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PubMed1996

Eye manifestations of congenital toxoplasmosis.

PURPOSE: To determine the natural history of treated and untreated congenital toxoplasmosis and impact of this infection on vision. METHODS: In this prospective, longitudinal study, 76 newborns were treated with pyrimethamine and sulfadiazine for approximately one year, and 18 individuals not treated during their first year of life entered the study after age 1 year (historical patients). RESULTS: Chorioretinal scars were the most common eye finding in all patients and were most common in the periphery (58% of treated and 82% of historical patients). Macular scars were present in 54% of the treated patients; 41% were bilateral. Macular scars were present in 76% of the historical patients; 23% were bilateral. Visual acuity in the presence of macular lesions ranged from 20/20 to 20/400. Of the patients followed up from the newborn period and treated, 29% had bilateral visual impairment, with visual acuity for the best eye of less than 20/40. Causes for this visual impairment in eyes with quiescent lesions included macular scars, dragging of the macula secondary to a peripheral lesion, retinal detachment, optic atrophy, cataract, amblyopia, and phthisis. There were recurrences in both treated (13%, 7/54) and previously untreated historical patients (44%, 8/18). The total, median, and range of years of follow-up during which recurrences were observed were, for treated patients, 189 years (total), five years (median), and three to ten years (range) and, for historical, untreated patients, 160 years (total), 11 years (median), and three to 24 years (range). New lesions occurred in previously normal retinas and also contiguous to older scars. Active lesions appeared to become quiescent within ten to 14 days after beginning pyrimethamine and sulfadiazine therapy. CONCLUSION: Many children with congenital toxoplasmosis have substantial retinal damage at birth and consequent loss of vision. Nonetheless, vision may be remarkably good in the presence of large macular scars. Active lesions become quiescent with treatment.

Adolescent↗
PubMed2006

Globe calcification in congenital toxoplasmosis.

Various patterns of distribution of intracerebral calcification have been described in congenital toxoplasmosis. We report a case of congenital toxoplasmosis with a rare finding of calcification in the globe detected by CT scan that has not been described earlier.

Brain Diseases↗
PubMed1992

IgA antibody response during acquired and congenital toxoplasmosis.

Toxoplasma gondii specific IgA and IgM antibodies were quantitated by an antibody capture agglutination assay in 260 patients with acquired toxoplasmosis and from 94 fetuses suspected of congenital toxoplasmosis and 30 infected children. In acquired toxoplasmosis, IgA antibodies to T gondii were found in 95% of the cases. In congenital toxoplasmosis IgA antibodies were more frequently detected (75%) in cord blood than IgM antibodies (61%). They persisted after birth, in some cases for up to 24 months. IgA antibodies were also detected in fetuses whose mothers had toxoplasmosis during their pregnancy. In infected fetuses IgM and IgA antibodies were detected in fetal blood as early as week 24 of pregnancy. Detection of IgA T gondii antibodies may be useful for the diagnosis of some recently acquired infection and for the diagnosis and follow up of the infection in the fetus and neonate.

Adult↗
PubMedDate not supplied

Congenital toxoplasmosis in a 15 day-old infant. A case report.

A case congenital toxoplasmosis in a 15-day old infant was reported, citing the difficulties encountered in establishing the diagnosis due to the wide range of the disease's clinical spectrum. Congenital toxoplasmosis was suspected after finding hydrocephalus, cerebral calcification, and chorioretinitis. Serology tests with the ELISA technique were highly positive for antibodies against IgG, whereas anti-IgM was negative. The patient died before the second serological analysis was done. The final diagnosis of congenital toxoplasmosis was eventually established at autopsy, based on the detection of T. gondii in the brain, testicular, liver, spleen and striated muscle tissues.

Enzyme-Linked Immunosorbent Assay↗
PubMed1981

Reliability of IgM-IFA and IgM-IHA tests on pure IgM fractions obtained by a simple gel filtration method in acquired and congenital toxoplasmosis.

We have devised a rapid and inexpensive gel filtration method to separate IgM fractions from small amounts of serum. These fractions have been titrated with IgM-IFAT and IgM-IHAT, and their titers have been compared with those obtained on whole serum. The results show that the separation of IgM from IgG allows detection of IgM antibodies in many cases of acquired toxoplasmosis, especially in cases of congenital toxoplasmosis. False positive results due to the presence of rheumatoid factors are also avoided. The IHA test performed on IgM fractions is constantly negative.

