All publications of Dr.Mehvish Aslam . Toba Tek Singh , پاکستان
Neglected parasitic disease during pregnancy:
Toxoplasmosis is a disease caused by protozoal parasite Toxoplasma gondii. It is a zoonotic disease. Common house hold cat are the major cause to spread the disease in pregnant women. While infection can be spread through contaminated water or food, undercooked meat, mother to fetus, organ and blood transplant (rare).
In healthy persons very mild symptoms were caused by Toxoplasmosis normally, but as far pregnant women it will cause serious damages to fetus leading to abortion. A cat can’t transmit disease as a pet but the infection comes from coming into contact with the infected faeces of a cat. If a woman before few weeks when she get pregnant or first time infected during her first pregnancy with toxoplasmosis is only a risk to an unborn baby. Congenital toxoplasmosis is the disease which transmits from mother to her unborn baby. If you catch toxoplasmosis for the first time during pregnancy, it does not mean that your baby will be infected. On average, only 4 in 10 of such infections will pass to the baby. Caught during pregnancy, toxoplasmosis can cause miscarriage, stillbirth or damage to the baby’s brain and other organs, particularly the eyes. However, most babies born with toxoplasmosis have no obvious damage at birth but develop symptoms, usually eye damage, during childhood or even adulthood. A few will have more serious symptoms such as blindness or brain damage.
Many factors in our daily routine are can play major roles to spread this contagious disease toxoplasmosis.
These factors could be:
• raw or undercooked meat (meat showing any traces of pink or blood), and raw cured meat
• unwashed vegetables and fruit
• cat faeces or soil contaminated with cat faeces
• unpasteurised goats’ milk and dairy products made from it.
The infection can also be passed:
• Through the placenta if the mother becomes infected infection (mother to unborn baby).
• Through infected matter entering human body fluids; if, for example, during the process of lambing, material splashes into eyes or open cuts.
• Through transplanted organs or blood products from other humans that are infected toxoplasmosis
• Through inhaling the parasite eggs (possible but very unusual).
Person-to-person infection is not possible, except from mother to unborn child. Anyone who eats anything infected with the parasite. Pregnant women who work on the land, in catering or farming may be at higher risk as they may be more likely to come into contact with the parasite. Lambing is a particular risk for pregnant women.
Tips to avoid toxoplasmosis during pregnancy
Only eat meat that has been thoroughly cooked (ie, with no trace of blood or pinkness).
• Avoid raw meat and cured meat, such as Parma ham.
• Wash hands, chopping boards and utensils thoroughly after preparing raw meat.
• Wash all fruit and vegetables thoroughly before cooking/eating to remove all traces of soil.
• Avoid unpasteurised goats’ milk and dairy products made from it.
• Wear gloves when gardening and wash hands and gloves afterwards – if you eat while gardening wash your hands first, and try to avoid gardening in areas that may have been soiled with cat faeces.
• Cover children’s sandpits to prevent cats using them as litter boxes.
• Remove faeces from cat litter tray every day wearing rubber gloves (or ask someone else do this), scald trays regularly with boiling water.
• If you are handling litter trays, wash gloves and hands thoroughly afterwards.
• Do not handle lambing ewes and do not bring lambs into the house
Blood tests for toxoplasmosis can be done at any stage before or during pregnancy. The blood test can usually only show possible infection two to three weeks after any risk incident, as it can take this long for antibodies to be detectable. The blood test involves taking a small amount of blood from the mother. There is no risk to the unborn baby. The blood test aims to show whether certain antibodies indicating toxoplasmosis are present or not, and, if they are present, to find out when the infection happened. If the tests show that there is a recent or current infection, there is a risk that the baby will be infected. But in case of negative blood result Doctor can go with polymerase chain reaction (PCR) result for further confirmation of results. As molecular test are DNA based and their report ones can’t be challenged. The obstetrician or GP will make a recommendation about any further action that might be required. It may take several weeks for the infection to pass from you to your baby. The degree of risk and severity of damage depends on when you were infected. All babies born to women with confirmed toxoplasmosis in pregnancy will be monitored closely by pediatricians and receive blood tests during their first year. Breastfeeding is safe if you have toxoplasmosis, the disease cannot be transmitted this way. You are also passing on extra antibodies to your baby, making their immune system stronger. Breastfeeding is therefore recommended, unless you are being treated with pyrimethamine. This medication should be changed before breastfeeding.
Unfortunately parasitic diseases are neglected in pregnant women in Pakistan. Presence of various abortion causes parasitic disease is serious problems for mother and fetal health also. Parasitic diseases can be considered seriously during pregnancy. Only few studies were found on toxoplasmosis from Pakistan. Therefore it is a suggestion to do more research on this parasite in Pakistan to highlight the damages of this disease and to reduce the possible damages from this disease.