant mother and pets is necessary

Similar analyzes are carried out by women planning to have a child. This is a blood test for toxoplasmosis, which suggests the risk of getting it during pregnancy. In addition to planning, such a study is assigned:

• with lymphadenopathy and the absence of such studies earlier;
• in the presence of immunodeficiency, including HIV;
• with suspicion of intrauterine infection of the born child.

The blood serum is examined for the content of immunoglobulin G and immunoglobulin M. There may be four variants of the result.

1. Two-thirds of adults are found to have IgG and no IgM. This indicates that there is immunity to the disease. There is no point in conducting further research, as well as taking preventive measures. Such a woman will not get sick with toxoplasmosis during pregnancy.
2. If there is no IgG and there is IgM, then infection is possible, and for the first time. It is also possible to transmit the infection to the fetus. Next, blood and urine are given for toxoplasma, after a couple of weeks, the study of blood serum is repeated. The same result indicates the fallacy of the first, if IgG is detected, then treatment is prescribed.
3. When both immunoglobulins are present, this is also the possibility of primary infection, but at the same time, such laboratory indicators during pregnancy are observed up to two years after the first infection with toxoplasmosis. For clarification, blood and urine are donated for toxoplasma, and the severity of the infection is analyzed to determine the time of infection.
4. The absence of both types of antibodies is the absence of both infection and immunity. This situation means that it is necessary to adhere to the rules of disease prevention in order not to become infected with it. You also need to repeat the analysis every trimester.

In order not to get toxoplasmosis during pregnancy, observe the following rules of prevention.

1. Do not eat raw (for example, minced meat) or half-baked meat (by the way, this includes not only steak with blood, but also barbecue, pasties).
2. Wash fruits, vegetables, herbs thoroughly.
3. Disinfect the cat litter (remembering that oocysts mature only on the third day, if you clean up after the cat every day, there is no danger). It is better to entrust this matter to another person.
4. Wash your hands well, especially after working outdoors.
5. Undergo the examinations prescribed by the doctor.

The consequences of toxoplasmosis during pregnancy will not necessarily affect the child. Therefore, the detection of a disease in a pregnant woman is not yet a reason for an abortion. First, it is necessary to conduct studies to determine whether the infection has penetrated the fetus.

1. The main method of analysis is ultrasound. It is carried out no earlier than a month after infection of the mother.
2. From the 16th week, you can perform an amniocentesis - the collection of amniotic fluid.

Only if the decoding of tests for toxoplasmosis shows infection of the fetus during pregnancy, is it recommended to interrupt it. This is done only with the consent of the woman, otherwise treatment is prescribed.

Ways to treat the disease

After testing for toxoplasmosis, infection can be detected during pregnancy. If there are no symptoms, no treatment is prescribed.

It is unlikely that the infection can be completely cured, but drugs significantly reduce the risk of infection of the fetus. This reduces the likelihood of adverse effects.

Up to 15 weeks, rovamycin is prescribed, since other drugs for symptoms of toxoplasmosis in humans during pregnancy can cause even more harm to the fetus. Further, and up to 36 weeks, sulfonamides, pyrimethamine, leucovorin and folic acid are prescribed for a month in order to compensate for the effect of the first three drugs. After 36 weeks, rovamycin is taken again.

Rovamycin tablets

Children born to mothers who definitely had toxoplasmosis during pregnancy do not necessarily have any abnormalities.

The infection enters the body in many ways. You can find her in the most unexpected places, but this does not mean that every meeting with her is dangerous.

For women of reproductive age, contracting an infection before conception has some advantages. A previously transferred infection provides the expectant mother with immunity for life and toxoplasmosis during pregnancy is no longer terrible for her.

Features of the development of the disease

In those infected with excellent health, acquired toxoplasmosis passes, most often, in a latent form. Immunity in a short time is able to suppress the infection, and a person will not even guess about the presence of strangers.

In rare cases, an infected person may experience minor symptoms:

• Temperature rise to subfebrile indicators.
• Slight malaise, drowsiness, dizziness.
• Slight enlargement of the lymph nodes.
• Headache.

All of these manifestations resemble those of the common cold, and people often write them off as a familiar ailment. Treatment of this condition is carried out symptomatically, or not applied at all. The infection is suppressed by the immune response and is not terrible for the average person. But for pregnant women, the likelihood of getting toxoplasmosis is dangerous.

