Toxoplasmosis can be a frightening diagnosis. Caused by a common parasite, the infection usually produces no problems for healthy people. But if contracted during pregnancy, toxoplasmosis can trigger a miscarriage or severe complications in the unborn child –- including blindness and mental retardation –- often before the mother realizes anything is wrong.

In the United States, roughly 4,000 babies are born with toxoplasmosis each year, and an unknown additional number are lost to infection-induced miscarriage. But those rates could be reduced significantly if testing for toxoplasmosis became a routine part of prenatal care, said Jose Montoya, M.D., who co-directs the Research Institute's Toxoplasma Serology Laboratory.

Much of what is known about toxoplasmosis comes from work done at PAMF, particularly by Jack Remington, M.D., director of the Department of Immunology and Infectious Diseases. Dr. Rem-ington and his colleagues have spent decades developing "gold-standard" tests to diagnose the infection accurately. The Research Institute hosts the national reference laboratory for toxo-plasmosis (www.pamf.org/serology), analyzing samples sent from around the world. Now, said Drs. Montoya and Remington, their goal is to see those tests made more widely available.

Many pregnant women in the United States are never tested for toxoplasmosis if they do not report eating undercooked meat, being in contact with cat feces or gardening, the most common infection routes. Unfortunately, Dr. Montoya said, patients' memories are often wrong, and many infections go undiagnosed. In the coming years, PAMF researchers hope to convince insurers, legislators and medical societies that set obstetric guidelines to require routine toxoplasmosis testing for pregnant women. "We believe that all pregnant women in the United States should have access to that standard of preventive care," Dr. Montoya said.

PAMF researchers are building on their work with toxoplasmosis to create reliable prenatal diagnostic tests for other diseases that can have serious effects if contracted by the fetus in utero, such as rubella and cytomegalovirus. Ideally, these tests would also someday be made routinely available to pregnant patients, Dr. Remington said. Physicians should also be encouraged to educate women on how to prevent such infections, something that few clinicians do, he added.

In addition to their research on toxoplasmosis, Drs. Montoya and Remington also work to better understand infections in patients with weakened immune systems. Their work has led to the creation of a unique unit at Stanford University Hospital for patients who develop infections after cancer treatment or organ transplants, where they are seen by specialists who understand their particular challenges.

"Patients with compromised immune systems are susceptible to many microbes that pose no problem for healthy people. You have to know what all the possibilities are. You also have to understand how antimicrobial drugs interact with immuno-suppressant drugs," Dr. Montoya explained. "To date, there has not been much research in this population, but we are dev-eloping the specialized knowledge to better treat these vulnerable patients."

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