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PubMed1989

Recent developments in the prevention and treatment of congenital toxoplasmosis.

The manifestations of congenital toxoplasmosis vary considerably in degree, characteristics and time of onset. Options for prevention of the disease include the appropriate disposal of cat litter and the avoidance of ingestion of both contaminated food and undercooked meat by pregnant women. Immunisation of the domestic cat population is a consideration for the future. Alternatively, immunisation of sero-negative pregnant women awaits the introduction of an effective and safe reagent. Current treatment modalities are not universally effective and new drugs are the subject of active development and research. Screening of pregnant women or perhaps newborn infants are potential options but the cost effectivity has yet to be established in many countries and the results of treatment during pregnancy and early childhood are encouraging but are as yet unproven. The majority of patients with congenital toxoplasmosis eventually develop toxoplasmic retinochoroiditis. Current treatment options for this condition are outlined. Acquired immune deficiency syndrome (AIDS) may, in some cases, represent a recrudescence of congenital intracerebral infection. Current treatment strategies for this condition are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Evaluation of the possibilities for preventing congenital toxoplasmosis.

Little is known about the best way to prevent congenital toxoplasmosis. Until recently, the major effort was directed at preventing the disease during pregnancy by the application of hygienic measures (primary prevention). With the advent of detecting congenital toxoplasmosis antenatally, another method for reducing the incidence of congenital toxoplasmosis becomes possible (secondary prevention). In this study, we evaluate these two methods for the prevention of congenital toxoplasmosis. For 12 consecutive years, we studied the incidence of congenital toxoplasmosis in 11,286 consecutive pregnant women. The impact of primary prevention was studied by measuring the reduction in seroconversion when hygienic measures were systematically applied. Primary prevention reduces the seroconversion rate during pregnancy by 63% (P = 0.013). The effect of secondary prevention was studied in 76 pregnant women at risk of delivering a child with congenital toxoplasmosis. Secondary prevention by means of serological screening combined with prenatal diagnosis detected congenital toxoplasmosis correctly in eight infected fetuses. Secondary prevention reduced the incidence of congenital toxoplasmosis an additional 40%. This reduction would predominantly be seen in the group of mildly to severely affected fetuses. From this study, the effectiveness of primary prevention is obvious. Health education on how to avoid toxoplasmosis during pregnancy should become standard obstetric care. Adequate serological screening and prenatal diagnosis can be helpful in reducing further the incidence of congenital toxoplasmosis. Whether or not screening for toxoplasmosis during pregnancy should be combined with primary prevention depends on the importance of congenital toxoplasmosis as a health problem in a given geographic area.

Belgium↗
PubMedDate not supplied

[The results of a serological examination of the population for toxoplasmosis and the estimated incidences of congenital toxoplasmosis in 2 foci in Uzbekistan].

Enzyme immunoassay was used in screening for toxoplasmosis of 500 residents of the town of Ghulistan and of 1074 residents of the town of Shavat in the Khorezm district of Uzbekistan. All the examinees were aged 15 to 40. The share of seropositive subjects in Ghulistan was 24.6%, that in Shavat 14.6%, the toxoplasmosis loimopotentials were 0.87 and 0.62%, respectively. The predicted parameters were as follows: new cases of toxoplasmosis among pregnant women were 4.9% in Ghulistan and 3.9% in Shavat, the incidence of congenital condition 1.7 and 1.3%, respectively, the incidence of manifest congenital toxoplasmosis 0.6 and 0.4%, respectively. The presence of a cat in the house was associated with higher share of seropositive subjects in the town of Shavat as against Ghulistan. An urban focus (Ghulistan) appeared more intensive as against a rural type focus (Shavat) at the expense of a higher intensity of the xenotropic route of the agent transmission.

Adolescent↗
PubMedDate not supplied

[Clinical course of congenital toxoplasmosis in children].

Hundred eleven children with the congenital toxoplasmosis were treated at the Department of Infectious and Parasitic Diseases in Childhood in 1979-1988. Multi-symptomatic toxoplasmosis has been diagnosed in 35 cases, ocular form in 65, oligosymptomatic in 6, and asymptomatic in 5 cases. Clinical symptoms suggesting congenital toxoplasmosis was seen in the majority of children (63 cases) in the first year of life and the disease was diagnosed in 50% of cases (33 children) at this age. Congenital toxoplasmosis in the group of 78 children has been diagnosed later. The majority of cases was ocular form. Diagnosis of the oligo- and asymptomatic congenital toxoplasmosis is possible in the first year of life, only. A titre of antibodies is exclusively an indicator of the immunologic response, not a severity of infection and does not contribute to the prognosis. Antitoxoplasma drugs were administered to 102 children including 33 under the first year of life. Pyrimethamine, sulphonamides, and spiramycin were used in the treatment. Dosage, duration of therapy, and way of administration have been established individually in dependence of patients age and clinical form of the congenital toxoplasmosis. Two out of 35 children with multi-symptomatic congenital toxoplasmosis died whereas 13 demonstrate psychomotor retardation of significant degree despite the fact that 11 of them were treated in the first year of life.

Adolescent↗
PubMed1989

Economic and public health considerations of congenital toxoplasmosis in lambs.

Congenital toxoplasmosis was diagnosed in a flock of Hampshire sheep in South Dakota. The 80 ewes produced 144 lambs, 30 of which were born dead; toxoplasmosis was diagnosed in 11 of the dead lambs. The remaining 114 lambs grew normally, but 68 (40.3%) had agglutinating Toxoplasma gondii antibodies. Modified agglutination test T gondii antibody titers for 114 lambs were: less than 100 (n = 46), 64 (n = 2), 256 (n = 1), 1,024 (n = 12), and greater than or equal to 4,096 (n = 53). Tissues of 8 seropositive lambs were bioassayed for T gondii tissue cysts. Toxoplasma gondii was isolated from the tongue and lamb chops of 7, heart of 3, and legs of lamb of all 8 lambs.