Toxoplasma are considered "omnivorous" microorganisms, and, due to this property, easily penetrate the placental barrier. Their influence during intrauterine development can lead to serious consequences for the fetus. A child with congenital toxoplasmosis either dies at the very beginning of pregnancy, or is born with serious abnormalities.

Clinical picture

If a woman has had toxoplasmosis before, immunity to this infection remains for life. In the future, he will protect the child at all stages of intrauterine development.

Expectant mothers who experience the disease for the first time do not have this protection, although it is believed that the risk of transmission from the mother is not always 100%. With an increase in the gestational age, the chance of infecting the child increases, but at the same time, the clinical manifestations of the consequences of toxoplasmosis in children decrease.

The percentage of gestational age with the possibility of infection of the fetus:

• First trimester - 15-20%.
• Second trimester - 30%
• Third trimester - 60% and above.

Acquired toxoplasmosis in pregnant women in the first three months of gestation, most often, leads to fetal death and miscarriage. In the embryo, the development of important organs and systems is disrupted, which at this stage of formation is incompatible with life.

If the infection in a pregnant woman occurred in the second trimester, the baby may well be born alive, but you can hardly call him healthy. Children with congenital toxoplasmosis are born with severe pathologies that are often visible to the naked eye. The clinical signs and symptoms with which a child is born depend on which organ is more affected.

At a later date, the symptoms of toxoplasmosis in pregnant women may not appear at all. A child can be born without visible abnormalities and, at first glance, quite healthy. Obvious violations are detected with the further development of the baby, although it often happens that the infection does not strike the child's body, and he remains completely healthy.

What threatens congenital toxoplasmosis?

Signs of toxoplasmosis at birth:

• Hydrocephalus - enlarged head, thinned bones.
• Damage to the visual system - inflammation and atrophy of the retina, optic nerve, macula. Often there is a bilateral pathology.
• Intracerebral calcification is a lesion of the cerebral cortex and basal ganglia in the form of seals, up to 3 mm in size.
• Damage to the cardiovascular system and the musculoskeletal system.

Toxoplasmosis in late pregnancy is manifested mainly by damage to the brain and nervous system of the child. In the first years of life, the baby has a mental retardation, up to oligophrenia.

To avoid infection of the unborn baby with toxoplasmosis, when planning a pregnancy, it is necessary to undergo a thorough examination, take tests and exclude the possibility of infection.

Diagnostics

Many doctors advise expectant mothers, becoming registered with a gynecologist, to be tested for toxoplasmosis during pregnancy. Unfortunately, in the medical practice of many antenatal clinics, such an examination is not included in a number of mandatory procedures.

To diagnose the condition, the patient is assigned the following tests for the presence of toxoplasmosis in pregnant women:

• Indirect immunofluorescence reaction (RNIF). Sensitivity to it manifests itself a week after infection.
• Compliment binding reaction (RCC). Sensitivity is determined from the second week after infection.
• Enzyme immunoassay (ELISA). Antibodies to toxoplasmosis of the IgM and IgG classes are detected.

The most reliable is the study of blood for toxoplasmosis using ELISA. Thanks to this method, it is possible to identify the infection and differentiate it from other diseases. In addition to the diagnosis, skin-allergic tests are used. A positive result is detected from the fourth week after infection.

A complete blood count for toxoplasmosis during pregnancy shows a normal or low level of white blood cells. At the same time, the number of lymphocytes is increased.

When deciphering a serological blood test for toxoplasmosis, the presence of stable IgG antibodies is considered the norm. The presence of IgM immunoglobulins simultaneously with IgG indicates the beginning of the recovery stage. The absence of IgM with positive IgG indicates both the stage of recovery and acquired immunity, that is, the infection occurred a long time ago, the prognosis for conception is positive.

Survey results

Normally, antibodies with the IgM code in the blood serum should be absent. This suggests that the pregnant woman does not have an infectious infection, and nothing threatens her unborn child. But the presence of antibodies with the IgG code is also considered the norm. This indicator may mean that the expectant mother was once sick (perhaps in a latent form) with toxoplasmosis, and now she is immune to this infection, which also indicates the safety of the fetus.

