One severe case of congenital toxoplasmosis in China with good response to azithromycin

Abstract

Background Most infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly. Case presentation A male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference. Conclusions Timely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.

Guías Latinoamericanas de Infecciones Congénitas y Perinatales de la Sociedad Latinoamericana de Infectología Pediátrica (SLIPE). Parte II

“…La pirimetamina se suspende definitivamente si los neutrófilos son < 500 céls/ mm 3 . Una alternativa es azitromicina 10 mg/kg/día durante 8 días al mes, hasta que se observe recuperación de los neutrófilos 77 . Otra alternativa que aparece en la guía colombiana de toxoplasmosis congénita en caso de alergia a sulfas es la asociación de pirimetamina 1 mg/ kg/día vía oral con clindamicina 20 mg/kg/día intramuscular, dividido en tres dosis en la fase aguda, y luego se cambia a clindamicina oral (clindamicina suspensión 75 mg = 5 mL) para mantenimiento hasta el primer año de vida 23 .…”

“…También se ha propuesto como tratamiento alternativo el uso de cotrimoxazol, extrapolado de su uso en adultos con infección por VIH y toxoplasmosis cerebral; sin embargo, no existen estudios que analicen su eficacia en niños con toxoplasmosis congénita 78 . Existe reporte de un caso tratado en combinación con azitromicina en China con buena respuesta (Tabla 2) 77 .…”

A Comprehensive Review of Toxoplasmosis: Serious Threat to Human Health

“…Congenital toxoplasmosis in newborns can be asymptomatic or cause retinochoroiditis and CNS involvement [126]. Congenital toxoplasmosis is thought to affect 1-10 out of every 10,000 live births in the United States, 770 live births in Brazil, and 3,000 live births in France [67].…”