Adult↗
PubMed1999

Prenatal diagnosis of congenital toxoplasmosis: a multicenter evaluation of different diagnostic parameters.

OBJECTIVE: Our purpose was to evaluate different methods of diagnosing congenital toxoplasmosis prenatally by amniocentesis and cordocentesis. STUDY DESIGN: In a retrospective multicenter study, we investigated consecutive women who had seroconversion for Toxoplasma gondii during pregnancy and who underwent either amniocentesis or cordocentesis or both to obtain a prenatal diagnosis of fetal toxoplasmosis. Data were obtained from 122 patients recruited in 6 different European Toxoplasma reference centers. Infants born to these mothers were followed up until 1 year of age to confirm or exclude congenital toxoplasmosis. Sensitivity, specificity, positive predictive value, and negative predictive value were measured for the following parameters: (1) detection of the parasite in amniotic fluid by mouse inoculation, (2) detection of the parasite in amniotic fluid by in vitro cell culture, (3) detection of Toxoplasma deoxyribonucleic acid in amniotic fluid by a polymerase chain reaction assay, (4) detection of the parasite in fetal blood by mouse inoculation, (5) detection of specific immunoglobulin M antibodies in fetal blood, and (6) detection of specific immunoglobulin A antibodies in fetal blood. RESULTS: The polymerase chain reaction test performed on amniotic fluid had the highest level of sensitivity (81%) and also a high level of specificity (96%). The combination of the polymerase chain reaction test and mouse inoculation of amniotic fluid increased sensitivity to 91%. The sensitivity of immunoglobulins M and A in fetal blood was 47% and 38%, respectively. In congenitally infected fetuses a negative correlation was observed between positive serologic parameters and gestational age at the time of maternal infection and at prenatal diagnosis. CONCLUSION: Congenital toxoplasmosis is best predicted by prenatal examination with the combination of T gondii polymerase chain reaction and mouse inoculation of amniotic fluid. The role of cordocentesis in the diagnosis of congenital toxoplasmosis is limited.

Amniocentesis↗
PubMed1988

[Congenital toxoplasmosis: value of modern IgM serodiagnosis is from the example of problem cases].

Congenital toxoplasmosis may be symptomatic or asymptomatic at the time of birth. In the latter case late manifestations may occur which can be avoided by early diagnosis and treatment. In comparison with the IgM-IFT we demonstrate the specificity and high sensitivity of a recently available immunosorbent agglutination assay (ISAGA) for the detection of IgM against toxoplasma. We also present evidence for the high diagnostic value of the ISAGA in cases where congenital toxoplasmosis is suspected. Based on the presented data we propose a pattern of diagnostic methods for the diagnosis or exclusion of congenital toxoplasmosis in newborns.

Antibodies, Protozoan↗
PubMed1990

Presence of gamma interferon in human acute and congenital toxoplasmosis.

The production of gamma interferon in acute acquired and congenital toxoplasmosis was studied. Gamma interferon was produced at significant titers (P less than 0.001) in the course of both congenital toxoplasmosis and acquired toxoplasmosis at an early stage of infection, when Toxoplasma gondii was multiplying. Its presence in fetal blood was correlated with the positive inoculation of fetal blood or amniotic fluid into mice (95%). The data suggest that the fetus is able to synthesize gamma interferon as early as week 21 of pregnancy. This test, easily and rapidly performed, could be included among those useful for diagnosing fetal toxoplasmic disease.

Acute Disease↗
PubMed1992

Neonatal screening for congenital toxoplasmosis in Denmark: presentation of the design of a prospective study.

The design of a two year prospective study of 45,000 mothers and their newborn children aiming at determining the incidence of congenital toxoplasmosis in Denmark is presented. Toxoplasma IgG antibodies in a bloodspot from the newborn, routinely collected on filterpaper (the Guthrie card), and IgG antibodies in a stored serum sample from the mother collected in the first trimester are compared. Seroconversion identify mothers infected with T. gondii during pregnancy and identify newborn children at risk of congenital toxoplasmosis. All children at risk will be treated and followed until congenital toxoplasmosis is verified or excluded. Children with verified congenital toxoplasmosis will be followed clinically and the effectiveness of the treatment will be evaluated. The study design allows determination of the materno-fetal transmission rate in untreated pregnancies, and will furthermore allow a good estimate of the incidence of congenital toxoplasmosis in Denmark. In addition we hope that the diagnosis and treatment of cases of subclinical toxoplasmosis will prevent chorioretinitis and minor cerebral disorders later in life. Of 6355 pregnancies tested during the first 3 month of the study, 14 cases of maternal seroconversions have been diagnosed. Only one child had detectable toxoplasma specific IgM antibodies at birth.

