Toxoplasmosis and Parvovirus B19 in pregnancy. How to reduce risks? 4
Let’s move to the infections. You’re certainly a specialist in infections of the mother and unborn child, a fetus. What is the best way to screen for fetal infections? Dr. Anton Titov, MD. What screenings for maternal infections during pregnancy are maybe not routinely being done today but should be done more widely? Dr. Anton Titov, MD. There are a few infections that are screened for widely. These are the oldest ones, the oldest established infection like syphilis, hepatitis. This is being screened everywhere. And fine. Treatment is very well known and efficient. After that, you have some infections that you don’t screen for. Dr. Yves Ville, MD. But you have to be aware that they exist. And you have to recognize when the fetus is affected. For example, Parvovirus B-19 causes severe anemia in the fetus. Women with young children in a daycare nursery should be aware of that. And actually, those daycare centers should advertise that they’ve seen cases in the nursery. So that women that have young children and are pregnant could be aware of Parvovirus B-19 risk. They should see a doctor so that we can check that the baby’s not anemic. Dr. Yves Ville, MD. But there are two infections that are not screened for very widely. One infection has been discovered in the 1940s. It is toxoplasmosis. So it’s a parasite, actually. Toxoplasmosis is worldwide, but some areas are more prone to this infection than others. Toxoplasmosis is a huge problem in Brazil. The strain of the toxoplasmosis parasite is very aggressive to the fetus. This is a problem in the United States. Historically, one of the pioneers about toxoplasmosis in pregnancy was from America. Dr. Yves Ville, MD. But I don’t think toxoplasmosis is very prevalent anymore because it’s a foodborne transmission. Mainly with food spoiled by oocytes of the parasites that are spread through cats. Toxoplasmosis cysts can be in the meat of lambs, for example, when the meat is not well cooked. And if the pregnant woman is ingesting that contaminated food, then the cyst can be destroyed. And an invasive form of the toxoplasmosis parasite can then cross the placenta. So toxoplasmosis is dangerous throughout the pregnancy. The advantage is that if the woman had had it years ago, when she was a child, or before pregnancy, in any case, she cannot get it a second time. Okay, so this one is easy. Dr. Yves Ville, MD. But fewer and fewer women are we are immune to toxoplasmosis because our food habits have changed. And we eat junk foods or very sterilized food or frozen food. The toxoplasma is not there. Dr. Yves Ville, MD. But if you travel to a high risk area, I mentioned Brazil. You go around the Mediterranean coast everywhere – Greece, Spain, France, Italy. Toxoplasmosis is more widespread, and cats and cattle are usually the sources of the toxoplasmosis infection. Medical second opinion. Then because you’re fewer and fewer women are immune, that’s a high risk. Toxoplasmosis is a risk for pregnancy. Dr. Yves Ville, MD. But for every infection, the earlier you get in the pregnancy, the more difficult it is to cross the placenta. Dr. Yves Ville, MD. But if it does cross the placenta, the damage is more than later. Treatment of toxoplasmosis is controversial. Dr. Yves Ville, MD. But it is likely that the antibiotics that we’re using are efficient in a large proportion of cases, not 100%, a large proportion of cases. Once you know that the feature is infected because you’ve isolated the toxoplasmosis parasite from the amniotic fluid by doing amniocentesis. You can treat toxoplasmosis. You can follow the effects of the toxoplasmosis infection and treatment by serial ultrasound by fetal magnetic resonance imaging. The ways of assessing fetuses now are very sophisticated. So the difficulty is to know which fetus needs what. Once you know there is a toxoplasmosis infection. Medical second opinion. Then the prognosis can be made very accurately by combining those techniques. Sometimes you take some blood from the cord, and you look at fetal blood counts at the amount of toxoplasmosis parasite or viruses in the blood. You can monitor this as you would monitor a neonate or child or an adult.
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