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PubMed1989

The effectiveness of a prenatal education programme for the prevention of congenital toxoplasmosis.

A 10 min education programme was developed which, if effective in changing the behaviour of pregnant women, would eliminate or greatly reduce the risk of congenital toxoplasmosis. It was taught in 26 randomly selected (case) prenatal classes offered to women early in their pregnancy. The remaining 26 (control) classes received routine class material which did not mention toxoplasmosis. A questionnaire was administered to all women prior to this early class (pre-test) and again after the last prenatal class, held just prior to delivery (post-test). Changes in pet, food and personal hygiene behaviour between the pre- and post-test were determined and a score calculated by adding points for change towards those behaviours recommended in the programme and subtracting points for change in the opposite direction. Cat owners in case classes had a significantly higher score in pet hygiene behaviour than those in control classes (P less than 0.05). No significant difference was found between the food or personal hygiene scores of women in case and control classes, possibly because of low power. However, although behaviours did not differ on the pre-test, women in case classes had significantly better cooking methods for roast beef and hamburger on the post-test (P less than 0.05 and P less than 0.01 respectively). It is concluded that this programme is effective and should be offered to all women in order to reduce congenital toxoplasmosis incidence.

Analysis of Variance↗
PubMedDate not supplied

Retinochoroiditis associated with congenital toxoplasmosis in children: IgG antibody profiles demonstrating the synthesis of local antibodies.

PURPOSE: Retinochoroiditis is generally diagnosed after the first year of life and the association with congenital toxoplasmosis presents a diagnostic dilemma. The detection of local intraocular specific antibodies could be useful for diagnosis. METHODS: We studied six patients (mean age 7 +/- 5 years) with retinochoroiditis which appeared after the first year of life. Aqueous and serum were analysed by immunoblotting for anti T. gondii IgG to diagnose toxoplasmosis. RESULTS: All serum samples were positive only for anti T. gondii IgG. The retinochoroiditis was active in three patients and inactive in the others. Immunoblot analysis of serum and aqueous from the patients with active lesions showed IgG versus the specific antigen of T. gondii. In the patients with inactive lesions the pattern was the same in the two compartments. In active forms, aqueous and serum Western blot patterns differed in proteins lower than 16kDa and higher than 116kDa: in aqueous the findings were typically positive for 30kDa. CONCLUSIONS: Aqueous humour analysis by the Western blot technique may be useful in the diagnosis of congenital toxoplasmosis. In the present small series, we nevertheless detected different patterns for inactive and active retinochoroiditis, confirming the diagnosis in the latter. Aqueous humour paracentesis may be indicated in a child with active retinochoroiditis with unusual clinical features, appearing after the first year of life, and with no clinical or serological evidence of congenital infection.

Animals↗
PubMed1985

Congenital toxoplasmosis. Clinical and neuroradiological evaluation of the cerebral lesions.

A study of 31 observations of congenital toxoplasmosis shows that there is a clear relationship between the cerebral lesions as observed on CT scan, neurological symptoms, and the date of maternal infection. The appearance of the CT scan is characteristic of cases with early maternal seroconversion (before the 20th week of pregnancy), of cases with maternal infection between the 20 and 30th week of pregnancy, and of cases with late maternal seroconversion (after the 30th week of pregnancy). Preventive maternal treatment does not change the pattern of the cerebral lesions observed on CT scan and thus proves ineffective in conferring real protection.

Brain↗
PubMedDate not supplied

Imaging of an atypical case of congenital toxoplasmosis.

In this article we describe the cranial computerized tomography findings of an infant with congenital toxoplasmosis, which was performed because she showed an atypical clinical course consisting of meningitis and multiple cerebral abscesses. In this case the cranial computerized tomography allowed the diagnosis of hydrocephalus and multiple cerebral abscesses, and guided the therapeutic approach.

Brain Abscess↗
PubMed1984

Detection of IgM-anti-toxoplasma antibodies in acute acquired and congenital toxoplasmosis.

