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Pregnant toxoplasmosis. Contagion, Symptoms, Treatments, Risks for the fetus, What to eat and avoid

Toxoplasmosis in pregnancy may pose a risk to the fetus.

Find out with mammamather how to avoid infection and how to wash vegetables and which foods to avoid.


Summary



What is toxoplasmosis in pregnancy?


Toxoplasmosis is an infection caused by the protozoan called "toxoplasma gondii". Toxoplasma outside of gestation is harmless and causes no serious symptoms other than a slight feeling of general malaise or even no symptoms that go unnoticed. After the first exposure to toxoplasmosis, the body produces specific antibodies that will prevent future exposure to the disease from manifesting itself. In this case the subject is immune to toxoplasmosis. Toxoplasmosis represents a danger if contracted during pregnancy, because the infection can cause damage with the risk of consequences for the fetus, therefore during the nine months non-immune future mothers must pay attention to avoid exposure to the pathogen . At the beginning of pregnancy, the pregnant woman is subjected to a blood sample which is used to detect:

  • if you have contracted toxo in the past and become immune;

  • if he has never contracted toxoplasmosis and therefore is not immune;

  • if the infection is ongoing.

Analyzes are prescribed in the course of the first pregnancy check and are included in the so-called Torch complex.



Toxoplasmosis preganant
Toxoplasmosis pregnant


Toxo infection



The parasite that causes toxoplasmosis infects warm-blooded living beings, i.e. humans, animals and birds. The cat, of all animals, is the only one in which the toxoplasma protozoan is able to reproduce. When a cat ingests the bacterium, it reproduces by forming spores which are then eliminated in the feces. Soils and food contaminated with infected cat feces represent a route of transmission of toxoplasmosis.


Toxoplasmosis, how is it contracted?


The contagion of toxoplasmosis can occur through the direct ingestion of products contaminated with toxoplasma spores through undercooked infected meats, contaminated vegetables and vegetables or with direct contact with infected feces.


Toxoplasmosis symptoms


The symptoms of toxoplasmosis are almost always very mild and non-specific so that in most cases they go unnoticed or are confused with other conditions such as flu or cold. The incubation time for toxoplasmosis ranges from 5 to 25 days. Symptoms of toxoplasma are:


  • Tiredness

  • Sore throat

  • Headache

  • Temperature

  • Bone pain

  • Enlargement of the posterior cervical lymph nodes

  • Pain in the joints

  • Enlargement of the liver and spleen

  • Myalgia

  • Muscle pain affecting one or more muscles,

  • General malaise

  • Enlargement of the spleen



In very rare cases, toxoplasmosis can occur in a more severe form, causing encephalopathy with the risk of brain damage and eye inflammation that can compromise vision. Symptoms usually subside within a few days or weeks.





Toxoplasmosis test


Among the pre-conceptional tests and among those to be performed during the first trimester of pregnancy there is the toxotest which serves to know if you are positive or negative (immune or not immune) to toxoplasma gondii. The test for toxoplasmosis consists of a blood sample that evaluates the presence of IgG and IgM antibodies.


  • The presence of IgM antibodies in the blood indicates that the disease is ongoing.

  • The presence of IgG antibodies in the blood indicates that in the past you have come into contact with the disease by developing antibodies (immune toxoplasmosis).

  • The absence of both IgG and IgM antibodies in the blood indicates that there are no antibodies and that the disease is not ongoing (non-immune toxoplasma).

The aim of the sampling is to identify the antibody titration in the blood early by measuring the IgG and IgM antibodies. Let's see the reference values ​​and how to interpret the blood tests


  • If a pregnant woman tests positive for IgG antibodies and negative for IgM antibodies, it means that she has contracted toxoplasmosis in the past and the baby is not at risk because the mother is toxo immune.

  • If a pregnant woman is negative for IgG antibodies and negative for IgM antibodies, it means that she has never contracted the disease and for this reason she is non-immune toxo and therefore care must be taken not to contract it during pregnancy.

  • If a pregnant woman has positive IgM antibodies it is a sign of recent infection, since it must be investigated with appropriate laboratory tests to evaluate the transmission of toxoplasmosis to the fetus.

In the event that the future mother has recently been exposed to the infection, it takes a few days for the first traces of the immune response (IgM immunoglobulins) to appear in the blood, confirming contact with toxoplasma.


