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PubMed1992

[Recall of the importance of serological monitoring of children with suspected congenital toxoplasmosis].

Emphasis is put on the need for repeating serologic tests at regular intervals until one year of age in infants with suspected congenital toxoplasmosis. In 11 of 33 cases, antibody titer changes were the only evidence of toxoplasmosis, a disease which may induce severe ocular lesions if appropriate treatment is not given. Although well-recognized as indispensable, serologic monitoring is not always performed; in one group of 326 infants with suspected congenital toxoplasmosis, 133 (41%) were not followed up for more than six weeks.

Enzyme-Linked Immunosorbent Assay↗
PubMed2005

Incidence of congenital toxoplasmosis estimated by neonatal screening: relevance of diagnostic confirmation in asymptomatic newborn infants.

Congenital toxoplasmosis is rarely identified by routine clinical examination. The aim of this study was to estimate the incidence of the disease in the region of Ribeirão Preto, south-eastern Brazil. A definitive diagnosis was made on the basis of the persistence of anti-Toxoplasma IgG antibodies beyond 1 year of age. Blood samples obtained from 15,162 neonates and adsorbed onto filter paper were tested for anti-Toxoplasma IgM antibodies. Fifteen samples gave positive results. A definitive diagnosis was confirmed in five of the 13 infants (38.5%) who completed follow-up. These five infants presented with serum IgM and/or IgA antibodies, and clinical abnormalities. Disease incidence was estimated to be 3.3/10,000 (95% CI 1.0-7.7), indicating the need for preventive measures. Neonatal screening is feasible, but screening tests with a better performance are required; positive screening results must be carefully confirmed.

Animals↗
PubMed1992

Economic evaluation of preventive programmes against congenital toxoplasmosis.

Benefit-cost analysis are applied to different strategies aimed at preventing congenital toxoplasmosis. The first strategy involves health education of pregnant women on how to avoid toxoplasma infection. The second strategy comprise serological surveillance in pregnancy combined with prenatal diagnosis and chemotherapy. The cost of health education is less than the cost of the serological screening, but health education will most likely lead to a haphazard testing of individuals and thereby increasing the cost. The best and most rational approach, and the programme which will prevent most cases and save most money for the society, is a combination of both programmes. Compared with the results of any of the two strategies alone, the benefits of the combined programme will increase significantly, while the cost (NOK 165 per participating woman) will only add fractions to that of the serological screening programme. The benefits of the strategies are influenced by many uncertain factors such as the discount rate, the incidence of infection, the intrauterine transmission rate, the outcome of pregnancy, the prognosis of the offspring, the sensitivity of the screening tests and the effectiveness of the programme. After applying a sensitivity analysis, both programmes were found to be of economic benefit to society at an incidence of maternal toxoplasmosis of 1-1.5 per 1000. Thus the pilot screening initiated in Norway to determine the incidence of infection, seems justified.

Cost-Benefit Analysis↗
PubMed1994

[Congenital toxoplasmosis in the Poznan region].

Among 3,734 women, hospitalized for giving birth, 58.9% had a positive Toxoplasma serological test (DA). No clinical expression of congenital toxoplasmosis was observed in 4,311 newborns; seven had a false positive ISAGA test with cord blood. Only 24% of the women were aware of congenital toxoplasmosis and only 3% were serologically examined before. Health education should be intensified and serological tests more commonly performed especially in the risk groups.

Adult↗
PubMed1977

Contribution to the early diagnosis of congenital toxoplasmosis.

A method based on a single serological test enabling the diagnosis of congenital toxoplasmosis immediately after birth is described. The concentration of anti-toxoplasmosis antibody from the CSF is compared to that of rubeola used as reference. It is thus possible to distinguish between the passive passage of antibodies in the CSF and their in situ synthesis. When concentration of antibody in the CSF is higher for toxoplasmosis than for rubeola, the existence of a congenital infection of toxoplasmosis can be suggested.

