To assess the epidemiology, clinical features, and genotypic characteristics of congenital toxoplasmosis (CT) in Martinique over a 12-year period. We conducted a retrospective study of CT cases diagnosed at the University Hospital of Martinique between 2010 and 2022. We then compared the clinical, genotypic, and epidemiological data of these cases with those from the Limousin region in mainland France. Twenty-five CT cases were identified in Martinique, with no pregnancy terminations or in utero deaths. Clinical findings showed low severity at birth, with ocular involvement of 8% within the first few months and 21% within the first 2 years. Of the 11 isolates genotyped in Martinique, nine belonged to Caribbean lineages (Caribbean 1, 2, and 3), whereas all the isolates from Limousin were of the Type II lineage. There was no significant difference in clinical severity between the two regions. However, the incidence of CT was three times higher in Martinique than in mainland France. Although the genetic diversity of Toxoplasma gondii strains associated with diagnosed cases of CT in Martinique differed from that observed in mainland France, no increase in clinical severity was observed; however, a higher risk of transplacental passage was possible. These findings provide important data to improve our understanding of the epidemiological and clinical aspects of CT in relation to the genetic diversity of circulating strains in Martinique. Furthermore, they emphasize the importance of screening for CT on an ongoing basis and monitoring affected children.

During pregnancy, a finely regulated balance between inflammatory and regulatory immune responses supports maternal-fetal tolerance while preserving defense against pathogens. Various congenital infections can disrupt this equilibrium and impair fetal development. Amniotic fluid plays a central role in fetal protection, particularly through its cytokine composition, which mirrors the immune status during pregnancy. In the context of congenital infection (bacterial, viral, or parasitic), the cytokine profile is altered, thereby influencing fetal prognosis. Numerous studies have examined the impact of congenital infections on the immune response and their consequences for both mother and fetus. However, data on the inflammatory profile of amniotic fluid remain limited, owing to the invasiveness of sampling procedures and the complexity of analyses. A deeper understanding of inflammatory changes in amniotic fluid would provide valuable insights into the pathogenesis of fetal diseases, facilitate the identification of predictive biomarkers for congenital lesions, and contribute to the development of new therapeutic strategies. This article provides an update on the pathophysiology of infections with congenital transmission, focusing on the immune response to bacteria, viruses, and parasites. Particular attention is given to congenital toxoplasmosis. Results and conclusions : data on the cytokine profile in amniotic fluid are limited. The cytokine profile varies depending on the type of pathogen. For Toxoplasma gondii, data are difficult to interpret but the cytokine profile to acute infection is strain-dependent.

The impact of climate change on environmental pathogens is a question whose importance will amplify in coming years. The protozoan parasite and global zoonosis Toxoplasma gondii is one such: empirical evidence indicates that oocyst survival is reduced at high temperatures. Paradoxically, a decline in incidence of T. gondii infections could amplify the burden of this disease, as the most damaging outcome occurs subsequent to first infection during pregnancy, and reductions in the incidence of the infection will increase the average age of first infection. We blend models of infection dynamics rooted in occurrence across the African continent with models of human demography to bound expectations for the future burden of this pathogen, accounting for the effects of changing temperatures. We discuss targeting efforts and approaches for mitigation.

The impact of climate change on environmental pathogens is a question whose importance will amplify in coming years. The protozoan parasite and global zoonosis Toxoplasma gondii is one such: empirical evidence indicates that oocyst survival is reduced at high temperatures. Paradoxically, a decline in incidence of T. gondii infections could amplify the burden of this disease, as the most damaging outcome occurs subsequent to first infection during pregnancy, and reductions in the incidence of the infection will increase the average age of first infection. We blend models of infection dynamics rooted in occurrence across the African continent with models of human demography to bound expectations for the future burden of this pathogen, accounting for the effects of changing temperatures. We discuss targeting efforts and approaches for mitigation.