The specificity and sensibility of IgM-IFAT for diagnosis of acute acquired and congenital toxoplasmosis may increase after separation of IgM fractions by simple gel filtration method. In the presence of IFA-IgG titers greater than 250 IU/ml with Remington test less than 1/50, specific IgM antibodies to Toxoplasma gondii should be detected by separation. The separation of IgM seems a necessary step for detecting IgM antibodies by IgM-IFA in the newborn sera.

Acute Disease↗
PubMed1976

[Demonstration of specific IgM antibody in cases of suspect congenital toxoplasmosis: interpretation of results (author's transl)].

From the aspect of laboratory Toxoplasmosis examination, a series of clinically and parasitologically confirmed cases of congenital Toxoplasmosis (CT) were selected. Serological findings (CFT, DT, IgM-IFAT) in infants and mothers were critically examined. The IgM titers in CT as a rule lay between 1:16 and 1:64, the highest recorded being 1:256. The serum IgM globulin levels showed no dependence on the high CFT titers. T recognize unspecific reactions amongst infants with positive IgM values, the serological testing of mothers was indispensable. It is also absolutely necessary with infants to repeatedly test serologically at intervals to clearly bring out the results of all the three serological reactions. The technical problems encountered for a definative diagnosis of CT and the clinical picture in the present critical examination are discussed.

Complement Fixation Tests↗
PubMed1980

What can be done to prevent congenital toxoplasmosis?

There is a great deal of confusion within the medical and lay communities regarding Toxoplasma infection in the pregnant woman. Many physicians are not aware of the significance of this infection in pregnant women or of measures that may decrease the likelihood of the birth of an infant with congenital toxoplasmosis. Data regarding the morbidity, incidence, cost, and measures for the prevention of congenital toxoplasmosis are discussed.

Antibodies↗
PubMed2003

Screening and prevention of congenital toxoplasmosis: an effectiveness study in a population with a high infection rate.

OBJECTIVES: Secondary prevention of congenital toxoplasmosis has been attempted by screening pregnant women or by screening neonates. We compared the results of these two approaches, in order to evaluate the effectiveness of these strategies and of the antibiotic treatment of infected women. METHODS: A prenatal serological screening program for toxoplasmosis enrolled 8061 pregnant women; 9730 neonates were screened during the same period. RESULTS: Out of 5288 susceptible pregnancies, 188 were identified as infected by Toxoplasma gondii (35/1000). The transmission rate was 11.3%, with a higher rate for neonates exposed in the last trimester (relative risk 10.6); four neonates were affected. Out of 9730 screened neonates, four tested positive (0.4/1000) and one was affected. Out of a total of 163 exposed neonates, 12 were clinically affected. The rate of clinical sequelae was 31.6% among those infected and 7.4% among all exposed to infection; neonates born of women who had not been treated were more likely to be affected than treated neonates (odds ratio 4), but after adjustment for trimester of infection no significant association was found. CONCLUSIONS: Neonatal screening for toxoplasmosis seems to be less effective than pregnancy screening. Observational data do not support the effectiveness of treatment during pregnancy to prevent clinical disorders.

Animals↗
PubMed1992

Incidence of congenital toxoplasmosis in live Guatemalan newborns.

Five hundred and fifty samples of blood collected from the umbilical cords of an equivalent number of newborns were analyzed for serological evidence of congenital toxoplasmosis based on the detection of IgG and IgM. Six newborns presented serological evidence of congenital toxoplasmosis (IgM > 1:5, < 80 IU/ml), which represents an incidence of 10.9 per 1000 live births. During pregnancy four of the mothers of these six newborns were asymptomatic, whereas the other two mothers presented non-specific signs and symptoms. The six newborns did not present positive signs of acute toxoplasmosis at birth. Three false positive were identified, all secondary to the presence of a rheumatoid (RF) and/or antinuclear factor (ANF). And in one of them the diagnosis of congenital syphilis was confirmed. The percentage of women that tested serum positive for IgG antibodies increased with age, with 55.8% of the pregnant women testing serum-negative, therefore carrying the risk of acquired toxoplasmosis in future pregnancies.

Adolescent↗
PubMed2005

Determinants of response to a parent questionnaire about development and behaviour in 3 year olds: European multicentre study of congenital toxoplasmosis.

