Management of Toxoplasmosis in Children

What Is Pediatric Toxoplasmosis?

Toxoplasmosis, one of the most prevalent parasites in the world and an acute or chronic disease, is brought on by an infection with the parasite Toxoplasma gondii. The parasite can cause severe complications in people with weak immune systems or infants born to infected mothers. In addition, in many cases, pregnant women who become infected with the parasite in the first trimester suffer a miscarriage.

What Are the Symptoms of Pediatric Toxoplasmosis?

If the child is healthy, they may show no signs of infection. However, if the infected child is relatively young or has a compromised immune system, the child shows signs and symptoms. For example, the infected infants do not show any signs and symptoms at birth, but later, children start showing symptoms. The following are the few signs and symptoms of toxoplasmosis:

• Body ache.

• Headache.

• Swollen lymph nodes or enlarged lymph nodes.

• Confusion.

• Fever.

• Lethargy.

• Coordination disabilities.

• Myocarditis (inflammation of the heart muscle).

• Prematurity.

• Pneumonitis (inflammation of lung tissue).

• Hepatosplenomegaly (spleen and liver enlargement).

• Jaundice (yellowing of the eye whites and skin).

• Various rashes.

• Toxoplasmosis in children can cause chorioretinitis, resulting in blurred vision and spots in the eye.

• Children with toxoplasmosis infection may affect organs like the liver, heart, lungs, and eyes. The triad commonly seen in patients with toxoplasmosis are intracranial pressure, chorioretinitis (inflammation of the choroid and retina of the eye), and hydrocephalus (a condition in which fluid accumulates in the skull and causes brain swelling).

• Toxoplasmosis in infants may result in impaired vision, speech, and poor brain development.

What Are the Causes of Pediatric Toxoplasmosis?

Congenital toxoplasmosis is caused exclusively due to a primary maternal infection during pregnancy that is caused by the Toxoplasmosis gondi. There are chances of reinfection in mothers with immunodeficiencies. Condition with T. gondii occurs majorly with the consumption of uncooked meat. The cysts and oocytes present in the contaminated water and foods also may be the reason for the toxoplasmosis infection.

The other standard transmission of the infection is transmitted from the infected mother to the infant. Therefore, infants infected in gestation are more prone to various diseases.

The infection transmission rate to the fetus is higher in women infected later during pregnancy. Overall, 30 to 40 % of pregnant women will have a congenitally infected child. Pregnancy is a significant journey carrying a baby, and individuals should also be careful about the foods they consume and avoid the things that cause infection. So be very careful and try to stay away from the foods that cause any infection Pregnant women should eat thoroughly cooked meat to prevent such infections.

How Frequent is Toxoplasmosis?

It is estimated that up to one in every three people worldwide are infected with (T. gondii), the parasite that causes toxoplasmosis. The majority of those who are affected have no symptoms.

How Is Toxoplasmosis Diagnosed?

The following methods make the diagnosis of toxoplasmosis:

• Blood Tests: Toxoplasmosis is usually often diagnosed through blood tests.The doctor will use a needle to extract blood from the vein and send it to a laboratory to be tested for T. gondii antibody presence. They may also search for parasite components (DNA).

• Biopsy: The healthcare professional may, on rare occasions, extract a small piece of tissue and send it to a lab to test for evidence of T. gondii.

• Imaging: If the doctor suspects that an individual may have toxoplasmosis in the brain, they may order a CT scan or an MRI. This is where they lie down in a machine that photographs the brain. The provider examines the photos to see whether any alterations indicate toxoplasmosis.

• Lumbar Puncture: The doctor will use a needle to retrieve cerebrospinal fluid (CSF) from the lower back during this operation. It will be transferred to a laboratory to be tested for T. gondii.

• Amniocentesis: If one is pregnant and has toxoplasmosis, the doctor may advise to get an amniocentesis. A tiny needle is used by the provider to gather cells from the fluid around the fetus. It will be transferred to a laboratory to be tested for T. gondii.

• Ultrasound: During an ultrasound, the doctor uses a handheld equipment to take images of the fetus. This alone cannot diagnose toxoplasmosis, but it can identify alterations in the fetus's brain that may indicate an infection.

What Is the Prognosis for Toxoplasmosis?

Some children with congenital toxoplasmosis may die early, while some may live for more extended periods with neurological disorders. Neurological disorders like intellectual disabilities, blurred vision, deafness, and seizures must be examined closely. Therefore, there should be proper observation and examination in children with toxoplasmosis. Even in the later stages, they are supposed to be observed. Accurate monitoring may prevent the child from further complications.

What Are the Treatment Options for Congenital Toxoplasmosis?

There is limited information that treating infected women during pregnancy may benefit the fetus. Therefore, Spiramycin is given to the infected mothers to prevent maternofetal transmission, that is, the transmission from the mother to the fetus. In addition, adding Trimethoprim or Sulphamethoxazole may avoid the transmission of infection from the mother to the baby. Symptomatic and asymptomatic neonates may improve with the outcome when treated. So it is better to start with oral Pyrimethamine.

Oral Sulphadiazine resolves neonatal jaundice. After the initial six months of treatment, Sulfadiazine and Leucovorin are also continued at the same dosage.

When to See a Doctor?

Although it does not exhibit any severe complications, it is better to consult the general physician for the following conditions:

• When the individual is pregnant, take immediate help from the health care provider and seek advice on preventing the transmission from the mother to the baby.

• If there is loss of vision, blurred vision, or any dark floating spots in the image.

• Unexplained fevers.

• Unexplained headaches.

• Sudden swelling in the lymph nodes, especially in the neck region.

Conclusion:

Toxoplasmosis is not usually a serious condition, but it poses a special risk to pregnant women and others with impaired immune systems. Fortunately, there are numerous methods for preventing an infection. Discuss with a doctor how to lower the likelihood of toxoplasmosis based on the unique circumstances.