THERAPEUTIC APPROACH AND CARE PROTOCOLS IN THE TREATMENT OF GESTATIONAL TOXOPLASMOSIS

Abstract

This narrative review aimed to discuss the current evidence on the therapeutic and care management of gestational toxoplasmosis. Toxoplasmosis is an infection caused by the intracellular protozoan Toxoplasma gondii, which, when acquired primarily during pregnancy, represents a severe threat to fetal health due to the risk of vertical transmission and the potential for serious sequelae, such as the classic triad of hydrocephalus, chorioretinitis, and intracranial calcifications. The probability of vertical transmission and clinical severity vary according to gestational age. Effective management depends on early and accurate diagnosis, which begins with serology for IgM and IgG antibodies, complemented by the IgG avidity test to differentiate acute from chronic infections. Fetal infection is confirmed by amniocentesis with PCR analysis after the 18th week of gestation. Therapeutic strategies are stratified: spiramycin is the drug of choice for prophylaxis of vertical transmission when fetal infection is unknown. In cases of confirmed fetal infection, treatment is changed to a combination of pyrimethamine, sulfadiazine, and folinic acid, which requires rigorous monitoring due to the risk of toxicity. The implementation of structured care protocols and systematic prenatal screening programs is crucial for reducing morbidity associated with congenital toxoplasmosis, and continuous postnatal follow-up is essential to mitigate late manifestations.