Toxoplasmosis

 

* Toxoplasmosis causes in women unimmunized risk of serious embryofetopathy throughout pregnancy.

Fetal damage risk is rare, but serious at the beginning of pregnancy, frequent but less severe late in pregnancy.

If the infection before conception, fetal damage risk is exceptional (immunocompromised patients).

– The risk of placental passage is low (1%) before 10 SA, and increases until the end of pregnancy (20% to 20 SA, 90% in the 9th month).

– The risk of serious congenital toxoplasmosis

pregnant + cat => Risk Toxoplasmosis

pregnant + cat => Risk Toxoplasmosis

* Severe congenital toxoplasmosis is manifested by severe brain damage, microcephaly, hydrocephalus with stenosis of the aqueduct of Sylvius, seizures, intracranial calcifications.

Benign congenital toxoplasmosis is manifested by a pigment chorioretinitis, hepatosplenomegaly, neonatal jaundice.

The risk of chorioretinitis years later is the subclinical toxoplasmosis.

* The IgM (Remington test positive from 1 / 50th) appear dice the first week of maternal infection (first detectable Ac) peak by 2-3 week and lasts for 3 to 6 months sometimes more one year.

IgG (Dye-test positivity threshold from 10 IU) appear in 2 to 3 weeks, they reach their peak around 2 months and they persist indefinitely.

The positive IgG + IgM positive => serology after 3 weeks later: the net rise is in favor of a recent infection that must be treated. If not climb past infection is possible with persistence of IgM

Fetopathies:

CNS: Hydrocephalus; intracerebral calcification; convulsions

Eye: Microphthalmos; strabismus; nystagmus; chorioretinitis or uveitis

* The sonographic signs of poor prognosis in a fetal toxoplasmosis ventricular dilatation, microcephaly, intracranial calcifications periventricular, hepatomegaly, fetal growth retardation, serous effusion

* The toxoplasmosis serology is required when reviewing declaration of pregnancy and each monthly consultation for non-immune women.

Any woman who seroconverted during pregnancy, whatever the term is to be treated with spiramycin (Rovamycine®) 6 cp / day until delivery.

In the presence of fetal infection and very likely if the ultrasound is normal justified in utero treatment with pyrimethamine-sulfonamide + folinic acid combination (after the 16th SA as teratogenic risk).

* At birth, a levy is charged on cord blood and placenta with serology and inoculation of mice; FO and transfontanellar ultrasound.

Serological surveillance newborn every 2 months until the age of 10 months and maintains spiramycin by treatment at home and stop maternal treatment.

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