Toxoplasmosis is caused by a parasite that lives and multiplies in cats.
A fetus may be born prematurely, and a newborn may have problems such as a small head or an enlarged liver.
Blood tests and tests of other fluids can be done to detect the infection in the fetus, newborn, or mother.
The infection may cause death in some children and long-term neurologic problems in others.
Pregnant women should avoid cat litter and should thoroughly cook meat before eating it.
Antiparasitic medications may be given to fetuses or newborns to treat the infection.
(See also Overview of Infections in Newborns Overview of Infections in Newborns Infections occur at all ages but are a great cause for concern in newborns because newborns, especially preterm ones, have an underdeveloped immune system and are more susceptible to infection... read more and Toxoplasmosis Toxoplasmosis Toxoplasmosis is infection caused by the single-celled protozoan parasite Toxoplasma gondii. Infection occurs when people unknowingly ingest toxoplasma cysts from cat feces or eat contaminated... read more in adults.)
The Toxoplasma gondii parasite lives and multiplies mainly in cats, and its eggs are shed in cat feces. Cat feces can contaminate food, soil, and water. Pregnant women become infected if they swallow Toxoplasma eggs after they touch contaminated cat litter, soil, or other objects and then touch their mouth or handle and eat food without washing their hands. Pregnant women can also become infected if they consume raw or undercooked meat or other foods that are contaminated. Fetuses become infected if Toxoplasma gondii crosses the placenta (the organ that provides nourishment to the fetus) during pregnancy.
Women who were infected before pregnancy typically do not pass the parasite on to their fetus unless their immune system has been weakened (for example, by HIV infection), reactivating the infection.
Infection in the fetus is more severe if the fetus is infected earlier in pregnancy.
Life Cycle of Toxoplasma gondii
Symptoms of Toxoplasmosis in Newborns
The fetus may grow slowly and be born prematurely Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of... read more .
At birth, newborns usually do not have symptoms, but they may have a number of problems, including
Enlarged liver and spleen
Inflammation of the heart, lungs, or eyes
Inflammation of the eyes (chorioretinitis) can result in blindness. Severe neurologic problems, including seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more , may occur. Some children have intellectual disability Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more .
Children born with congenital toxoplasmosis may be severely ill and die shortly after birth, or they may have no symptoms until months or years later. Some never become ill.
Diagnosis of Toxoplasmosis in Newborns
For the mother: Blood tests
For the fetus: Testing of the amniotic fluid
For the newborn: Testing of blood and other fluids, brain imaging, spinal tap, and eye examinations
The diagnosis of toxoplasmosis in a pregnant woman is usually based on blood tests that detect antibodies against the parasite. (Antibodies Antibodies One of the body's lines of defense ( immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more are proteins produced by the immune system to help defend the body against attack, including by parasites.)
To determine whether a fetus has been infected, a doctor can take a sample of the fluid around the fetus (amniotic fluid) and test it for antibodies to the parasite and for the parasite's genetic material (DNA). The test, a procedure called amniocentesis Amniocentesis Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more , is usually done after the 14th week of pregnancy.
In some states, the infection is found in seemingly healthy newborns during routine newborn screening tests using a dried blood spot. If doctors suspect a newborn is infected, they test the blood and the fluid that surrounds the brain and spinal cord (spinal fluid). To obtain spinal fluid, doctors do a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more (lumbar puncture). Other body fluids and the placenta may also be tested. Doctors do imaging tests, such as computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT) or magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI), of the brain to look for abnormalities typical of toxoplasmosis. Newborns are also given a thorough eye examination by an ophthalmologist (a medical doctor who specializes in the evaluation and treatment of all types of eye disorders) and hearing tests.
Prognosis for Toxoplasmosis in Newborns
Some children have a severe infection and die early, whereas others survive but have long-term neurologic problems. Occasionally, neurologic problems (such as intellectual disability Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more , deafness Hearing Impairment in Children Hearing impairment refers to any degree of hearing loss, mild to severe, and can occur when there is a problem with a part of the ear, including the inner, middle, and outer ears, or the nerves... read more , and seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more ) or eye problems such as chorioretinitis, develop years later in children who appeared normal at birth. Therefore, children with congenital toxoplasmosis should be closely monitored by doctors beyond infancy.
Prevention of Toxoplasmosis in Newborns
Pregnant women should avoid handling cat litter. If this is not possible, pregnant women should change the entire litter box every day because the toxoplasmosis eggs do not become infectious for about 24 hours after the cat excretes them. Woman also should wear gloves and then carefully wash their hands to reduce the risk of infection.
Pregnant women should thoroughly cook meat before eating it. Fruits and vegetables should be washed thoroughly or peeled, and all food preparation should be followed immediately by handwashing.
To reduce the risk of transmitting the infection to the fetus, infected pregnant women may be give the antibiotic spiramycin. However, this medication does not treat the fetus. Doctors may also give the combination antibiotic trimethoprim/sulfamethoxazole to further prevent transmission.
Treatment of Toxoplasmosis in Newborns
For fetuses: Pyrimethamine and sulfonamides
For newborns: Pyrimethamine, sulfadiazine, and leucovorin
Pyrimethamine and sulfonamides may be given later in pregnancy if the fetus is infected.
Infected newborns with or without symptoms are treated with pyrimethamine, sulfadiazine, and leucovorin (a drug that prevents side effects of pyrimethamine).
Inflammation of the eyes is sometimes treated with corticosteroids.