Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial

Sitta, Rémi; Thiébaut, Rodolphe; Laurichesse‐Delmas, H.; Pons, Denis; Nourrisson, Céline; Winer, Norbert; Lavergne, Rose‐Anne; Berrébi, Alain; Fillaux, Judith; Assouline, Corinne; Mesnard, Louis; Villena, Isabelle; Bory, J; Bouar, G. Le; Robert‐Gangneux, Florence; D’ercole, C.; L’Ollivier, Coralie; Bretelle, Florence; Guidicelli, B.; Garcia, Patricia; Cordier, A.; Benachi, Alexandra; Vauloup‐Fellous, Christelle; Letamendia, Emmanuelle; Ville, Y.; Bougnoux, Marie‐Elisabeth; Perrotin, Franck; Langendonck, Nathalie Van; Potin, J.; Marty, Pierre; Pomarès, Christelle; Trastour, C.; Houfflin‐Debarge, V.; Deleplancque, Anne Sophie; Kieffer, François; Jouannic, Jean‐Marie; Costa, Jean‐Marc; Cheve, Marie-Thérèse; Col, Jean-Yves; Biquard, F.; Cimon, Bernard; Sterkers, Yvon; Lachaud, Laurence; Burlet, G.; Maréchaud, M; Perraud, Estelle; Grebille, Anne-Gaëlle; Valentin, M.; Houzé, Sandrine; Omnès, Sophie; Chitrit, Yvon; Boissinot, C.; Yera, Hélène; Anselem, O.; Tsatsaris, Vassilis; Sénat, Marie-Victoire; Fuchs, Florent; Angoulvant, Adéla; Muszynski, Charles; Totet, Anne; Noël, Catherine; Bidat, Laurent; Barjat, Tiphaine; Flori, Pierre; Pelloux, Hervé; Brenier-Pinchart, Marie-Pierre; Thong-Vanh, Catherine; Mandelbrot, Laurent; Floch, Corinne; Carbillon, Lionel; Lachassine, Eric; Ricbourg, Aude; Paris, Luc; Dommergues, Marc; Rousseau, Thierry; Dalle, Frédéric; Dardé, Marie Laure; Aubard, Véronique; Olivier, Camille; Verspyk, Eric; Favennec, Loïc

doi:10.1016/j.ajog.2018.05.031

Cited by 82 publications

(77 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An Austrian study also demonstrated a 6-fold decrease in CT among babies born to mothers who received appropriate antenatal treatment versus no treatment (162). A recent randomized, open-label trial in 36 French centers, comparing pyr-sulf plus folinic acid to spiramycin following seroconversion in pregnant women, revealed a lower rate of placental transmission with pyr-sulf than that with spiramycin; the study showed a trend toward lower transmission rates but failed to show statistical significance, since only 143 women were enrolled between November 2010 and January 2014 (173). The difference was strongest when treatment was started within 3 weeks after seroconversion, and the incidence of abnormal ultrasound findings was significantly lower for patients receiving pyr-sulf than for those receiving spiramycin (173).…”

Section: Congenital Toxoplasmosismentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

SUMMARYPrimary infection is usually subclinical, but cervical lymphadenopathy or ocular disease can be present in some patients. Active infection is characterized by tachyzoites, while tissue cysts characterize latent disease. Infection in the fetus and in immunocompromised patients can cause devastating disease. The combination of pyrimethamine and sulfadiazine (pyr-sulf), targeting the active stage of the infection, is the current gold standard for treating toxoplasmosis, but failure rates remain significant. Although other regimens are available, including pyrimethamine in combination with clindamycin, atovaquone, clarithromycin, or azithromycin or monotherapy with trimethoprim-sulfamethoxazole (TMP-SMX) or atovaquone, none have been found to be superior to pyr-sulf, and no regimen is active against the latent stage of the infection. Furthermore, the efficacy of these regimens against ocular disease remains uncertain. In multiple studies, systematic screening for infection during gestation, followed by treatment with spiramycin for acute maternal infections and with pyr-sulf for those with established fetal infection, has been shown to be effective at preventing vertical transmission and minimizing the severity of congenital toxoplasmosis (CT). Despite significant progress in treating human disease, there is a strong impetus to develop novel therapeutics for both the acute and latent forms of the infection. Here we present an overview of toxoplasmosis treatment in humans and in animal models. Additional research is needed to identify novel drugs by use of innovative high-throughput screening technologies and to improve experimental models to reflect human disease. Such advances will pave the way for lead candidates to be tested in thoroughly designed clinical trials in defined patient populations.