Analysis Transcripts

When studying laboratory parameters for toxoplasmosis during pregnancy, the combination of these antibodies and their titer may indicate the nature of the development of the infection at the moment or the absence of its influence. Based on the results obtained, the doctor can give accurate recommendations for pregnancy planning.

Variants of detected antibodies:

• IgG and IgM antibodies are absent - this is the norm for a person who has never encountered Toxoplasma. For a woman planning a pregnancy, it means a possible risk of infection, since she does not have immunity to this infection. Extra care and preventive measures must be taken.
• Only IgG antibodies are present - the expectant mother has developed immunity to Toxoplasma, and she can safely conceive and bear a child.
• Only IgM antibodies are present - infection occurred relatively recently, no more than 2 months ago. The planned pregnancy should be postponed for at least six months and treatment should be started. After a course of therapy, you need to re-analyze.
• Antibodies with IgG and IgM codes were found in the blood - the infection entered the woman's body in the period from 2 to 6 months. Conception of a child can be carried out no earlier than six months after treatment.

When calculating the antibody titer, they are compared with reference values. A negative indicator in the column of a laboratory record means that the titer of certain immunoglobulins is less than the expected norm. A positive value indicates that the allowed number has been exceeded.

Test for duration of infection

In 1989, Finnish scientists proposed to introduce into the examination algorithm testing for avidity of antibodies detected during the detection of infection in pregnant women.

This indicator is determined as part of a serological analysis for TORCH infection. Its value characterizes the connection of the produced immunity antibodies with the infectious agent. Their strength indicates the duration of infection.

When infected with toxoplasmosis, a person's immune system begins to produce antibodies with the IgM code. Somewhat later, IgG antibodies appear. Initially, they have low avidity, which may indicate a recent primary infection. In the future, their connection with a foreign agent increases.

The definition of avidity allows you to establish or exclude the primary infection with toxoplasmosis, which is an important aspect during pregnancy and for its planning. With the simultaneous detection of IgG and IgM antibodies, we can talk about a recent infection.

But antibodies with the IgM code can be detected for a long time even when they disappear. These are trace amounts and should not be taken into account. Here, the avidity index of these antibodies is important for further pregnancy prognosis.

Index options for the diagnosis of toxoplasmosis:

• Less than 0.3 - low avidity of antibodies. Confirms the presence of a primary infection.
• More than or equal to 0.35 - high avidity. Primary infection is excluded.
• 0.3-0.35 - borderline avidity of antibodies, in which it is impossible to unequivocally judge the duration of the influence of toxoplasmosis.

Detected antibodies in the blood of a pregnant woman do not always indicate 100% infection with TORCH infection.

The sensitivity of test systems does not always give the correct result. To obtain an accurate prognosis, it is necessary to examine the pregnant woman again.

Specifics of treatment during pregnancy

If infection with toxoplasmosis during pregnancy is detected before 24 weeks, the doctor recommends interrupting it. Therapy is carried out using strong antibiotics, and this is especially harmful for the early development of the fetus.

Preparations for pregnant women are selected with extreme caution. Rovamycin is considered the most suitable. It reduces the possibility of transmission of infection to the fetus and is quite easily tolerated by women during the period of bearing a child.

In later pregnancy, Fansidar (Pyrimethamine) may be prescribed for acute toxoplasmosis. Since it can affect the function of hematopoiesis, folic acid is prescribed in addition to it.

In special cases, when drawing up an individual treatment regimen, immunomodulators are prescribed.

Prevention

To avoid infection with toxoplasmosis, women who do not have immunity to it must comply with increased requirements for personal hygiene. This must be done both before and during the bearing of the child.

Preventive measures:

• Do not eat foods that are not thermally processed enough.
• Eliminate raw meat from your diet.
• Do not have contact with raw meat. If this cannot be avoided, you must wash your hands thoroughly.
• Limit contact with pets, especially cats.
• After interacting with an animal or cleaning its tray, wash your hands with particular diligence.
• Get your pet tested for toxoplasmosis if possible.

If a cat has been living in the house for a long time, then, most likely, the woman’s immunity has already been developed.

When registering at the antenatal clinic, all pregnant women undergo various tests. Including a test for TORCH infection, which includes the detection of antibodies to Toxoplasma.

