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Ethical and psychological aspects regarding the infection with Toxoplasma gondii

during pregnancy

Roxana-Gabriela Cobzaru1,2, Ana-Maria Dumitrescu1, Magda Leon1,3, Mariana Luca1,2, Anca

Saa1,!, Luiza "oni #ț 1, Carmen R$%#1,2 , Danisia &aba1,'

1( )Grigore *( +o%a niersit. o/ Medicine and +0armac., /acult. o/ Medicine

2( +arasitolog. De%artment

3( Medical Semiolog. De%artment

!( Anatom. and mbriolog. De%artment

'( Radiolog. and Medical "maging De%artment

Congenital toxo%lasmosis re%resents a %arasitic %at0olog., transmitted /rom mot0er to c0ild

it0in t0e intrauterine li/e, /olloing t0e maternal in/ection it0 *oxo%lasma gondii *(

gondii4, during %regnanc.( *0e transmission occurs accidentall. in 0umans intermediar 

0osts4 /rom t0e %rinci%al 0ost 0ic0 is t0e cat( *0e in/ection can be transmitted to t0e /aetus

 bot0 during %regnanc. and labor, and , ulteriorl., during t0e birt0 itsel/( *0e %regnant oman

deelo%s a mild /orm o/ in/ection, t0ing 0ic0 stands against /ast recognition o/ disease, and

t0ere/ore tardie administration o/ treatment( *0e treatment it0 s%iram.cin, /or exam%le,

reduces t0e %ossibilities o/ transmitting t0e in/ection to t0e /aetus, and its lac5 o/ initiation

determines t0e onset o/ t0e congenital in/ection( *0ere/ore, among t0e /irst measures t0at

s0ould be ta5en in determining toxo%lasmosis it0in %regnanc. and reducing its transmission

is monitoring t0e seroconersion in t0e case o/ a seronegatie %regnant oman( Among t0eim%ortant as%ects it0 re%ercussions on t0e %regnant oman6s %s.c0ic and it0 et0ical

signi/icance is t0e %remature birt0 o/ t0e c0ild, t0at ta5es %lace in more t0an 0al/ o/ t0e cases

and t0e %ossible deterioration o/ t0e c0ild6s nerous, auditor., isual and tegumentar.

s.stems, signs isible eer since birt0( "n t0is situation, t0e mot0er is con/runted it0 certain

dillemas, 0aing to decide, once 0aing t0e certaint. o/ t0e in/ection it0 *( gondii and

5noing all t0e re%ercussions u%on t0e /uture bab., 0ereas s0e is going to 5ee% t0e

 %regnanc. or abort( "n t0e case o/ abortion, t0ere are ta5en into consideration its et0ical

im%lications, 0ig0lig0ting t0e res%ect gien to et0ical %rinci%les and t0e im%ortance o/ 

medical decision it0in doctor-%atient relations0i%( *0e /act t0at t0e mot0er ma. not 5no

about t0e in/ection, until t0e birt0 o/ a c0ild it0 arious %at0ologies, counts /or t0e

 %s.c0ological as%ect o/ t0e situation, it0 t0e necessit. o/ %s.c0ot0era%. indicated b. t0es%ecialist and corres%onding treatment( Seere e%isodes o/ de%ression, anxiet., %anic attac5s,

a lac5 o/ sel/-esteem and certain %0obias ma. a%%ear in t0e case o/ abortion, as ell as in t0e

case o/ /inding out t0e diagnosis b. t0e time o/ late %regnanc., 0ic0 could orsen t0ings

antici%atedl.( KEY WORDS7 *(gondii, s%.ramicin, et0ical %rinci%les, %regnanc.,

 %s.c0ot0era%.(

Congenital toxo%lasmosis re%resents a %arasitic %at0olog., transmitted /rom mot0er 

to c0ild it0in t0e intrauterine li/e, /olloing t0e maternal in/ection it0 *oxo%lasma gondii

*( gondii4, during %regnanc.( *0e transmission occurs accidentall. in 0umans intermediar 

0osts4 /rom t0e %rinci%al 0ost 0ic0 is t0e cat( *0e in/ection can be transmitted to t0e /aetus

 bot0 during %regnanc. and labor, and , ulteriorl., during t0e birt0 itsel/( According to seeral

studies more t0an a t0ird o/ t0e global %o%ulation 0as su//ered /rom an in/ection it0 t0is

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 %arasite, sero%realence being di//erentl. distributed across regions and de%ending on t0e

socio-economic status( Most o/ neborns it0 congenital toxo%lasmosis do not s0o an.

clinical signs o/ in/ection at birt0, but t0ose 0o deelo%ed clinical abnormalities, undetected

initiall., t0oug0, are /ound it0 %at0ologies o/ t0e nerous, isual, auditor., res%ectiel.

tegumentar. tissues later on in c0ild0ood 1, 24(

*0e %regnant oman deelo%s a mild /orm o/ in/ection, i/ t0e in/ection 0as occurred

in t0e esrl. %0ases o/ gestation, t0ing 0ic0 stands against /ast recognition o/ disease, and

t0ere/ore tardie administration o/ treatment( *0e treatment it0 s%iram.cin, /or exam%le,

reduces t0e %ossibilities o/ transmitting t0e in/ection to t0e /aetus, and its lac5 o/ initiation

determines t0e onset o/ t0e congenital in/ection( *0ere/ore, among t0e /irst measures t0at

s0ould be ta5en in determining toxo%lasmosis it0in %regnanc. and reducing its transmission

is monitoring t0e seroconersion in t0e case o/ a seronegatie %regnant oman, t0at 0as been

around cats s0ort time be/ore %regnanc. or during %regnanc.( *0ere/ore, een t0oug0

education s0ould %la. a ma8or role in %reenting t0e s%read o/ congenital toxo%lasmosis, t0is

lac5s most o/ t0e times( *0is 8usti/ies t0e necessit. o/ im%roed s.stematic serological

