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Republished: What obstetricians should be aware of – serious side effects of antibiotic toxoplasmosis treatment in pregnancy
  1. Sara Ardabili,
  2. Joachim Kohl,
  3. Gülseven Gül,
  4. Markus Hodel
  1. Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
  1. Correspondence to Dr Sara Ardabili; sara.ardabili{at}

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In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years


Infection with Toxoplasma gondii is usually an asymptomatic or oligosymptomatic, self-limiting disease in immunocompetent individuals. However, during the pregnancy, primary infection can lead to transplacental vertical transmission resulting in congenital toxoplasmosis with possible severe sequelae. The efficacy of systematic screening remains controversial and the effect of antibiotic treatment is unclear. Although main side effects of antibiotic drugs used for toxoplasmosis are well known, mostly from malaria treatment, there is a lack of information about occurrence in pregnant woman treated for toxoplasmosis. We report a case of a healthy pregnant woman with primary toxoplasmosis infection in the second trimester, who developed a severe adverse reaction in form of hypersensitivity pneumonia after antibiotic treatment with pyrimethamine and sulfadiazine and discuss the literature.


Toxoplasma gondii is an intracellular protozoan parasite. Infection can be acquired by consumption of tissue cysts in raw or poorly cooked meat or oocysts on unwashed food or in water, contaminated with cat faeces.1–3 With an adequate immune response, the acute stage of infection with parasitaemia of rapidly dividing tachyzoites changes to a chronic stage with persistence of slow-growing, cyst-forming bradyzoites.1–3

Approximately one-third of the world′s population is infected with T. gondii (prevalence varies considerably from 11% in the USA to 78% in Brazil),1 2 but in immunocompetent individuals, infections usually show no or only mild flu-like symptoms (eg, fever, malaise and lymphadenopathy).1 2 However, in pregnant women, primary infection (and in very rare cases in immunocompromised women either reactivation of chronic …

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  • Contributors SA conceived the presented idea and performed the literature search. SA wrote the manuscript with support from JK, GG and MH. All authors discussed the results and contributed to the final manuscript. MH supervised the project.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.