Toxoplasmosis During Pregnancy

Front 1

The greatest risk of fetal infection with toxoplasmosis is associated with ( Choose one answer):
a)Maternal infection acquired long time before conception
b)Maternal infection acquired during the first trimester
c)Maternal infection acquired during the second trimester
d)Maternal infection acquired during the third trimester

Back 1

d)Maternal infection acquired during the third trimester

Front 2

The risk of severe fetal damage in congenital toxoplasmosis is highest if
( Choose one answer)
a)Maternal infection acquired long time before conception
b)Maternal infection acquired during the first trimester
c)Maternal infection acquired during the second trimester
d)Maternal infection acquired during the third trimester

Back 2

b)Maternal infection acquired during the first trimester

Front 3

Choose one statement of the following to give as an advice to pregnant woman to protect her from toxoplasmosis:
Avoid ingestion or handling of raw or partly cooked meat that may containToxoplasma cysts.
Avoid contact with cats
Cleaning a cat's litter box if necessary should be done on alternate day basis
Storage of meat for 24 hours in a typical domestic freezer is not enough to kill the parasite.

Back 3

Avoid ingestion or handling of raw or partly cooked meat that may containToxoplasma cysts.

Front 4

Which of the following statements regarding screening of pregnant women is true and which is false:
Pregnant women are tested for T. gondii antibodies on their first visit to their gynaecologist
For pregnant women with negative antibody titer no further serology testing is advisable
Those women who seroconvert during pregnancy are followed clinically and their fetuses are examined for T. gondii infection
Fetuses are examined for T. gondii infection by ultrasound, but amniocentesis is not usually necessary

Back 4

T
F
T
F

Front 5

Symptoms of toxoplasmosis in pregnant women include all of the following except one:
Usually there is no symptoms.
Mild flu-like symptoms.
Swollen lymph nodes particularly in the neck or axilla
Anaemia

Back 5

Anaemia

Front 6

Features of congenital toxoplasmosis include all the following except one:
Abortion or premature birth
Newborns with milder infections may not have symptoms or problems for months or even years.
Congenital toxoplasmosis can damage the baby's eyes, nervous system, skin, and ears.
All develop problems (especially in the eyes) when they become adolescents

Back 6

All develop problems (especially in the eyes) when they become adolescents

Front 7

The method of choice for diagnosing fetal infection with toxoplasma is ( Choose one):
Amniotic fluid PCR
Serologic testing of cord blood
Brain imaging
CSF analysis, and ophthalmologic evaluation

Back 7

Amniotic fluid PCR

Front 8

Which of the following statements regarding the use of spiramycin in pregnancy is true and which is false:
The aim is to reduce the risk of the transplacental transmission of the infection
The aim is to reduce the severity of congenital disease
It is given only if fetal infection is confirmed
If fetal infection is confirmed spiramycin is given in alternate 3-weeks courses with sulphadiazine and pyrimethamine until delivery

Back 8

T?
F
F
T

Front 9

Which of the following statements regarding the use of sulphadiazine- pyrimethamine in pregnancy is true and which is false:
The aim is to reduce the risk of the transplacental transmission of the infection
The aim is to reduce the severity of congenital disease
It is given if fetal infection is confirmed
It is given in alternate 3-weeks courses with spiramycin until delivery

Back 9

F
T
T
T

Front 10

Which of the following statements regarding management of infected infants are true and which is false:
All infected infants are given specific therapy until the age of 2 years
Therapy should be given irrespective of the severity of the disease
Rotating 4- weeks courses of sulphadiazine with pyrimethamine and folinic acid followed by spiramycin are given
Corticosteroids should be given for all patients

Back 10

F
T
F
F

Front 11

Toxoplasmosis is a parasitic disease caused by........ Infections of humans are common, and are usually..... .

Back 11

a protozoan, Toxoplasma gondii
asymptomatic

Front 12

Congenital toxoplasmosis is a special form in which an unborn child is infected via ......
If a woman receives her .....to toxoplasmosis while pregnant, the baby is at .....

Back 12

the placenta
first exposure
particular risk

Front 13

Fetal infection occurs via the placenta. The .... in the pregnancy, the lesser chance of transmission, but the effects are more ...... The .... in the pregnancy, the ..... chance of transmission, but the effects are less severe

Back 13

earlier
severe
later
greater

Front 14

Screening of pregnant women
A ...... at the first pre-natal doctor visit can determine whether or not the woman has had previous exposure and therefore whether or not she is at risk.
A ...... indicates previous exposure and immunity and largely ensures the unborn baby's safety.

Back 14

simple blood draw
positive antibody titer

Front 15

For pregnant women with ....., indicating no previous exposure to T. gondii, as frequent as monthly serology testing is advisable as treatment during pregnancy for those women exposed to T. gondii for the first time decreases dramatically the risk of passing the parasite to the fetus.

Back 15

negative antibody titer

Front 16

However, while risks can be minimized, they cannot be eliminated.
Despite these risks, pregnant women are not routinely screened for toxoplasmosis in most countries (Portugal ,France , Austria , and Italy being the exceptions) for reasons of .... and the high number of ...... generated.

Back 16

cost-effectiveness
false positives

Front 17

Preventive measures
A woman with no previous exposure should avoid .....

