Prenatal brain imaging in congenital toxoplasmosis

Malinger, G.; Werner, Heron; Leonel, Jorge; Rebolledo, M.; Duque, Marta; Mizyrycki, S.; Lerman‐Sagie, Tally; Herrera, Mauricio

doi:10.1002/pd.2795

Cited by 58 publications

(45 citation statements)

References 15 publications

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“…In toxoplasmosis, fetuses usually demonstrate cerebral parenchymal echogenic nodules occurring in multiple areas without predilection for the periventricular zone [21]. In our study, the three fetuses presented with multiple parenchymal calcifications, which were in fact better demonstrated using US than MRI, as usually observed.…”

Section: Discussionsupporting

confidence: 58%

Prenatal brain MRI of fetuses with Zika virus infection

et al. 2016

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Results Three out of 12 cases of severe cerebral lesions fulfilled all inclusion criteria. History of maternal Zika virus infection had been documented in two cases. Calcifications and ventriculomegaly were present at US in all cases. MRI showed micrencephaly (n = 3), low cerebellar biometry (n = 2), occipital subependymal pseudocysts (n = 2), polymicrogyria with laminar necrosis and opercular dysplasia (n = 3), absent (n = 1) or hypoplastic (n = 1) corpus callosum and hypoplastic brainstem (n = 1). Conclusion Severe cerebral damage was observed in our series, with indirect findings suggesting that the germinal matrix is the principal target for Zika virus. The lesions are very similar to severe forms of congenital cytomegalovirus and lymphocytic choriomeningitis virus infections.

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Section: Discussionsupporting

confidence: 58%

Prenatal brain MRI of fetuses with Zika virus infection

et al. 2016

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“…The most specific signs are cerebral calcifications and ventricular enlargement, which mimic ZIKV infection effects, as illustrated in Fig. 2A and B (54,55). Despite significant cerebral lesions, microcephaly has not been described at birth (primary microcephaly) (54,56), but it can be observed later (secondary microcephaly).…”

Section: Toxoplasmosismentioning

confidence: 94%

Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes

et al. 2016

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SUMMARYThe rapid spread of the Zika virus (ZIKV) in the Americas and its potential association with thousands of suspected cases of microcephaly in Brazil and higher rates of Guillain-Barré syndrome meet the conditions for a Public Health Emergency of International Concern, as stated by the World Health Organization in February 2016. Two months later, the Centers for Disease Control and Prevention (CDC) announced that the current available evidence supports the existence of a causal relationship between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Microcephaly can be caused by several factors, and its clinical course and prognosis are difficult to predict. Other pathogens with proven teratogenicity have been identified long before the current ZIKV epidemic. Despite the growing number of cases with maternal signs of infection and/or presence of ZIKV in tissues of affected newborns or fetuses, it is currently difficult to assess the magnitude of increase of microcephaly prevalence in Brazil, as well as the role of other factors in the development of congenital neurological conditions. Meanwhile, health agencies and medical organizations have issued cautious guidelines advising health care practitioners and expectant couples traveling to, returning from, or living in affected areas. Analogous to dengue virus (DENV) epidemics, ZIKV has the potential to become endemic in all countries infested byAedesmosquitoes, while new mutations could impact viral replication in humans, leading to increased virulence and consequently heightened chances of viral transmission to additional naive mosquito vectors. Studies are urgently needed to answer the questions surrounding ZIKV and its role in congenital neurological conditions.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Objective: To evaluate the neurodevelopmental and ocular outcome of a continuous retrospective series of fetal toxoplasmosis infections for which prenatal ultrasound (US) follow-up revealed abnormal cerebral findings without associated ventriculomegaly. Materials and Methods: We retrospectively reviewed all cases of proven fetal Toxoplasma gondii infection with fetal cerebral anomalies at US examination without significant ventriculomegaly (≥10 mm) evaluated in our center over a 5-year period. US and magnetic resonance imaging findings were collected. The neurodevelopmental and ocular outcomes of the cases were studied. Results: Nine fetuses were included. Hyperechogenic foci of the cerebral parenchyma were isolated in five cases. Among those, four children had normal neurological development. Amblyopia was detected in on case. Hyperechogenic foci were associated with other anomalies of cerebral parenchyma in three cases among which two children had normal neurological development. Termination of pregnancy was performed in three cases: one case within the context of severe maternal schizophrenia with isolated hyperechogenic foci, one case where hyperechogenic foci were associated with extensive lesions of the white matter, and one case for severe fetal hydrops. Conclusion: The neurological prognosis of cerebral hyperechogenic lesions without ventriculomegaly in fetal toxoplasmosis infection may be favorable. The risk of ocular damage however remains high and unpredictable in the prenatal period.

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Prenatal brain imaging in congenital toxoplasmosis

Abstract: Ventriculomegaly associated with multiple echo-dense nodules is characteristic of severe fetal toxoplasmosis and carries a poor prognosis. When the ventricles have normal size or are only mildly dilated, the nodules restricted to the parenchyma development may be normal.

Cited by 58 publications

References 15 publications

Prenatal brain MRI of fetuses with Zika virus infection

Prenatal brain MRI of fetuses with Zika virus infection

Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes

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

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