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PubMed1995

[Toxoplasmosis and pregnancy--findings from umbilical cord blood screening in 30,000 newborn infants].

Cord blood screening for congenital toxoplasmosis was performed prospectively on 30,000 samples collected between 1986 and 1994 in the region of Basel, Switzerland, covering up to 95% of all births. Congenital infection was suspected in cases of serum with specific antitoxoplasma IgM or IgA or with a level of specific IgG above 300 IU/ml as measured by EIA from Sanofi-Pasteur. The percentage of cases to be screened declined from 2.5 to 1.2% and the cases of confirmed congenital toxoplasmosis from 0.073 to 0.033% during the observation period. This observation may be due to several reasons, such as improved primary prevention or more frequent diagnosis and treatment during pregnancy. In 178 cases of cord blood serology suspicious for acute toxoplasmosis, an enquiry with the gynecologist in charge of the pregnant woman was carried out. 126 mothers (71%) presented with a confirmed immunity against Toxoplasma gondii early in pregnancy and screening of the child was not needed. From 37 pregnancies (21%) no information was available. 15 out of 24 confirmed cases of toxoplasmosis of the mother during pregnancy were detected by cord blood analysis. In 17 of 24 cases of maternal toxoplasmosis treatment with spiramycin, pyrimethamine/sulfadoxine or both was performed. 10 of 17 newborns from mothers treated during pregnancy had elevated toxoplasma IgG titres at birth, but only one child was infected. 7 newborns had an inconspicuous toxoplasma serology at birth and were not infected. 7 cases of toxoplasmosis during pregnancy were detected by the check back and remained untreated; 4 out of 7 newborns had congenital toxoplasmosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Protozoan↗
PubMed1977

Auditory and visual defects resulting from symptomatic and subclinical congenital cytomegaloviral and toxoplasma infections.

Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures. Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis. These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.

Audiometry↗
PubMedDate not supplied

Upward extension of an atrophic tract of the retinal pigment epithelium associated with congenital macular toxoplasmosis.

PURPOSE: To report an unusual case of gravitational atrophic tract of the retinal pigment epithelium in a 20-year old woman. METHODS: Case Report. RESULTS: The patient had macular cicatricial congenital toxoplasmic chorioretinitis in both eyes. In the right eye, an atrophic tract of the retinal pigment epithelium originating from the upper margin of the macular scar extended upwards toward the retinal periphery. CONCLUSION: The unusual upward direction of the atrophic tract of retinal pigment epithelium may be explained by the in utero head position during the active phase of the chorioretinal disease.

Adult↗
PubMed2001

Eye manifestations of intrauterine infections.

The eye finding most characteristic of a prenatal, and therefore, congenital infection is a chorioretinal scar or an active chorioretinitis as can be seen in congenital toxoplasmosis, CMV, HSV, lymphocytic choriomeningitis virus, or varicella zoster infections. Congenital cataracts are suggestive, but less specific for congenital infection. They may be a relatively isolated finding in rubella, syphilis, varicella zoster, and Epstein-Barr virus infections. When they are present in congenital toxoplasmosis, HSV, and CMV, they are associated with extensive eye involvement. Other manifestations are less common as discussed above. The mechanism of action of these agents appears to be both a direct toxic and a teratogenic effect.

Adult↗
PubMed2001

Histopathological features of ocular toxoplasmosis in the fetus and infant.

BACKGROUND: Ocular disease is a frequent manifestation of congenital Toxoplasma gondii infection. There are only limited data available in the literature concerning early stages of this disease in fetuses and infants. The purpose of our study was to characterize histopathological features in the eyes of 10 fetuses and 2 infants with congenital toxoplasmosis. METHODS: Fifteen eyes from 10 fetuses, 3 eyes from 2 premature infants, and both eyes from a 2-year-old child with congenital toxoplasmosis were examined by light microscopy. Immunohistochemical analysis to identify inflammatory cells and T gondii antigens was performed. The findings in infected eyes were compared with those of age-matched control eyes. RESULTS: Retinitis (10/18 eyes), retinal necrosis (4/18 eyes), disruption of the retinal pigment epithelium (12/18 eyes), and choroidal inflammation and congestion (15/18 eyes) were characteristic findings. Optic neuritis was present in 5 of 8 fetal eyes with associated optic nerve available for evaluation. An eye obtained from a 32-week-old fetus showed retinal rosettes at the edge of a scar. T cells predominated in retinal lesions and choroid. Parasites were identified by immunohistochemical analysis in 10 of 18 eyes. CONCLUSIONS: Ocular toxoplasmosis causes irreversible damage to the retina in utero. The fetus and infant mount inflammatory responses that may contribute to ocular damage. These findings have important implications for serological screening programs and in utero therapy.

Antigens, CD↗
PubMed1989

[Ocular toxoplasmosis in 1989].