Background: Congenital toxoplasmosis remains a significant cause of fetal morbidity worldwide. This case-control study aimed to identify sociodemographic, dietary, and behavioral factors associated with Toxoplasma gondii infection during pregnancy in Italy by comparing infected women with seronegative controls, and to evaluate modifiable risk behaviors and treatment-related outcomes among affected patients. Methods: This case-control study included 201 pregnant women (100 with T. gondii infection and 101 seronegative controls). Participants completed a structured questionnaire on sociodemographic factors, diet, environmental exposures, and preventive behaviors. Clinical data were collected for infected women and analyzed using SPSS v27.0. Results: Sociodemographic and obstetric characteristics did not differ between groups. Infected women were more likely to live in rural areas (p < 0.001), have a lower educational level (p = 0.009), consume unpasteurized dairy products and cured meats (p < 0.05), purchase food from farmers or butchers (p = 0.01), and do not check food preparation practices when eating outside the home. High-risk animal-related behaviors were also more common among cases (p < 0.001). Despite similar baseline awareness, adherence to preventive measures was lower among cases; most infections were diagnosed in the first trimester and treated with spiramycin with good tolerability. Conclusions: Maternal toxoplasmosis is mainly associated with modifiable behavioral and environmental factors, underscoring the need for targeted, preconception counseling to reduce the risk of congenital infection.

Congenital toxoplasmosis results from transplacental transmission of Toxoplasma gondii during maternal primary infection. While the classic triad-hydrocephalus, intracranial calcifications, and chorioretinitis-defines severe forms, hypothalamic-pituitary axis involvement is extremely rare. Endocrine complications, particularly central hypothyroidism, are seldom described in this context. We report a preterm newborn at 35weeks' gestation, representing the first documented case of isolated central hypothyroidism associated with severe congenital toxoplasmosis. Neuroimaging revealed major triventricular hydrocephalus, multiple cystic formations, and cerebral calcifications consistent with toxoplasmic meningoencephalitis. Ocular examination showed bilateral cataracts, microphthalmia, and retinal detachment. Laboratory studies confirmed congenital toxoplasmosis by positive IgM/IgG serology and cerebrospinal fluid PCR. Endocrine assessment demonstrated central hypothyroidism with low TSH (0.012mIU/L) and T4 (4.31pmol/L) levels, while exploration of the other hypothalamic-pituitary axes was normal, suggesting selective thyrotropic axis dysfunction. Treatment included pyrimethamine, sulfadiazine, folinic acid, and levothyroxine replacement. The infant died on day 54 of life from a nosocomial infection.This case highlights an exceptional presentation of congenital toxoplasmosis associated with isolated central hypothyroidism. The findings suggest potential inflammatory or vascular damage to the hypothalamic-pituitary axis. Early recognition and hormone replacement therapy are essential to prevent further neurological impairment. Systematic endocrine evaluation is recommended in neonates with severe central nervous system involvement due to congenital toxoplasmosis.

Cerebral toxoplasmosis is one of the most common opportunistic infections among AIDS patients. Clinical and neuroimaging manifestations are diverse and non-specific, resulting in frequent delayed diagnosis and even misdiagnosis, leading to neurological impairment, coma, and death. In addition to clinical and serological examinations, multimodal neuroimaging is indispensable for early diagnosis and subsequent treatment evaluation. Indeed, functional magnetic resonance imaging technologies and positron emission tomography provide complementary information for early diagnosis and treatment, which can improve prognosis when combined with prevention strategies. Recent advances in vaccine development have provided new hope for the prevention of cerebral toxoplasmosis. This article reviews multimodal imaging evaluation strategies and other recent clinical advances for the prevention, diagnosis, and treatment of AIDS-related cerebral toxoplasmosis.

Congenital toxoplasmosis (CT) results from vertical transmission of Toxoplasma gondii during maternal infection in pregnancy. Early diagnosis in newborns is crucial to initiate timely therapy and prevent long-term sequelae. The IgM Immunosorbent Agglutination Assay (ISAGA) has historically been considered an important diagnostic tool for CT; however, its recent market withdrawal necessitates alternative approaches. We conducted a retrospective observational study at Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, including 44 newborns born to mothers with confirmed toxoplasmosis between 2019 and 2022. Newborns were classified as CT (n = 19) or non-CT (n = 25) based on serological follow-up, comparative Western blot (CWB) and Interferon Gamma Release Assay (IGRA). Sensitivity and specificity of CWB, IgM Chemiluminescent Immunoassay (CLIA), and IgM ISAGA were assessed at birth and at one month. At birth, CWB demonstrated 88.9% sensitivity, significantly higher than IgM CLIA (52.6%) and IgM ISAGA (57.9%). Specificity was 100% at birth and 92% at one month. CWB retained high sensitivity at one month (81.8%). IGRA complemented CWB in confirming or excluding infection in cases with equivocal or false-negative serology. Comparative Western blot thus represents a robust diagnostic alternative for CT, ensuring early detection and timely treatment, particularly in the absence of IgM ISAGA.

