Patient selection: pregnant woman with suspected or confirmed acquisition of toxoplasmosis during this pregnancy
Steps:
(1) Determine the week of gestation at which infection was acquired.
(2) Perform fetal ultrasound for fetal abnormalities suggestive of congenital toxoplasmosis..
(3) Perform PCR for Toxoplasmosis on amniotic fluid at 18 weeks of gestation or later (as soon as feasible).
Spiramycin therapy is given if:
(1) Initially (prior to knowledge of testing) if infection acquired at < 18 weeks gestation.
(2) After testing with negative PCR and ultrasound:
(2a) if infection acquired at < 18 week gestation
(2b) if infection acquired at >= 18 weeks gestation and want to switch from pyrimethamine + sulfadiazine + folinic acid.
Pyrimethamine + sulfadiazine + folinic acid therapy is given if:
(1) Initially (prior to knowledge of testing) if infection acquired at >= 18 weeks gestation.
(2) After testing with the PCR and/or ultrasound are positive:
(2a) if infection acquired at < 18 week gestation
(2b) if infection acquired at >= 18 weeks gestation.
The antiprotozoal therapy is continued until delivery.