The clinical aspect of congenital toxoplasmosis is sometimes typical, sometimes atypical. The advantage of the serological study of the aqueous is an early diagnosis and an early treatment for less expense. The classical treatment relies on the therapeutic association Pyrimethamine + Adiazine + corticosteroids which will be used during acute phases, at ordinary doses, but may be prolonged further over many months in difficult cases. Severe forms are those that are spontaneously severe or increased with the exclusive use of corticosteroids in previous attacks, noticeably when injected by local route, and in bilateral forms. Prevention of ocular toxoplasmosis is represented by the detection of sero-conversion in mother and treatment in the newborn. Due to the legal aspect of this procedure in France, the incidence of congenital toxoplasmosis has already decreased during the past years and will continue to diminish in the next future. However the possibility of acquired forms cannot be excluded, even in non immuno-depressed patients.

Adrenal Cortex Hormones↗
PubMed2006

Chimeric antigens of Toxoplasma gondii: toward standardization of toxoplasmosis serodiagnosis using recombinant products.

We have evaluated the diagnostic utility of six antigenic regions of the Toxoplasma gondii MIC2, MIC3, M2AP, GRA3, GRA7, and SAG1 gene products, assembled in recombinant chimeric antigens by genetic engineering, in order to replace the soluble, whole-cell tachyzoite extract in serological assays. Serum samples from 100 adults with acquired T. gondii infection and from 30 infants born to mothers with primary toxoplasmosis contracted during pregnancy, of whom 20 were congenitally infected, were included. Immunoglobulin G (IgG) and IgM antibodies against epitopes carried by chimeric antigens were measured by performing parallel enzyme immunoassays (recombinant enzyme-linked immunosorbent assays [Rec-ELISAs]), and the results obtained by standard commercial assays with the whole-cell Toxoplasma antigen and assays with the chimeric antigens were compared. Our results demonstrate that IgG and IgM Rec-ELISAs with individual chimeric antigens have performance characteristics comparable to those of the corresponding commercial assays. Furthermore, we show that IgM-capture assays based on chimeric antigens improve the ability to diagnose congenital toxoplasmosis postnatally compared with the ability to diagnose congenital toxoplasmosis by the use of standard assays. The use of recombinant chimeric antigens is effective in distinguishing T. gondii-infected individuals from T. gondii-uninfected individuals and shows that immunoassays based on recombinant products could provide the basis for standardized commercial tests for the serodiagnosis of toxoplasmosis.

Adult↗
PubMed2004

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy.

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

Animals↗
PubMed2002

[Visual and auditory impairment in children with congenital cytomegalovirus and Toxoplasma gondii infection].

Intrauterine infections are an important cause of hearing and visual impairment in children. The aim of this paper was to evaluate the character and frequency of hearing and visual disturbances in children with congenital toxoplasmosis and cytomegalovirus infection. 38 out of 54 children with congenital toxoplasmosis as well as 34 out of 403 children with congenital human cytomegalovirus disease, with visual/auditory impairment, hospitalized in Infant Department in Children's Memorial Health Institute between 1995-2001 were enrolled in this study. Visual impairment was observed in all children with toxoplasmosis (with visual dysfunction rate of 74%), but there was no deafness found. Vision impairment had been observed in 18% of children with congenital cytomegalovirus infection compared to 35% of children with auditory impairment (bilateral deafness had been found in half of them). Neurological deficits' rate was much higher in children with toxoplasmosis (52% vs. 4%). Because of common hearing impairment in children with congenital cytomegalovirus infection and vision impairment in children with congenital toxoplasmosis, it is essential to start the prophylaxis to decrease the percentage of handicapped children.

Animals↗
PubMed1995

Outcome of children after maternal primary Toxoplasma infection during pregnancy with emphasis on avidity of specific IgG. The Study Group.

Congenital toxoplasmosis results from maternal primary infection during pregnancy. In our serologic screening study 42 of 16,733 pregnant women had findings suggestive of primary infection. Here we document the outcome of their offspring, 37 of 39 liveborn children. After 12 months postnatally, serologically verified congenital toxoplasmosis appeared in 4 children. All these children had persisting IgG at the age of 12 months by both the dye test and the IgG enzyme-linked immunosorbent assay. All the congenitally infected infants had also specific IgM and IgA and showed significant increases in avidity of specific IgG during the 12-month follow-up. One of them had a unilateral retinal scar and intracranial calcifications. An additional 3 infants of the mothers with primary infection during early pregnancy presented with unilateral retinal scars but without seroresponses during the first 12 months of life. Maternal high avidity of IgG during the first trimester is a strong indicator against primary infection during pregnancy; the fetuses of such mothers are at low risk for congenital toxoplasmosis.

Base Sequence↗
PubMed2006

Age-dependent impairment of functional helper T cell responses to immunodominant epitopes of Toxoplasma gondii antigens in congenitally infected individuals.