 %rogrammes t0at stand /or t0e earl. %reention o/ congenital toxo%lasmosis andadministration o/ treatment 1, 2, 34(

 +rimaril., t0e congenital toxo%lasmosis initiates in omen in/ected it0 *( gondii

it0in gestation , 0en t0e %arasite crosses t0e %lacenta and transmits t0e in/ection to t0e

o//s%ring( Alt0oug0 rare, t0ere are some exce%tions /rom t0is /irst t.%e o/ in/ection7 t0e case

o/ omen 0o %rimaril. get in/ected 8ust be/ore t0e conce%tion, t0e ones 0o got alread. a

c0ronic in/ection it0 t0e %arasite and get double in/ection it0 a di//erent strain, as ell, and

t0e case o/ immunocom%romised %ersons omen su//ering /rom A"DS, /or exam%le4( "t is

im%ortant to mention t0at not ala.s t0e in/ection o/ t0e %lacenta can lead to /etal

toxo%lasmosis, but, t0at, 0en it 0a%%ens, it cannot be it0out its in/ection /irst, 5non as t0e

9%arasitemic %0ase( *0e gestational age o/ t0e mot0er 0as a er. im%ortant im%act on t0e

incidence disease 3, !4(*0ere/ore, t0e earlier t0e in/ection occurs it0in gestation, t0e more

 %robabl. it is t0at t0e /aetus ill deelo% t0e disease, being t0e inersed situation 0en t0e

in/ection 0ad alread. occurred in t0e mot0er be/ore getting %regnant( "n literature, t0ere 0ae

 been mentions regarding t0is issue, stating t0at most o/ stillbirt0s, abortions, brain necrosis

and 0.droce%0alus deelo%ed in /aetuses 0ose mot0ers 0ere in/ected it0 *( gondii earlier 

in gestation, an exce%tion being re%resented b. t0e in/ection t0at occurs in t0e t0ird semester 

o/ %regnanc., it0 more agressie strains( *0e %at0ological clinical deelo%ments a//ecting

t0e nerous, isual and auditor. s.stems are7 microce%0al., 0.droce%0alus and retardation in

t0e case o/ nerous s.stem a//ection, retinochoroiditis and retinal damage in the case of the visual system, seizures in the case of the tegumentary system and in the case of the auditory system (3). These all are very dangerous pathologies to develop within a faetus and involveserious thinking of bioethical principles within the decision to keep the baby or abort. The doctorpatient relationship which is absolutely marked by confidentiality and security of the patientsconfessions and personal data comes in the rescue of the situation in order to come to the rightmedical decision. Therefore there is a contradiction between the bioethical principle of non-maleficience and the one of beneficience, and that is where one of the most important uestionsand issues come from. !ecause it is right to have your own baby, but in cases such as retardation,hydrocephalus or microcephalus, especially the pathologies involved by the damage of thenervous system , the cahnces that the baby en"oys a normal healthy life and does not become a burden for his family are very low. #f course, little chances of a better life for the child e$ist due tocertain postnatal treatment, but there is little evidence though of the efficacy of some prenataltreatment. The informed consent comes only from the patient only after she is presented all the

risk factors involved by keeping the pregnancy and all the positive aspects regarding the

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confrunting situation, and after the medical decision, the mother is helped with abortion, if it has been decided so, this being respected the bioethical principle of respect for autonomy (%).

The psychological issue involved by the matter is one of great importance as well, due tothe contradiction between the desire of having a baby and avoiding giving birth to someone who wouldn&t be able to live a proper life, thus harming not only youself as a mother, but also the rest

of the family involved and create a burdon to society, not mentioning the possible costs involved by raising-up a child with so many pathologies and needs. 't is a difficult situation for the mother who may not even have been aware of the infection untill a later stage of it. The role of psychotherapy is a comple$ one as it helps the taking of medical decison, as well, and orientatesthe mother towards her ne$t steps. 't is helpful not only within pregnancy, but also before andmainly after in case of abortion, as to avoid depression, an$iety, panic attacks, a feeling of self-esteem and suicidary acts (%).

ongenital to$oplasmosis remains an important trigger for both medical and e$istentialissues, a true challenge for systematic prevention programmes that involve serological testing inseronegative pregnant women, that have been surrounded by cats or live in rural areas and acontinuous field of further investigation.

Re/erences7

1( 

Daid &( M( :o.nson,*im G( ;reg0itt , *oxo%lasmosis7 A Com%re0ensie Clinical Guide,

 >1?

2( Louis M( ;eiss,@ami @im, *oxo%lasma Gondii7 *0e Model A%icom%lexan( +ers%ecties

and Met0ods, London, @, Academic +ress, 2>>?

3(  Asgari  B(, e5ri  M(, Monabati  A(, @alantari  M(, Mo0ammad%our   "(,  Molecular 

Genot.%ing o/ Toxoplasma gondii  in &uman S%ontaneous Aborted etuses in S0iraz,Sout0ern "ran "ran : +ublic &ealt0( 2>13? !247 2>E2'?

!( SDL+ Subasing0e, @arunaeera