Why is the disease dangerous for pregnant women? How to avoid complications and give birth to a healthy baby? You will get answers to these and other important questions after reading our article.

What is toxoplasmosis and why is it dangerous

This disease is caused by the protozoan Toxoplasma gondii. Often the pathology proceeds without symptoms. However, this does not mean that it does not affect the internal organs, the central nervous system, and the lymph nodes. Mom does not even suspect that she has become a carrier of the infection.

Intermediate hosts are warm-blooded animals and humans. And the main ones are representatives of the cat family (Felidae).

They can become infected with Toxoplasma when they eat the carriers of the infection - mice and rats. Animals excrete oocysts of microorganisms with faeces.

Types of Toxoplasma:

The source of the disease can be more than 180 representatives of the animal world. There are several risk factors for Toxoplasma infection:

• direct contact with infected animals (including domestic cats);
• contact with the excrement of sick animals;
• eating undercooked meat;
• blood transfusion;
• transplantation of organs and tissues.

Toxoplasmosis - a disease caused by toxoplasma - occurs in humans easily and without any special consequences. This infection is dangerous only for pregnant women. With intrauterine infection, the risk of infection of the fetus and the development of serious complications is very high. Outside of pregnancy, a severe course of the disease occurs in people with sharply reduced immunity.

Symptoms

In most cases, toxoplasmosis is asymptomatic. Infection occurs completely unnoticed by a woman. In some cases, the appearance of such symptoms is noted:

• moderate increase in body temperature;
• headache;
• muscle pain;
• swollen lymph nodes.

In severe cases, pain in the joints, rashes on the skin, signs of brain damage may occur. This condition occurs mainly in people with congenital or acquired immunodeficiency, as well as in newborns. In healthy adults, the disease occurs with minimal clinical manifestations.

A pregnant woman diagnosed with toxoplasmosis does not pose a danger to others. From person to person through direct contact, this disease is not transmitted.

Diagnostics

Toxoplasmosis belongs to the group of TORCH infections. Examination for these diseases is mandatory for all expectant mothers. To detect Toxoplasma, a single blood test from a vein is required. The test is prescribed at the first visit to the doctor, regardless of the duration of the current pregnancy.

Serological studies for suspected toxoplasmosis are carried out at intervals of 2-4 weeks. During this time, the antibody titer increases significantly, and it is possible to unambiguously make a diagnosis based on the level of specific immunoglobulins. IgM, indicating a fresh infection, persist in the blood for 6 months. IgG appear at 6-8 weeks from the onset of the disease and remain for life.

After the survey, three scenarios are possible:

Option number 1. No IgM and IgG

Option number 2. No IgM, IgG present

Option number 3. There is IgM. IgG may or may not be present

Such a reaction suggests that the infection has occurred quite recently and the acute phase of inflammation is currently underway. A woman is at high risk for the development of pregnancy complications and the formation of malformations in the fetus. Additional diagnostics and treatment by an infectious disease specialist is required.

Consequences for the fetus

I trimester

Toxoplasmosis for up to 12 weeks threatens the development of such complications:

• spontaneous miscarriage;
• regressive pregnancy;
• the formation of malformations of the internal organs of the fetus.

The shorter the gestational age, the higher the likelihood of serious developmental anomalies that are incompatible with life. The most common conditions are:

• anencephaly (complete or partial absence of the cerebral hemispheres, skull bones and soft tissues);
• microcephaly (significant reduction in the size of the skull and brain);
• anophthalmia (underdevelopment of the eyeball);
• hydrocephalus (accumulation of fluid under the membranes of the brain);
• damage to internal organs, including the liver and spleen.

In rare cases, when infected in the first trimester, there is no formation of serious malformations. In this situation, the infection of the mother simply leads to the appearance of a similar disease in the child. Signs of the disease are detected after the birth of the baby. Such a child has a high chance of survival and successful development after recovery.

II trimester

Infection for a period of 12-18 weeks leads to the following consequences:

• damage to the central nervous system (hydrocephalus, the formation of calcifications in the brain tissues);
• damage to the liver and spleen;
• chorioretinitis (inflammation of the retina and choroid).

When infected for a period of 18-24 weeks, the following conditions occur:

• hepatosplenomegaly followed by jaundice;
• anemia;
• thrombocytopenia;
• dysfunction of the brain.

