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Congenital Toxoplasmosis

  • Overview

    You’re likely to be confused and overwhelmed—not to mention scared—if your infant has been diagnosed with congenital toxoplasmosis. But you can play an active role in helping him get better. Developing a basic understanding of the condition is a great first step as you partner with your child’s health care team to form a treatment plan.

    • Toxoplasmosis is a disease caused by the parasite toxoplasma gondii.
    • If the parasite infects a pregnant woman, it can enter the placenta and affect the baby inside.
    • The parasite usually enters the body through the mouth. It can be spread in two ways: eating uncooked or undercooked meat or eggs containing the organism, or by oral contact with either soil or cat feces containing parasite eggs (e.g., gardening in infected soil or handling cat litter or feces and then putting your hands in your mouth).
    • Cats are the only animals that can transmit the toxoplasma gondii parasite directly to people (and only through their feces), but there is no documented correlation between cat ownership—especially if the cats are kept indoors—and toxoplasmosis.
      • Cats can only become infected with the parasite if they eat prey already containing the parasite, or if they come into contact with infected soil. For this reason, cats kept indoors are highly unlikely to be toxoplasma gondii carriers.
      • Despite the old wives’ tale, it’s not necessary to get rid of your cat if you (or a family member) are pregnant. You should be sure to take proper steps to avoid contact with cat litter and feces

    If you’re pregnant, here are some things to avoid in order to lessen your risk of acquiring toxoplasmosis:

    • consuming undercooked meat
    • gardening or yard work that involves direct contact with soil
    • eating raw eggs
    • touching cat feces and/or cat litter
    • exposure to insects (e.g., flies) that have been in contact with cat feces

    If your baby has been infected with the toxoplasma gondii parasite, treatment should begin right away to ensure that the condition has a minimal effect on her health.

    How Children’s Hospital Boston approaches congenital toxoplasmosis

    Here at Children’s, physicians in our Division of Infectious Diseases treat congenital toxoplasmosis in infants.

    Physicians in the Division of Infectious Diseases care for children and adolescents with a variety of infections.

    • In addition to treating children, we also are dedicated to researching better ways to diagnose, treat and prevent infectious diseases.

    How does Children’s treat congenital toxoplasmosis?

    • If the condition is detected early through a blood test, antiparasitic treatments can eliminate toxoplasmosis before the parasite harms the fetus.
    • Children’s clinicians treat babies born with congenital toxoplasmosis with anti-toxoplasmosis medications, usually for 1 year after birth.
    • One of our experts will determine which combination of medications is best suited for your baby.

    Newborn medicine

    At Children's Division of Newborn Medicine, we specialize in treating babies with a wide range of congenital and acquired conditions. Your baby will be seen by a specially trained team of physicians, nurses, therapists and other health professionals who routinely diagnose and treat newborns with critical illnesses.

    Leading the way in fetal and neonatal care

    Babies who have a congenital neurological condition need intense, specialized care. At the Fetal-Neonatal Neurology Program at Children’s, we provide comprehensive evaluation and treatment for these young children. Because newborns’ brains are in a crucial window of rapid development, we identify problems as early as possible and intervene quickly.

    Essential support services
    Read about general information and resources for Children’s patients and their families.

    Congenital Toxoplasmosis: Reviewed by Sandra Burchett, MD, MSc, Clinical Director, Children’s Hospital Boston Division of Infectious Diseases

    Boston Children's Hospital 
    300 Longwood Avenue
    Pavilion 2
    Boston MA 02115

     617-355-3896
     fax: 617-730-0302


  • In-Depth

    At Children’s Hospital Boston, we understand that you may have a lot of questions when your child is diagnosed with congenital toxoplasmosis, such as:

    •           What exactly is this condition?

    •           What are potential complications in my child’s case?

    •           What are the treatments available?

    •           Are there any possible side effects from treatment?

    •           How will the disease affect my child in the long term?

    •           Most importantly – is my child going to be OK?

    We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and treatment options fully.

    Background

    According to the Centers for Disease Control and Prevention, more than 60 million men, women and children in the United States have toxoplasmosis. Most people infected with toxoplasmosis have no symptoms (and don’t need any treatment). However, pregnant women should be especially careful about exposing themselves to the parasite because toxoplasmosis can be very serious in a newborn baby.

    Fortunately, the risk of maternal transmission of the parasite to the fetus during the first trimester of pregnancy (when the baby is most vulnerable) is relatively low, at 15 to 20 percent. However, by the third trimester, a pregnant woman with toxoplasmosis has a 60 percent chance of infecting her child.