Antibodies↗
PubMed2003

Ophthalmic outcomes after prenatal and postnatal treatment of congenital toxoplasmosis.

PURPOSE: To describe the ophthalmologic outcomes of cases of congenital toxoplasmosis treated prenatally and postnatally. DESIGN: Observational case series. METHOD: Follow-up ophthalmologic examinations of 18 children born to mothers who were infected before 25 weeks gestation were performed concurrently by two ophthalmologists. The infection in these children was first suspected when their mothers seroconverted during gestation. Toxoplasmic infection of the fetus was diagnosed by fetal blood or amniotic fluid analysis. Mothers were treated by a regimen of alternating pyrimethamine-sulfonamides and spiramycin during gestation. Pyrimethamine-sulfonamides treatment was continued from birth to 1 year of age. RESULTS: The median age of the children was 4.5 years (range 1-11), when the follow-up ophthalmologic examinations were performed. Visual acuity was decreased in only one child, who had extensive bilateral macular and peripheral lesions. A posterior pole scar was noted in four eyes (four children) for whom visual acuity remained normal. Peripheral lesions were observed in nine eyes (five children). Both eyes were normal in 11 of 18 (61%) of the children. CONCLUSIONS: In these children at a high risk for congenital toxoplasmic retinochoroiditis, a favorable visual outcome was observed in all but one case.

Antiprotozoal Agents↗
PubMed1985

[A proposed protocol for prevention of congenital toxoplasmosis adaptable in a tropical zone].

In Toulouse, various epidemiological works and biological results regarding toxoplasma infection permitted us to study immunity in pregnant women. 66 to 70% are immunized. Incidence of acquired toxoplasmosis is 1 to 2 for 1,000 pregnancies. Carefully planned, regionalized programs with obstetricians and pediatricians are realized to prevent congenital toxoplasmosis. Epidemiological studies may be realized to estimate the prevalence and the incidence of congenital toxoplasmosis before such programs can be recommended on a national scale in tropical area.

Female↗
PubMed2006

Cord blood screening for congenital toxoplasmosis in northwestern Switzerland, 1982-1999.

BACKGROUND: In the absence of mandatory nationwide toxoplasmosis screening during pregnancy in Switzerland, the Basel region introduced cord blood screening in 1982. METHODS: From 1982 to 1999, 64,622 cord blood samples (>90% of all neonates) collected in Basel region obstetric units were screened for toxoplasma specific immunoglobulin (Ig) G, M and A antibodies using commercial kits. Neonates with relevant results (IgG titers > or =300 IU/mL, or > or =200 IU/mL in the Abbott Toxo IMX system, and/or positive IgM or IgA antibodies) were monitored until clarification of infection status. From 1991 onward, retrospective maternal and follow-up data on these children were also collected by questionnaire. RESULTS: Despite increasing maternal age, seroprevalence for toxoplasmosis decreased steadily from 53% (1982-1985) to 35% (1999). During the same period, the prevalence of congenital toxoplasmosis declined from 0.08% to 0.012%. IgM and/or IgA antibodies were present with the Platelia Toxo test (enzyme-linked immunosorbent assay; sanofi pasteur; Bio-Rad) in the cord blood samples of 17 of 18 infected neonates born between 1986 and 1999, regardless of maternal treatment in pregnancy. Vertical transmission rates in 69 women with proven or suspected primary infection between 1991 and 1999 were 3.9% with, compared to 27.7% without, antiparasitic treatment during pregnancy. CONCLUSION: Toxoplasma seroprevalence and congenital toxoplasmosis incidence declined markedly in northwestern Switzerland from 1982 to 1999. Our data provide no conclusive evidence that maternal antiparasitic therapy in pregnancy affects vertical transmission because the treatment group also included women with suspected but unproven primary infection during pregnancy. Because toxoplasma specific IgA/IgM antibodies in cord blood identified almost all infected children, screening at birth may be more cost effective than during pregnancy.

Adolescent↗
PubMed2006

Refinement of the mouse model of congenital toxoplasmosis.

