Infections of the Cardiovascular and Lymphatic System
Toxoplasmosis……………..Don’t Blame Fluffy!
As part of their commitment to “going green,” Layla and Steve Jackson lived on a small farm in rural northwest Pennsylvania. Steve chopped wood from their forest to burn in their Franklin stove, and about 25% of their electricity was generated by the wind turbines on top of their mountain. They raised almost all of their own food between their small apple orchard, huge vegetable garden, and a berry patch. The couple reared numerous sheep, a few pigs, and one dairy cow. These animals plus the rabbit, turkey, and deer Steve hunted more than covered their meat and milk needs. Although the young couple loved working their farm, to make ends meet ﬁnancially, they also taught at the local high school. Layla was a 10th grade math teacher and Steve served as both the choral and band directors for grades 7–12. Unless the roads were icy in the winter, the “green team” biked the four miles to work every day. While this lifestyle kept them extremely busy, Layla and Steve felt great satisfaction knowing their carbon footprint was signiﬁcantly less than that of the average American.
As Layla picked the green beans and weeded around the squash one July morning, she pondered how their lifestyle would change in November when their ﬁrst child was due to be born. She was pleased to be able to raise their child in the unpolluted environment of their country farm and nourish him with homegrown foods free of the pesticides and preservatives found in many commercially produced items. “Of course,” Layla said to herself while patting her belly, “I think we’ll have to break down and drive a little more this winter. You’ll be a bit too small for my baby bicycle seat.” As if on cue, the baby started “dancing.” Laughing, Layla collected the baskets of produce she had harvested and headed to the kitchen to start making lunch. After rinsing the fresh-picked fruits and vegetables, Layla used her garden’s bounty to assemble a delicious salad and homemade strawberry shortcake with cream from Josie, their cow. Later that afternoon, the couple went to Dr. Schneider’s ofﬁce for Layla’s monthly prenatal examination. They watched with amazement as the obstetrician used ultrasound to measure the baby’s growth, conﬁrming that Layla was 23 weeks pregnant. Dr. Schneider pointed out different features of their developing child. They saw a tiny beating heart and learned it was time to paint the nursery blue!
Layla’s pregnancy progressed normally until her next appointment at 27 weeks gestation. Dr. Schneider was surprised to ﬁnd Layla hadn’t gained any weight in four weeks. “At this stage of your pregnancy, you should be gaining about 0.5 to 1 pound per week,” Dr. Schneider said with concern. “Are you eating enough nutritious foods?” Layla was happy to report a healthy appetite that she regularly indulged with the foods she and Steve raised. “I bet it’s the extra exercise I’m getting,” Layla explained. “I’ve been canning produce as fast as I can harvest the garden and orchard. I’m up and down the hillside a dozen times a day hauling a full bushel basket, so I bet I’m just burning off the calories with my gardening.” Dr. Schneider cautioned Layla not to be lifting heavy baskets and encouraged her to add an afternoon snack to her usual diet. “I want to see you in two weeks to be sure your weight gain is back on track,” Dr. Schneider ordered. Exactly one week later, Layla called and scheduled an urgent appointment. For the previous 48 hours, Layla had experienced signiﬁcant vomiting and diarrhea. By the time she arrived at Dr. Schneider’s, Layla was weak and slightly dehydrated. Frantic, Layla reported a decrease in fetal activity. Dr. Schneider admitted Layla to the hospital for IV ﬂuids and prescribed medication to ease her GI distress.
An hour later Dr. Schneider performed an ultrasound to check on the progress of Layla’s developing son and was shocked to see no fetal growth since her week 23 examination. In the morning, Dr. Schneider arrived at the hospital early to examine Layla and her baby. Steve was asleep in a chair and Layla sat up in bed weeping gently. She hadn’t felt the baby move since midnight. Dr. Schneider conﬁrmed Layla’s worst fears with another ultrasound, which showed no fetal heartbeat. Labor was induced to deliver Layla and Steve’s 28-week-old stillborn son. A fetal autopsy revealed elevated titers of toxoplasmosis antibodies, hydrocephalus and brain lesions.
A week later, Layla and Steve met with Dr. Schneider to review the autopsy report and answer their long list of questions. “So, I got toxoplasmosis and that’s why I was so sick…and then I made the baby sick too,” Layla said dismally.
“No,” Dr. Schneider replied, “not exactly. Your GI symptoms were coincidental and represent a secondary infection. They simply alerted us to the problem with the baby’s growth. It does; however, appear you’ve been infected with toxoplasmosis and the pathogen crossed the placenta to affect your baby. “Wait a minute,” Steve interjected. “How did Layla get toxoplasmosis? I’ve heard about this disease. Pregnant women get it from changing litter boxes. We don’t have a pet cat. In fact, we don’t even have strays in our barn!”
“Dr. Schneider, was there any way to diagnose and treat my infection that might have saved our baby?” Layla asked. “There are different diagnostic tests for toxoplasmosis, but they aren’t routinely run in a prenatal panel in the U.S. unless we have reason to suspect infection,” Dr. Schneider explained. “If a pregnant woman is infected, several treatment protocols are available, but the beneﬁts must be carefully weighed against the risks since the likelihood of transmission and fetal damage varies with the gestational age of the mother seroconversion
“Now that I’ve been infected with toxoplasmosis, do I need to be treated? If I’m cured can we still have other children, or will I infect them too, causing another miscarriage?” Layla asked hopefully. “Not to worry,” Dr. Schneider consoled the young couple. “You’ve suffered a devastating loss, but I’m conﬁdent you’ll soon be parents.”
Anderson, R. et.al. Case study in microbiology: A Personal Approach, Publisher: John Wiley & Sons Copyright year: © 2006.