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PubMed1999

Diagnosis of congenital toxoplasmosis in the neonatal period: A multicenter evaluation.

OBJECTIVE: To evaluate different laboratory tests used to diagnose congenital toxoplasmosis in the neonatal period. STUDY DESIGN: A retrospective multicenter study of 294 pregnant women who experienced seroconversion for Toxoplasma gondii and subsequently delivered live-born infants. Fetal infection was assessed via specific IgM and IgA antibodies (cord and neonatal blood) and detection of T gondii in placenta and cord blood by mouse inoculation. RESULTS: Ninety-three (32%) of the 294 infants were congenitally infected. The sensitivity of IgA in cord blood and in neonatal blood was 64% and 66%; the sensitivity of IgM was 41% and 42%, respectively. Mouse inoculation of the placenta and cord blood had sensitivities of 45% and 16%. Positive results of the serologic tests in congenitally infected children correlated significantly with the gestational age at the time of maternal infection but was not significantly influenced by the administration of specific antiparasitic treatment during pregnancy. CONCLUSION: Specific T gondii IgA antibody is a more sensitive test than IgM for detecting congenital toxoplasmosis in the neonatal period. The overall specificity is better for serologic tests performed on neonatal blood than for those on cord blood. Neonatal screening with IgM or IgA antibodies will not detect the majority of children with congenital toxoplasmosis when the maternal infection occurred before the 20th week of pregnancy.

Anti-Bacterial Agents↗
PubMed2002

A theoretical analysis of the relations between the risk of congenital toxoplasmosis and the annual infection rates with a convincing argument for better public intervention.

In a theoretical analysis of the present study, we quantitatively indicate a potential threat of congenital toxoplasmosis to Japanese young women by the use of a simple mathematical model or a special case of the well-known catalytic infection model. For introducing a risk function of congenital toxoplasmosis, an annual infection rate, r, was divided into r(1), the rate before age a(0 < a < 15), and r(2), the rate after age a. Presuming the values of r(1), r(2) and a on the basis of the current situation of Toxoplasma infection in Japan, simulation analyses were performed with the mathematical model. As the simulation clearly demonstrated, Japanese young women are potentially facing a threat of congenital toxoplasmosis, although the current risk of it is relatively lower. From the viewpoint of risk management, public intervention programs are required. Based on our analyses, public intervention programs can be classified into two groups: group 1 for women before age a and group 2 for those after age a, and each group is expected to give a different kind of effect to the risk of congenital toxoplasmosis. The present study implies that a certain public intervention program could augment the risk, inadvertently.

Adolescent↗
PubMedDate not supplied

Possible reasons for failure of conventional tests for diagnosis of fatal congenital toxoplasmosis: report of a case diagnosed by PCR and immunoblot.

Diagnosis of subclinical congenital toxoplasmosis has to rely on serological methods or isolation of the parasite. We present a case of congenital toxoplasmosis, in which conventional tests failed to establish the diagnosis. It was shown that this infant developed an intrathecal antibody response that was directed only against one of two Toxoplasma gondii strains used for routine diagnosis. In contrast to conventional tests, the diagnosis of cerebral toxoplasmosis could be established by using immunoblot and polymerase chain reaction (PCR). We therefore suggest that in unclarified cases, PCR and immunoblot, using at least two different strains of T. gondii, should be considered as additional tools for diagnosis of an infection with Toxoplasma and that examination of cerebrospinal fluid may be critical.

Adult↗
PubMed2002

Genotype of 86 Toxoplasma gondii isolates associated with human congenital toxoplasmosis, and correlation with clinical findings.

To study the influence of Toxoplasma gondii genotypes on the severity of human congenital toxoplasmosis (asymptomatic, benign, or severe infection or newborn or fetal death), 8 microsatellite markers were used to analyze 86 T. gondii isolates collected from patients with congenital toxoplasmosis. Seventy-four different genotypes were detected, some identical genotypes originating probably from the same source of contamination. The 3 less polymorphic microsatellite markers associated with 6 isoenzymatic markers allowed a classification of isolates into the 3 classical types and detected atypical genotypes. Whatever the clinical findings, type II isolates were largely predominant (84.88% in the whole collection and 96.49% in 57 consecutive cases). Type I and atypical isolates were not found in asymptomatic or benign congenital toxoplasmosis. However, in 4 cases in which children were not infected despite isolation of T. gondii from placenta, only type I isolates were found.

Animals↗
PubMed2005

Congenital toxoplasmosis from an HIV-infected woman as a result of reactivation.

Congenital toxoplasmosis usually results from acquired infection in non-immune pregnant women. However, severely HIV-infected women with a latent Toxoplasma infection can transmit the parasite as a result of reactivation. We report a case of toxoplasmic reactivation in an HIV-infected woman with moderate immunosuppression resulting in a severe congenital toxoplasmosis.

Adult↗
PubMed2001

Serological rebound in congenital toxoplasmosis: long-term follow-up of 133 children.

