Being pregnant is a tough process especially if it is your first time. There are many things to take note of and things that you should avoid. But some things are just false beliefs such as you should not be exercising if you are pregnant. Though, some advice you should be taking note of is having cats when you are pregnant.
Cats are usually related to toxoplasmosis which is a parasitic infection. The single-cell parasite named Toxoplasma gondii found throughout the world and responsible for infecting 40 million people in the United States. The infection usually does not cause harm or produce any symptoms in a healthy person. However, individuals who have compromised immune systems or are pregnant who are infected can lead to serious health problems.
Life Cycle of Toxoplasmosis Gondii
Diagram: The above life cycle shows how the transmission of the Toxoplasma gondii parasite happens from infective stage to diagnostic stage
How does Toxoplasmosis affect Pregnant Women?
Usually, the chance of getting infected during the first pregnancy is thought to be very slim. But if being infected during first pregnancy or a few months before conceive it can cause
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Miscarriage
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Stillbirth
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Birth defects
Moreover, if you do get infected first time during your pregnancy, there will be different risk to your child depending on when you were infected:
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Early-in-pregnancy: Less likely to spread to your baby, however it can be serious if problems arise
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Later-in-pregnancy: More likely to spread to your baby, but problems developed are less severe
In the UK, It is estimated that 1 in 10,000 babies is born with Toxoplasmosis.
Why do people get infected with Toxoplasmosis?
The infection can happen through many routes from swallowing anything infected or contaminated by the parasite. It could be due to
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Eating raw or undercooked meat (pork, lamb and venison), shellfish (oysters, clams, or mussels) or raw cured meat such as Parma ham or salami
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Unwashed vegetables and fruits
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Accidental ingestion after handling undercooked, contaminated meat or shellfish without properly washing hands
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Eating food that was contacted with contaminated surfaces such as knives, cutting boards, spoons from other raw, contaminated meat or shellfish.
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Drinking water infected with Toxoplasma gondii
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Accidental swallowing parasite via contact with Cat feces containing Toxoplasma Gondii when cleaning a cat’s litter box or accidental ingestion through contaminated soil during gardening or eating unwashed fruits or vegetables from the garden.
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Mother-to-child (congenital toxoplasmosis)
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Happen through organ transplantation or blood donation
What happened to babies born with Congenital Toxoplasmosis?
Most of the babies born with Congenital Toxoplasmosis are asymptomatic (no symptoms). Though, babies born prematurely or having an abnormally low birth weight can be a sign of infection.
As the baby grows older, the signs of infection would develop gradually
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Swollen lymph nodes
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Bruises
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Jaundice
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Anemia
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Enlarged liver or spleen
Toxoplasmosis can also lead to severe symptoms including
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Retinal damage
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Hydrocephalus - Fluid build up brain
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Intracranial calcifications - Result from the parasites damaging certain areas of parasites (affecting intellectual disabilities, seizures, motor and developmental delays, hearing loss)
Though, if the infection is treated at the early stage, there should not be serious consequences from Toxoplasmosis. However, delayed treatment may result in suffering serious health problems.
What can I do to avoid getting infected?
If you are pregnant, you should take note and AVOID the situation below:
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Eating raw or undercooked meat
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Eating raw eggs
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Gardening or yard work that involves direct contact with soil
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Contacting with cat feces and cat litter
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Exposure to insects (e.g. flies) that have been in contact with cat feces
Remember to speak to your doctor if you have plans of getting pregnant as a cat owner.
No, no we are not saying cats are off limit
Although pregnant women can catch Toxoplasma gondii through cats via feces, there is no direct relation between toxoplasmosis and owning a cat. This is because cats get infected when they consume raw or undercooked meat containing parasites or direct contact with infected soil. But do not worry about getting rid of your family cat, precaution can be done to prevent the toxoplasmosis infection:
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Keep cats indoors. Cats at home would avoid accidental ingestion of infected prey or exposure to contaminated soil
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Avoid handling cat litter or feces. Get another family member to take care of the litter box. If you must, make sure to wear disposable gloves and remove the litter without direct contact and wash your hands with soap afterward.
How is Toxoplasmosis being treated?
Generally, the treatment is catered for immunocompromised patients such as HIV for opportunistic infection.
In acute infection, tested positive with Toxo IgG they are treated with:
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Trimethoprim/ sulfamethoxazole 10mg/kg/day IV/PO in 2 divided doses.
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Alternative with Pyrimethamine 200mg PO loading dose, following by 50mg PO every 24 hours (if BW <= 60kg) or 75mg every 24 hours (if BW > 60kg) PLUS Folinic acid 10-25mg IV/PO every 24 hours PLUS Clindamycin 600mg IV/PO every 6 hours or Sulfadiazine 1gm PO every 6 hours
In Suppressive/ Maintenance therapy, patient is treated with:
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Trimethoprim/ sulfamethoxazole (80/400mg) 2 tablets PO every 12 hours
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Alternative with Dapsone 100mg PO every 24 hours OR Clindamycin 600mg PO every 8 hours PLUS Pyrimethamine 50mg PO twice-weekly PLUS/MINUS Folinic Acid 10-25mg PO twice weekly OR Sulfadiazine 0.5-1.0gm PO every 6 hours PLUS Pyrimethamine 25-50mg PO every 24 hours PLUS Folinic acid 10-25mg PO every 24 hours
Primary Prophylaxis when Toxo IgG tested positive but with CD4 <100
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Trimethoprim/ sulfamethoxazole (80/400mg) 2 tablets PO every 24 hours
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Alternative with Dapsone 50mg PO every 24 hours PLUS Pyrimethamine 50mg PO once weekly PLUS Folinic acid 25mg PO once weekly OR Dapsone 200mg PO once weekly PLUS Pyrimethamine 75mg PO once weekly PLUS Folinic Acid 25mg PO once weekly
Should I still breastfeed if I get infected with Toxoplasmosis?
Yes. The possibility of Toxoplasma gondii infection transmission through milk is not likely. It is more common to found Toxoplasmosis with babies drinking unpasteurised goat’s milk and there were no evidence of transmission of Toxoplasmosis through human breast milk. However, it is being said that if there is present of cracks and infection of nipple of mother with Toxoplasmosis, hence it is possible that the infection transmitted through breast milk. Again, the likelihood of human milk transmission is very small. Please consult with your doctor if you are infected with Toxoplasmosis during your pregnancy or breastfeeding term.
References
1. https://www.cdc.gov/parasites/toxoplasmosis/gen_info/faqs.html
2. https://www.childrenshospital.org/conditions-and-treatments/conditions/c/congenital-toxoplasmosis/symptoms-and-causes
3. http://www.abcdcatsvets.org/toxoplasma-gondii-infection-2/#treatment
4. https://www.cdc.gov/parasites/toxoplasmosis/gen_info/pregnant.html
5. https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/national-antimicrobial-guideline-2019-full-version-3rd-edition.pdf
