Screening methods for congenital toxoplasma and risk of disease

Abstract

If a woman acquires a primary Toxoplasma gondii infection during pregnancy, the fetus can become infected. Severe systemic and central-nervous-system signs of the infection may be apparent at birth, but most infected newborn babies do not have over the signs of the disease. Even so, infected infants are at substantial risk of developing long-term sequelae, including chorioretinal disease (up to 85% of infected children) and neurological abnormalities. 1 Koppe JG Loewer-Sieger DH De Roever-Bonnet H Results of 20 year follow-up of congenital toxoplasmosis. Lancet. 1986; i: 254-256 Summary Scopus (280) Google Scholar , 2 Wilson CB Remington JS Stagno S Reynolds DW Development of adverse sequelae in children born with subclinical congenital toxoplasma infection. Pediatrics. 1980; 66: 767-774 PubMed Google Scholar , 3 Couvreur J Desmonts G Aron-Rosa D Le prognostic oculaire de la toxoplasmose congenitale: role du traitement. Ann Pediat (Paris). 1984; 31: 855-858 PubMed Google Scholar Significant reductions in the frequency and severity of disease at birth have been associated with in-utero treatment of infected fetuses. 4 Berrebi A Kobuch WE Bessieres MH et al. Termination of pregnancy for maternal toxoplasmosis. Lancet. 1994; 344: 36-39 Summary PubMed Scopus (93) Google Scholar , 5 Hohlfeld P Daffos F Thulliez P et al. Fetal toxoplasmosis; outcome of pregnancy and infant follow-up after in-utero treatment. J Pediatr. 1989; 15: 765-769 Summary Full Text PDF Scopus (228) Google Scholar , 6 Peyron F Wallon M Bernardoux C Long-term follow-up of patients with congenital ocular toxoplasmosis. N Engl J Med. 1996; 334: 993-994 Crossref PubMed Scopus (54) Google Scholar , 7 Foulon W Villena I Stray-Pedersen B et al. Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol. 1999; 180: 410-415 Summary Full Text Full Text PDF PubMed Scopus (241) Google Scholar Extended postnatal treatment regimens, started in the newborn period or early infancy, 8 Guerina NG Hsu HW Meissner HC et al. Neonatal serological screening and early treatment of congenital Toxoplasma gondii infection. N Engl J Med. 1994; 330: 1858-1863 Crossref PubMed Scopus (376) Google Scholar , 9 McAuley J Boyer K Patel D et al. Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago collaborative treatment trial. Clin Infect Dis. 1994; 18: 38-72 Crossref PubMed Scopus (302) Google Scholar or as a continuation of in-utero treatment, 5 Hohlfeld P Daffos F Thulliez P et al. Fetal toxoplasmosis; outcome of pregnancy and infant follow-up after in-utero treatment. J Pediatr. 1989; 15: 765-769 Summary Full Text PDF Scopus (228) Google Scholar , 6 Peyron F Wallon M Bernardoux C Long-term follow-up of patients with congenital ocular toxoplasmosis. N Engl J Med. 1996; 334: 993-994 Crossref PubMed Scopus (54) Google Scholar have also been associated with a marked reduction in the expected long-term complications. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counsellingThis information will assist the clinical counselling of pregnant women diagnosed with acute toxoplasmosis and may guide individual decisions on investigative and therapeutic options. Further studies are required to determine the long-term risks of clinical symptoms and disability due to congenital toxoplasmosis. Full-Text PDF Feasibility of neonatal screening for toxoplasma infection in the absence of prenatal treatmentThe risks of transmission of infection and of disease in the infant are low in an area with a low risk of toxoplasma infection. A neonatal screening programme based on detection of toxoplasma-specific IgM antibodies alone will identify between 70% and 80% of cases of congenital toxoplasmosis. Full-Text PDF