    Causes

    The toxoplasma gondii parasite can enter the body in a number of ways (most commonly, through the mouth). If you’re pregnant, be especially careful to avoid these situations:

    • consuming raw or undercooked meat
    • eating raw eggs
    • handling cat feces and/or cat litter (though this doesn’t mean you can’t have a pet cat — see our FAQ section for more information
    • exposure to insects (e.g., flies) that have been in contact with cat feces

    Symptoms

    Many (up to 90 percent of) babies born with congenital toxoplasmosis experience no immediate symptoms. However, one sign of infection is a premature birth or an abnormally low birth weight.

    As an infected baby grows, more signs and symptoms can appear. These may include the following:

    • swollen lymph nodes
    • bruises
    • jaundice
    • anemia
    • enlarged liver or spleen

    Toxoplasmosis can also cause some more serious problems, including the following:

    • retinal damage
    • hydrocephalus a buildup of cerebrospinal fluid in the brain
    • intracranial calcificationsthese indicate areas of the brain that have been damaged by the parasite, and are often linked to the following conditions:
    • intellectual disabilities
    • seizures
    • motor and developmental delays
    • hearing loss

    Long-term outlook

    If your child is treated early, there should be no serious consequences of toxoplasmosis. However, if treatment is delayed, your child may suffer some serious health problems as a result of the infection. For more information, see the Treatment and Care tab.

    Questions to ask your doctor

    Many parents are concerned about toxoplasmosis and can have lots of questions about the condition and how it can affect their baby.

    You may find it helpful to jot down questions as they arise—that way, when you talk to your doctor, you can be sure that all of your concerns are addressed.

    Here are some questions to get you started:

    • Should I have a blood test for toxoplasmosis?
    • Our family has a cat. How can I make sure the cat’s litter and waste are handled safely so that the parasite doesn’t spread?
    • Do I need to avoid gardening or other yard work to prevent exposure to infected soil?
    • What else can I do to prevent infection?
    • I’m infected. Is there any way to avoid passing it on to my baby?
    • What steps can we take if my baby does get infected? What treatment(s) do you recommend, and why?
    • Are there any potential side effects from treatment?
    • What’s the long-term outlook for a baby with toxoplasmosis?

    FAQ

    Q: What is toxoplasmosis?

    A: Toxoplasmosis is a disease caused by the parasite toxoplasma gondii and is usually acquired by the parasite getting into the body by the mouth (for instance, by eating undercooked meat).

    Q: Why is toxoplasmosis a problem?

    A: While most people infected with toxoplasmosis have no symptoms (and don’t need any treatment), pregnant women should be especially careful about exposing themselves to the parasite because toxoplasmosis can be very serious in a newborn baby.

    Q: What can I do to prevent infection?

    A: If you’re pregnant, be especially careful to avoid these situations:

    • consuming raw or undercooked meat
    • consuming raw eggs
    • gardening or doing other yard work that puts you in direct contact with soil
    • exposure to cat feces and cat litter
    • exposure to insects (e.g., flies) that have been in contact with cat feces

    Q: Our family has pet cats. Do we have to get rid of them to be safe from toxoplasmosis?

    A: No.Although cats can transmit the toxoplasma gondii parasite to pregnant women through their feces (where infected parasite eggs can be shed), there is no demonstrated link between toxoplasmosis and simply owning a cat. Here’s why:

    Cats themselves can only become infected with toxoplasma gondiiif they eat prey containing the parasite, or come into contact with infected soil. For these reasons, cats kept indoors are highly unlikely to become carriers of the parasite. In addition, only pregnant women are at elevated risk of toxoplasmosis through handling cat litter and/or feces. Other family members, including young children, do not face this elevated risk.

    Many pregnant women (and their families) fear that they need to part with the family cat to be safe from toxoplasmosis—but that’s not the case at all. You can keep your cat while taking these steps to prevent toxoplasmosis infection:

    • Keep cats indoors. A cat that doesn’t go outside can’t eat infected prey or come into contact with infected soil.
    • Don’t come into direct contact with cat litter or feces.Have another family member take care of cleaning the litter box and disposing of cat waste. If you must handle litter box duties yourself, always wear disposable gloves and be sure to wash your hands thoroughly afterward.

    Q: What are the chances that my baby will be infected if I am?

    A: It depends on when you are infected.

    • The risk of maternal transmission of the parasite to the fetus during the first trimester of pregnancy (when the baby is most vulnerable) is relatively low, at 15 to 20 percent.
    • However, by the third trimester, a pregnant woman with toxoplasmosis has a 60 percent chance of infecting her child.

    Q: How is toxoplasmosis diagnosed?

    A: A blood test before or during pregnancy can determine if you have been exposed to the toxoplasma gondii parasite.

    • If you are infected, another type of test can determine whether your baby is infected.
    • In addition, fetal ultrasounds can determine if your baby's organs are damaged.