show abstract

Section: Congenital Toxoplasmosismentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Moreover, there appeared to be a 3-week window of opportunity for initiation of treatment after maternal seroconversion. Two women in the pyrimethamine + sulfadiazine group developed a severe rash that required hospitalization 95 . Since sulfadiazine can precipitate a hemolytic crisis in individuals with glucose 6-phosphate dehydrogenase (G6PDH) deficiency, G6PDH testing should be considered before initiation of treatment.…”

Section: • If Vertical Transmission Is Confirmed Fetal Infectionmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in congenital infection

Khalil

Sotiriadis

Chaoui³

et al. 2020

Ultrasound in Obstet & Gyne

130

View full text Add to dashboard Cite

ISUOG Practice Guidelines: role of ultrasound in congenital infection Clinical Standards Committee The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (

show abstract

“…). Fransa'da seroprevalans oranı %37-44 gibi daha yüksek oranlarda olduğu için gebeliğin başlangıcında bakılan anti-T. gondii IgG ve IgM'ye ek olarak bir, iki veya üç ay aralarla T. gondii'ye spesifik antikorların tekrar taranması önerilmektedir(13). Ülkemizde Sağlık Bakanlığı'nın bu konuda bir önerisi olmadığı için farklı kuruluşlar toksoplazmozis tarama ve yönetimini farklı şekilde yapmaktadırlar(10).…”

unclassified

Retrospective Evaluation of the Seropositivity Rate of Toxoplasmosis and Clinical Results in Pregnant Women That were Admitted to a Tertiary Health Institution Between 2012 and 2017 in Turkey

Durukan¹,

Kıllı²

2019

Turkiye Parazitol Derg

View full text Add to dashboard Cite

The aim of this study was to determine the frequency of toxoplasmosis in pregnant women who were admitted to our hospital in their first trimester and to contribute to screening and management strategies by evaluating clinical outcomes. Methods: In this retrospective study, women in their first trimester of pregnancy who were aged between 15-49 years, admitted to the Mersin University Medical Faculty Gynecology and Obstetrics outpatient clinic between 2012-2017, and screened for Toxoplasma gondii immunoglobulin M (IgM) antibodies were included. The data was obtained from the hospital's digital records. First, the high-risk patients were identified who had anti-T. gondii IgM seropositivity and subsequently underwent anti-T. gondii immunoglobulin G (IgG) and anti-T. gondii IgG avidity tests. Next, the invasive procedures and medical treatments performed for diagnosis and treatment, as well as the clinical course and results for each patient were evaluated. Cases were then analyzed according to the admittance year and patient's age. Results: Anti-T. gondii IgM positivity was found in 266 (7.66%) of 3474 pregnant women meeting the study's criteria. The frequency of the Toxoplasma IgM seropositivity was the highest in the 15-25 age group and this frequency decreased gradually as the age of the patients increased. Congenital toxoplasmosis was detected in 1 of 61 patients who had a positive polymerase chain reaction for T. gondii performed in the amniotic fluid. Conclusion: In our province, the prevalence of anti-T. gondii IgM was found to be 7.66% in pregnant women who were admitted to a tertiary health institution in their first trimester of pregnancy. This rate is much higher than the average in Turkey; therefore, we suggest that routine screening of pregnant women for T. gondii may be recommended in this region.

show abstract

Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial

Cited by 82 publications

References 38 publications

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

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

ISUOG Practice Guidelines: role of ultrasound in congenital infection

Retrospective Evaluation of the Seropositivity Rate of Toxoplasmosis and Clinical Results in Pregnant Women That were Admitted to a Tertiary Health Institution Between 2012 and 2017 in Turkey

Contact Info

Product

Resources

About