UNLABELLED: Although serological rebound is common in infants with congenital toxoplasmosis, clinical recommendations for management, in particular the need for additional treatment, vary. The goals of our retrospective cohort study in 133 consecutive children with congenital toxoplasmosis were to estimate the incidence and duration of the rebounds, identify predictive factors, assess the long-term risk of eye lesions and the need for treatment. We first estimated the incidence and duration of rebounds and identified predictive factors using an univariate analysis and a Cox model modified to include time-dependent variables. Two cohort studies were then conducted to compare the incidence density of secondary eye lesions in children who had a rebound versus no rebound, and among children who had a rebound after initial therapy, in those who received an additional course of treatment and in those who did not. Of the 133 children, 93 (70%) had at least one rebound during a mean follow-up of 95 months. Of those with one rebound diagnosed after initial treatment, 33 received an additional 3-month course of pyrimethamine/sulphadoxine and 48 were not treated. Intracranial calcification at birth was associated with an increased relative risk (RR) of rebound (RR = 2.601; P = 0.03), and treatment with pyrimethamine/sulphadoxine between 2 and 12 months of age with a decreased risk (RR = 0.3; P = 0.0845), whereas age of pregnancy at maternal infection, type of treatment during pregnancy and sex were not found to be predictive factors. There was no difference in incidence densities of secondary eye lesions in children without rebound (7/3,367 child-months) compared to those with at least one rebound (22/9,609 child-months) (RR = 1.10; 95% CI: 0.47-2.58), and, among the 81 children who had one rebound diagnosed after initial treatment, in those who received an additional course of treatment and in those who did not (RR = 0.72; 95% CI: 0.30-1.72). CONCLUSION: serological rebound is common in children with congenital toxoplasmosis but, due to the risk and constraints, an additional course of treatment and more ophthalmological surveillance than currently practiced do not seem warranted.

Animals↗
PubMed1991

Rat model of congenital toxoplasmosis.

A rat model of congenital toxoplasmosis is described for the study of protective immunity and chemotherapy during pregnancy. Six Sprague-Dawley 7- to 15-day gestational rats were inoculated orally (three rats, trial A) or subcutaneously (three rats, trial B) with 10,000 infective oocysts of the CT-1 strain of Toxoplasma gondii. The tissues of rat pups born from these rats were bioassayed for T. gondii infection. T. gondii was recovered from 30 of 33 (90.9%, trial B) and 23 of 28 (82.17%, trial A) rat pups bioassayed at 1 to 134 days of age. Two 10- to 14-day gestational pregnant rats were inoculated subcutaneously (trial C) with 10,000 infective bradyzoites from tissue cysts; 10 of 23 (43.8%) of the newborn pups were infected with T. gondii. Congenital infection occurred only when rats were infected during pregnancy. None of three rats in trial A that had given birth to congenitally infected rat pups produced congenitally infected rat pups during the second pregnancy.

Animals↗
PubMed1977

[Subdural hygroma in infants with congenital toxoplasmosis (author's transl)].

Cytological examination of the fluid from subdural hygromas revealed congenital Toxoplasmosis in 14 of 43 infants (32,5%). Conversely, subdural hygroma was a significant clinical symptom in 42 cases of congenital Toxoplasmosis. In 9 cases trophozoites or cystes of Toxoplasma Gondii were found in the subdural fluid, and in 4 of these in the cerebrospinal fluid as well. Since serological investigations in young infants and particularly severe infections often remain inconclusive the cytological examination of cerebrospinal fluid is emphasized importance of.

Cysts↗
PubMed2001

Bax-induced apoptosis not demonstrated in the congenital toxoplasmosis in mice.

A prominent neuropathological change observed in a murine model of congenital toxoplasmosis is cerebral cortical hypoplasia. In the early embryonic life of toxoplasmosis mice, the number of apoptotic cell observed in cerebral cortex is increased, indicating that increased number of apoptotic cells might relate to the pathogenetic mechanism of the cortical hypoplasia. Immunohistochemical expression of apoptosis-related factors, Bcl-2 and Bax has been studied in fetal murine brains infected with toxoplasma and in controls. Paraffin sections of the fetal brains on embryonic day (ED) 10, 12, 14, 16 and 18 were applied for the immunostains of Bcl-2 and Bax. Totally, 47 experimental animals (ED10: n=8, ED12: n=6, ED14: n=12, ED16: n=6, ED18: n=15) and 48 control animals (ED10: n=6, ED12: n=8, ED14: n=9, ED16: n=9, ED18: n=16) were examined. Bcl-2 positive cells were detected on ED10, whereas Bax positive cells appeared on ED14. No difference of Bcl-2 and Bax expression between toxoplasmosis and control groups was detected, suggesting that there is no clear relation between Bax-induced apoptosis and cortical dysplasia in congenital toxoplasmosis.

Animals↗
PubMed1995

Congenital toxoplasmosis: a significant cause of neurological morbidity in Israel?