Antibodies, Protozoan↗
PubMed1994

Survey of local policies for prevention of congenital toxoplasmosis.

District policies for the primary and secondary prevention of congenital toxoplasmosis in England, Wales, Jersey, and the Isle of Man were surveyed in 1992. Consultants in communicable disease control were asked to describe past, present, and proposed prenatal screening programmes and current health education policies. One hundred and eighty-seven out of 196 districts responded to a postal questionnaire. One district had a prenatal screening programme for toxoplasmosis and five were discussing possible programmes. Over half (55%) had never had a programme or considered introducing one and 68 (36%) districts had decided against screening. Fifty-four per cent of districts had health education policies on toxoplasmosis, and most of these provided leaflets in antenatal clinics. A sample of districts that in 1992 were considering or had not ruled out screening was followed up in February 1994. None had implemented a screening policy. All but one district, therefore, are following the recommendation by a working group of the Royal College of Obstetricians and Gynaecologists that prenatal screening for toxoplasmosis should not be introduced in the United Kingdom. The value of current health education policies in the primary prevention of congenital toxoplasmosis needs to be assessed.

Female↗
PubMed1996

Resolution of intracranial calcifications in infants with treated congenital toxoplasmosis.

PURPOSE: To determine the natural history of intracranial calcifications in infants with treated congenital toxoplasmosis. MATERIALS AND METHODS: Between January 1982 and March 1994, cranial computed tomography was performed in 56 infants with treated congenital toxoplasmosis when they were newborns and approximately 1 year old. Locations and sizes of intracranial calcifications were noted. RESULTS: Forty newborns had intracranial calcifications. By 1 year of age, calcifications diminished or resolved in 30 (75%) and remained stable in 10 (25%) of these treated infants. Ten (33%) of the 30 infants whose calcifications diminished versus seven (70%) of the 10 infants with stable calcifications received less intensive antimicrobial treatment than the other treated infants. In contrast, a small number of infants who were untreated or treated 1 month or less had intracranial calcifications that increased or remained stable during their 1st year of life. CONCLUSION: Diminution or resolution of intracranial calcifications was an unexpected and remarkable finding in infants with treated, congenital toxoplasmosis, consonant with their improved neurologic functioning.

Anti-Infective Agents↗
PubMed2001

Epidemiology of congenital toxoplasmosis identified by population-based newborn screening in Massachusetts.

BACKGROUND: Fourteen years of newborn screening in Massachusetts for congenital toxoplasmosis infection identified subpopulations that appeared to have higher rates of infection. Elaborating an epidemiologic profile and risk correlates might aid implementing targeted prenatal education and newborn screening strategies with the goal of early postnatal treatment to prevent morbidity. OBJECTIVE: To describe the epidemiology of congenital toxoplasmosis in Massachusetts and risk correlates of infection using birth certificate data. METHODS: A case-control study was conducted based on Massachusetts birth certificate data. Cases were all infants with congenital toxoplasmosis identified by statewide universal newborn screening from 1988 to 1999. Controls were all children born on the same day as those infants in Massachusetts. RESULTS: Factors that strongly predicted congenital toxoplasmosis infection were mother's country of birth outside the US (especially the southeast Asian refugee origin countries of Cambodia and Laos), mother's educational level and higher gravidity. CONCLUSIONS: More extensive, culturally and linguistically appropriate, prenatal education is needed for pregnant women, regardless of a mother's educational level, especially for non-US-born mothers, and not focused only on primiparous women. Other states may be able to use their state-specific birth certificate data to compare risk profiles with those of Massachusetts to guide a toxoplasmosis screening policy on the basis of population similarities and differences.

Adult↗
PubMed1990

Onset of ocular complications in congenital toxoplasmosis associated with immunoglobulin M antibodies to Toxoplasma gondii.