III trimester

Infection with Toxoplasma after 24 weeks leads to the development of congenital toxoplasmosis. This condition can lead to intrauterine death of the fetus or death of the newborn as a result of a severe infection. Surviving babies develop toxoplasmosis in an acute form, manifested by the following symptoms:

• high body temperature;
• enlargement of the liver and spleen;
• skin rashes (pink and red spots on the limbs and lower abdomen);
• vomit;
• convulsions.

Complete recovery from congenital toxoplasmosis is rare. Most children who have had this disease at an early age, there is a serious damage to the nervous system. There is an oligophrenia - a severe violation of the intellect. Perhaps the development of convulsive syndrome, paralysis and paresis of individual muscle groups. Many children have serious pathologies of the eyes, liver, heart and other organs.

Prenatal diagnosis of toxoplasmosis

To detect congenital malformations of the fetus, an ultrasound examination is mandatory. Serious anomalies that are not compatible with life can be detected already in the first trimester of pregnancy. At later dates, other abnormalities in the development of the fetus can be detected, as well as indirect signs of a progressive infection.

Principles of treatment

With the development of toxoplasmosis in the I and II trimester and the identification of serious anomalies in the development of the fetus, termination of pregnancy is recommended. The choice of method will depend on the condition of the woman and the gestational age. Artificial termination of pregnancy is carried out before the term of 22 weeks.

If a woman decides to keep the pregnancy, she should be treated with antibiotics. In the first trimester, antibiotics are not prescribed. Therapy begins after 14 weeks. With toxoplasmosis, drugs from the group of sulfonamides and macrolides (pyrimethamine, spiramycin, etc.) are prescribed. The course of treatment lasts at least 4 weeks. When conducting therapy in the III trimester, drugs from the sulfonamide group are canceled 2 weeks before the upcoming birth.

Some drugs used to treat toxoplasmosis adversely affect bone marrow function. To prevent serious complications caused by this condition, folic acid is prescribed at a high dosage (5 mg / day). Folic acid intake is essential throughout antibiotic therapy.

During treatment, the condition of the woman is necessarily monitored. A weekly blood and urine test is prescribed, weight gain and blood pressure are assessed. The condition of the fetus is monitored by ultrasound. After 32 weeks, the fetal heart rate is monitored weekly using CTG.

A child born from a woman with toxoplasmosis is examined in the first days of life. When the diagnosis is confirmed, specific antibiotic therapy is carried out in alternating courses lasting up to 4 weeks. The neonatologist and infectious disease specialist monitor the child's condition. An examination by a neurologist and an ophthalmologist is indicated to exclude malformations of the nervous system and the organ of vision.

Prevention

Following these simple rules will help prevent infection with Toxoplasma:

1. Do not eat undercooked meat.
2. Do not taste raw meat while cooking.
3. Only use gloves when carving raw meat.
4. Wash fruits and vegetables thoroughly before eating.
5. Keep your hands clean when working in the garden or in the country. Do not forget about protective gloves when working with the ground.
6. Use gloves when handling pets (do not touch feces with bare hands). It is best to entrust the cleaning of the cat litter to other relatives for the entire period of your pregnancy.
7. Do not let domestic cats outside.
8. Don't let cats sleep on your bed.
9. Do not feed domestic cats raw meat. Use only dry food or canned food.
10. Check if your cat is infected with toxoplasmosis (get tested at a veterinary clinic).

If you suspect toxoplasmosis, you should contact an infectious disease specialist or a gynecologist.

Photo: DPDx Image Library, Public Domain

Toxoplasma is able to cross the placenta of a pregnant woman. They affect the course of pregnancy itself and cause developmental pathology in the fetus. Serological screening of a pregnant woman for toxoplasmosis and antimicrobial therapy are common methods of preventing toxoplasmosis in pregnant women.

Rice. 2. Scheme of the spread of infection. Wild and domestic cats are the main hosts of toxoplasmosis. Warm-blooded animals (including humans) and birds are intermediate.

Rice. 3. Domestic and wild cats are the main source of distribution of Toxoplasma.

Lymph nodes increase significantly in size.

Toxoplasmosis in pregnant women can occur in the form of carriage, have a latent (hidden) course, have an acute or subacute course, acquire a chronic course with periodic exacerbations. The disease most often proceeds benignly.