The incidence of congenital toxoplasmosis in Israel is largely unknown, as is the impact of this condition on the neurological diseases of childhood. We examined the association between toxoplasmosis and three neurological disorders: epilepsy, cerebral palsy, and nerve deafness. Ninety-five children 1-15 years of age who had one of these three diagnoses but who had not had perinatal meningitis or anoxia and had no genetic predisposition for the documented neurological disorder were eligible for the study; 109 children hospitalized for elective surgery served as age-matched controls. Demographic and serological data were analyzed by logistic regression. The prevalences of serum antibodies to Toxoplasma gondii in the study and control groups were 22% and 9%, respectively. Children with one of the three neurological disorders were significantly more likely to have IgG antibodies to T. gondii (relative risk, 2.5; P = .03). The relative risk of seropositivity was remarkably high (7.1) among children with nerve deafness (P = .01). Large-scale prospective cohort studies of pregnant women are needed to substantiate the impact of congenital toxoplasmosis on the neurological diseases of childhood in Israel.

Adolescent↗
PubMed2003

Incidence of congenital toxoplasmosis in southern Brazil: a prospective study.

The study aimed to determine the incidence of congenital infection by Toxoplasma gondii and to describe neonatal and maternal characteristics regarding newborn infants treated at a teaching hospital in the town of Passo Fundo, State of Rio Grande do Sul, Brazil. Cord blood samples collected from 1,250 live newborns were analyzed. The laboratory diagnosis was established by the detection of Toxoplasma gondii IgM using an enzyme linked fluorescent assay. Gestational age, intrauterine growth, anthropometric measures, and prenatal characteristics were assessed. The incidence of congenital toxoplasmosis at birth was 8/10,000 (95%CI 0.2-44.5). Mean birthweight was 3,080 +/- 215.56 grams and mean gestational age was 38.43 +/- 1.88 weeks. With regard to prenatal care, 58% of the pregnant patients visited their doctors five times or more and 38.9% were serologically tested for toxoplasmosis in the first trimester of pregnancy. The incidence of congenital toxoplasmosis was similar to that found in most studies conducted in our country and abroad. Our study sample is representative of the town of Passo Fundo and therefore it is possible to consider the frequency observed as the prevalence of the disease in this town during the study period.

Animals↗
PubMed2001

Congenital toxoplasmosis: a review.

Toxoplasmosis is caused by infection with the protozoan parasite Toxoplasma gondii. In the United States, approximately 85% of women of childbearing age are susceptible to acute infection with T. gondii. Acute infections in pregnant women may cause serious health problems when the organism is transmitted to the fetus (congenital toxoplasmosis), including mental retardation, seizures, blindness, and death. An estimated 400 to 4000 cases of congenital toxoplasmosis occur in the U.S. each year. Manifestations of congenital toxoplasmosis may not become apparent until the second or third decade of life. Serologic tests are used to diagnose acute infection in pregnant women, but false-positive tests occur frequently, therefore, serologic diagnosis must be confirmed at a reference laboratory before treatment with potentially toxic drugs should be considered. Much of congenital toxoplasmosis can be prevented by educating women of childbearing age and pregnant women to avoid eating raw or undercooked meat, to avoid cross-contamination of other foods with raw or undercooked meat, and to use proper cat-litter and soil-related hygiene.

Animals↗
PubMed1994

Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial.

Between December 1981 and May 1991, 44 infants and children with congenital toxoplasmosis were referred to our study group. A uniform approach to evaluation and therapy was developed and is described herein along with the clinical characteristics of these infants and children. In addition, case histories that illustrate especially important clinical features or previously undescribed findings are presented. Factors that contributed to the more severe disabilities included delayed diagnosis and initiation of therapy; prolonged, concomitant neonatal hypoxia and hypoglycemia; profound visual impairment; and prolonged, uncorrected increased intracranial pressure with hydrocephalus and compression of the brain. Years after therapy was discontinued, three children developed new retinal lesions (without loss of visual acuity when therapy for Toxoplasma gondii was initiated promptly), and three children experienced a new onset of afebrile seizures. Most remarkable were the normal developmental, neurological, and ophthalmologic findings at the early follow-up evaluations of many--but not all--of the treated children despite severe manifestations, such as substantial systemic disease, hydrocephalus, microcephalus, multiple intracranial calcifications, and extensive macular destruction detected at birth. These favorable outcomes contrast markedly with outcomes reported previously for children with congenital toxoplasmosis who were untreated or treated for only 1 month.

Animals↗
PubMed1999

Congenital toxoplasmosis: prenatal diagnosis, treatment and postnatal outcome.

We report a female patient with congenital toxoplasmosis who presented with hydrops fetalis and cerebral abnormalities, detected on fetal ultrasound. Following prenatal treatment, the hydrops fetalis resolved and at four months of age she has normal growth and development. This case emphasizes the potential good prognosis in cases with congenital toxoplasmosis detected and treated prenatally.

Adult↗