Toxoplasmosis During Pregnancy

Topic Overview

What is toxoplasmosis?

Toxoplasmosis is a common infection found in birds, animals, and people.

For most people, it doesn't cause serious health problems. But for a pregnant woman’s growing baby, it can cause brain damage and vision loss. Still, the chance of a pregnant woman getting the infection and passing it on to her baby is low.

If you're pregnant or planning to have a baby and are worried that you may have toxoplasmosis, ask your doctor about getting tested. After you have had the infection, you can't get it again or pass it on to your baby. You're immune. Your body has learned how to fight it off. You don't have to worry about passing the infection to your baby.

But if you aren't immune, you'll want to take special care while you're pregnant. Avoid touching or eating anything that may be infected, such as infected meat and infected cat feces.

What causes toxoplasmosis?

A parasite causes toxoplasmosis.

You can get the infection by:

  • Eating infected meat that hasn't been fully cooked or frozen.
  • Changing an infected cat’s litter box. Cats infected with the parasite pass it on to others through their feces.
  • Digging or gardening in sand or soil where an infected cat has left feces.
  • Eating anything that has touched infected cat feces, including fruits and vegetables that haven't been washed. You can also get the infection by eating food that has touched tables and counters your cat has walked on.

What are the symptoms?

If you get toxoplasmosis, you may feel like you have the flu, or you may not feel sick at all. Most people who get the infection don't even know that they have it.

In healthy people, the infection often goes away on its own. But babies and people whose bodies don't fight infection well need to take medicine to treat the infection and prevent serious health problems.

How is toxoplasmosis diagnosed?

A blood test can tell whether you have or have ever had toxoplasmosis. If you're worried about getting the infection, ask your doctor about having the test.

If you get the infection while you're pregnant, you'll need to have your baby tested. Your doctor can take some fluid from the sac that surrounds your baby and check for the infection.

How is it treated?

If you get toxoplasmosis while you're pregnant, you'll take medicine that treats the infection. This medicine is called an antibiotic.

This medicine may:

  • Keep your baby from getting the infection.
  • Lower your baby’s chance of having serious health problems if he or she does get it.

Your baby has a better chance of being healthy at birth if you get treatment while you're pregnant.

If your baby has the infection, he or she will also need to take antibiotics for a year after birth. This lowers the chance of having problems later on.

How can you prevent toxoplasmosis during pregnancy?

There are several things you can do to avoid getting toxoplasmosis:

  • If you have a cat or are caring for one, ask someone to clean or empty the litter box while you're pregnant. Wash tables and counters well if a cat may have walked on them. If you have to clean the cat’s litter box, wear gloves and a face mask. Be sure to wash your hands after you're done.
  • Eat only meat that has been fully cooked or frozen. Avoid dried meats, such as beef jerky.
  • Avoid contact with cat feces in your garden. If you touch soil, be sure to wear gloves and wash your hands after you're done.
  • Wash fruits and vegetables before you eat them.
  • Wash your hands and anything you use to prepare raw meat, chicken, fish, fruits, or vegetables.

Frequently Asked Questions

Learning about toxoplasmosis:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Cause

Toxoplasmosis is an infection caused by a tiny parasite that infects birds and mammals, including humans. Cats are the only live carriers of toxoplasmosis. When a cat is infected, its feces contain toxoplasma eggs for about 2 weeks. These eggs can survive in moist soil for up to 18 months. Eggs in soil or sand can also contaminate food and water.

Cats that never go outside and do not catch mice indoors cannot be infected with toxoplasmosis.

Infection by mouth

You can get toxoplasmosis from cat feces or in contaminated food or water. People most often get toxoplasmosis by:

  • Eating the eggs. You can become infected by mouth after touching anything that has come into contact with infected cat feces, such as when cleaning a cat's litter box or gardening where a cat has left feces. Eating contaminated food, such as unwashed vegetables, or eating with contaminated hands are examples of how you can get infected with toxoplasma eggs.
  • Eating the meat of an infected animal. You can get toxoplasmosis from meat that is not fully cooked or has not been frozen. For more information on meat preparation, see the Prevention section of this topic.

