Congenital toxoplasmosis; diagnosis confirmed by passage to mouse.
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Prenatal diagnosis of toxoplasmosis gondii in twin pregnancies has been described twice. In both cases they were accomplished by prenatal blood sampling of the foetuses. We report the first prenatal diagnosis with a discordant result in a dizygotic pregnancy. One of the foetuses died in utero and the other was born unaffected at term.
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The management of a pregnant women or a child infected by Toxoplasma gondii rests on the screening of pregnant women at risk of infection. Treatment is prescribed if an infection occurs. A prenatal diagnosis (detection of T. gondii in amniotic fluid) may be performed, a positive result leading to a reinforcement of the treatment. After birth, the follow-up of the child is needed in order to prevent and detect the sequellae, mainly ocular. For all these steps, the biological methods used to diagnose T. gondii infection are of paramount importance.
BACKGROUND: The neurological outcome for severe toxoplasmosis can be poor despite appropriate management. CASE REPORT: A maternal toxoplasma infection occurred at 16 weeks of amenorrhoea; prenatal diagnosis was attempted at 20 weeks, fetal infection was confirmed by mouse inoculation at the 30th week. Pyrimethamine plus sulfadiazine treatment was initiated. However, at 37 weeks of amenorrhoea, sonographic examination of the fetus detected hydrocephalus. Despite prompt ventriculo-peritoneal shunting after birth and medical treatment of toxoplasmosis, the neurological developmental outcome was complicated and prognosis is poor at 5 years of age. CONCLUSION: This case shows that parents must be carefully warned about risks of a prenatal toxoplasmosis.
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