Congenital Toxoplasmosis | Symptoms & Causes
At Boston Children’s Hospital, we understand that you may have a lot of questions when your child is diagnosed with congenital toxoplasmosis, such as:
- What exactly is this condition?
- What are potential complications in my child’s case?
- What are the treatments available?
- Are there any possible side effects from treatment?
- How will the disease affect my child in the long term?
- Most importantly — is my child going to be OK?
We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and treatment options fully.
Background
According to the Centers for Disease Control and Prevention, more than 60 million men, women and children in the United States have toxoplasmosis. Most people infected with toxoplasmosis have no symptoms (and don’t need any treatment). However, pregnant women should be especially careful about exposing themselves to the parasite because toxoplasmosis can be very serious in a newborn baby.
Fortunately, the risk of maternal transmission of the parasite to the fetus during the first trimester of pregnancy (when the baby is most vulnerable) is relatively low, at 15 to 20 percent. However, by the third trimester, a pregnant woman with toxoplasmosis has a 60 percent chance of infecting her child.
What causes congenital toxoplasmosis?
The toxoplasma gondii parasite can enter the body in a number of ways (most commonly, through the mouth). If you’re pregnant, be especially careful to avoid these situations:
- consuming raw or undercooked meat
- eating raw eggs
- handling cat feces and/or cat litter (though this doesn’t mean you can’t have a pet cat — see our FAQ section for more information
- exposure to insects (e.g., flies) that have been in contact with cat feces
What are the symptoms of congenital toxoplasmosis?
Many (up to 90 percent of) babies born with congenital toxoplasmosis experience no immediate symptoms. However, one sign of infection is a premature birth or an abnormally low birth weight.
As an infected baby grows, more signs and symptoms can appear. These may include the following:
Toxoplasmosis can also cause some more serious problems, including the following:
- retinal damage
- hydrocephalus — a buildup of cerebrospinal fluid in the brain
- intracranial calcifications — these indicate areas of the brain that have been damaged by the parasite, and are often linked to the following conditions:
- intellectual disabilities
- seizures
- motor and developmental delays
- hearing loss
Long-term outlook
If your child is treated early, there should be no serious consequences of toxoplasmosis. However, if treatment is delayed, your child may suffer some serious health problems as a result of the infection. For more information, see the diagnosis and treatments section.
Questions to ask your doctor
Many parents are concerned about toxoplasmosis and can have lots of questions about the condition and how it can affect their baby.
You may find it helpful to jot down questions as they arise — that way, when you talk to your doctor, you can be sure that all of your concerns are addressed.
Here are some questions to get you started:
- Should I have a blood test for toxoplasmosis?
- Our family has a cat. How can I make sure the cat’s litter and waste are handled safely so that the parasite doesn’t spread?
- Do I need to avoid gardening or other yard work to prevent exposure to infected soil?
- What else can I do to prevent infection?
- I’m infected. Is there any way to avoid passing it on to my baby?
- What steps can we take if my baby does get infected? What treatment(s) do you recommend, and why?
- Are there any potential side effects from treatment?
- What’s the long-term outlook for a baby with toxoplasmosis?
Congenital Toxoplasmosis | Diagnosis & Treatments
How do we diagnose congenital toxoplasmosis?
The first step in treating your child is forming an accurate and complete diagnosis.
A blood test before or during pregnancy can determine if you have been exposed to the toxoplasma gondii parasite.
- If you are infected, another type of test can determine whether your baby is infected.
- In addition, fetal ultrasounds can determine if your baby's organs are damaged.
Currently, physicians in the United States do not routinely screen pregnant women for toxoplasma gondii, so if you suspect you may have been exposed to the parasite, ask your doctor to perform a blood test.
After we complete all necessary tests, Boston Children’s Hospital’s experts meet to review and discuss what they have learned. Then we will meet with you and your family to discuss the results and outline the best treatment options.
How do we treat congenital toxoplasmosis?
If your child has been diagnosed with toxoplasmosis, you may be confused, frightened and overwhelmed. But you can rest assured that, at Boston Children's Hospital, your child is in good hands.
Our physicians are expert, compassionate, and committed to focusing on the whole child, not just his condition—that's one reason we're frequently ranked as a top pediatric hospital in the United States.
It's important to know the following about toxoplasmosis:
- If detected early, antiparasitic treatments can eliminate toxoplasmosis before the parasite harms the fetus.
- Boston Children's treats babies born with congenital toxoplasmosis with anti-toxoplasmosis medications, usually for 1 year after birth.