Toxoplasmosis baby


Contracting toxoplasmosis during pregnancy poses a potential risk to the fetus. However, it should be emphasized that even if the pregnant woman contracts toxo, the infection does not necessarily transfer to the placenta and then to the baby. The placenta represents a barrier against the disease which is more or less dangerous in relation to the filter action carried out by the placenta in relation to the gestational period. The defensive and placental filter system is more effective at the beginning of pregnancy, so the risk of transmitting the disease to the fetus is greater as gestation proceeds.


Toxoplasmosis in pregnancy risks to the fetus



The chances of fetal infection increase with each trimester of pregnancy but the risk of this causing severe fetal harm decreases as pregnancy progresses.






Toxoplasmosis contracted in the first trimester of pregnancy has a 15% risk of crossing the placenta.

Cases of toxoplasmic infection before the embryo and then the fetus are very rare, it is estimated at around 1%. In the presence of infection, the consequences for the fetus are generally very serious even to cause an abortion. Second-trimester toxoplasmosis infections have a 25% risk of placental crossing. Damage to the fetus is variable, the most serious form is represented by congenital toxoplasmosis characterized by the symptomatological tetrad:


  • Neurological syndrome with tremors, paraesthesia, changes in muscle tone, myoclonia, tremors and convulsions;

  • Hydrocephalus;

  • Intracranial calcifications of varying numbers and sizes;

  • Eye damage.

Toxoplasmosis infections in the third trimester have a probability of crossing the placenta in the order of 65% but in most cases without causing fetal damage. However, up to 85% of newborns with congenital toxoplasmosis will show signs and symptoms of the infection if left untreated. The infection can range from mild to severe.

In mild cases, the obvious damage is toxoplasmosis chorio retinitis, ie inflammation of the retina and choroid of the eye; further manifestations of congenital toxoplasmosis may not show signs of themselves until adolescence or young adulthood. Serious neonatal diseases related to congenital toxoplasma infection include seizures, coma, microcephaly and hydrocephalus.



Toxoplasmosis treatment

How to cure toxoplasmosis in pregnancy? Therapy for positive toxoplasma in pregnancy first of all requires a timely diagnosis, which is why non-immune pregnant women are subjected to blood chemistry every month by measuring IgG and IgM antibodies. In the event that there is a diagnosis of positive toxoplasmosis in pregnancy, an attempt is made to block the transmission of the infection from mother to fetus through antibiotic treatment as suggested in the guidelines of the Ministry of Health and the Higher Institute of Health. If the maternal infection occurs before the 16th week, the administration of the antibiotic spiramycin is preferred. If the pregnant woman has contracted toxoplasmosis after the 16th week of pregnancy in relation to the specific case, antibiotic therapy includes either spiramycin or pyrimethamine combined with sulfadiazine, in order to fight the infection. Drug therapy is accompanied by prenatal investigations for detecting signs of infection in the fetus such as amniocentesis and ultrasound. Ultrasound is important for the search for fetal signs of toxoplasma gondii infection such as:

  • ascites,

  • microcephaly,

  • intracranial calcifications,

  • impaired fetal growth.

How is Toxo contracted? Prevention



The transmission of toxoplasma in pregnancy always represents a risk, so it is important to know the sources of contagion and the behaviors that can carry the disease in pregnant women.



Toxoplasmosis contagion

  • eating raw or undercooked contaminated meat;

  • drinking unpasteurized goat milk;

  • with contact with feces of infected cats;

  • handling contaminated bedding;

  • gardening in soil where toxoplasma spores are present.



Toxoplasmosis in pregnancy what to eat and foods to avoid



Meat and fish



Recent studies point to meat as the main source of toxo infection. In particular, pork and lamb are the main transmission routes. The only way to kill the toxoplasmosis spores is to cook the meat well, therefore, long cooking is always preferred. The best cooking for meat is baked, stewed or steamed, however, grilled meat should be consumed with particular attention because in addition to being carcinogenic it may not be cooked enough to have killed the spores. Preparations with minced meat such as meatballs, rolls, meatloafs and rolls require a long cooking to prevent parts that are not thoroughly cooked inside the dish. Always make sure that there are no portions of pinkish-colored meat inside the meatballs and never taste the meat before it is fully cooked. The frankfurters in pregnancy deserve a separate mention. Raw sausages should always be avoided during pregnancy, although they are precooked, it is not totally excluded that they can carry diseases such as toxoplasmosis and listeria. The advice is not to eat raw sausages but always carefully cooked (boiled, baked or boiled) and in moderation since it is a very fatty and caloric food. The same goes for smoked salmon which does not foresee any risk for the transmission of toxoplasmosis but it is a food that must be avoided because it is at risk of contamination by listeria monocytogenes if not properly killed and treated, so better not to risk it. Avoid raw or semi-raw meats and never eat meat-based dishes in which there is no certainty of proper cooking.