Congenital infections cause stillbirth, prematurity, birth defects, and neonatal death, representing a major preventable cause of infant morbidity and mortality. In Brazil, data on their hospital burden remain limited. This retrospective, population-based time series study analyzed hospitalizations of infants (<12 mo) primarily associated with congenital syphilis, toxoplasmosis, rubella, cytomegalovirus, or herpes in Brazil's Unified Health System (SUS) from 2008 to 2024. Data were extracted from the SUS Hospital Information System (SIH). Hospitalizations were evaluated by annual volume, population-adjusted rates, mean and total costs, intensive care unit (ICU) use, length of stay (LOS), and in-hospital mortality, stratified by region. Temporal trends were examined using Spearman's correlation and group differences using one-way ANOVA. A total of 194,531 hospitalizations were recorded, representing a 394% increase from 4,449 in 2008 to 20,971 in 2024. Congenital syphilis accounted for 88% of admissions and increased across all regions, while toxoplasmosis and cytomegalovirus rose moderately and rubella declined following immunization. National hospital expenditures reached US$49.1 million, rising 170% over the period. Mean LOS decreased modestly (-.8 d), and ICU use remained low except for herpes (up to 32%). In-hospital mortality declined from .73% to .13%, but 29.5% of patients were hospitalized outside their municipality of residence, indicating persistent regional disparities. Hospitalizations due to congenital infections-predominantly syphilis-have increased substantially in Brazil, reflecting gaps in prenatal screening, partner management, and maternal-child health coordination. Despite declining mortality, regional inequalities in hospitalization rates, access, and costs persist.

Congenital toxoplasmosis is both prevalent and severe in Brazil. The Minas Gerais Congenital Toxoplasmosis Control Program (PCTC-MG) used prenatal and neonatal screening to identify neonates at risk for congenital toxoplasmosis. This study aimed to evaluate the clinical and laboratory parameters used to diagnose the disease in this population. This retrospective cohort study included children with suspected congenital toxoplasmosis who participated in the PCTC-MG between 2013 and 2020. A total of 347 children participated in the study; 228 had confirmed toxoplasmosis and 119 were excluded. The majority (314/347; 90.5%) underwent neonatal screening for IgM in filter paper (FP). Among these, 269/314 (85.7%) had positive or indeterminate results, with 186 (69.1%) confirmed infections, while 45/314 (14.3%) had nonreactive results, with 17 confirmed infections. There was an association between treatment during pregnancy (45/227; 19.8%) and a lower number of reagent IgM results in FP ( P = 0.002) and serum ( P = 0.001). A higher gestational age was associated with a higher proportion of IgM in the FP ( P = 0.001) and serum ( P = 0.004). Retinochoroiditis (73.2%; 167/228) and neurologic changes (36.9%; 75/203) were frequent in the infected children. The treatment decision was based on the presence of IgM/IgA (176/226; 77.9%), retinochoroiditis (45/226; 19.9%) or persistence/increase in IgG levels (4/226; 1.8%). Screening with specific and sensitive serology identified most, but not all, children with congenital toxoplasmosis. Ophthalmologic evaluations and neuroimaging are mandatory in this context. The absence of IgM in the FP did not exclude the diagnosis.

Prevalence, risk factors, diagnosis and outcomes of Toxoplasma gondii infection in pregnancy: A review.

Timely serodiagnosis of Toxoplasma gondii is critical for HIV/AIDS patients, in whom latent infection can reactivate into life-threatening toxoplasmic encephalitis. This study aimed to evaluate the diagnostic performance of a novel recombinant T. gondii matrix antigen 1 (TgMAG1)-based indirect ELISA and a commercial latex agglutination test (LAT) for detecting anti-T. gondii IgG in HIV/AIDS patients, using the Sabin-Feldman dye test (DT) as the reference standard. A secondary objective was to determine the current prevalence of latent toxoplasmosis in this population in Thailand. We conducted a comparative serological evaluation using 348 residual clinical specimens collected from 2016 to 2019 from HIV/AIDS patients. All samples were tested using the in-house TgMAG1 ELISA, a commercial LAT, and the DT. The sensitivity, specificity, and agreement (kappa statistic) of each index test were calculated against the DT. The DT identified a T. gondii seroprevalence of 12.36% (43/348; 95% CI: 8.94-16.64). Compared to the DT, the TgMAG1-ELISA demonstrated a sensitivity of 72.09% and a specificity of 93.11%, with moderate agreement (κ = 0.598). The LAT showed a similar sensitivity of 69.76% but a higher specificity of 97.04%, achieving substantial agreement with the DT (κ = 0.696). In conclusion, both the TgMAG1-based ELISA and LAT demonstrated high specificity but moderate sensitivity compared to the reference standard. Consequently, while these assays are valuable screening tools in settings lacking the DT, their results require careful interpretation and potential confirmation in high-risk populations.

