Imagine the shock of your baby being born with a swollen brain, blindness and debilitating seizures. Now imagine learning that these devastating diseases could have been prevented if you had had a simple test for this common parasite. Toxoplasma gondii.
Toxoplasma The disease can be contracted anywhere an infected cat has defecated, such as in the litter box, sandbox, garden or yard. Other routes of infection include eating contaminated water, undercooked meat or shellfish.
Most people have a mild form of the disease and are able to control the infection.
However, if it is contracted for the first time during pregnancy, Toxoplasma The virus can cross the placenta and cause spontaneous abortion or serious birth defects. This transmission from mother to child during pregnancy is called congenital toxoplasmosis.
Up to 4,400 babies may be born each year in the United States with congenital toxoplasmosis.
As a professor of microbiology at Indiana University School of Medicine, I study the biology of Toxoplasma in my lab. Blood tests can monitor the amount of Toxoplasma antibodies in the parent.
Increases in cases indicate that an acute infection is occurring, putting the fetus at risk for congenital toxoplasmosis. However, prompt administration of antiparasitic drugs to pregnant women who develop toxoplasmosis can help protect the fetus from the most serious consequences of congenital toxoplasmosis.
Several countries, such as France and Austria, have been testing and treating toxoplasmosis during pregnancy for decades. Brazil recently launched a similar program.
However, Toxoplasma tests are not included in prenatal screening in the United States.
Why screen for toxoplasmosis during pregnancy?
Toxoplasma It’s a widespread and stealthy infection. More than 40 million American adults are infected with the parasite, underscoring how easy it is to catch. And because the infection usually doesn’t cause noticeable symptoms, many mothers of infected babies don’t remember when or how they got infected.
Studies in several countries have demonstrated the benefits of detecting and treating toxoplasmosis during pregnancy.
The first randomized clinical trial to evaluate the efficacy and safety of a treatment to reduce prenatal transmission of toxoplasmosis, Toxogest, published its results in 2018. Although the trial was halted due to lack of funding, the results suggested that the treatment not only reduced transmission of the infection, but also the severity of disease in cases of breakthrough infections.
A meta-analysis of 33 studies published between 2017 and 2021 also found that pregnant women who received the antibiotic spiramycin also had significantly lower rates of parasite transmission to their unborn child compared to untreated mothers.
For Dr. Jose Montoya, a toxoplasmosis researcher and clinician at Sutter Health’s Remington Laboratory, the value of screening is clear. “In countries that do prenatal screening for toxoplasmosis, the severity of congenital toxoplasmosis is much lower than what is routinely seen in the United States,” he said.
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Congenital toxoplasmosis may be more common than previously thought
Some have argued that congenital toxoplasmosis is too rare to warrant prenatal screening. But the United States now screens for diseases even rarer than toxoplasmosis, such as phenylketonuria.
The incidence of congenital toxoplasmosis may also be underestimated. Currently, there are no national surveillance data on toxoplasmosis because it is not a reportable disease in the United States. Because most states do not monitor or report this infection during pregnancy, researchers do not know how many miscarriages are caused by this disease. Toxoplasma or how many children suffer from the infection.
A 2021 report from the Centers for Disease Control and Prevention (CDC) highlighted gaps in toxoplasmosis surveillance in the United States, saying that routine, standardized testing during pregnancy would provide crucial data to assess the extent of this threat to babies. Additionally, it would shed light on the causes of the high stillbirth rate in the United States, which disproportionately affects Black women.
Some researchers have warned that Toxoplasma Prevalence may increase with the popularity of organic and free-range foods and with climate change.
Free-roaming animals are more likely to contract infectious diseases Toxoplasma Oocysts are found in outdoor pastures and water sources, which are more likely to be contaminated by cat feces. Warmer temperatures and more powerful storms due to climate change are promoting the persistence and spread of oocysts in the environment, for example by increasing soil erosion and polluting waterways.
In addition, there are reports of unusually virulent cases of the virus. Toxoplasma Strains migrating from South America may worsen the severity of congenital toxoplasmosis infections in the United States.
Costs of toxoplasmosis during pregnancy
“This disease not only has a high physical and emotional cost, but also a significant economic cost,” said Dr. Rima McLeod, director of the University of Chicago Toxoplasmosis Center.
A 2011 study by McLeod estimated that following the French model of prenatal screening and treatment could save American taxpayers $620 per child, or $2.5 billion per year.
Researchers have also developed new technologies that reduce concerns about testing costs.
McLeod’s team developed an inexpensive finger-prick test that detects Toxoplasma within 30 minutes. Other researchers have also developed a saliva-based test.
How to avoid toxoplasmosis
Toxoplasma Congenital toxoplasmosis causes significant and permanent neurological and visual impairment in hundreds of babies born each year in the United States. Congenital toxoplasmosis can be largely reduced through prenatal testing and safe, easy-to-implement treatment protocols.
“Those who conducted the Toxogest clinical trial did not incorporate a placebo control because it was deemed unethical not to monitor and treat congenital toxoplasmosis,” Montoya said.
“But currently, pregnant women in the United States are being relegated to a placebo group, deprived of simple, inexpensive procedures that could save their children from birth defects.”
In the absence of routine prenatal screening for congenital toxoplasmosis, the best thing pregnant women can do is become vigilant about risk factors. Pregnant women should avoid cleaning the litter box and other areas where cats may have defecated. Fruits and vegetables should be washed before consumption. Meat products should be cooked to the proper temperature.
Bill Sullivan, professor of pharmacology and toxicology, Indiana University
This article is republished from The Conversation under a Creative Commons license. Read the original article.