Pregnancy toxoplasmosis

Hypersensitivity to sulfonamides or chemically related drugs (eg, sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors, sunscreens with PABA, local anesthetics) pregnancy at term lactation infants less than 2 months of age (except in congenital toxoplasmosis as adjunct with pyrimethamine) porphyria salicylate hypersensitivity. 

Antibiotics also are active against other protozoans. Tetracycline and erythromycin are alternative therapies for the treatment of intestinal amebiasis. Clindamycin, in combination with other agents, is effective therapy for toxoplasmosis, pneumocystosis, and babesiosis. Spiramycin is a macrolide antibiotic that is used to treat primary toxoplasmosis acquired during pregnancy. Treatment lowers the risk of the development of congenital toxoplasmosis. 

Bart s (y ). Mothers carrying a fetus with Hb Bart s usually present clinically between 20 and 26 weeks gestation with pregnancy-induced hypertension and polyhydramnios. Ultrasound of the fetus shows hydrops. Severe anemia (Hb usually <80g/L) is noted on a fetal blood sample obtained by cordocentesis. It is important to rule out other causes for the hydropic fetus by performing TORCH (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex) testing. 

Toxoplasmosis is common in the United Kingdom and in most cases causes a mild influenza-like illness, although infection during pregnancy can be a cause of abortion or neurological damage in the foetus. In patients with HIV, toxoplasma can be the cause of serious illness. Toxoplasma encephalitis is a common complication of HIV infection. 

Toxoplasmosis is usually diagnosed based on the detection of specific IgG and IgM antibodies however, the inclusion of other tests is mandatory for a conclusive diagnosis of toxoplasmosis during pregnancy, in HIV/AIDS patients and in neonates (Jones et ah, 2003.). These tests must include measurement of IgG avidity, IgA, IgE, and direct detection by PCR in all cases, including the amniotic fluid. Since IgG can persist for decades, IgM which typically persists for 6-9 months is used as a marker of recent infection. 

Spiramycin, which concentrates in placental tissue, is used to treat acute acquired toxoplasmosis in pregnancy to prevent transmission to the fetus. If fetal infection is detected, the combination of pyrimethamine and sulfadiazine is administered to the mother (only after the first 12-14 weeks of pregnancy) and to the newborn in the postnatal period. 

Macrolides. Clinical papers report the use of spiramycin in the effective prevention of post-operative staphylococcal infections in the elderly, and possibly of congenital toxoplasmosis in pregnancy. Enhancement of erythromycin activity against gram-negative bacteria has been noted upon alkalinization of the assay medium or the urine. 

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