    Currently, physicians in the United States do not routinely screen pregnant women for toxoplasma gondii, so if you suspect you may have been exposed to the parasite, ask your doctor to perform a blood test.

    Q: What symptoms might my baby have?

    A: Many babies show no immediate signs of infection. However, as a baby grows, she may show more signs of infection, which may include the following:

    • swollen lymph nodes
    • bruises
    • jaundice
    • anemia
    • enlarged liver or spleen

    There are also more serious symptoms; for more information on these, see the Symptoms [LINK] tab.

    Q: What are our treatment options?

    A: Here at Children’s, physicians in our Division of Infectious Diseases treat congenital toxoplasmosis in infants.

    • If detected early through a blood test, antiparasitic treatments can eliminate toxoplasmosis before the parasite harms the fetus.
    • We treat babies born with congenital toxoplasmosis with anti-toxoplasmosis medications, usually for 1 year after birth.
    • One of our experts will determine which combination of medications is best suited for your baby.

    Q: What is my child’s long-term outlook?

    A: If your child is treated early, there should be no serious consequences of toxoplasmosis. However, if treatment is delayed, your child may suffer some serious health problems as a result of the infection.

    Q: What makes Children’s different?

    A: Our physicians are expert, compassionate and committed to focusing on the whole child, not just his condition—that’s one reason we’re frequently ranked as a top pediatric hospital in the United States.

    And at Children’s, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

    Fetal-Neonatal Neurology Program
     Learn more about our program for babies with congenital neurological conditions.
  • Tests

    The first step in treating your child is forming an accurate and complete diagnosis.

    A blood test before or during pregnancy can determine if you have been exposed to the toxoplasma gondii parasite.

    • If you are infected, another type of test can determine whether your baby is infected.
    • In addition, fetal ultrasounds can determine if your baby's organs are damaged.

    Currently, physicians in the United States do not routinely screen pregnant women for toxoplasma gondii, so if you suspect you may have been exposed to the parasite, ask your doctor to perform a blood test.

    After we complete all necessary tests, Children’s Hospital Boston’s experts meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options.

    Envisioning the “baby-to-be”
    See how Children’s uses imaging techniques to make diagnoses before birth.
  • If your child has been diagnosed with toxoplasmosis, you may be confused, frightened and overwhelmed. But you can rest assured that, at Boston Children's Hospital, your child is in good hands.

    Our physicians are expert, compassionate, and committed to focusing on the whole child, not just his condition—that's one reason we're frequently ranked as a top pediatric hospital in the United States.

    It's important to know the following about toxoplasmosis:

    • If detected early, antiparasitic treatments can eliminate toxoplasmosis before the parasite harms the fetus.
    • Children's treats babies born with congenital toxoplasmosis with anti-toxoplasmosis medications, usually for 1 year after birth.
    • We typically use pyrimethamine or sulfadiazine because studies have shown that babies treated with these medications typically have fewer complications from the infection.
    • One of our experts will determine which combination of medications is best suited for your baby.

    At Children's, we consider you and your child integral parts of the care team, and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.

    Coping and support

    It's essential to remember that, while hearing that your child is infected with toxoplasmosis can feel very isolating, many children and their families have been down this path before. We've helped them, and we can help you, too.

    There are lots of resources available for your family—within Children's, in the outside community and online. These include:

    Patient education:From the very first visit, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have. And they'll also reach out to you by phone, continuing the care and support you received while at Children's.

    Parent to parent: Want to talk with someone whose baby has been treated for toxoplasmosis? We can put you in touch with other families who have been through similar experiences and can share their experience.

    Faith-based support:If you are in need of spiritual support, we'll help connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during the time you and your child are in the hospital.

    Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

    On our For Patients and Families site, you can read all you need to know about:

    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family
      Children's is on Facebook!
      Hear from our fans and become one yourself at Facebook.com/BostonChildrensHospital.
  • Research & Innovation

    Research in Children’s Hospital Boston’s Division of Infectious Diseases includes both basic investigation and clinical research.

    Our research has the broad objective of learning more about how diseases develop and spread as well as how the body uses its defenses to fight back. 

    Investigators target viruses, bacteria and fungi that cause disease in community-wide infections in the United States, in infections of children with compromised immune systems and in global public health.

    Read more about these ongoing research studies.

    Community-based care for newborns

    The Community Newborn Medicine Program at Children's cares for ill and convalescent newborns in a family centered, community setting. Our community-based Newborn Medicine faculty provide advanced newborn therapies in Neonatal Intensive Care Units (NICU) and in Special Care Nurseries (SCN) in several suburban medical centers that are affiliated with Children's.

    The affiliated nursery programs include:

    NICU

    SCN

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