1
|
Fortin O, Mulkey SB, Fraser JL. Advancing fetal diagnosis and prognostication using comprehensive prenatal phenotyping and genetic testing. Pediatr Res 2024:10.1038/s41390-024-03343-9. [PMID: 38937640 DOI: 10.1038/s41390-024-03343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Prenatal diagnoses of congenital malformations have increased significantly in recent years with use of high-resolution prenatal imaging. Despite more precise radiological diagnoses, discussions with expectant parents remain challenging because congenital malformations are associated with a wide spectrum of outcomes. Comprehensive prenatal genetic testing has become an essential tool that improves the accuracy of prognostication. Testing strategies include chromosomal microarray, exome sequencing, and genome sequencing. The diagnostic yield varies depending on the specific malformations, severity of the abnormalities, and multi-organ involvement. The utility of prenatal genetic diagnosis includes increased diagnostic clarity for clinicians and families, informed pregnancy decision-making, neonatal care planning, and reproductive planning. Turnaround time for results of comprehensive genetic testing remains a barrier, especially for parents that are decision-making, although this has improved over time. Uncertainty inherent to many genetic testing results is a challenge. Appropriate genetic counseling is essential for parents to understand the diagnosis and prognosis and to make informed decisions. Recent research has investigated the yield of exome or genome sequencing in structurally normal fetuses, both with non-invasive screening methods and invasive diagnostic testing; the prenatal diagnostic community must evaluate and analyze the significant ethical considerations associated with this practice prior to generalizing its use. IMPACT: Reviews available genetic testing options during the prenatal period in detail. Discusses the impact of prenatal genetic testing on care using case-based examples. Consolidates the current literature on the yield of genetic testing for prenatal diagnosis of congenital malformations.
Collapse
Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology and Rehabilitation Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jamie L Fraser
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA.
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| |
Collapse
|
2
|
Park L, Reyes-Hadsall S, Dhillon R, Frauenfelder A, Graneiro A, Fayiga FF, Lange C, Duarte AM. Concerning Newborn Rashes and Developmental Abnormalities: Part II: Congenital Infections, Ichthyosis, Neurocutaneous Disorders, Vascular Malformations, and Midline Lesions. Pediatr Rev 2023; 44:447-465. [PMID: 37525307 DOI: 10.1542/pir.2022-005640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Lily Park
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | - Sophia Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Rummit Dhillon
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| | | | - Ana Graneiro
- Department of Allergy and Immunology, Nicklaus Children's Hospital, Miami, FL
| | - Folasade F Fayiga
- University of Miami Miller School of Medicine, Miami, FL
- Wright State University Boonshoft School of Medicine, Fairborn, OH
- Children's Skin Center, Miami, FL
| | - Carlos Lange
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
| | - Ana M Duarte
- University of Miami Miller School of Medicine, Miami, FL
- Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
- Children's Skin Center, Miami, FL
- Florida International University, Miami, FL
- Nova Southwestern University, Fort Lauderdale, FL
| |
Collapse
|
3
|
Chen Y, Zheng X, Huang X, Huang X, Zhang J. A retrospective study of air quality associated with teratogenic pathogen screening in women of reproductive age in southern China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:83615-83627. [PMID: 37347331 DOI: 10.1007/s11356-023-28239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
Adverse pregnancy outcomes are associated with a poor ambient atmospheric environment. Infections by teratogenic pathogens such as cytomegalovirus (CMV) and herpes simplex virus (HSV) are the main cause of the worse pregnant outcomes. However, environmental factors governing these infections are uncertain and epidemiological studies are limited. An epidemiological study on relationships between air pollutants and antibodies against teratogenic pathogens will be explored. In total, 5475 women of childbearing age were enrolled in the study between January 2018 and December 2019 in a hospital in Shantou, China. Antibodies against pathogens were measured by electrochemical luminescence. Everyday air quality data, concerning particulate matter (PM), sulfur dioxide (SO2), nitrogen dioxide (NO2), and other parameters, were acquired from a government web site, and the relationships between them were evaluated with nonparametric and multivariate linear regression analyses. Not only titers of herpes simplex virus HSV(I+II) IgGs in spring, but also titers of cytomegalovirus IgG (CMV IgG) and HSV I IgG in autumn, both had positive associations with concentrations of SO2. When PM2.5 or PM10 exposure is elevated, HSV(I+II) IgGs, TOX IgM should be paid more attention in spring or summer. Air pollution may be crucial for teratogenic pathogen infections. This study highlights air pollution could increase the risk of teratogenic pathogen infection, implying stronger measures should be taken to protect air environment and screenings of associated antibody should be strengthened in different season.