Salami and sausages


The cold cuts have different types of processing which in some cases does not involve cooking the meat. Uncooked cured meats should therefore be avoided. Among the sausages you can consume:


  • baked ham;

  • mortadella;

  • Turkey breast.

On the other hand, the following are prohibited:

  • raw ham;

  • salami;

  • bresaola;

  • frankfurters;

  • speck;

  • bacon

unless they are consumed cooked in dishes.


Cheese and dairy products


Consuming dairy and dairy products such as mozzarella and cheese presents no risk of transmitting toxoplasmosis if you prepare yourself with pasteurized milk.




Egg


Cooked eggs do not represent a danger to mother and fetus, raw or undercooked eggs such as soft-boiled or bull's-eye should be avoided for the transmission of food poisoning.



Vegetables


Raw vegetables must always be carefully washed first under water to remove all soil residues before being consumed and then disinfected. Salad, tomatoes, cucumbers, carrots, turnips and all vegetables, if eaten raw, must always be cleaned first. The packaged salad deserves a home rinse before being eaten. Fresh aromas such as basil, parsley, mint and thyme should also be washed if used raw. As for dried smells such as oregano, bay leaf and rosemary they certainly have a very low risk margin if consumed raw but they are not completely risk-free. Mushrooms deserve particular attention, which must be washed (with gloves) with plenty of running water and then soaked with bicarbonate before being consumed. It is safer to eat cooked mushrooms rather than raw. The olives, even if raw, can be eaten as long as they are first thoroughly washed and disinfected either with amuchina or bicarbonate. Absolute tranquility can be had by eating cooked olives. Ketchup even if prepared with raw tomatoes being an industrial product can be consumed but always in moderation because it is too rich in sugar. At the restaurant it is better to avoid eating raw or grilled vegetables where there is no certainty that they have been carefully washed and cooked. If the vegetables are eaten cooked there is no limitation. For quick cooking such as vegetables (courgettes, aubergines and peppers) sautéed, grilled or barbecued to avoid the risk of contamination with toxoplasmosis, it is sufficient to wash carefully before preparation.



Fruit


Fruit always needs careful washing under running water to remove soil residues. A toothbrush can be used to remove waxes and pesticide residues from the peel. The fruit must then be disinfected with amuchina or bicarbonate and rinsed before being eaten. Well-washed fruit can be eaten with the peel. The fruit that must be peeled, such as kiwi, melon and watermelon, must always be washed first to avoid contaminating the pulp of the fruit through the blade of the knife with any spores present on the peel. If it is not possible to check if the fruit has been properly washed, for example in a restaurant, it is better not to eat it.



How to wash and disinfect fruit and vegetables?


According to your preferences for the disinfection of fruit and vegetables you can use:

  • bicarbonate

  • amuchina

To disinfect with baking soda, just dissolve a spoonful in a basin with water and leave the vegetables to soak for 15 minutes and then rinse with running water. For disinfection with amuchina dilute 20 ml of product in 1 liter of water and leave the fruit and vegetables to soak for at least 15 minutes. Rinse thoroughly and consume.



Hygiene in the home to prevent toxo


To avoid that everyday domestic behaviors represent a source of contagion, it is good to:


  • Avoid contact with the cat's litter box, which must be cleaned frequently as feline feces become contagious in approximately 48 hours

  • Wear gloves when gardening

  • Avoid busy green areas where animal feces are present

  • Wash your hands often

  • Thoroughly clean surfaces and food preparation utensils such as cutting boards and knives.


Toxoplasmosis cats


Cat yes or cat no? As mentioned, the cat's feces represent the vehicle with which the toxoplasmosis spores are deposited in the soil. Contrary to what was believed in the past, domestic cats are rarely a vehicle for the contagion of toxoplasmosis. The small cats, in fact, are almost always fed with packaged foods and equipped with a clean litter avoiding any spores from becoming contagious. On the other hand, stray cats are a source of contagion because they feed on birds, mice and other animals therefore easily subject to infection. Cat bites and scratches should not be underestimated.



Toxoplasmosis and breastfeeding


Toxoplasmosis infection in breastfeeding women does not pose a risk to the baby. Therefore, a mother who is not immune to toxoplasmosis after childbirth and throughout the breastfeeding period can consume all foods without the fear of contracting the infection.


Mammamather pocket obstetrician

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