Fetal infection

If you are first infected while you are pregnant or up to 8 weeks before becoming pregnant, you can pass the parasite on to your growing baby (fetus). If you have already developed immunity to toxoplasmosis before pregnancy, you cannot get reinfected or pass the infection on to your fetus.

Symptoms

In a person with a healthy immune system

When first infected with toxoplasmosis, most people don't get sick. A few people have mild flu-like symptoms, which can last as long as several months. This is why people rarely know whether or when they have had toxoplasmosis. Symptoms can include:

  • Swollen glands.
  • Muscle aches.
  • Fatigue.
  • Fever.
  • Sore throat.
  • Skin rash.

In a newborn

Most infected newborns have no symptoms at birth. But without treatment, some can develop eye or brain damage that ranges from mild to severe. Blindness can develop up to 20 years after birth, but this is rare.

Some infected newborns have severe symptoms at birth, including:

In a person with a weak immune system

A person who has a very weak immune system (weakened by HIV infection, organ transplant medicines, or lymphoma) can develop life-threatening toxoplasmosis. Antibiotic therapy is often used to prevent this from happening. Severe infection requires aggressive treatment.

In very rare cases, otherwise healthy people who get toxoplasmosis can have severe symptoms related to the brain, eyes, lungs, or heart.1

What Happens

After having toxoplasmosis once, you cannot get it again. This is because your immune system has learned how to fight it. When you are immune to toxoplasmosis, you don't have to worry about getting it and passing it on to a fetus (growing baby).

If you have an impaired immune system (such as from HIV infection or chemotherapy), you may have problems with repeat toxoplasmosis infections.

Infection during or just before pregnancy

A fetus cannot protect itself from toxoplasmosis. The toxoplasma parasite can infect your fetus up to 2 months after you have been infected.

  • If your fetus is infected during the first half of pregnancy, toxoplasmosis may cause serious brain or eye damage.
  • If your fetus is infected later in pregnancy, toxoplasmosis is less likely to cause serious problems.

Infected infants who are not treated with antibiotics after birth can develop severe infection during the first 20 years of life. This can lead to intellectual disability, eye damage, and sometimes blindness.

What Increases Your Risk

You can lower your risk of getting toxoplasmosis by avoiding possible sources of the toxoplasma parasite. Your risk increases if you:

  • Eat undercooked meat or any food that has touched raw meat. Any meat is potentially infected.
  • Eat or drink contaminated fruits, vegetables, or water.
  • Eat with unwashed hands or utensils that have touched raw meat.
  • Clean a cat's litter box and fail to wash your hands afterward, or breathe in cat litter dust.
  • Garden or work the soil without gloves and hand-washing. The parasite can survive in soil for months after being left behind by a cat.

Risks to the fetus

The further along in pregnancy you become infected by toxoplasmosis, the greater the chance of fetal infection. But the earlier fetal infection occurs, the greater the risk of more severe problems after birth.

Any baby born with toxoplasmosis needs treatment to prevent later problems from the infection.

When To Call a Doctor

Talk to your health professional during your first prenatal exam if you are concerned about your risk factors for toxoplasmosis during pregnancy. Together, you can decide about whether to have a toxoplasmosis screening.

Call your health professional if you are pregnant and develop swollen glands, fever, sore throat, or other flu-like symptoms.

Watchful Waiting

Most health professionals in the United States take a wait-and-see approach during a pregnancy because fetal toxoplasmosis is not common. Toxoplasmosis screening is performed when the health professional thinks that the fetus or newborn may be affected. In countries where toxoplasmosis is more common, experts say that early testing and treatment are key to preventing severe fetal consequences.

If you are pregnant or are trying to become pregnant and think you have been exposed to Toxoplasma gondii, discuss testing with your health professional. For more information, see the Exams and Tests section of this topic.

Who To See

Your obstetrician, family medicine doctor, or certified nurse-midwife can test you for toxoplasmosis immunity. But your health professional must have access to a reference laboratory that can produce dependable test results.