BACKGROUND: We aimed to determine how response to a parent-completed postal questionnaire measuring development, behaviour, impairment, and parental concerns and anxiety, varies in different European centres. METHODS: Prospective cohort study of 3 year old children, with and without congenital toxoplasmosis, who were identified by prenatal or neonatal screening for toxoplasmosis in 11 centres in 7 countries. Parents were mailed a questionnaire that comprised all or part of existing validated tools. We determined the effect of characteristics of the centre and child on response, age at questionnaire completion, and response to child drawing tasks. RESULTS: The questionnaire took 21 minutes to complete on average. 67% (714/1058) of parents responded. Few parents (60/1058) refused to participate. The strongest determinants of response were the score for organisational attributes of the study centre (such as direct involvement in follow up and access to an address register), and infection with congenital toxoplasmosis. Age at completion was associated with study centre, presence of neurological abnormalities in early infancy, and duration of prenatal treatment. Completion rates for individual questions exceeded 92% except for child completed drawings of a man (70%), which were completed more by girls, older children, and in certain centres. CONCLUSION: Differences in response across European centres were predominantly related to the organisation of follow up and access to correct addresses. The questionnaire was acceptable in all six countries and offers a low cost tool for assessing development, behaviour, and parental concerns and anxiety, in multinational studies.

Child Behavior↗
PubMed2001

Impact of health education on knowledge and prevention behavior for congenital toxoplasmosis: the experience in Poznań, Poland.

In 1991-1997 educational activities were undertaken in the Poznań region of Poland to promote health education for the prevention of toxoplasmosis. The effect of education was measured in 2710 pregnant women by a questionnaire survey. Knowledge of toxoplasmosis and its prevention was almost doubled within 4 years. Similarly, the proportion of women having antenatal serological tests for toxoplasmosis significantly increased. In the examined population the knowledge of how Toxoplasma gondii is transmitted/acquired was better than the knowledge of individual risk factors for congenital toxoplasmosis. Correct hygienic behaviors in pregnancy were often practised by women who lacked good knowledge of toxoplasmosis. The experience from this study suggests the possible effectiveness of including prevention of toxoplasmosis into the whole package of preventing infectious diseases in pregnancy and into healthy lifestyle promotion. Health educational activities need to be realized by modern promotional technologies in addition to making available traditional written educational texts. There is a considerable role of medical services in promotion of a hygienic behavior in pregnant women preventing congenital toxoplasmosis in their offspring. Health education should be especially tailored to the population of pregnant women below the age of 21.

Adult↗
PubMed2001

Prenatal diagnosis using polymerase chain reaction on amniotic fluid for congenital toxoplasmosis.

OBJECTIVE: To evaluate sensitivity, specificity, and predictive values of a prenatal amniotic fluid (AF) polymerase chain reaction (PCR) test for diagnosis of congenital toxoplasmosis. METHODS: A multicenter prospective study was done on 271 women with proved primary Toxoplasma infection during pregnancy and who had amniocentesis for prenatal diagnosis by PCR. Live-born infants were eligible for analysis only if a serologic follow-up could assess a definitive infection status. RESULTS: Of the 270 evaluable cases, 75 were congenitally infected, 48 of whom had a positive PCR at prenatal diagnosis. Overall sensitivity of PCR on AF was estimated at 64% (95% confidence interval [CI] 53.1%, 74.9%), negative predictive value of 87.8% (95% CI 83.5%, 92.1%), whereas specificity and positive predictive value were 100% (95% CIs 98%, 100% and 92.3%, 100%, respectively). Among cases with congenital toxoplasmosis, there were no significant differences between those with positive or negative PCR with regard to median gestational age at maternal infection, interval between maternal infection and amniocentesis, or duration of treatment before amniocentesis. However, sensitivity of PCR was found to be significantly higher for maternal infections that occurred between 17 and 21 weeks' gestation (P <.02). CONCLUSION: A negative PCR of AF cannot rule out congenital infection. In this case, continuation of treatment with spiramycin combined with ultrasonographic follow-up and postnatal follow-up are warranted. Our results also suggest presumptive treatment combining pyrimethamine and sulfonamides in case of maternal infection occurring late in pregnancy.

