The clinical spectrum of congenital toxoplasmosis: Problems in recognition

Abstract

Four cases of acute congenital toxoplasmosis in twins are presented to illustrate the variable clinical spectrum of this infection. In two, who died of the infection, the diagnosis was not suspected because “specific” signs usually associated with congenital toxoplasmosis were not present. Nonspecific signs compatible with many other clinical disease entities were the predominant features in these cases. In addition, the diagnosis in the surviving infants would not have been suspected without the benefit of postmortem examination of their twins. High levels of IgM and IgA immunoglobulins are reported in one of the infants and similar results in other congenitally infected infants are described. Macroglobulin anti-Toxoplasma antibodies (ATA) were demonstrated in the serum of one of the twins. The demonstration of such macroglobulin ATA in newborn infants appears to establish the diagnosis of acute congenital toxoplasmosis. Gross and histologic changes found at autopsy are described. The parasite was demonstrated in glomeruli and renal tubules, thus suggesting the possibility of isolation and/or visualization of Toxoplasma in the urine of patients with acute toxoplasmosis. The importance and difficulty of establishing the correct diagnosis in infected infants who appear to be normal at birth or who show less than the “classical” signs of congenital toxoplasmosis are discussed.