Abortion, Veterinary↗
PubMed1999

A switch towards Th2 during serological rebound in children with congenital toxoplasmosis.

Serological rebounds occur frequently in patients with congenital toxoplasmosis, but remain poorly understood. A link between Th1 and Th2 cytokines and the pathophysiology of infectious diseases has been reported. Production of interferon-gamma (IFN-gamma) and IL-4 in supernatants of whole blood after in vitro specific Toxoplasma gondii stimulation and serum-specific IgE levels were studied in 31 congenitally infected children. IFN-gamma was produced at higher levels by lymphocytes from children with stable congenital toxoplasmosis (n = 18) than from children showing serological rebound (n = 13) (P < 0.04). Conversely, supernatants from children with serological rebound showed higher levels of IL-4 than those from children with stable congenital toxoplasmosis (P < 0.03). The polarized Th2 response was confirmed by a greater (IL-4:IFN-gamma) x 100 ratio (P < 0.0001) and production of T. gondii-specific IgE in six out of 13 children showing serological rebound. These results suggest a role of Th2 cytokines in destabilization of congenital toxoplasmosis and perhaps in local reactivation of the parasite.

Adult↗
PubMed2005

Ocular manifestations in congenital toxoplasmosis.

BACKGROUND: Retinochoroiditis is the most common ocular manifestation of congenital toxoplasmosis, but other associated ophthalmological pathologies can also occur. The aim of this study was to determine the nature of the latter in treated cases of the disease and to assess their impact on visual function. METHODS: Four hundred and thirty consecutive children with serologically confirmed congenital toxoplasmosis were included in this study. Data were prospectively collected using standardized ophthalmological assessment forms. The presence of retinochoroiditis and of associated pathologies was ascertained, and their impact on visual function was assessed. RESULTS: After a median follow-up of 12 years [range 0.6-26 years], 130 children manifested retinochoroiditis. We detected 22 foci of retinochoroiditis at birth and 264 additional ones during the follow-up period. Of these, 48 (17%) were active when first diagnosed. Twenty-five of the 130 children (19%) had other associated ocular pathologies. Of these, 21 (16%) had a strabismus, which was due to macular lesions in 86% of the cases; 7 (5.4%) presented with unilateral microphthalmia, and 4 (3%) with cataracts. Most of these events were detected after the onset of retinochoroiditis. None of the children presented with ocular involvement in the absence of chorioretinal lesions. Macular lesions occurred more frequently in children with associated pathologies (p<0.0001), and associated pathologies were likewise more common in individuals with macular lesions (p=0.0003). Visual impairment occurred in 31/130 cases, and in all but 3 of these eyes it was due not to an associated pathology but to macular retinochoroiditis. CONCLUSIONS: At the end of the follow-up period, ocular involvement existed in 30% of the treated children with congenital toxoplasmosis. Associated eye pathologies were manifested less frequently than anticipated. They may occur later in life and are an indirect marker of the severity of congenital toxoplasmosis, but they do not have a direct impact on visual acuity. The overall functional prognosis of congenital toxoplasmosis is better than would be expected on the basis of literature findings, with only 2 of the 130 children suffering bilateral visual impairment.

Adolescent↗
PubMed2004

[Maternal pancytopenia during antenatal treatment of congenital toxoplasmosis].

INTRODUCTION: The treatment of reference of congenital toxoplasmosis combines two folate synthesis inhibitors, pyrimethamine and an antibacterial sulfamide (sulfadiazine or sulfadoxine). Despite the efficacy of this combination, the possibility of eventually severe side effects must also be taken into account. OBSERVATION: A pancytopenia occurred at 37 weeks of amenorrhea during antenatal treatment for congenital toxoplasmosis in a tripara. The outcome was positive following administration of strong doses of parenteral folinic acid combined with platelet transfusion and broad-spectrum antibiotics. DISCUSSION: Each of the molecules (pyrimethamine and antibacterial sulfamide) used for the treatment of congenital toxoplasmosis can lead to acute haematological problems. The occurrence of maternal pancytopenia however remains exceptional. It is principally related to pyrimethamine and is usually observed in the presence of factors enhancing folate deficiency.

Adult↗
PubMed1976

[Toxoplasmosis and pregnancy. Evaluation of 2 years of prevention of congenital toxoplasmosis in the maternity ward of Hôpital Saint-Antoine (1973-1974)].

The authors report the results of prophylaxis of congenital toxoplasmosis in a maternity hospital in Paris for a two years period (1973-1974). 6269 pregnant women were surveyed. 18 toxoplasmosis were detected in evolution at the first prenatal examination, 10 seroconversions were identified among the first examination antibody negative women, when re-examined during the pregnancy. 25 of these 28 women were treated regularly. The seroconversions of the 3 other women were detected only at delivery. In addition 25 women were treated because of high antibody titers (Dye-Test greater than or equal to 300. U.I/ml). 6 congenital toxoplasmosis, 2 of them were manifest, were observed among the children whose mothers were treated for confirmed toxoplasmosis. The extremely low level of seroconversions may be in relation to hygienic and dietetic prescriptions. The difficulties of this prophylaxis are analysed: they are due to studied population and to problems of interpretation or serologic examinations.

Female↗