If you are diagnosed with toxoplasmosis infection while pregnant, a perinatologist or infectious disease specialist can provide treatment to prevent or reduce fetal infection.

If your newborn became infected during your pregnancy (congenital toxoplasmosis), a doctor specializing in newborn care (neonatologist) or an infectious disease specialist can provide treatment.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

In most areas of the United States and Canada, fetal toxoplasmosis infection is rare. In the U.S., about 1 to 10 infants per 10,000 actually become infected before birth.2 This is why screening for toxoplasmosis is not a part of routine prenatal care in this country. But getting tested for toxoplasmosis may be a good idea if you are pregnant or planning to become pregnant and:

  • You are worried that you might get toxoplasmosis.
  • You think you may not be able to avoid exposure to the parasite.

Consider what higher-risk countries recommend as you make your decision about testing:

A blood test is used to see whether you have the antibody to the toxoplasma parasite. If you have the antibody, that means you have already been infected, and your immune system now makes antibodies that can fight toxoplasma. These antibodies protect your fetus and newborn from infection.

You may need more than one blood test to make sure the result is accurate.

Tests for toxoplasmosis

  • Toxoplasmosis blood test looks for the antibody to toxoplasma. If test results or symptoms show possible infection, another test is done 2 to 3 weeks later to confirm the diagnosis.
  • Amniocentesis is used to collect amniotic fluid for testing. A polymerase chain reaction (PCR) test is used on the fluid to check for signs of toxoplasma DNA. This test can detect fetal toxoplasmosis.
  • Fetal ultrasound is used to check for signs of toxoplasmosis damage in the fetus.

Early Detection

Birth defects are most likely to develop when a fetus is infected during weeks 10 through 24 of pregnancy.1 This is why early detection and treatment of fetal toxoplasmosis is important for preventing severe fetal problems. (If an infection develops later in pregnancy, severe fetal problems are less likely, but treatment is important to prevent future problems.)

Treatment Overview

If you are not pregnant and have a healthy immune system, you won't need treatment for toxoplasmosis. Any symptoms that develop typically go away on their own. But if you become infected while pregnant, you will need treatment to try to protect your growing baby (fetus).

Because the immune system of a fetus is not mature enough to fight off a toxoplasmosis infection, antibiotics are needed to kill the parasite. Infants who are treated before birth are more likely to be healthy after birth. Newborns who are not diagnosed and treated until after birth have a higher risk of brain and eye damage before birth or during the first 2 years of life.

If you are diagnosed with a new toxoplasmosis infection during pregnancy, you will be treated with an antibiotic that targets infection in the placenta. If further testing shows that your fetus is infected, you will be given two antibiotics that are known to reduce the impact of toxoplasmosis on the fetus.3 For more information, see the Medications section of this topic.

Sometimes fetal ultrasound testing early in a pregnancy shows severe or life-threatening fetal problems. In such cases, parents may consider ending the pregnancy.

Prevention

If you are not pregnant (or not planning to be pregnant soon) and have a healthy immune system, you do not need to prevent toxoplasmosis infection. It is a passing infection with mild or no symptoms.

If you have had toxoplasmosis, you cannot get it again. This is because your immune system has learned how to fight it. This immunity protects both you and your fetus from toxoplasmosis.

You can have a blood test to learn whether you are immune to toxoplasmosis.

If you are pregnant or plan to be pregnant soon

If you do not know whether you are immune to toxoplasmosis or know that you are not immune, avoid contact with the toxoplasma parasite to protect your fetus from infection.

