A small outbreak of spontaneous abortion in four patients from two households.

To the Editor: Two sisters, Patient K (age 36) and Patient S (age 38) lived in the same household and shared all foods prepared in their home. Patient K was pregnant, and her sister, Patient S, became pregnant two months later. Patient K suffered a sudden, spontaneous abortion; two months later, Patient S also suffered a spontaneous abortion. Two sisters-in-law, Patient L (age 33) and Patient 2 (age 27), resided in the same household and shared all meals. About two months after Patient Z became pregnant, Patient L also became pregnant. Patient Z’s pregnancy ended in spontaneous abortion, and two months later, Patient L also suffered a spontaneous abortion. All four patients had positive indirect hemagglutination (IHA) tests for toxoplasmosis. Over a five-year period, 139 pregnant women visiting the Mother and Child Care Center in Risafa, Iraq, tested IHA-positive for toxoplasmosis infection; however, only four women (two pairs of women, each pair sharing households) had spontaneous abortions. Women with serological evidence of toxoplasmosis infection prior to pregnancy do not infect their neonate; the fetus may be at risk only when primary infection is acquired during pregnancy.’ Toxoplasmosis is transmitted to the fetus in utero during a pregnancy only as a result of parasitemia.Q The modes of transmission of toxoplasmosis in our culture, and especially in our four patients, have not been definitively established. Cooked meat cannot be considered a vehicle for infection in Iraq. However, direct contamination by flies3 and cockroaches4 serving as the mechanical carriers for the oecyst from cat feces is possible. There is a close association between the prevalence of toxoplasmosis in humans and the presence of toxoplasmosis in domestic cats.5T6 Toxoplasmosis infection is a preventable disease, and, even when primary infection occurs during pregnancy, early diagnosis and treatment can reduce the frequency and severity of disease in the neonate.7