Signs and symptoms of toxoplasmosis during pregnancy

Latent form of toxoplasmosis

The asymptomatic course of the disease can only be determined by determining the level of antibodies or the determination in the enzyme-linked immunosorbent assay (ELISA) of IgM immunoglobulins.

Acute form of toxoplasmosis in pregnant women

The acute form of the disease is always difficult. The incubation period (period of reproduction of Toxoplasma) averages several weeks. General weakness, malaise, muscle pain, chills and subfebrile body temperature are the main symptoms of toxoplasmosis during pregnancy during this period.

• Enlarged lymph nodes (more often in the neck and nape, less often in the axillary and inguinal regions) have a soft texture, are slightly painful on palpation, and are not soldered to each other. Their size is not more than 1.5 cm. An increase in mesenteric lymph nodes simulates a picture of an acute abdomen.
• The disease often proceeds as a neuroinfection with the phenomena of meningoencephalitis or encephalitis. Optic neuritis and paresis develop.
• The rash is short-term, has the character of spots (roseol) and papules.
• With damage to muscle tissue, myositis and myocarditis develop.
• In some cases, the liver and spleen are enlarged.
• With damage to the organs of vision, chorioretinitis develops.

The acute form of toxoplasmosis lasts from several days to several months. Subsequently, a secondary latent form of the disease is formed or the disease acquires a chronic course.

Rice. 4. Toxoplasma from pseudocysts or cysts are activated and penetrate into the blood, from where they enter the fetus through the placenta, affecting it at any phase of its development.

Chronic toxoplasmosis during pregnancy

Chronic toxoplasmosis occurs with constant exacerbations and rare intervals of weakening of the symptoms of the disease, with little effectiveness of anti-infective treatment. Prolonged low-grade fever, phenomena of intoxication and asthenia, generalized enlargement of the lymph nodes are the main symptoms of toxoplasmosis during pregnancy during this period of the disease.

The clinical manifestations of the disease depend on the damage to the internal organs - the central and peripheral nervous system, muscles, eyes, liver, spleen, genital organs. Patients are worried about weakness, sleep is disturbed, appetite worsens. Memory loss, adynamia and psycho-emotional instability are constant symptoms of the disease.

Symptoms of toxoplasmosis during pregnancy do not have any features or differences from the known clinical picture of the disease.

The signs and symptoms of toxoplasmosis are described in detail in the article.

Laboratory diagnosis of toxoplasmosis in pregnant women

Serological methods: indirect immunofluorescence reaction (RNIF), enzyme immunoassay (ELISA Toxo, IgG, IgM) form the basis of laboratory diagnosis of toxoplasmosis. The dynamics of the level of antibodies of the IgG and IgM class is a marker of the effectiveness of the therapy.

The presence of IgM antibodies, significantly increasing dynamics of immunoglobulin titer, their high level confirm the diagnosis of toxoplasmosis. The reliability of diagnosis is confirmed by the data of monitoring the level of antibodies in dynamics.

An increase in the level of antibodies of all classes is noted at 2-3 weeks from the moment of infection. The correct interpretation of the data obtained is the responsibility of the doctor.

The following factors indicate infection during pregnancy:

• an increase in antibody titers in the case of a reaction with an interval of 2-3 weeks,
• the presence of epidemiological prerequisites for primary infection,
• detection of toxoplasma trophozoids in the biological fluids of the body of a pregnant woman,
• the reference diagnostic method is a positive reaction for the detection of DNA pathogens in the amniotic fluid (PCR method).

Patients with toxoplasmosis do not pose a danger to others, which allows them not to be isolated for the duration of treatment, but to be treated at home or in a general somatic hospital.

Treatment of toxoplasmosis in pregnant women is carried out from the second trimester of pregnancy. Rovamycin And Fansidar drugs of choice for the treatment of this disease. It is advisable to carry out two full courses of antimicrobial therapy with a break of 1-1.5 months. A good effect is given by the simultaneous use of immunomodulators ( Galovit, Polyoxidonium). A decrease in the level of antibodies of the IgM class indicates a positive trend in the treatment process

Selection of the drug, its dose and determination of the duration of treatment is carried out only by a doctor. Identification of toxoplasmosis in early pregnancy and adequate treatment will prevent infection of the fetus.

