RUBELLA, TOXOPLASMOSIS

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 • Rubella

It is  a viral infection that usually occurs during childhood. If infection occurs during pregnancy it can seriously affect the embryo (children with low birth weight, blood-clotting problems, digestive tract to the liver and spleen). The damage is high when the infection is contracted in the first 20 weeks of gestation.


Although most fertile women are immune to it, having had it in childhood or having already been vaccinated (80% of fertile women), in a pre-gestational consultation the doctor may request proof of rubella vaccine. If  a woman is not immunized, then she must be vaccinated thus preventing foetal infection.   
 

Pregnant women who are not immune to Rubella must not be vaccinated during pregnancy. They must avoid contact with those who have the disease, and vaccination is recommended after delivery for future pregnancies.
 

 

• Toxoplasmosis

 

Toxoplasmosis is an infection caused by a parasite called Toxoplasma gondii.

 

How does this infection spread?

The infection is acquired through eating of raw or undercooked meat or sausages containing cysts called toxoplasma tachyzoites.


Water, soil, or plants contaminated with cysts of Toxoplasma are also a source of infection.

 

Cats are a risk factor because they are carriers of cysts of Toxoplasma that can be passed on  through their faeces.


How can the infection  be prevented? 

 

It is advisable to avoid eating raw meat and cook well all meat products. Sausages are usually safe, but if there is the slightest doubt about their origin it is best  not to eat them or freeze them at minus 18 degrees for 24 hours.


Vegetables should be washed, especially if you buy  them directly from an orchard. Fruits should be peeled or washed properly. You should wash your hands before and after handling food. If you work on the land or do gardening  you should wear gloves.

 

Transmission by contact with cats is unlikely, especially if it is a domestic cat but if you want to be sure you can go to a vet,  who performs serological tests in order to check if the cat is a carrier.. In any case, avoid cleaning their faeces, feed them with cooked meat (not raw) and keep them inside.

 

How is toxoplasmosis diagnosed?

 

All pregnant women are tested for toxoplasmosis in the first quarter.  during which IgG antibodies are determined. If the test result is positive,the mother is immunized against the infectionnegating the need to worry about these preventive measures. If the result is negative,  the test must be  repeated in the second and the last trimester.

 

What are the consequences of this infection on the mother?

The first thing the mother needs to know is that toxoplasmosis usually causes no symptoms in adults. Most of the diagnosis of infection in the mother is made through routine tests performed during pregnancy.


In case the analysis for toxoplasmosis antibodies results positive, while the previous one was negative, we should talk about  seroconversion. IgG antibodies are positive after two weeks of infection, they increase in the following 6-8 weeks, and remain positive for life.The posivitization of IgM, instead, occurs after two weeks and last for one year.

 

What happens in cases of maternal infection?


The first thing to do after  serum  conversion is  the IGC avidity test. If avidity is high, then it is an indication of an infection that occurred a long time ago (between 20 and 40 weeks). If avidity is low, it is an indication of a recent infection - less than 12 weeks. At low avidity IgG treatment should be started immediately.

 

How is the infection of the fetus diagnosed ?

 

If there is any suspicion of maternal infection in any trimester of pregnancy, you should have an amniocentesis done to detect the presence of toxoplasma (with DNA) in amniotic fluid.


If Toxoplasma is not detected in the amniotic fluid, the patient can relax, but if the patient prefers to continue with treatment until birth, a monthly U.S.is recommended to monitor the child.
 

If Toxoplasma is detected in the amniotic fluid, suggesting that foetal infection occurred, a specific treatment is recommended. Doctors will closely monitor the patient with a monthly ultrasound, particularly in the central nervous system.

 

How can it affect the fetus?

The first thing that you should know is that there is a difference between an infected foetus  (presence of toxoplasma in amniotic fluid) and a foetus that has congenital lesions. The ultrasound can detect  serious malformations such as cerebral calcifications or hydrocephalus (increased fluid within the head).


Sometimes calcification can be detected in the liver and ascites. The fact that nothing is detected by ultrasound does not exclude that there may be neurological damage. Therefore, all foetuses diagnosed with toxoplasmosis infection in the uterus, should be specifically evaluated and treated anfter birth.

 

How is an infection with toxoplasmosis treated during pregnancy?

 

The first treatment for suspected maternal infection is spiramycin g 1 / 8 hours which is orally administered until the end of gestation.


If Toxoplasma is found in the amniotic fluid (amniocentesis), spiramycin  treatment is replaced with the oral administration of pyrimethamine 50g/24 hours + sulfadiazine 3g/24 hours.

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