Collapse
Affiliation(s)
- Yanrong Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Xiangbin Zheng
- Center for Reproductive Medicine, Shantou Central Hospital, Shantou, 515041, Guangdong, China
- Clinical Research Center, Shantou Central Hospital, Shantou, 515041, Guangdong, China
| | - Xiaofan Huang
- Center for Reproductive Medicine, Shantou Central Hospital, Shantou, 515041, Guangdong, China
| | - Xin Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China
| | - Juan Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong, China.
| |
Collapse
|
4
|
Tao Y, Shen C, Zhang Y, Zhao X, Leow CY, Wu J, Ji M, Xu Z. Advances in research on schistosomiasis and toxoplasmosis in China: A bibliometric analysis of Chinese academic journals published from 1980 to 2021. Acta Trop 2023; 238:106783. [PMID: 36455636 DOI: 10.1016/j.actatropica.2022.106783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The scale-up of zoonoses prevention control and eradication in China, coupled with numerous academic articles in Chinese journals has led to the development of new tools and strategies aimed at further consolidating parasite control goals. As a result, there is a growing need for an up-to-date understanding of the research progress and prevention and control experience of parasitic diseases in China. METHODS To understand the research status of schistosomiasis and toxoplasmosis in China, academic articles published in Chinese journals from 1980 to 2021 were retrieved from China National Knowledge Infrastructure (CNKI) and Wanfang databases. The Bibliographic Items Co-occurrence Matrix Builder (BICOMB) software was used to extract and analyze the keyword frequencies. The 'K/A ratio' as the frequency of a keyword that occurred in all the articles within a certain time stage was calculated to compare the popularity of the same keyword in different time stages. Keyword co-occurrence network maps were constructed by VOSviewer software. RESULTS A total of 18,508 articles in the research field of Schistosoma and 13,289 articles in the field of Toxoplasma gondii were included. Results in both fields showed some similarities: the annual number of articles presented an increasing trend before entering the 21st century and decreased rapidly in recent years. Two opposite changing trends of keyword frequency could be observed in the K/A ratio analysis: the K/A ratios of 'Surveillance' and 'Infection' continuously increased over time, while those of 'Schistosoma mansoni' and 'Mesenteric lymph nodes' decreased. The diversification of keyword co-occurrence networks could be observed in the co-occurrence network maps. CONCLUSIONS This bibliometric analysis reveals trends in research themes in the fields of Schistosoma and Toxoplasma gondii from 1980 to 2021, presenting China's experience such as a high degree of government involvement and multidisciplinary participation in schistosomiasis and toxoplasmosis control and elimination.
Collapse
Affiliation(s)
- Yiran Tao
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China; The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Chunxiang Shen
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Yu Zhang
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Xinyu Zhao
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China; The First Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Chiuan Yee Leow
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Jian Wu
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School of Nanjing Medical University, Suzhou, Jiangsu, PR China.
| | - Minjun Ji
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China; NHC Key Laboratory of Antibody Technique, Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Zhipeng Xu
- Department of Pathogen Biology, Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, PR China; NHC Key Laboratory of Antibody Technique, Nanjing Medical University, Nanjing, Jiangsu, PR China.
| |
Collapse
|
5
|
Wong YP, Tan GC, Omar SZ, Mustangin M, Singh Y, Salker MS, Abd Aziz NH, Shafiee MN. SARS-CoV-2 Infection in Pregnancy: Placental Histomorphological Patterns, Disease Severity and Perinatal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9517. [PMID: 35954874 PMCID: PMC9368100 DOI: 10.3390/ijerph19159517] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
The association between maternal COVID-19 infection, placental histomorphology and perinatal outcomes is uncertain. The published studies on how placental structure is affected after SARS-CoV-2 virus in COVID-19-infected pregnant women are lacking. We investigated the effects of maternal SARS-CoV-2 infection on placental histomorphology and pregnancy outcomes. A retrospective cohort study on 47 pregnant women with confirmed SARS-CoV-2 infection, matched with non-infected controls, was conducted. Relevant clinicopathological data and primary birth outcomes were recorded. Histomorphology and SARS-CoV-2 immunohistochemistry analyses of placental tissues were performed. Only 1 of 47 cases showed SARS-CoV-2 immunoreactivity in the syncytiotrophoblasts. Histologically, decidual vasculopathy (n = 22/47, p = 0.004), maternal vascular thrombosis (n = 9/47, p = 0.015) and chronic histiocytic intervillositis (n = 10/47, p = 0.027) were significantly higher in the COVID-19-infected placentas when compared to the control group. Maternal vascular thrombosis was a significant feature in the active COVID-19 group. A significant lower gestational age (p < 0.001)) at delivery and a higher caesarean section rate (p = 0.007) were observed in the active SARS-CoV-2-infected cases, resulting in a significant lower fetal-placental weight ratio (p = 0.022) and poorer Apgar score (p < 0.001). Notably, active (p = 0.027), symptomatic (p = 0.039), severe-critical (p = 0.002) maternal COVID-19 infection and placental inflammation (p = 0.011) were associated with an increased risk of preterm delivery. Altered placental villous maturation and severe-critical maternal COVID-19 infection were associated with an elevated risk of poor Apgar scores at birth (p = 0.018) and maternal mortality (p = 0.023), respectively.
