Toxoplasmosis in pregnancy
Introduction
Introduction to pregnancy combined with toxoplasmosis Toxoplasmosis is a zoonotic parasitic disease caused by Toxoplasma gondii. The disease is closely related to eugenics. Pregnant women are infected with toxoplasmosis during pregnancy. Toxoplasma can be transmitted to the fetus through the placenta, directly affecting the development of the fetus, resulting in multiple fetal malformations (reported whether there are brain, spina bifida, small Head deformity, no eyes, monocular, small eyes, high myopia, etc.), or even death, can also cause miscarriage, stillbirth, premature birth, etc. basic knowledge The proportion of the disease: the infection rate of Toxoplasma gondii in pregnant women is 6.84%, and the vertical transmission rate of mother and child is 9.57%. Susceptible population: pregnant women Mode of infection: fecal mouth spread Complications: miscarriage, premature delivery, hypotension, hepatitis, myocarditis
Cause
Causes of pregnancy combined with toxoplasmosis
There are two types of congenital infections and acquired infections.
Congenital infections are more serious, often accompanied by central nervous system symptoms, both recessive and dominant. Recessive type, also known as asymptomatic type, latent type, is the most common in clinical practice. It is healthy in the first month after birth and has no obvious abnormal performance. Most of the patients with retinal choroiditis appear in the 2nd to 7th month after birth, eye and central nervous system. Systemic symptoms can sometimes be delayed for years, even until adulthood. The dominant type is also called stimulating type, which is rare in clinical practice. It is characterized by typical congenital toxoplasmosis.
The condition of acquired infection is mild, and most of the patients with no symptoms are divided into two types: limited type and systemic type. The limited type is most common in the anterior and occipital lymph nodes, often accompanied by low fever, weakness, sore throat. The whole body type can be seen with high fever, maculopapular rash, headache, vomiting and the like. Toxoplasmosis, whether congenital or acquired infection, is mostly a recessive infection, and its incidence has obvious regional differences, and gradually increases with age.
Prevention
Pregnancy with toxoplasmosis prevention
In order to avoid the occurrence of congenital toxoplasmosis, pregnant women with a history of obvious animal contact should be tested for Toxoplasma IgM in the early, middle and late stages of pregnancy, so as to detect early cases of Toxoplasma gondii acute infection, timely termination of pregnancy or early delivery. medical treatement.
Complication
Complications of pregnancy combined with toxoplasmosis Complications, premature birth, hypotension, hepatitis, myocarditis
The infection rate of hypotension, hepatitis, nephritis, anemia, etc. was 14.3% (2/14), and that of patients without comorbidities was 7.0% (3/42). It was also reported that the incidence of uterine contractions, postpartum hemorrhage, uterine insufficiency, micro-heat, endometritis, and early water-breaking were higher than normal. The insect also affects endocrine by damaging the placenta and ovaries.
Concurrent pneumonia, myocarditis, orchitis, meningitis.
Pick up the patient's blood, bone marrow or cerebrospinal fluid, pleural effusion, sputum, bronchoalveolar lavage, aqueous humor, amniotic fluid, etc., or biopsy of lymph nodes, muscles, liver, placenta, etc., for Wright's or Ji's staining microscopy can find trophozoites or cysts, but the positive rate is not high. Direct immunofluorescence can also be used to examine Toxoplasma gondii in tissues.
Symptom
Symptoms of pregnancy combined with toxoplasmosis Common symptoms Postpartum hemorrhage Developmental malformation Lymph node enlargement Dysplasia Cerebellar malformation Abortion Stillbirth spina bifida
Pregnant women suffering from toxoplasmosis are asymptomatic, or mild symptoms, and a small number of people with symptoms are diversified.
Clinically, there are acute and chronic points. Acute lymphadenitis is mostly, lymph nodes are swollen and tender. Chronic often manifests as retinal choroiditis.
Toxoplasma infection can increase pregnancy complications during pregnancy, such as abortion, premature delivery, stillbirth, pregnancy-induced hypertension, premature rupture of membranes, uterine atony, postpartum hemorrhage, and neonatal asphyxia. Pregnant women with acute toxoplasmosis are more likely to have vertical transmission. The smaller the fetus at the time of infection, the shorter the pregnancy time and the more severe the fetal damage.
If the gestational age is less than 3 months, it will cause miscarriage. The survivor Toxoplasma gondii trophozoite can infect the fetus in the uterus through the placenta of the lesion, causing congenital toxoplasmosis, a systemic infectious disease, with three major clinical manifestations of retinal choroiditis, intracerebral calcification, and hydrocephalus. Congenital toxoplasmosis is divided into two types: systemic and central nervous symptoms. Systemic type occurs within 4 weeks after birth, with systemic symptoms such as fever, lymphadenitis, vomiting, diarrhea, almost all left retinal choroiditis, intracerebral calcification, hydrocephalus, neurodevelopmental delay, muscle stiffness and paralysis disease. Symptoms of central nervous system manifest as symptoms of infection such as encephalitis and meningitis. There are reports of retinal choroiditis up to 80%, cerebrospinal fluid abnormalities accounted for 69%, intracerebral calcification accounted for 27%, hydrocephalus accounted for 14%, and microcephaly accounted for 7%.
Examine
Examination of pregnancy with toxoplasmosis
Direct microscopic examination of patients with blood, bone marrow or cerebrospinal fluid, pleural effusion, sputum, bronchoalveolar lavage fluid, aqueous humor, amniotic fluid, etc. for smear, or lymph nodes, muscle, liver, placenta and other biopsies, for Wright or Ji's staining microscopy can find trophozoites or cysts, but the positive rate is not high. Direct immunofluorescence can also be used to examine Toxoplasma gondii in tissues. Detection of antigens, introduction of blood coagulation tests and other tests.
Diagnosis
Diagnosis and diagnosis of pregnancy combined with toxoplasmosis
In order to detect the infection of Toxoplasma gondii in pregnant women in time, enzyme-linked immunosorbent assay (ELISA) should be performed in early pregnancy to detect Toxoplasma gondii IgM, and the negative ones should be reviewed in the middle and late pregnancy. If Toxoplasma gondii IgG and IgM are negative, suggesting that they have not been infected with Toxoplasma gondii, and have no immunity to Toxoplasma gondii, should be closely monitored. If only Helicobacter pylori lgM positive, suggesting acute infection of Toxoplasma gondii, occurs in early pregnancy, pregnancy should be terminated, occurs in the middle and late pregnancy, neonatal umbilical cord blood toxoplasmosis IgM should be detected at the time of delivery to determine whether there is intrauterine infection. If only Toxoplasma gondii IgG is positive, it suggests that pregnant women have had a history of Toxoplasma infection and have developed immunity. In recent years, PCR has also been used to detect maternal serum and neonatal umbilical cord blood toxoplasma DNA. In addition, fundus examination with or without retinal choroiditis and neonatal head X-ray film with or without intracerebral calcification, are helpful to confirm the diagnosis. It has been reported that the newly infected rate of Toxoplasma gondii in pregnant women is 6.84%, and the vertical transmission rate of mother and child is 9.57%.