Human infection with Toxoplasma gondii is generally asymptomatic in immunocompetent adults while it causes significant morbidity in congenitally infected children. Cell mediated immunity plays the main role in host resistance to T. gondii infection and a Th1 cytokine profile is necessary for protection and control of infection. The present work focused on comparing the helper T cell response to the GRA1 antigen of the parasite between children with congenital toxoplasmosis and healthy adults with acquired infection. We demonstrated that in young children with congenital infection the specific T cell response to parasite antigens is impaired and that such hypo-responsiveness is restored during childhood. Also, we provided clear evidence that in individuals with congenital toxoplasmosis the acquisition of functional helper T cell responses is disease-unrelated and indistinguishable in terms of strength, epitope specificity, and cytokine profile from the corresponding responses in immunocompetent adults with asymptomatic acquired T. gondii infection.

Adult↗
PubMed1996

Human V delta 2+ gamma delta T-cell tolerance to foreign antigens of Toxoplasma gondii.

Little is known about the mechanisms involved in human gammadelta T-cell tolerance to self or to foreign antigens. Patients with congenital toxoplasmosis offer a unique opportunity to examine Vdelta2+ gammadelta T-cell tolerance. Analysis of gammadelta T cells in patients with congenital toxoplasmosis revealed evidence for anergy of these cells with or without clonal Vdelta2+ gammadelta T-cell expansion in the acute phase of the Toxoplasma infection. T cells in general were unresponsive and did not proliferate upon exposure to mitogens or to Toxoplasma lysate antigens or in response to live Toxoplasma-infected cells when the congenitally infected infants were 1 month of age, and they exhibited selective anergy to Toxoplasma lysate antigens and live Toxoplasma-infected cells when the infants were aged 5 months. During the chronic phase of congenital toxoplasmosis in the patients who were more than I year of age, the repertoires of the gammadelta T-cell receptors were found to be within normal ranges. In addition, in the chronic phase, the gammadelta T cells proliferated and secreted gamma-interferon in response to exposure to live Toxoplasmia-infected cells. By contrast, alphabeta T cells remained anergic. Vdelta2+ gammadelta T cells have been considered to undergo extrathymic maturation and thus to be subject to development of peripheral tolerance. Our findings indicate that Vdelta2+ gammadelta T-cell tolerance was lost in these infected infants earlier than alphabeta T-cell tolerance. These findings suggest that gammadelta T cells play a role in protection against Toxoplasma gondii in the chronic phase when congenitally infected children are more than 1 year of age, especially in those in whom alphabeta T cells continue to exhibit deficits in specific immune responses to Toxoplasma antigens.

Acute Disease↗
PubMed1994

Progress in the prevention of hearing loss in infants.

Two leading causes of hearing loss in infants and young children have been bacterial meningitis due to Haemophilus influenzae Type b (Hib) and congenital toxoplasmosis. In this two-part review, we describe the essential nature and incidence of these two diseases and how the availability of a Hib vaccine effective and safe with infants as young as 2 mo of age; the prospect of universal immunization against Hib disease; the introduction of cephalosporin antibiotic and corticosteroid treatment; and the use of early and prolonged antimicrobial therapy with children with congenital toxoplasmosis promises significant reduction, if not complete eradication, of hearing loss in infants and toddlers attributable to Hib bacterial meningitis and congenital toxoplasmosis. As a result, there may be up to a third fewer children under the age of five with severe hearing impairment annually in the United States.

Ceftriaxone↗
PubMed1999

Control of congenital infection with Toxoplasma gondii by neonatal screening based on detection of specific immunoglobulin M antibodies eluted from phenylketonuria filter-paper blood-spot samples.

Two ongoing neonatal screening programmes for congenital infection with Toxoplasma gondii are presented. The New England Newborn Screening Programme has included congenital toxoplasmosis since 1986. The test is based on detection of Toxoplasma-specific immunoglobulin M (IgM) antibodies eluted from the phenylketonuria (PKU) card. The seroprevalence of Toxoplasma IgG antibodies is at present about 13% and the birth prevalence of congenital toxoplasmosis approximately 1 per 10000 liveborn children. The Danish national neonatal screening programme was expanded to include congenital toxoplasmosis from 1 January 1999. The test is also based on detection of Toxoplasma-specific IgM antibodies eluted from PKU cards. The seroprevalence of Toxoplasma IgG antibodies in pregnant women is around 25% and the birth prevalence about 1 per 3000 liveborn children. The birth prevalence of congenital Toxoplasma infection is within the range of other congenital disorders included in different screening programmes. Neonatal screening is feasible in areas with a low risk of congenital infection where prenatal screening will not be applicable.

Animals↗
PubMed1979

Toxoplasmosis as a cause of perinatal death in goats.

Lesions typical of congenital toxoplasmosis were found in 5 aborted and stillborn kids. Serological findings in 2 of these kids and all their dams supported the diagnosis of congenital toxoplasmosis. In additon. Toxoplasma gondii was isolated from twin kids.

Abortion, Veterinary↗