Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: A cohort study in 13 European centres

Abstract

Aim: To determine the effectiveness of prenatal treatment for clinical manifestations of congenital toxoplasmosis. Methods: We prospectively identified 255 live‐born infants with congenital toxoplasmosis using prenatal or neonatal screening. We determined the effect of prenatal treatment on the risks of intracranial or ocular lesions in infancy, accounting for gestational age at maternal seroconversion. Results: Prenatal treatment within 4 wk of seroconversion reduced the risk of intracranial lesions compared with no treatment (odds ratio, OR 0.28; 95% CI: 0.08–0.75), but there was no significant effect when initiated after 4 wk (OR 0.76; 95% CI: 0.35–1.59; overall p‐value 0.19). Compared to spiramycin alone, no treatment doubled the risk of intracranial lesions (OR 2.33; 95% CI: 1.04–5.50), but the risk did not differ with pyrimethamine‐sulphonamide treatment (overall p‐value 0.52). There was no consistent relationship between the type or timing of treatment and the risk of ocular lesions. Gestational age at maternal seroconversion was inversely associated with the risk of intracranial but not ocular lesions. Conclusion: Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta‐analysis of individual patient data from cohort studies is required to confirm these findings.

Association between the risk of congenital toxoplasmosis and the classification of toxoplasmosis in pregnant women and prenatal treatment in Brazil, 1994–2009

“…On the other hand, the two other drug regimens are mainly prescribed if fetal toxoplasmosis is confirmed, since spiramycin does not cross the placental barrier, which makes it ineffective for treatment of the fetus. 13,14,17,28,30 In the present study, there were no significant differences in CT transmission rates when regimens 2 and 3 were compared to regimen 1. In the reviewed literature, only two French studies associated transmission rates of CT to particular drug regimens.…”

“…The three prenatal treatment regimens analyzed by the authors are the ones most commonly recommended in consensus documents and guidelines drawn up by groups studying toxoplasmosis in different countries, such as: EMSCOT (European Multicenter Study on Congenital Toxoplasmosis), 28 the SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group, 17 the Royal Institute of Public Health in the UK, 16 the US Centers for Disease Control and Prevention (CDC) National Center for Infectious Diseases, 27 the Argentine Congress of Congenital Toxoplasmosis, 23 and, in Brazil, from the Brazilian Network of Toxoplasmosis and State Health Secretariat Paraná 29 and the State Health Secretariat, FD. 7 Furthermore, future publications from the Program of Toxoplasmosis of the Ministry of Health in Brazil will include guidelines on specific drug regimens (personal communication).…”

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in Trinidad and Tobago

“…Taking into account that prenatal screening may be a viable option for populations with high rates of primary infection during pregnancy (up to 3.5%) (44), it is worth considering routine screening as an interim measure, with prompt treatment for those who become infected during pregnancy. It is relevant to mention that contrary to reports suggesting evidence for prenatal treatment of toxoplasmosis (9,34,45), there are reports that show a lack of support for this approach (45)(46)(47).…”

Treatment of Toxoplasmosis: Historical Perspective, Animal Models, and Current Clinical Practice

“…In a large European CT study involving 11 centers, antenatal spiramycin or pyr-sulf treatment did not prevent vertical transmission irrespective of the timing of antimicrobial initiation (157). In another European study involving 13 centers, prenatal treatment within 4 weeks of seroconversion reduced clinical signs, but there was no difference between pyr-sulf and spiramycin (170).…”