Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study

Abstract

Aim: Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. Methods: Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. Results: Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. Conclusion: Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.

Diagnosing congenital toxoplasmosis: where are we? A systematic review

“…Table 1 provides an overview of all studies included in the final sample and of all data elements used during the data analysis process. The 41 studies were distributed into the previously determined three categories as follows: DIAGNOSTIC METHODS [2,4,5,8,9,12,14,16,17,20,25,27,29,32,34,35,37,41,42 (nineteen studies)]; DIAGNOSIS IN PREGNANT WOMEN [ 3,7,10,14,25,27,35,42,46,50,51,53, 59 thirteen studies)]; DIAGNOSIS IN NEONATES [7,8,11,20,61,64,65,67,68,70,71,72 (twelve studies)] and DIAGNOSIS IN INFANTS [1,3,5,9,11,12,20,27,…”

Prognosis of Fetal Parenchymal Cerebral Lesions without Ventriculomegaly in Congenital Toxoplasmosis Infection

“…These two questions still remain very controversial. Surprisingly, only few reports on cerebral US findings in case of fetal infection have been reported [3,[7][8][9][10][11] . Whatever the recommendation on systematic maternal serum screening across different countries, we consider that the cerebral signs associated with congenital toxoplasmosis should be more largely diffused.…”

“…Whatever the recommendation on systematic maternal serum screening across different countries, we consider that the cerebral signs associated with congenital toxoplasmosis should be more largely diffused. Except for cases of significant ventricular dilation, very few studies have focused on fetal cerebral signs in congenital toxoplasmosis [3,[7][8][9][10][11]] . Yet, a better knowledge of these signs would be of interest as fetal prognosis largely depends on the severity of the cerebral damage.…”

“…To the best of our knowledge, the association between these calcifications and the neurodevelopment of the children has not yet been specifically assessed. In the prenatal period, cerebral hyperechogenic foci have been described in case of congenital toxoplasmosis, but most often associated with ventriculomegaly, making it difficult to evaluate their specific impact on future neurological development [7,8] . Some authors described them as 'calcification' by analogy with the images of calcifications that may be observed later on in life on skull radiographs of patients with neurological impairment [11] .…”

Toxoplasma seroepidemiology in women who intend to marry in Jahrom, Islamic Republic of Iran

“…In a prospective study in Italy, prenatal polymerase chain reaction showed that seven of 50 (14%) had positive immunological status for toxoplasmosis, and 17% of their infants were infected at 1 year serological follow-up [18]. In a study in Shanghai, China to explore the prevention and treatment of early pregnancy TORCH infection (toxoplasmosis, other infections, rubella, cytomegalovirus, herpes simplex 2), 3.28% of cases were positive for Toxoplasma IgM antibody [19].…”