Liliana Sá*, Ana Maria Ferreira, Teresa Pinheiro and Teresa Caldeira

Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Department of Paediatrics and Neonatology, Portugal

*Corresponding Author: Liliana Sá, Centro Hospitalar de Entre o Douro e Vouga (CHEDV), Department of Paediatrics and Neonatology, Portugal.

Received: December 24, 2021; Published: January 31, 2022

Abstract

Background: Congenital toxoplasmosis occurs when there is a maternal primary infection during pregnancy and transplacental transmission of the parasite occurs to the fetus. The incidence is about 1- 10/10.000 births. It is a preventable disease with possible severe consequences. In the postnatal period, diagnosis is established by the persistence of anti-Toxoplasma IgG by 12 months of age.

Methods: We performed a retrospective study of children with suspected congenital toxoplasmosis born in our hospital between 2008 and 2018. The aim was to define the clinical and serological characteristics of children with congenital toxoplasmosis to optimize diagnostic work-up and treatment.

Results: Of the 51 suspected cases only 7.8% proved to be infected. Seroconversion occurred mostly in the 1st trimester (49%). Amniocentesis was performed in 39.2% of women and all tested negative in the polymerase chain reaction for Toxoplasma gondii DNA detection in the amniotic fluid. 60.8% of women were treated with spiramycin. All children were asymptomatic at birth except for one that presented with chorioretinitis. 68.6% of infants started treatment immediately after birth (40% spiramycin, 57% pyrimethamine/sulfadiazine). Median treatment duration was 2.4 months and interruption was determined by a negative polymerase chain reaction for Toxoplasma gondii in peripheral blood. None tested positive for toxoplasma specific IgM nor polymerase chain reaction test. In two cases anti- Toxoplasma IgG tested positive after the first year of life and treatment was re-introduced. No significant impairments were detected.

Conclusions: Given the characteristics of this infection, to confirm or exclude congenital toxoplasmosis several serological and parasitological tests are required.
Keywords: Chorioretinitis; Congenital Infection; Congenital Toxoplasmosis; Thalamic Calcifications; TORCH

References

1. Peyron , et al. “Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group”. Pathogens 8.1 (2019): 24.
2. Couvreur J and Desmonts G. “Congenital and maternal toxoplasmosis: a review of 300 congenital cases”. Developmental Medicine and Child Neurology 4 (1962): 519-530.
3. Koppe JG., et al. “Results of 20 years follow-up of congenital toxoplasmosis”. Lancet8475 (1986): 254-256.
4. Remington JS., et al. “Infectious diseases of the fetus and newborn infant”. 3rd The W. B. Saunders Co., Philadelphia. Toxoplasmosis (1990): 89-195.
5. Vilares A., et al. “Toxoplasmose: diagnóstico laboratorial de casos clínicos suspeitos de infeção entre 2009 e 2013”. Observações Boletim Epidemiológico. Instituto Nacional de Saúde Ricardo Jorge (2013).
6. Nissen J., et al. “The disease burden of congenital toxoplasmosis in Denmark, 2014”. PLoS one5 (2017): e0178282.
7. Villena I., et al. “Congenital toxoplasmosis in France in 2007: first results from a national surveillance system”. Eurosurveillance 25 (2010): 19600.
8. Wallon M., et al. “Congenital Toxoplasma infection: monthly prenatal screening decreases transmission rate and improves clinical outcome at age 3 years”. Clinical Infectious Diseases 9 (2013): 1223-1231.
9. Pons JC., et al. “Congenital toxoplasmosis: transmission to the fetus of a pre-pregnancy maternal infection”. La Presse médicale 3 (1995): 179-182.
10. Villena I., et al. “Prenatal diagnosis of congenital toxoplasmosis transmitted by an immunocompetent woman infected before conception. Reims Toxoplasmosis Group”. Prenatal Diagnosis 18 (1998): 1079-1081.
11. Tamma “Toxoplasmosis”. Pediatrics In Review 12 (2007): 470-471.
12. Couvreur J., et al. “In utero treatment of toxoplasmosis fetopathy with the combination of pyrimethamine-sulfadiazine”. Fetal Diagnosis 1 (1993): 45-50.
13. Guerina NG., et al. “Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection”. The New England Journal of Medicine 26 (1994): 1858-1863.
14. Bader TJ., et al. “Prenatal screening for toxoplasmosis”. Obstetrics and Gynecology 3 (2019): 457-464.
15. Eskild A., et al. “Screening for toxoplasmosis in pregnancy: what is the evidence of reducting a health problem?” Journal of Medical Screening 4 (1996): 188-194.
16. Foulon , et al. “Impact of primary prevention on the incidence of toxoplasmosis during pregnancy”. Obstetrics and Gynecology 72.3 Pt 1 (1998): 363-366.
17. Joynson DH and Payne “Screening for toxoplasma in pregnancy”. Lancet 2.8614 (1988): 795-796.
18. Pomares C and Montoya “Laboratory Diagnosis of Congenital Toxoplasmosis’. Journal of Clinical Microbiology 54.10 (2016): 2448-2454.
19. Tekkesin “Diagnosis of toxoplasmosis in pregnancy: a review”. HOAJ Biology 1.1 (2021): 9.
20. Jenum PA., et al. “Improved diagnosis of primary Toxoplasma gondii infection in early pregnancy by determination if anti-toxoplasma immunoglobulin G avidity”. Journal of Clinical Microbiology 8 (1997): 1972-1977.
21. Halliday JL., et al. “Importance of complete follow-up of spontaneous fetal loss after amniocentesis and chorion villi sampling”. Lancet 340 (1992): 1236.
22. Tabor A., et al. “Randomized controlled trial of genetic amniocentesis in 4606 low-risk women”. Lancet8493 (1986): 1287-1293.
23. Avelino MM., et al. “Congenital toxoplasmosis and prenatal care state programs”. BMC Infectious Diseases 14 (2014): 33.
24. Hotop A., et al. “Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy”. Clinical Infectious Diseases 11 (2012): 1545-1552.
25. “Protocolos de Diagnóstico e Terapêutica em Infecciologia Perinatal”. Secção de Neonatologia da SPP.
26. Pinhal AL., et al. “Congenital toxoplasmosis in a Portuguese tertiary hospital - report of 4 cases”. Journal of Pediatric and Neonatal Individualized Medicine 2 (2019): e080219.
27. Montoya “Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis”. The Journal of Infectious Diseases 185.1 (2002): S73-82.
28. Stajner T., et al. “Prenatal and Early Postnatal Diagnosis of Congenital Toxoplasmosis in a Setting with No Systematic Screening in Pregnancy”. Medicine (Baltimore)9 (2016): e2979.
29. Grover CM., et al. “Rapid prenatal diagnosis of congenital Toxoplasma infection by using a polymerase chain reaction and amniotic fluid”. Journal of Clinical Microbiology 10 (1990): 2297-2301.
30. Remigton JS., et al. “Infectious Diseases of the Fetus and Newborn Infant. 6. Remington JS, Klein JO, Wilson CB, Baker CJ, Vol. 31. press in United States of America: Saunders Elsevier; Toxoplasmosis; (2006): 947-1091.
31. McAuley JB., et al. “Textbook of Pediatric Infectious Diseases, 235. 6th edition”. United States of America: Saunders Elsevier, press; Toxoplasmosis (2009): 2954-2971.

Citation

Citation: Liliana Sá., et al. “Prenatal and Early Postnatal Diagnosis of Congenital Toxoplasmosis: Retrospective Study”. Acta Scientific Paediatrics 5.2 (2022): 30-36.

Copyright

Copyright: © 2022 Liliana Sá., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.