  • Avoid cat feces, in both the home and the garden.
    • If you have a cat and you are either pregnant or planning to become pregnant soon, have someone else clean the cat litter box. If you must clean the box yourself, do it daily. The toxoplasma eggs take 1 to 5 days to become infectious.4 Wear gloves and a face mask, and wash your hands afterward.
    • Make a habit of washing any table or counter surfaces that a cat may have walked across.
    • Consider keeping your cat indoors. A cat who goes outdoors is likely to become infected with Toxoplasma gondii by eating infected birds or rodents. (Eating indoor mice also poses a risk.)
    • When gardening or handling soil, wear gloves and wash your hands afterward.
    • Wash all foods that could have had contact with cat feces, including commercial fruits and vegetables.
  • Eat only well-cooked or previously frozen meat. Avoid dried meats. Sustained high or low temperatures are needed to kill Toxoplasma gondii in meat.
  • Carefully wash your hands and all utensils after preparing raw meat, poultry, seafood, fruits, or vegetables.
  • Avoid untreated drinking water. This is a concern when you are in the wilderness or are traveling to developing countries where drinking water is not treated.

Home Treatment

There is no home treatment available for toxoplasmosis. See the Prevention section of this topic for measures you can take to prevent infection.

Medications

Medicine for toxoplasmosis is only needed when the infection affects a growing baby (fetus) or someone with a very weak immune system. So although a pregnant woman who has a healthy immune system is not personally at risk when infected, treatment is needed to protect her fetus.

If you are diagnosed with toxoplasmosis during pregnancy, you will be treated with antibiotics.3

  • Antibiotic treatment reduces the chances that your fetus will become infected.
  • If your fetus becomes infected (diagnosed using amniocentesis), another antibiotic may replace or be added to your treatment.
  • If your newborn has toxoplasmosis, he or she will take antibiotics for the first year of life. This is needed to lower the risk of brain damage and blindness from the infection.

Medication Choices

Antibiotic therapy

What To Think About

Antibiotic treatment during pregnancy may not cure a fetal toxoplasmosis infection.1

Surgery

There is no surgery available for treating toxoplasmosis.

Other Treatment

There is no alternative treatment available for toxoplasmosis.

Most people with untreated toxoplasmosis since birth require eye care from an ophthalmologist by the time they reach adulthood.

Other Places To Get Help

Organizations

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL  60007-1098
Phone: (847) 434-4000
Fax: (847) 434-8000
E-mail: kidsdocs@aap.org
Web Address: www.aap.org
 

The American Academy of Pediatrics (AAP) offers a variety of educational materials, such as links to publications about parenting and general growth and development. Immunization information, safety and prevention tips, AAP guidelines for various conditions, and links to other organizations are also available.


Centers for Disease Control and Prevention (CDC): Division of Parasitic Diseases
1600 Clifton Road
Atlanta, GA  30333
Phone: 1-800-CDC-INFO (1-800-232-4636)
TDD: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web Address: www.cdc.gov/ncidod/dpd
 

The Division of Parasitic Diseases is a branch of the U.S. Centers for Disease Control and Prevention (CDC). Its mission is to prevent and control parasitic diseases throughout the world. Its Web site provides information and updates on parasitic diseases.


Related Information

References

Citations

  1. Montoya JG, et al. (2005). Toxoplasma gondii section of Infectious diseases and their etiologic agents. In GL Mandell et al., eds., Principles and Practice of Infectious Diseases, pp. 3170–3198. Philadelphia: Elsevier Churchill Livingstone.
  2. Savoia MC (2004). Toxoplasmosis section of Bacterial, fungal, and parasitic disease. In GN Burrow et al., eds., Medical Complications During Pregnancy, 6th ed., pp. 330–332. Philadelphia: Elsevier Saunders.
  3. American College of Obstetricians and Gynecologists (2000). Perinatal viral and parasitic infections. ACOG Practice Bulletin No. 20. Obstetrics and Gynecology, 96(3): 1–13.
  4. U.S. Department of Health and Human Services (2000). CDC recommendations regarding selected conditions affecting women's health: Preventing congenital toxoplasmosis. MMWR, 49(RR-2): 57–75.

Credits

Author Sandy Jocoy, RN
Editor Kathleen M. Ariss, MS
Associate Editor Tracy Landauer
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Gregory A L Davies, MD, FRCSC, FACOG - Maternal-Fetal Medicine
Last Updated June 18, 2009

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