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Sofie Rifayani Krisnadi: Bagian Obstetri Ginekologi RSUP Dr. Hasan Sadikin Bandung
Sofie Rifayani Krisnadi: Bagian Obstetri Ginekologi RSUP Dr. Hasan Sadikin Bandung
Sofie Rifayani Krisnadi: Bagian Obstetri Ginekologi RSUP Dr. Hasan Sadikin Bandung
What is Toxoplasmosis ?
How is it caught ?
Who is at risk ?
How would I know if I have got it ?
What is the problem if caught during
pregnancy ?
What can be done if I got it ?
How to prevent ?
Infection cause by
Toxoplasma gondii
Intracellular parasite
Infected almost
mammalia & aves
Serious problem in
pregnant women &
immunocompromised
people
Is the mother infected ? When ?
Is the fetus infected? If yes, shows she/he
symptoms of the disease?
Is the newborn infected? Shows she/he
symptoms?
Long term follow up
Serological in case of
maternal (swollen lymph gland,fever) or
fetal symptoms (detected in USG)
Serological screening
to detect asymptomatic infections
Serological Monitoring of Toxoplasmosis in Pregnant Women
45 % 5 50
Sample 1 lgG+/ lgM- %+ / lgM+
lgG lgG +%/ lgM+
High Avidity Low Avidity lgG- / lgM- lgG+ / lgM+ lgG- / lgM+ **
Infection Non
acquired > 4 Immune
months ago Patient *
if the test is taken in
second half of Follow up
pregnancy, look must be
on the titer of lgG continued
until the end
of pregnancy Recent
Primary
Low lgG High lgG Infection Infection
acquired < 4 Additional Guidelines :
Old Probable months ago First sample should be collected early in pregnancy and
Infection Recent preferably tested with both lgG & lgM
Infection * if lgG-/lgM- : non immune patient, follow up must be
continued until the end of pregnancy
** if lgM+ without lgG, it may be the beginning of infection,
Confirmatory test needed reset 2-3 weeks later, if the result unchange : unspecific lgM
lgG, lgM
Result of infection
during pregnancy :
Stillbirthr Yes Yes Yes Yes No
Birth defect Yes No No No No
Immune
patient Retest 1 - 4 weeks later
- primary infection ?
- old infection with residual lgM ?
Infection Infection
acquired > 4 acquired < 4
months ago months ago
Additional Guidelines :
Primary infection in pregnancy depending on gestational week of bloodsample collection
No treatment exists in pregnancy, but interruption of pregnancy may be an option if infection
occurs before 17th week of gestation
If infection occurs after 17th week of gestation is not harmful for the fetus
Serological Monitoring of Rubella in Pregnant Women
Prenatal Screening (first half of Pregnancy)
Determination of lgG
lgG + lgG -
lgG +
lgG -
Seroconversion
Not infected
lgM detection
lgM + lgM +
lgG - lgG +
lgG - lgG +
Jaundice
Anaemia/Thrombocytopenia
Seizure, blindness, deafness
Physical/motor impairment
Antiviral
Do not kiss toddlers on the mouth
Do not share food/ drinks/ utensils
Wash hands after contact with child
excrete
Wash toys
HSV-1 & HSV-2
Primary infection symptomatic
Systemic symptoms +/-
Virus become latent
Reactivate periodically
Blistering/ulcerations genitalia externa
Pain, dysuria
Vaginal/Urethral discharge
Local lymphadenopathy
Systemic symptoms (fever, myalgia)
Could be asymptomatic
Antivirals
Supportive treatment
Continue acyclovir in the last 4 weeks
If symptoms occurs during 6 weeks before labour,
consider cesarean section
Cesarean section for women with lesions at the
onset of labour
Symptomatic herpes in pregnancy (First Episode)
Collect blood sample immediately, testing for HSV2 Antibodies
Determination of lgG
lgG - lgG +
lgG +
Primary infection *
Note :
Management of primary and recurrent infection at the end of pregnancy is different :
Primary infection : High risk of mother to child transmission
Recurrent infection : Low risk of mother to child transmission
Serological Testing of the Pregnant Woman
without a History of Genital Herpes and her Partner
Testing for HSV2 and HSV1 Antibodies
Pregnant Woman Her Partner
lgG + lgG -
seroconversion
primary infection not infected
*