Characterization of Congenital Toxoplasmosis in Israel

Abstract

Background: Congenital toxoplasmosis (CT) can cause significant neurologic manifestations and other untoward sequelae. Neither the current epidemiology nor the disease severity of CT in Israel is known. Methods: Records of CT were collected from the National Toxoplasmosis Reference Laboratory and from 15 medical centers across Israel between 2001 and 2017. Eligible case-patients were fetuses or infants <12 months of age at the time of diagnosis. Results: Of the 43 CT cases identified, 24 (55%) were in Jews and the remaining 19 cases were in patients of Arab (non-Bedouin) origin. The overall annual estimated rate of symptomatic CT was calculated as 0.55 per 100,000 live births. One or more severe clinical manifestations were reported in 12 (46%) of the 28 live-born infants and included cerebral calcifications (7 cases), chorioretinitis (4 cases), hydrocephalus (2 cases) and 1 case of death. Sensitivities of blood polymerase chain reaction (PCR), cerebrospinal fluid PCR and IgM antibody tests were 50% each. However, analyzing PCR samples from both sites, together with IgM testing, increased the sensitivity to 93%. Conclusions: The relative rate of severe manifestations was higher than in previous European reports. It is possible that the greater disease severity observed in Israel is in part due to the lack of systematic antenatal treatment and screening. Arab (non-Bedouin) infants are at higher risk for contracting CT. Performing serologic and PCR tests simultaneously is essential to improve CT diagnosis. This study demonstrates a need for an educational program to target high-risk populations.

Congenital Toxoplasmosis: The State of the Art

“…The prevalence and severity of principal signs of disease are significantly different in the United States, France, other Western European countries, Israel, and South America ( 23 – 30 ). The reported rate of severe congenital toxoplasmosis is higher in the United States and South America in comparison to European countries due to different and more virulent T. gondii strains implicated and in the absence of antepartum treatment in the United States ( 1 , 14 , 31 – 34 ).…”

“…The reported rate of severe congenital toxoplasmosis is higher in the United States and South America in comparison to European countries due to different and more virulent T. gondii strains implicated and in the absence of antepartum treatment in the United States ( 1 , 14 , 31 – 34 ). In Israel the proportion of severe disease is higher than in Europe probably because of the lack of systematic prenatal screening and treatment but is lower in comparison to United States ( 30 ).…”

Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020

“…The results indicate high infant mortality due to congenital toxoplasmosis in Brazil compared to other countries, even if a small number of studies address the theme [19,20], highlighting that toxoplasmosis is more severe in South American countries than others arguing that the Toxoplasma gondii strains in this region of the continent are more virulent than those in the northern hemisphere [21]. The trend of infant mortality due to congenital toxoplasmosis found in this study was increasing, which points to the need for even firmer interventions in coping with the disease.…”

Toxoplasmosis Infection in Newborn

“…In humans, the infection usually occurs through eating raw or undercooked meat containing viable tissue cysts and drinking the water and food contaminated with feces of infected cats, moreover it can also be transmitted from the mother to the embryo. [ 3 4 5 ] All felids can be the final hosts of T. gondii ; infected cats excrete T. gondii oocytes through their feces. [ 6 ] T. gondii infection is traditionally asymptomatic and self-limiting in immunocompetent people; however, it can cause a variety of life-threatening clinical complications in immunocompromised individuals.…”