Back 17

handling raw meat, exposure to cat feces, and gardening (cat feces are common in garden soil).

Front 18

Most cats are ..... and so are not a danger, but the risk may be reduced further by having the ......

Back 18

-not actively shedding oocysts
-litterbox emptied daily (oocysts require longer than a single day to become infective), and by having someone else empty the litterbox.

Front 19

Cats aren't the only source of infection to humans.
Humans can also become infected via .........

Back 19

improperly cooked meat, improperly washed vegetables, drinking untreated water (from a stream or river for example) & gardening.

Front 20

General advices to pregnant women
Avoid cleaning ......., if this is not possible wear gloves & a mask. During pregnancy women should ....... after cleaning litter trays.
Ensure litter trays are scooped at least once a day.
Ensure your meat is ......
...... after handling animals.
Wear .... while gardening.

Back 20

-the litter trays
-change & wash their clothes
-cooked thoroughly.
-Wash your hands
-gloves

Front 21

General advices to pregnant women
Wash .... thoroughly before eating.
Wash your ...after handling raw meat, fruit & vegetables.
Wash your .... before eating.
Don't let your cat .....
Don't drink ......
Thoroughly cleaning ..... Use ...... boards for fruit/vegetables & meat.
Keep the litter tray away from .....

Back 21

-fruit & vegetables
-hands
-hands
-hunts
-unpasteurised milk.
-chopping boards & utensils
-separate
-the kitchen & other eating areas

Front 22

Clinical manifestations of Toxoplasmosis in pregnant women :
Most of the infections are ...... However maternal infection should be suspected if women have

Back 22

-asymptomatic
-1. A mononucleosis–like syndrome and a negative heterophile antibody test
2. Isolated regional adenopathy not due to another cause (eg, HIV)
3. Chorioretinitis.

Front 23

Clinical manifestations of congenital Toxoplasmosis:
The consequences of the infection of the fetus can .....: between subclinic and very serious.The classical triad of Congenital Toxoplasmosis is :

Back 23

-be very different
-Chorioretinitis
Intracranial calcification
Hydrocephalus

Front 24

Clinical manifestations of congenital Toxoplasmosis
Other manifestations include ..........
But even the subclinical infection can lead to late-onset problems, most common in ....

Back 24

-mental retardation, skin rash, hepatitis, pneumonia, myocarditis, and myositis
-the eyes

Front 25

Diagnosis of Toxoplasmosis
..... (for maternal infection)
....(for fetal infection)
......(for neonatal infection)

Acute maternal infection is suggested by ....

Back 25

-Serial IgM & IgG measurement
-Amniotic fluid PCR
-Serologic testing, brain imaging, CSF analysis, and ophthalmologic evaluation
-seroconversion or a ≥ 4-fold rise between acute and convalescent IgG titers.

Front 26

....... is emerging as the method of choice for diagnosis of fetal infection.
There are numerous other serologic tests, some of which are done only in reference laboratories. The most reliable are .....
Tests to isolate the organism include inoculation into mice and tissue culture, but these are not usually done because they are expensive, not highly sensitive, and can take weeks before yielding results.

Back 26

-PCR analysis of amniotic fluid
-the Sabin-Feldman dye test, the indirect immunofluorescent antibody (IFA) test, and the direct agglutination assay.

Front 27

In suspected congenital toxoplasmosis, ......should be done
As invasive prenatal testing has some risk to the fetus (18.5 pregnancy losses per toxoplasmosis case prevented),postnatal or neonatal screening is preferred. The exceptions are cases where fetal abnormalities are noted, and thus screening can be targeted.

Back 27

-serologic tests, MRI or CT imaging of the brain, CSF analysis, and a thorough eye examination by an ophthalmologist

Front 28

Treatment During pregnancy
Treatment is very important for recently infected pregnant women, to prevent infection of the fetus.
The .....is given at a dose of .... throughout the pregnancy in an attempt to reduce the risk of .....

Back 28

-macrolide antibiotic spiramycin
-3g/ day
-transplacental passage of the parasite

Front 29

If fetal infection is confirmed by .... is given to reduce the severity of congenital diseases.
..... (50 -100 mg / kg / day)– ...... ( 0.5 – 1 mg / kg / day) with vitamin supplement is given for ....., followed by a further 3 weeks therapy consisting of ...... (3g / day)
Alternating 3 weeks drug courses are given until delivery.

Back 29

antiparasite therapy
Sulfadiazine
pyrimethamine
vitamin
3 weeks
spiramycin

Front 30

Treatment of infected infants
Since a baby's immune system does not develop fully for the first year of life, and the r...... that form throughout the body are very difficult to eradicate with ....., an infection can be very serious in the young.

Back 30

-resilient cysts
-anti-protozoans

Front 31

All infected infants are given ..... until the age of ....irrespective of the .....
Rotating 3 – weeks courses of ....with..... and .....followed by ...... (100mg/kg/ day)are given.
The role of corticosteroids is not fully established but these are often given when..... is noted.

Back 31

specific therapy
1 year
-severity of the disease
-sulfadiazine
-pyrimethamine
-folinic acid
-spiramycin
-ventricular dilatation