Four patients with congenital toxoplasmosis serologically diagnosed by the Sabin-Feldman test (SFT) and the IgM-indirect fluorescent antibody test (IgM-IFAT) in the first year of life presented with eye disease between the age of 21 months and ten years. Repeated serological testing revealed increasing levels of specific antibodies as measured by the SFT. IgM antibodies to Toxoplasma gondii were detected in all four patients by the immunosorbent agglutination assay, in two by the IgM-IFAT and in three by the IgM-indirect haemagglutination test. Findings suggest that specific IgM antibodies reappear at the time of reactivation of congenital toxoplasmosis later in life, or possibly persist for an extraordinary long period (up to ten years).

Age Factors↗
PubMed2005

Association between congenital toxoplasmosis and parent-reported developmental outcomes, concerns, and impairments, in 3 year old children.

BACKGROUND: Information is lacking on the effects of congenital toxoplasmosis on development, behavior, and impairment in later childhood, as well as on parental concerns and anxiety. This information is important for counselling parents about the prognosis for an infected child and for policy decisions on screening. METHODS: We prospectively studied a cohort of children identified by screening for toxoplasmosis in pregnant women or neonates between 1996 and 2000 in ten European centers. At 3 years of age, parents of children with and without congenital toxoplasmosis were surveyed about their child's development, behavior, and impairment, and about parental concerns and anxiety, using a postal questionnaire. RESULTS: Parents of 178/223 (80%) infected, and 527/821 (64%) uninfected children responded. We found no evidence that impaired development or behavior were more common in infected children, or that any potential effect of congenital toxoplasmosis was masked by prenatal treatment. Parents of infected children were significantly more anxious and reported more visual problems in their children. CONCLUSION: On average, children aged three to four years with congenital toxoplasmosis identified by screening and treated during infancy in this European setting had risks of abnormal development and behavior similar to uninfected children. Parental anxiety about infected children needs to be addressed by clinicians. Future studies with longer follow up and clinician-administered assessments may be better able to detect any subtle differences in child outcomes.

Anxiety↗
PubMed1995

[Should a preventive congenital toxoplasmosis program be established in Switzerland?].

The Swiss Federal Office of Public Health established a multidisciplinary working group whose objectives were to review the subject of congenital toxoplasmosis (CT), to strengthen, as far as possible, the level of knowledge concerning congenital toxoplasmosis in Switzerland (particularly the epidemiological and economic aspects) and to propose a CT prevention programme acceptable to all concerned medical disciplines. Two main questions were considered: (1.) Does the size of the congenital toxoplasmosis problem justify the cost of a systematic screening programme for pregnant women? (2.) How secure is laboratory diagnosis? Neither the national system of reporting by laboratories and physicians, mortality statistics nor insurance records are adequate to estimate the incidence of congenital toxoplasmosis. A study carried out at the main hospital departments of neonatology and pediatrics in Switzerland provides a more accurate estimate but does not match the number of cases predicted by mathematical models. The discrepancy does not put the seroprevalence studies in doubt but rather the estimate of the rate of transmission of T. gondii to the fetus and its degree of virulence. The implementation of a better surveillance system would provide information for adoption and funding of a prevention programme based on facts rather than estimations. Those who support a generalized screening programme for pregnant women must also make an effort to convince the community of its importance. A prenatal screening programme for pregnant women should resolve problems rather than create new ones. The security of the diagnosis of an infection and the effects to the fetus are of vital importance for the principle primum nil nocere.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-Benefit Analysis↗
PubMed1999

Three children with congenital toxoplasmosis: early report from a Swedish prospective screening study.

The aim of this prospective study was to define the incidence of congenital toxoplasmosis in Sweden. Blood eluates collected on filter papers, Guthrie cards, from 40978 newborn babies were analysed for specific immunoglobulin M (IgM) and IgG antitoxoplasma antibodies. This is a preliminary report of three children with congenital toxoplasmosis, defined by the occurrence of antitoxoplasma-specific IgM antibodies. Two children were asymptomatic at birth. They were both normally developed at the age of 12 and 15 months, respectively. The third child had unidentified but uncomplicated symptoms of infection in the neonatal period. As a result of the screening congenital toxoplasmosis was confirmed and treatment instituted. Microphthalmus and peripheral chorioretinitis were detected in one eye. In spite of the chemotherapeutic treatment he developed hydrocephalus needing neurosurgical intervention at the age of 3 months. His development at 14 months was normal. The incidence in Sweden of congenital toxoplasmosis detected by specific IgM antitoxoplasma antibodies in blood from filter papers is less than 1:10000.

Anti-Bacterial Agents↗