Difficulties in the diagnosis of congenital toxoplasmosis by cordocentesis: case report

Article Abstract:

Congenital toxoplasmosis is the infection of the fetus with the protozoa Toxoplasma gondii before it is born. A pregnancy complicated by T. gondii infection is managed by medical evaluation of both mother and fetus, drug therapy to prevent or treat infection, and consideration of termination of the pregnancy. The disease should be detected early to prevent the potential development of severe visual problems during childhood or later life. The amniotic fluid, which surrounds the fetus, or fetal blood from the umbilical cord can be analyzed for the presence of genetic material from the parasite, and for antibodies, or immune proteins, specifically directed against the parasite; it can also be used to determine the ability of the blood to cause infection in a laboratory animal. A case is described of a 28-year-old woman diagnosed with T. gondii infection at 17 weeks of pregnancy. She had traveled eight weeks before conception and experienced cold-like symptoms at six weeks of pregnancy. Imaging and blood tests showed that the fetus was normal and uninfected at 17 weeks of pregnancy. The patient was treated with antiparasitic agents, and fetal blood and amniotic fluid were sampled at 23 weeks of pregnancy. She gave birth to a healthy female infant at 38 weeks of pregnancy without developing complications. Although the infant had no physical signs of congenital toxoplasmosis, Toxoplasma antibodies were detected in fetal blood and Toxoplasma DNA in cord blood and placental tissue samples was obtained at delivery. The infant was treated with antiparasitic agents until seven months of age, and developed mild leukopenia, an abnormal decrease in white blood cells. Otherwise, she had normal growth, development, and visual function at seven months. The presence of Toxoplasma antibody in fetal blood may have been incorrect finding, and presence of Toxoplasma DNA in placenta and cord blood samples may have been due to contamination with infected maternal blood. This case shows the difficulty in diagnosis and management of toxoplasmosis during pregnancy, and unnecessary use of potentially toxic treatment and extensive follow-up of the infant. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Testing, Fetal diseases, Toxoplasmosis, Cordocentesis

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Increased plasma levels of vasoactive intestinal polypeptide in pre-eclampsia

Article Abstract:

Vasoactive intestinal polypeptide (VIP) is a small protein-like factor present in the mucosa, or moist surface layer, of the gastrointestinal tract and elsewhere. It acts to prevent stomach functions, such as the secretion of stomach acid. VIP can also be detected in the nerves of the female genital tract, where it may cause dilation of blood vessels and relaxation of muscle. The blood levels of VIP are increased at delivery and during the period following childbirth, and VIP may help to relax the muscle of the uterus during childbirth. Since VIP can dilate blood vessels and cause a drop in blood pressure, VIP may also be involved in controlling blood pressure during pregnancy. The role of VIP in preeclampsia, a circulatory complication of pregnancy, is not known. Preeclampsia is characterized by increasing high blood pressure, headaches, the presence of the protein albumin in the urine, and tissue fluid accumulation in the legs and feet. The blood levels of VIP were assessed at 32 to 40 weeks of pregnancy in 18 women with preeclampsia and eight women without this complication. The average blood level of VIP was 13.9 picomoles per liter (pmol/l) in patients with pre-eclampsia and 4.4 pmol/l among women without this disorder. These findings show that VIP is increased among pregnant women with preeclampsia, possibly as part of a compensatory mechanism to renew blood flow to various organs, including the uterus and placenta, the tissue which provides the fetus with nutrition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Physiological aspects, Preeclampsia, Vasoactive intestinal peptides

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