Snapshot A neonate, whose mother is an animal caretaker, is found to be jaundiced. The child is noted have hepatosplenomegaly, and the adjacent retinal exam was performed. Introduction Toxoplasmosis is a disease caused by infection with the pathogen, Toxoplasma gondii TORCH infection (Toxoplasmosis, Other [syphilis], Rubella, CMV, and Herpes) Primary transplacental transmission from mother with a primary infection contracted via eating raw meet contact with cat feces (i.e. scooping litter in domestic cats) Epidemiology 10-30% of the population are carriers most prevalent in France Neonatal disease is only a risk if the mother acquires Toxoplasmosis during pregnancy 1/3 transit the disease to the fetus 1/3 of exposed fetuses show symptoms Exception to this is if mother is immunocompromised and reactivates latent infection Presentation Symptoms primary infection is usually asymptoms (i.e.mother displays no symptoms of disease) reactivation symptoms usually present in immunocompromised patients including encephalitis (in AIDS patients) other nonspecific symptoms that may be observed in infants/adults can include fever headache altered mental status seizures parasthesias or paralsysis jaundice Physical exam chorioretinitis (ocular toxoplasmosis) hepatosplenomegaly jaundice convulsions/seizures mental status changes Evaluation Screening not effective at detecting or preventing transmission of disease Serology/PCR can be used to identify specific pathogen Tissue sample may be used for histologic determination of presence of disease can isolate organism in mice or tissue culture Fetal ultrasound may be used to determine anomalies in known cases may show hydrocephalus CT multiple, isodense/hypodense intracranial calcifications aka, "ring-enhancing lesions" MRI more sensitive for imaging of basal ganglia (most common location) Differential Other TORCH infections, CNS lymphoma in AIDS patients Treatment Medical management Treat primary infection indicated only if contracted during pregnancy antibiotics treat both mother and child and include pyrimethamine, sulfadiazine, and folate for at least 4-8 weeks continuation of antibiotics and folate until clinical and radiologic resolution Prophylaxis indicated in immunocompromised patients in HIV/AIDS patients when CD4 < 100 with positive IgG TMP-SMX or pyrimethamine plus dapsone Prognosis, Prevention, and Complications Prognosis ranges widely depending on timing of diagnosis and aggressiveness of treatment can be devastating to fetus and lethal in immunocompromised patients if untreated Prevention avoid eating raw meat and first contact with housecats or cat feces Complications birth defects are common in untreated cases