No cats, no travel, no problem? A rare case of severe congenital toxoplasmosis

Ring-enhancing brain lesions present a common radiological conundrum, especially in immunocompetent hosts where there is a broad differential diagnosis. Toxoplasma gondii, an obligate intracellular protozoan, typically causes encephalitis in immunocompromised patients, especially those with HIV/AIDS. Toxoplasma cerebral lesions in apparently immunocompetent people pose a diagnostic dilemma. The clinical features may mimic neoplastic or fungal causes, particularly when there are atypical radiological and histological presentations. We report an immunocompetent patient with toxoplasma encephalitis causing multiple cerebral lesions, with persistent clinical deterioration, ambiguous radiological findings and delayed response to treatment. The case emphasises the importance of tissue diagnosis and multidisciplinary management in this condition.

Central nervous system (CNS) infections are an important cause of morbidity and mortality among people living with HIV (PLWHIV), particularly in resource-limited settings. Cryptococcosis, toxoplasmosis and cerebral malaria often present with overlapping neurological symptoms, complicating diagnosis where confirmatory tests are unavailable. This study aimed to determine the prevalence and associated signs and symptoms of parasitic and fungal infections with neurological tropism in PLWHIV hospitalized in Libreville. A retrospective review was conducted at the Infectious Diseases Ward of the Centre Hospitalier Universitaire de Libreville (IDW-CHUL) between April and September 2021. Data were recorded from the medical files of PLWHIV hospitalised for suspected cryptococcal meningoencephalitis presenting with fever and headache alone or associated with other neurological signs. Diagnoses of cryptococcosis, toxoplasmosis, and malaria were based on microscopy, cryptococcal antigen testing, and brain CT scan. Cases of tuberculosis, other bacterial or viral meningitis were not included. Sociodemographic, clinical, and immunological data were analysed, and associations between symptoms and CNS infections were assessed. Among 255 hospitalised PLHIV, most were aged under 55 years (86.3%, n = 220), female (72.5%, n = 185), and severely immunosuppressed (CD4 < 200 cells/mm³, 57.2%, n = 127). Parasitic or fungal infections were identified in 32.9% (n = 84) of cases: cryptococcosis (14.5%), cerebral toxoplasmosis (13.7%), and complicated malaria (9.8%), with 5.1% presenting co-infections. Advanced HIV disease (WHO stage III-IV) was significantly associated with cryptococcosis and toxoplasmosis (p < 0.01). Fever and headache (81.2%, n = 207) were the most common symptoms. According to diagnosis, fever, headache, seizures, and/or focal deficits were more suggestive of toxoplasmosis (cOR 3.5, 95%CI [1.0-12.4], p = 0.05), while prostration was more frequent in malaria (cOR 2.9, 95%CI [0.98-9.0], p = 0.05), and neck stiffness was characteristic of cryptococcosis. Parasitic and fungal CNS infections remain frequent and severe in hospitalised PLWHIV in Libreville, mainly in advanced disease with profound immunosuppression. In the absence of diagnostic tools, recognition of symptom clusters may guide syndromic triage and empirical therapy.

This case report describes a 15-year-old male who presented to the clinic for the first time with long standing unexplained reduced vision of the right eye. Through a comprehensive ophthalmic evaluation, direct ophthalmoscopy revealed a well-demarcated chorioretinal lesion in the macular region of the right eye and in the peripheral retina of the left eye. The case illustrates the diagnostic challenges of identifying ocular toxoplasmosis when external signs are minimal or absent and emphasizes the critical role of a thorough ophthalmic evaluation in detecting underlying chorioretinal pathology. Early recognition of such lesions is essential to appropriate management, prevention of further vision loss, and timely referral for specialized care.