Collapse
Affiliation(s)
- Yin Ping Wong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Geok Chin Tan
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Siti Zarqah Omar
- Department of Pathology, Hospital Sultanah Nur Zahirah, Kuala Terengganu 20400, Terengganu, Malaysia;
| | - Muaatamarulain Mustangin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia;
| | - Yogesh Singh
- Institute of Medical Genetics and Applied Genomics, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
- Research Institute for Women’s Health, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
| | - Madhuri S. Salker
- Research Institute for Women’s Health, University of Tubingen, Calwerstrasse 7, 72076 Tubingen, Germany;
| | - Nor Haslinda Abd Aziz
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.H.A.A.); (M.N.S.)
| | - Mohamad Nasir Shafiee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia; (N.H.A.A.); (M.N.S.)
| |
Collapse
|
6
|
Thomas AX, Link N, Robak LA, Demmler‐Harrison G, Pao EC, Squire AE, Michels S, Cohen JS, Comi A, Prontera P, Verrotti di Pianella A, Di Cara G, Garavelli L, Caraffi SG, Fusco C, Zuntini R, Parks KC, Sherr EH, Hashem MO, Maddirevula S, Alkuraya FS, Contractar IAF, Neil JE, Walsh CA, Bellen HJ, Chao H, Clark RD, Mirzaa GM. ANKLE2-related microcephaly: A variable microcephaly syndrome resembling Zika infection. Ann Clin Transl Neurol 2022; 9:1276-1288. [PMID: 35871307 PMCID: PMC9380164 DOI: 10.1002/acn3.51629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study delineates the clinical and molecular spectrum of ANKLE2-related microcephaly (MIC), as well as highlights shared pathological mechanisms between ANKLE2 and the Zika virus. METHODS We identified 12 individuals with MIC and variants in ANKLE2 with a broad range of features. Probands underwent thorough phenotypic evaluations, developmental assessments, and anthropometric measurements. Brain imaging studies were systematically reviewed for developmental abnormalities. We functionally interrogated a subset of identified ANKLE2 variants in Drosophila melanogaster. RESULTS All individuals had MIC (z-score ≤ -3), including nine with congenital MIC. We identified a broad range of brain abnormalities including simplified cortical gyral pattern, full or partial callosal agenesis, increased extra-axial spaces, hypomyelination, cerebellar vermis hypoplasia, and enlarged cisterna magna. All probands had developmental delays in at least one domain, with speech and language delays being the most common. Six probands had skin findings characteristic of ANKLE2 including hyper- and hypopigmented macules. Only one individual had scalp rugae. Functional characterization in Drosophila recapitulated the human MIC phenotype. Of the four variants tested, p.Val229Gly, p.Arg236*, and p.Arg536Cys acted as partial-loss-of-function variants, whereas the c.1421-1G>C splicing variant demonstrated a strong loss-of-function effect. INTERPRETATION Deleterious variants in the ANKLE2 gene cause a unique MIC syndrome characterized by congenital or postnatal MIC, a broad range of structural brain abnormalities, and skin pigmentary changes. Thorough functional characterization has identified shared pathogenic mechanisms between ANKLE2-related MIC and congenital Zika virus infection. This study further highlights the importance of a thorough diagnostic evaluation including molecular diagnostic testing in individuals with MIC.