The goals of the present investigation, focusing on the BALB/c mouse model of congenital toxoplasmosis, were: (1) to find a method to determine pregnancy in the mouse. The method has 100% sensitivity and 72% specificity; (2) to test congenital transmission during the chronic stage of toxoplasmosis. This occurred in 2 of 10 mice tested; (3) to investigate the relationship between the infective dose and the rate of congenital transmission. This was not demonstrated for doses of 10(2) to 10(3) bradyzoites and oocysts of Prugniaud, M3 and M7741 strains, with transmission rates of 3 of 8 to 6 of 10 mice inoculated; (4) to determine homologous and heterologous protection. Homologous protection was demonstrated with Prugniaud cysts, and heterologous protection was found between ME-49 and M3 cysts. This finding is consistent with the uniform natural protection against congenital toxoplasmosis seen in immune women and ewes.

Animals↗
PubMed1989

Prevention of congenital toxoplasmosis; experience in The Netherlands.

Prevention is the pre-eminent strategy to control congenital toxoplasmosis. In a trial study in the province South-Holland a program of both primary and secondary prevention during pregnancy was applied. 28000 women were enrolled. 55% of them were seronegative, and only 55 primary infections were traced amongst them. Although a conclusive evaluation of the results of the study has not yet been accomplished, this low figure will be discussed within the scope of certain logistic and organizational obstacles incurred in the so-called TIP (Toxoplasma Infection Prevention)-study in the Netherlands.

Antibodies, Protozoan↗
PubMed1999

Fetal cataract in congenital toxoplasmosis.

We report a case of the prenatal diagnosis of fetal cataract due to congenital toxoplasmosis. To the best of our knowledge, this is the first report of such a case. We discuss the long-term ocular sequelae of the condition and how they should affect prenatal counselling.

Adolescent↗
PubMed1982

Congenital toxoplasmosis: long-term follow-up.

The incidence in Europe is high, about 6 in 1000 births. Five percent of these babies either die or are severely damaged by the disease. In the others most infections are clinically asymptomatic in the neonatal period. In +/- 70% of all infants with congential infections relapses of chorioretinitis give rise to scars in their eyes after a follow-up of 16 years. The relapses were occurring later on both in treated and untreated infants. Most scars were in the periphery of the retina, but scars in the neighbourhood of the macula can threaten the vision. In 1--2% of these children later on uveitis impairing vision due to congenital toxoplasmosis will occur. As a control 117 children in the age 12--14 years without congenital toxoplasmosis were studied. No chorioretinitis-scars were found in the eyes although +/- 50--60% had antibodies against toxoplasmosis, resulting from an acquired infection. The problem of prevention is unsolved. There is no vaccine. Deliberately infecting girls before pregnancy is too dangerous. Screening of pregnant women is possible but no clear-cut safe therapy is available. Screening of the baby after birth is too late.

Adolescent↗
PubMed1992

Incidence of congenital toxoplasmosis in the Republic of Slovenia.

Over a 12-month period, 3959 pregnant women were systematically tested with the Sabin-Feldman dye test in order to assess the incidence of congenital toxoplasmosis in Slovenia. The results suggest that this is approximately 3/1000 live births. This relatively high incidence of congenital toxoplasmosis in Slovenia may make the costing of preventive screening programmes justifiable.

Adult↗
PubMed1988

Early prenatal diagnosis of congenital toxoplasmosis using amniotic fluid samples and tissue culture.

The presence of Toxoplasma gondii in amniotic fluid was demonstrated using tissue culture in four of nine cases of congenital toxoplasmosis, whereas Toxoplasma gondii antigen was undetectable using a sensitive enzyme immunoassay technique. Parasites were identified in monolayers four days after inoculation using an indirect immunofluorescence assay. Since tissue culture may provide evidence of infection within a few days, this method is proposed for early prenatal diagnosis of congenital toxoplasmosis.

Amniotic Fluid↗
PubMed2003

Usefulness of Western blot in serological follow-up of newborns suspected of congenital toxoplasmosis.