Adult↗
PubMed2001

Prenatal diagnosis of congenital toxoplasmosis by duplex real-time PCR using fluorescence resonance energy transfer hybridization probes.

The diagnosis of congenital toxoplasmosis frequently relies on PCR tests of amniotic fluid (AF). A duplex real-time quantitative PCR test based on fluorescence resonance energy transfer was developed to quantify the parasite load and to decrease the risk of contamination. An internal control based on the detection of 10 pg mouse DNA added to the AF was included to check for PCR efficiency. The relationship between the parasite load and the occurrence of ultrasonographic abnormalities in 87 samples of AF was analyzed. Seven AF (8%) had a parasitic load > 10(3); 14 (16%) had > 10(2)-< or =10(3); 26 (30%) had > 10-< or = 10(2); and 40 (46%) had < or = 10 parasites/ml. Four of the six AF with cerebral ventriculomegaly had >10(3) parasites/ml. The other two had 130 and 24 parasites/ml, respectively. No parasitic loads of > 10(3) parasites/ml and no ultrasonographic abnormalities were observed in the 11 AF with maternal toxoplasmosis in the third trimester. Therefore, there is a trend to associate high parasite count with ultrasonographic abnormality, but the main concern remains early maternal infection. The importance of quantification should be better evaluated with postnatal studies. The duplex LightCycler PCR test currently provides rapid and safe results.

Amniocentesis↗
PubMed2006

Isolated central diabetes insipidus in a newborn with congenital toxoplasmosis.

We present a 5 day-old male newborn with isolated central diabetes insipidus due to congenital toxoplasmosis. This patient was referred to us for hydrocephalus. As we investigated the aetiology of the hydrocephalus, the patient's serum and cerebrospinal fluid tested positive for toxoplasmosis via ELISA and polymerase chain reaction. Computed tomography showed obstructive hydrocephalus and disseminated cranial calcifications. Central diabetes insipidus developed on the 10th day, apparently as a result of the toxoplasmosis infection, and was treated successfully with oral desmopressin.

Administration, Oral↗
PubMed1990

[Congenital toxoplasmosis. 5 cases of mother-to-child transmission of pre-pregnancy infection].

Five cases of congenital toxoplasmosis consecutive to a maternal toxoplasma infection that had preceded pregnancy were observed. One woman with normal immune system had developed a well-documented lymph node toxoplasmosis 2 months before conceiving. Four women had chronic toxoplasmosis diagnosed in the course of an immunosuppressive disease: Hodgkin's disease in 1 case, systemic lupus erythematosus in 2 cases and pancytopenia in 1 case. Toxoplasmosis had been recognized 3, 5 and 10 years respectively before conception in 3 women, and at an uncertain date in 1 woman. Three women had received corticosteroids during pregnancy, and 2 had undergone splenectomy. Among the 6 children (2 were twins), 1 presented with severe foetal disease at birth, 1 developed lethal systemic toxoplasmosis after birth, 1 showed hydrocephalus with therapeutically well-controlled chorioretinitis, 1 had isolated eye lesion and 2 had asymptomatic infection. The parasite seems to have been transmitted after the 20th week of pregnancy in all cases. The physiopathology of mother-to child toxoplasma transmission, the role played by maternal immunodeficiency and the practical implications of these exceptional cases are discussed.

Female↗
PubMed1983

[Congenital toxoplasmosis. Remarks apropos of serologic surveillance in 15,000 pregnant women].

The risk of acquired toxoplasmosis during pregnancy (1.2% of susceptible women) and of transmission of Toxoplasma gondii to the fetus (1% of neonates) was estimated from results of serial serological tests done in 15 132 pregnant women from 1977 to 1982. Congenital toxoplasmosis was studied in the product of 47 induced abortions and in 34 neonates. In aborted fetuses, congenital toxoplasmosis was established by serological tests in 3 cases and based on histological findings in 4. Among the neonates, 11 cases are reported; the 5 severe cases are due to early contamination.

Abortion, Induced↗