Collapse
Affiliation(s)
- Ajay X. Thomas
- Division Neurology and Developmental Neuroscience, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
- Jan and Dan Duncan Neurological Research InstituteTexas Children's HospitalHoustonTexasUSA
| | - Nichole Link
- Department of NeurobiologyUniversity of UtahSalt Lake CityUtahUSA
| | - Laurie A. Robak
- Jan and Dan Duncan Neurological Research InstituteTexas Children's HospitalHoustonTexasUSA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
| | - Gail Demmler‐Harrison
- Division Infectious Diseases, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
| | | | | | | | - Julie S. Cohen
- Department of Neurology and Developmental MedicineKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Anne Comi
- Department of Neurology and Developmental MedicineKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Paolo Prontera
- Medical Genetics UnitUniversity and Hospital of PerugiaPerugiaItaly
| | | | - Giuseppe Di Cara
- Pediatric Clinic, Department of Medical and Surgical SciencesUniversity of PerugiaPerugiaItaly
| | - Livia Garavelli
- Medical Genetics UnitAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | | | - Carlo Fusco
- Child Neurology and Psychiatry UnitAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Roberta Zuntini
- Medical Genetics UnitAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Kendall C. Parks
- Department of Neurology, Institute of Human GeneticsUniversity of California in San FranciscoSan FranciscoCaliforniaUSA
| | - Elliott H. Sherr
- Department of Neurology, Institute of Human GeneticsUniversity of California in San FranciscoSan FranciscoCaliforniaUSA
| | - Mais O. Hashem
- Department of Translational Genomics, Center for Genomic MedicineKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Sateesh Maddirevula
- Department of Translational Genomics, Center for Genomic MedicineKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fowzan S. Alkuraya
- Department of Translational Genomics, Center for Genomic MedicineKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | | | - Jennifer E. Neil
- Division of Genetics and Genomics and Howard Hughes Medical InstituteBoston Children's HospitalBostonMassachusettsUSA
| | - Christopher A. Walsh
- Division of Genetics and Genomics and Howard Hughes Medical InstituteBoston Children's HospitalBostonMassachusettsUSA
- Departments of Pediatrics and NeurologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Hugo J. Bellen
- Jan and Dan Duncan Neurological Research InstituteTexas Children's HospitalHoustonTexasUSA
- Division Infectious Diseases, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
- Howard Hughes Medical InstituteBaylor College of MedicineHoustonTexasUSA
- Department of NeuroscienceBaylor College of MedicineHoustonTexasUSA
| | - Hsiao‐Tuan Chao
- Division Neurology and Developmental Neuroscience, Department of PediatricsBaylor College of MedicineHoustonTexasUSA
- Jan and Dan Duncan Neurological Research InstituteTexas Children's HospitalHoustonTexasUSA
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexasUSA
- Department of NeuroscienceBaylor College of MedicineHoustonTexasUSA
- McNair Medical InstituteThe Robert and Janice McNair FoundationHoustonTexasUSA
| | - Robin D. Clark
- Division of Clinical Genetics, Department of PediatricsLoma Linda UniversityLoma LindaCaliforniaUSA
| | - Ghayda M. Mirzaa
- Center for Integrative Brain ResearchSeattle Children's Research InstituteSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Brotman‐Baty Institute for Precision MedicineSeattleWashingtonUSA
| |
Collapse
|
7
|
Bollani L, Auriti C, Achille C, Garofoli F, De Rose DU, Meroni V, Salvatori G, Tzialla C. Congenital Toxoplasmosis: The State of the Art. Front Pediatr 2022; 10:894573. [PMID: 35874584 PMCID: PMC9301253 DOI: 10.3389/fped.2022.894573] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Infection with the protozoan parasite Toxoplasma gondii occurs worldwide and usually causes no symptoms. However, a primary infection of pregnant women, may infect the fetus by transplacental transmission. The risk of mother-to-child transmission depends on week of pregnancy at the time of maternal infection: it is low in the first trimester, may reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when infection occurs early in pregnancy than later. Systematic serologic testing in pregnant women who have no antibodies at the beginning of pregnancy, can accurately reveal active maternal infection. Therefore, the risk of fetal infection should be assessed and preventive treatment with spiramycin must be introduced as soon as possible to reduce the risk of mother-to-child transmission, and the severity of fetal infection. When maternal infection is confirmed, prenatal diagnosis with Polymerase Chain Reaction (PCR) on amniotic fluid is recommended. If fetal infection is certain, the maternal treatment is changed to a combination of pyrimethamine-sulfonamide and folinic acid. Congenitally infected newborns are usually asymptomatic at birth, but at risk for tardive sequelae, such as blindness. When congenital infection is evident, disease include retinochoroiditis, cerebral calcifications, hydrocephalus, neurocognitive impairment. The diagnosis of congenital infection must be confirmed at birth and management, specific therapy, and follow-up with multidisciplinary counseling, must be guaranteed.
Collapse
Affiliation(s)
- Lina Bollani
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Cristian Achille
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Garofoli
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Meroni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Chryssoula Tzialla
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|