Pregnant women with suspected toxoplasmosis should be tested. he parasite is rarely detected in tissue or body fluids. Antitoxoplasma IgG develops within 2 to 3 weeks after infection, peaks at 1 to 2 months, and usually persists for lifesometimes in high titers. Although IgM antibodies appear by 10 days after infection and usually become negative within 3 to 4 months, they may remain detectable for years. hus, IgM antibodies are not used alone to diagnose acute toxoplasmosis (Dhakal, 2015). Best results are obtained with the Toxoplasma Serologic Proile performed at the Palo Alto Medical Foundation Research Institute (ww.toxolab@pamf.org). Toxoplasma IgG avidity increases with time. hus, if a high-avidity IgG result is found, infection in the preceding 3 to 5 months is excluded. Multiple tests are available that allow high avidity results to conirm latent infection with a 100-percent positivepredictive value (Villard, 2013).
Congenital toxoplasmosis is suspected when sonography reveals findings such as hydrocephaly, intracranial or hepatic calciications, ascites, placental thickening, hyperechoic bowel, and growth restriction. Prenatal diagnosis of congenital toxoplasmosis is performed using PCR ampliication of toxoplasma DNA in amnionic luid (Filisetti, 2015; Montoya, 2008). he sensitivity of PCR varies with gestational age and is lowest before 18 weeks (Romand, 2001).
No randomized clinical trials have assessed the benefit and eicacy of treatment to decrease the risk for congenital infection. A systematic review of data from 1438 treated pregnancies found weak evidence for early treatment to reduce congenital toxoplasmosis risks (SYROCOT Study Group, 2007). Treatment has been associated with a reduction in rates of serious neurological sequelae and neonatal demise (Cortina-Borja, 2010).
Prenatal treatment is based on two regimens-spiramycin alone or a pyrimethamine-sulfonamide combination given with folinic acid (American College of Obstetricians and Gynecologists, 2017). These two regimens have also been used consecutively (Hotop, 2012). Little evidence supports the use of a speciic regimen (Montazeri, 2017; Valentini, 2015). hat said, most experts will use spiramycin in women with acute infection early in pregnancy to reduce vertical transmission. Because it does not cross the placenta, spiramycin may not be used to treat fetal infection. Pyrimethamine-sulfadiazine with folinic acid is selected for maternal infection after 18 weeks' gestation or if fetal infection is suspected.
There is no vaccine for toxoplasmosis, so avoidance of infection is necessary if congenital infection is to be prevented. Eforts include: (1) cooking meat to safe temperatures; (2) peeling or thoroughly washing fruits and vegetables; (3) cleaning all food preparation surfaces and utensils that have contacted raw meat, poultry, seafood, or unwashed fruits and vegetables; (4) wearing gloves when changing cat litter, or else delegating this duty; and (5) avoiding feeding cats raw or undercooked meat and keeping cats indoors. Although these preventive steps are recommended, no data support their efectiveness (American College of Obstetricians and Gynecologists, 2017; Di Mario, 2015).