The goal of the study reported here was to compare the results of Western blot with other serological methods for testing newborns suspected of having congenital toxoplasmosis. Western blot, enzyme-linked immunosorbent assay, immunoglobulin (Ig)M immunosorbent agglutination assay, and indirect immunofluorescence assay were performed on the sera of 126 neonates collected at birth and at 1 and 3 months of life. Western blot was more sensitive than IgM detection with the immunosorbent agglutination assay (82.6% vs. 69.6%), and the specificity of the two methods was 96.1% and 92.2%, respectively. Among the serological techniques tested, the combination of Western blot (IgG and IgM) with IgM immunosorbent agglutination assay achieved the greatest improvement in the sensitivity of early (postpartum) diagnosis of congenital toxoplasmosis.

Animals↗
PubMed1999

Value of prenatal diagnosis and early postnatal diagnosis of congenital toxoplasmosis: retrospective study of 110 cases.

We reviewed the files of 110 women with Toxoplasma seroconversion during pregnancy. Prenatal diagnosis was attempted for 94 women by amniotic fluid sampling. Toxoplasma gondii was detected by PCR, with or without tissue culture and mouse inoculation. The early neonatal diagnostic procedure included placental testing by PCR and/or mouse inoculation, cord blood serological testing, and comparison of maternal and newborn antibodies by Western blotting (WB). Serological follow-up of the infants was conducted during the first year of life or until the diagnosis of congenital toxoplasmosis (CT) could be ruled out. Congenital infection was diagnosed in 27 individuals (20 live births) in the prenatal and/or neonatal period. The sensitivity and specificity of prenatal diagnosis were 81 and 100%, respectively. Placental examination was positive for 66.7% of individuals with CT and was always negative for neonates without CT. Cord blood serology detected immunoglobulin M (IgM) and/or IgA in 80% of infected newborns, with respective specificities of 91.2 and 87.7%. By WB we detected bands on IgG and IgM blots recognized by the newborn serum but not by the maternal serum (neosynthesized IgG and/or IgM) for 88.2% of infected infants within the first 2 months of life with a specificity of 100%. Early postnatal diagnosis was negative for 2 of the 20 neonates with CT. Both of these newborns had a negative prenatal diagnosis and were asymptomatic, suggesting a very low parasite load. In conclusion, despite the use of advanced methods, some cases of congenital toxoplasmosis cannot be detected early, which underlines the importance of careful follow-up of newborns who are at risk.

Animals↗
PubMed1997

[Study of developing clinical outbreak and serological rebounds in children with congenital toxoplasmosis and follow-up during the first 2 years of life].

BACKGROUND: The survival of T gondii bradyzoites in cysts explains clinical recurrences and serological rebounds after birth in children with congenital toxoplasmosis. At the present time, management of such manifestations is not well defined. PATIENTS AND METHODS: Sixty-three infants with congenital toxoplasmosis were followed-up at the University Hospital of Lille (France) during the first two years of life. For each child, the treatment before and after birth was well defined. Clinical, ophthalmological, radiological and serological data were collected every third month. Serological assays specially adapted to this age bracket were used for the quantification of specific IgG, or for the detection of T gondii specific IgM and IgA. RESULTS: Seventy-six serological rebounds were reported in 55 of the 63 children (87%). They concerned essentially IgG (96%) and less frequently IgM (47%) or IgA (60%). At the same time, only five clinical recurrences were observed, four of them being preceded by a serological rebound. DISCUSSION: Treatment of fetuses or children with pyrimethamine and sulfonamides versus spiramycin alone was associated with a decrease in the frequency of serological rebounds during the first year of life (P < 0.001). Such a therapeutic regimen during the second year of life decreases the appearance of serological rebounds in children without rebound antecedent (P < 0.001). CONCLUSION: The increase in number of rebounds after the end of a course of pyrimethamine and sulfonamides necessitates the evaluation of such a long term treatment without interruption.

Child, Preschool↗