Features of dispensary observation of pregnant women

Toxoplasmosis during pregnancy is confirmed by an infectious disease doctor. In the Russian Federation, women of childbearing age are infected with toxoplasma in 20-30% of cases.

1. Women who have been ill with toxoplasmosis before pregnancy (for half a year or more) and who do not have any complaints and symptoms of the disease, with a consistently low level of IgM, do not need treatment. They are considered practically healthy persons. Children born to such women are screened for toxoplasmosis if clinically indicated.

Women not infected with toxoplasma make up 70-80%. They are at risk for congenital toxoplasmosis.

1. The high-risk group is made up of pregnant women infected during pregnancy, since the infection in 30-40% of cases is transmitted to the fetus. When positive serological reactions appear for the first time, an increase in antibody titer by 3-4 times, emergency preventive treatment is indicated for pregnant women. Children born from such women are examined for toxoplasmosis and, if indicated, are subject to treatment. Dispensary observation of such children is 10 years.
2. In order to identify primary infection, pregnant women who are not infected with toxoplasma are subject to dispensary observation and are examined once every 1 to 2 months.

Continuous serological monitoring during pregnancy is the basis for the prevention of toxoplasmosis.

Consequences of toxoplasmosis during pregnancy

Rice. 6. In the photo, the fetus is at the 8th week of pregnancy. Toxoplasma infection in the 1st trimester of pregnancy is complicated by severe developmental anomalies and intrauterine fetal death. The risk of infection of the fetus during this period is 17%.

Rice. 7. In the photo, the fetus is at 12 weeks of gestation. Toxoplasma infection of the fetus at 12-18 weeks of gestation is complicated by severe damage to the central nervous system (hydrocephalus), organs of vision and liver. The risk of infection of the fetus during this period is 25%.

Rice. 8. In the photo, the fetus is at 18 weeks of gestation. Toxoplasma infection of the fetus at 18-24 weeks of gestation is complicated by the pathology of many internal organs. At birth, newborns have jaundice, anemia, an enlarged liver and spleen, and thrombocytopenia. The risk of infection of the fetus during this period is 65%.

Rice. 9. In the photo, the fetus is at 28 weeks of gestation. Infection of the fetus with toxoplasma in the later stages (28-40 weeks) is complicated by deafness and damage to the organs of vision, which appear several years after birth. The risk of infection of the fetus during this period is 80%.

Congenital toxoplasmosis

Congenital toxoplasmosis is 1-8 patients per 1000 live births.

Infection of pregnant women in the early stages or shortly before pregnancy is dangerous due to the possibility of damage to the fetal egg by Toxoplasma, which leads to miscarriage, stillbirth, the birth of children with malformations, hepatosplenomegaly, etc.

With an asymptomatic infection in a pregnant woman during the period of immune suppression, reactivation of toxoplasmosis may occur. Toxoplasma from pseudocysts and cysts are activated and penetrate into the blood, from where they enter the body of the fetus through the placenta, affecting it at any phase of its development.

Infection of the fetus in late pregnancy leads to the birth of children whose symptoms of toxoplasmosis in the form of deafness and damage to the organs of vision appear several years after birth.

Congenital toxoplasmosis occurs either in the form of an acute disease, or it can immediately take a latent or chronic course.

The acute form of congenital toxoplasmosis is severe. Intoxication, fever, skin rashes (exanthema), damage to many internal organs, eyes, central nervous system, and swollen lymph nodes are the main clinical manifestations of the disease. The disease often acquires a progressive course. The child dies in the first weeks of life.

In some cases, the severity of the process gradually subsides and the disease becomes chronic. During this period, the disease is manifested by signs of damage to the central nervous system - mental retardation, paresis, paralysis, epileptiform seizures, chorioretinitis.

Rice. 10. Rash in a newborn with toxoplasmosis (exanthema of newborns).

Rice. 11. Congenital toxoplasmosis. The sizes of the enlarged liver and spleen are marked with a felt-tip pen.

Rice. 12. Enlargement of the liver in congenital toxoplasmosis is often accompanied by jaundice.

Rice. 13. Hydrocephalus is a malformation of the nervous system in toxoplasmosis.