Toxoplasmosis is a global parasitic disease that can be transmitted from
mother-to-child when the infection is acquired for the first time during pregnancy.
Clinical manifestations of congenital disease include retinochoroiditis, cerebral
calcifications, and hydrocephalus. Prenatal testing for toxoplasmosis is routinely
offered in many countries so that infected mothers can be treated with antibiotics to
reduce the risk of mother-to-child transmission. The diagnosis of toxoplasmosis during
pregnancy is complicated because determining whether infection occurred prior to
conception or during pregnancy is critical, besides the fact that false-positive tests are
common and that there is lack of standardization among these tests. If maternal
infection is confirmed before 18 weeks of gestation and the fetus is not yet infected the
use of spyramicin is recommended to prevent mother-to-child transmission, as this
drug has a high concentration in the placenta and has no teratogenic effects. If infection
is presumed or confirmed in the fetus, the treatment should be switched to
pyrimethamine, sulfadiazine and folinic acid (PSF) until the end of the gestational
period to prevent further damage to the newborn. When maternal infection is confirmed
after 18 weeks of gestation, the use of PSF is required, and should be used until
delivery. However, these drugs can present some adverse effects, such as paresthesia,
pruritus, urticaria, diarrhea, nausea, and vomiting for spiramycin, and arrhythmia,
erythema multiforme, pancytopenia, hematuria, and eosinophilic pneumonitis for
pyrimethamine. There is an urgent need for having safer drugs on hand that are a
suitable chemotherapy or prophylaxis for children and pregnant women, and further
studies are needed to address this.
Keywords: Folinic Acid, Pregnancy, Pyrimethamine, Spiramycin, Sulfadiazine,
Toxoplasmosis, Treatment.
