Book of Medical Disorders in Pregnancy - Tintash

ence of congenital brain damage. The
exact incidence of congenital
toxoplasmosis is not known in Pakistan,
but there is every possibility that some
neurologic abnormalities of
undetermined origin are due to
toxoplasmic infection. It is, therefore,
strongly recommended that pregnant
women should be screened for this
disease during antenatal period. National
Health Institute Islamabad has a good
virology department where blood can be
sent for testing. The physician will note
that the infected mothers are usually
healthy, and give no history of illness
during or prior to pregnancy. A pregnant
woman, who has fever and
lymphadenopathy or complains of
excessive fatigue, should be thoroughly
investigated. When serologic evidence
of acute acquired maternal
toxoplasmosis is confirmed, therapeutic
termination of pregnancy is indicated.
Diagnosis: Toxoplasmosis is usually
diagnosed by serological methods. The
test is based on the observation of the
parasites, after incubation with normal
human serum. The organism stains
deeply with alkaline methylene blue.
Toxoplasmas incubated with serum
containing antibodies remain unstained.
The presence of antibodies can be
detected by this method as early as 10
days after infection. The titre rises
sharply to high levels such as me:
260,000 and remains high for months.
The titre falls slowly to low levels 1:4
over a period of many years. Positive
serologic diagnosis in acute cases
requires either a change in antibody titre
from negative to positive; a rapidly
rising titre; or a very high stable titre
(1:64,000) or greater. The toxoplasma
complement fixation test becomes
positive a few weeks after the dye test. A
170
high dye test titre in the presence of a
negative complement fixation test
indicates a recent active infection. This
excludes the possibility of passive
transfer of antibodies to the child from
the mother. The test should be repeated
after 4 months to detect the persistence
of a high antibody titre in the child. Like
rubella screening, a strong case can be
made for routine screening of
toxoplasmosis in all pregnant women. It
is only the awareness of hazards and
serious complications which make this
test mandatory. Toxoplasma may be
recovered from the blood, spinal fluid,
and biopsied tissues.
Treatment: Triple sulphonamides
mixture, (sulfadiazine, sulfamethazine,
and sulfamerazine) combined with
pyrimethamine, a folic acid antagonist,
has been reported to be of value in acute
cases. The safety of treatment during
pregnancy has been questioned, because
the folic acid antagonist may cause
abortion and also be teratogenic.
Fig13.6: Shows herpetic rash over the
body
Herpesvirus hominis infection:
Incubation period varies between 4 to 7
days. HYH affects the female genital
tract and causes infection of the new
born and may result in abortion. About