Abstract
BackgroundThe different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity. There is no evidence to prove that maternal treatment reduces the risk of fetal infection. The purpose of this study was to assess methods for the confirmation of congenital toxoplasmosis after maternal treatment with spiramycin during pregnancy, and to evaluate the effect of this treatment on clinical manifestations of the disease in newborns (NB).MethodsThis was a community-based, cross-sectional study of acute toxoplasmosis in newborns at risk of acquiring congenital infection. Participating newborns were born in the Clinical Hospital Maternity Ward of the Federal University of Goiás. Eligible participants were divided into 2 groups: group 1 consisted of 44 newborns born to mothers treated with spiramycin during pregnancy and group 2 consisted of 24 newborns born to mothers not treated with spiramycin during pregnancy because the diagnosis of toxoplasmosis was not performed. The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease.ResultsThe sensitivity of the markers (T. gondii DNA detected by PCR, and the presence of specific anti-T. gondii IgM and IgA) for congenital toxoplasmosis was higher in group 2 than in group 1 (31.6, 68.4, 36.8% and 3.7, 25.9, 11.1% respectively). Even with a low PCR sensitivity, the group 2 results indicate the importance of developing new techniques for the diagnosis of congenital toxoplasmosis in newborns. Within group 1, 70.4% of the infected newborns were asymptomatic and, in group 2, 68.4% showed clinical manifestations of congenital toxoplasmosis.ConclusionsThe higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns. Given the low sensitivity of the tests used, when there is suspicion of congenital transmission several serological and parasitological tests are required in order to confirm or exclude congenital toxoplasmosis in newborns.
Highlights
The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity
Most infected NB (60%) are asymptomatic [1,2]; they may develop severe sequelae such as blindness or mental retardation if not treated [1,2,10,11,12]. It has not yet been conclusively proven that maternal treatment reduces the risk of fetal infection [3,13,14,15,16,17,18,19], some studies have demonstrated a beneficial effect of treatment [20,21,22,23,24,25,26,27]
Population This was a community-based, cross-sectional study of acute toxoplasmosis in NB considered at risk for acquiring congenital infection; all NB participants were born in the Maternity Ward of the Clinical Hospital (HC) of the University Federal of Goiás (UFG) (Brazil) between October 2004 and December 2011
Summary
The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity. Most infected NB (60%) are asymptomatic [1,2]; they may develop severe sequelae such as blindness or mental retardation if not treated [1,2,10,11,12] It has not yet been conclusively proven that maternal treatment reduces the risk of fetal infection [3,13,14,15,16,17,18,19], some studies have demonstrated a beneficial effect of treatment [20,21,22,23,24,25,26,27]. Many authors believe that spiramycin is able to reduce the severity of fetal infection by delaying the onset of fetal disease and allowing greater maturation of the fetal immune system [28,29,30]
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