- We typically use pyrimethamine or sulfadiazine because studies have shown that babies treated with these medications typically have fewer complications from the infection.
- One of our experts will determine which combination of medications is best suited for your baby.
At Boston Children's, we consider you and your child integral parts of the care team, and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.
Coping and support
It's essential to remember that, while hearing that your child is infected with toxoplasmosis can feel very isolating, many children and their families have been down this path before. We've helped them, and we can help you, too.
There are lots of resources available for your family—within Boston Children's, in the outside community and online. These include:
Patient education: From the very first visit, our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have. And they'll also reach out to you by phone, continuing the care and support you received while at Boston Children's.
Parent to parent: Want to talk with someone whose baby has been treated for toxoplasmosis? We can put you in touch with other families who have been through similar experiences and can share their experience.
Faith-based support: If you are in need of spiritual support, we'll help connect you with the Boston Children's Department of Spiritual Care (chaplaincy). Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during the time you and your child are in the hospital.
Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
On our patient resources site, you can read all you need to know about:
Congenital Toxoplasmosis | Frequently Asked Questions
FAQs about congenital toxoplasmosis
Toxoplasmosis is a disease caused by the parasite toxoplasma gondii and is usually acquired by the parasite getting into the body by the mouth (for instance, by eating undercooked meat).
While most people infected with toxoplasmosis have no symptoms (and don’t need any treatment), pregnant women should be especially careful about exposing themselves to the parasite because toxoplasmosis can be very serious in a newborn baby.
If you’re pregnant, be especially careful to avoid these situations:
- consuming raw or undercooked meat
- consuming raw eggs
- gardening or doing other yard work that puts you in direct contact with soil
- exposure to cat feces and cat litter
- exposure to insects (e.g., flies) that have been in contact with cat feces
No. Although cats can transmit the toxoplasma gondii parasite to pregnant women through their feces (where infected parasite eggs can be shed), there is no demonstrated link between toxoplasmosis and simply owning a cat. Here’s why:
Cats themselves can only become infected with toxoplasma gondiiif they eat prey containing the parasite, or come into contact with infected soil. For these reasons, cats kept indoors are highly unlikely to become carriers of the parasite. In addition, only pregnant women are at elevated risk of toxoplasmosis through handling cat litter and/or feces. Other family members, including young children, do not face this elevated risk.
Many pregnant women (and their families) fear that they need to part with the family cat to be safe from toxoplasmosis — but that’s not the case at all. You can keep your cat while taking these steps to prevent toxoplasmosis infection:
- Keep cats indoors. A cat that doesn’t go outside can’t eat infected prey or come into contact with infected soil.
- Don’t come into direct contact with cat litter or feces. Have another family member take care of cleaning the litter box and disposing of cat waste. If you must handle litter box duties yourself, always wear disposable gloves and be sure to wash your hands thoroughly afterward.
It depends on when you are infected.
- The risk of maternal transmission of the parasite to the fetus during the first trimester of pregnancy (when the baby is most vulnerable) is relatively low, at 15 to 20 percent.
- However, by the third trimester, a pregnant woman with toxoplasmosis has a 60 percent chance of infecting her child.
A blood test before or during pregnancy can determine if you have been exposed to the toxoplasma gondii parasite.
- If you are infected, another type of test can determine whether your baby is infected.
- In addition, fetal ultrasounds can determine if your baby's organs are damaged.
Currently, physicians in the United States do not routinely screen pregnant women for toxoplasma gondii, so if you suspect you may have been exposed to the parasite, ask your doctor to perform a blood test.
Here at Boston Children’s, physicians in our Division of Infectious Diseases treat congenital toxoplasmosis in infants.
- If detected early through a blood test, antiparasitic treatments can eliminate toxoplasmosis before the parasite harms the fetus.
- We treat babies born with congenital toxoplasmosis with anti-toxoplasmosis medications, usually for 1 year after birth.
- One of our experts will determine which combination of medications is best suited for your baby.
If your child is treated early, there should be no serious consequences of toxoplasmosis. However, if treatment is delayed, your child may suffer some serious health problems as a result of the infection.
Our physicians are expert, compassionate and committed to focusing on the whole child, not just his condition — that’s one reason we’re frequently ranked as a top pediatric hospital in the United States.
And at Boston Children’s, we consider you and your child integral parts of the care team and not simply recipients of care. You and your care team will work together to customize a plan of care for your child.