ABSTRACTNeurological manifestations remain a significant cause of hospitalization and in-hospital mortality among people living with HIV (PLWH), even in the era of antiretroviral therapy (ART). This study aims to describe the clinical and epidemiological profile of PLWH with neurological opportunistic infections (nOIs) and to identify factors associated with in-hospital mortality. We conducted a retrospective cohort study with PLWH aged >18 years hospitalized due to nOIs between November 2017 and December 2021 at a tertiary hospital in Brazil. Demographic, clinical, and laboratory data were extracted from electronic medical records. Logistic regression was used to evaluate associations between patient characteristics and in-hospital mortality. Among 237 hospitalized PLWH, 89 (37.6%) had nOIs. The median CD4 count at admission was 55 cells/mm³ (IQR 22.5–149), and 91.7% had previously used ART (only 22.7% used it regularly). The most frequent infections were cerebral toxoplasmosis (50.6%), cryptococcal meningitis (10.1%), and progressive multifocal leukoencephalopathy (9%). A total of 19 in-hospital deaths occurred. In the multivariate analysis, undefined neurological infections (aOR: 8.67; 95%CI: 1.23–61.17) and ICU admission (aOR: 58.61; 95% CI: 10.24–335.49) were independently associated with mortality. In conclusion, severe immunosuppression and low ART adherence were common in this cohort. Cerebral toxoplasmosis was the most prevalent neurological infection. ICU admission and undefined neurological syndromes were strong predictors of in-hospital mortality. Early diagnosis, prompt treatment, and strategies to improve ART adherence are essential to reduce fatal outcomes in this population.

Recent data on toxoplasmosis seroprevalence in Spain is limited, and pregnancy-screening programs are being discontinued. This study aimed to describe seroprevalence in pregnant women in Catalonia using newborn dried blood samples (DBS) from the Catalonian Newborn Screening (NBS) Program; as well as to assess detection of Toxoplasma gondii antibodies in DBS (Anti-Toxoplasma gondii ELISA (IgG/IgM), Euroimmun Lubeck, Germany) as a NBS tool and for retrospective diagnosis of congenital toxoplasmosis (CT) in cases from the Spanish Research Network of Congenital Toxoplasmosis (REIV-TOXO). A total of 3,231 DBS samples from NBS program (September 2022-August 2023) were randomly selected and analyzed, alongside with 30 DBS from CT confirmed cases. The overall seroprevalence of T. gondii IgG in pregnant women was 15.5% (95%CI: 14.33-16.85), higher in foreign women 22.6%, particularly Latin American (30.3%). Analysis of DBS from CT cases showed concordance in IgG detection but only 3.3% (1/30) were IgM positive despite 37% (10/27) having positive serum IgM at birth. In conclusion, IgG analysis in newborn DBS provides valuable information on pregnant seroprevalence. However, its value for identifying CT cases in retrospective diagnosis or as neonatal screening is poor given the low IgM detection. Thus, prenatal screening remains the most effective approach to identify children at risk.

Toxoplasmic encephalitis (TE) and primary central nervous system (CNS) lymphoma are the major differential diagnoses of ring-enhanced brain lesions in acquired immunodeficiency syndrome (AIDS). Biopsy may be difficult; thus, empirical anti-toxoplasma therapy is often initiated. We report an AIDS patient receiving chemotherapy for Kaposi's sarcoma who developed TE. Weekly gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated diminishment of ring enhancement 7 days after treatment, preceding neurological improvement and lesion size reduction. This early radiological change, captured by rare weekly gadolinium-enhanced MRI, was useful for differentiating TE from lymphoma before neurological improvement.

Acriptega, a combination of Dolutegravir, Lamivudine, and Tenofovir, is a cornerstone of modern antiretroviral therapy due to its efficacy and tolerability. However, treatment failures persist despite this optimization, raising questions about barriers to successful treatment. Through the analysis of two clinical cases, this study explores the biological and behavioral factors contributing to these failures following a switch to this molecule. The first case is a 69-year-old female patient, diagnosed with HIV in 2002 following pulmonary tuberculosis, who was regularly monitored with an undetectable viral load and a CD4 count &gt; 500 cells/mm³ until the Acriptega transition and the onset of tumor symptoms in 2024. The second case is a 62-year-old female patient, diagnosed with HIV in 2009 following cerebral toxoplasmosis. She was regularly monitored with good treatment adherence and an undetectable viral load. After switching her triple therapy, she developed gastroenteritis, which led to the discovery of her treatment failure. This case study highlights that failure after switching to Acriptega is linked to the absence of prior resistance testing (genotyping). A safe switchover requires a rigorous assessment of the patient’s virological history to prevent the emergence of cross-resistance. Close monitoring via genotyping is essential.