Abundant and convincing evidence demonstrates that medicines block transmission of Toxoplasma gondii from the pregnant woman to her fetus, kill tachyzoites, reduce or eliminate parasite burden, reduce or eliminate eye disease, reduce or eliminate brain disease, reduce severity of disease, eliminate meningitis, treat meningoencephalitis, and lower immune markers of infection.1, 2, 3, and 4 Earlier, there was some controversy in the literature (discussed in Reference 4), but currently, review of data from in vitro and experimental animal studies, attention to older publications of studies that were performed meticulously (reviewed in References 1, 2, 3, and 4), and several recent studies have clarified the efficacy and benefits of proper, early, and rapid diagnosis and medical treatment.5,6 The recent data demonstrate how important it is to establish such diagnosis and treatment as the standard for medical care to prevent the loss of productive lives to this disease. The time when the acute infection is diagnosed and treated is critical.1, 2, 3, 4, and 5 The earlier the infection is treated, the better the outcomes will be for fetus, infant, and congenitally infected person.5,6 For this reason, the focus of this chapter is to make clear how diagnosis and treatment of the fetus and infant can be optimized and how this is carried out practically.
PREVENTION WITH EDUCATION DURING GESTATION
The approach to diagnose, prevent, and treat infections of the fetus is summarized in Tables 116-1, 116-2, 116-3, 116-4, 116-5, 116-6, 116-7, and 116-8 and Figures 116-1, 116-2, 116-3, and 116-4. The pregnant woman with acute acquired T. gondii infection and the mother of a congenitally infected infant may have retinal disease caused by the parasite and should have a retinal examination. Simple instructions concerning avoiding means of acquisition of the parasite provide an opportunity to prevent some fetal infections in the pregnant woman. An educational pamphlet is provided in Chapter 57, Figure 57-3. This may be downloaded from the Internet without charge or copyright (http://www.toxoplasmosis.org/pamphlet.pdf) so it can be provided to pregnant patients or those considering becoming pregnant. However, environmental contamination by oocysts is common and often unrecognized. Risk cannot be eliminated entirely by education. Infection may occur in persons with no recognized risk factors.
Table 116-1Guidelines for Treatment of Toxoplasma gondii Infection in the Pregnant Woman and Congenital Toxoplasma Infection in the Fetus, Infant, and Older Childrena |Favorite Table|Download (.pdf) Table 116-1Guidelines for Treatment of Toxoplasma gondii Infection in the Pregnant Woman and Congenital Toxoplasma Infection in the Fetus, Infant, and Older Childrena
|Infection ||Medication ||Dosage ||Duration of Therapy |
|In pregnant women infected during gestation: || || || |
|First 18 weeks of gestation or until term if fetus found ...|