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De Santis M, Tartaglia S, Apicella M, Visconti D, Noia G, Valentini P, Lanzone A, Santangelo R, Masini L. The prevention of congenital toxoplasmosis using a combination of Spiramycin and Cotrimoxazole: The long-time experience of a tertiary referral centre. Trop Med Int Health 2024; 29:697-705. [PMID: 38842439 DOI: 10.1111/tmi.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii and is responsible for gestational and congenital infections worldwide. The current standard therapy is based on the administration of Spiramycin to prevent trans-placental transmission. Other therapies are being studied to reduce the rates of foetal transmission and symptomatic congenital infection. OBJECTIVES We report our long-standing experience in maternal toxoplasmosis infection treatment using a combination of Spiramycin-Cotrimoxazole, assessing its effectiveness in preventing vertical transmission compared to the expected incidence of congenital infection. METHODS We retrospectively collected cases of pregnant women referred to our centre for suspected toxoplasmosis infection according to Lebech criteria, treated with Spiramycin-Cotrimoxazole. RESULTS Of 1364 women referred to our centre, postnatal follow-up of primary toxoplasmosis was available in 562 cases (73.9%). The overall vertical transmission rate was 3.4% in women treated immediately with Spiramycin-Cotrimoxazole after the diagnosis of infection. In comparison, it was 7.7% in women undergoing the same therapy but late or with poor compliance. The foetal transmission rate was 71.4% in untreated cases. All the infected newborns of mother treated adequately with Spiramycin-Cotrimoxazole were asymptomatic afterbirth, while 6/21 infected infants of the inadequate Spiramycin-Cotrimoxazole therapy group had postnatal sequelae (28.5%). The incidence of transmission after appropriate Spiramycin-Cotrimoxazole therapy was significantly lower than the expected rate reported in literature. CONCLUSIONS A combination of Spiramycin and Cotrimoxazole is safe and effective in preventing foetal congenital toxoplasmosis and reducing sequelae in case of in-utero infection. The timing and adherence to the therapy are crucial to lowering the risk of congenital infection and neonatal morbidity.
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MESH Headings
- Humans
- Spiramycin/therapeutic use
- Female
- Pregnancy
- Toxoplasmosis, Congenital/prevention & control
- Toxoplasmosis, Congenital/drug therapy
- Toxoplasmosis, Congenital/epidemiology
- Infectious Disease Transmission, Vertical/prevention & control
- Retrospective Studies
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
- Tertiary Care Centers
- Infant, Newborn
- Pregnancy Complications, Parasitic/prevention & control
- Pregnancy Complications, Parasitic/drug therapy
- Pregnancy Complications, Parasitic/epidemiology
- Adult
- Drug Therapy, Combination
- Anti-Bacterial Agents/therapeutic use
- Toxoplasmosis/prevention & control
- Toxoplasmosis/transmission
- Toxoplasmosis/drug therapy
- Toxoplasmosis/epidemiology
- Antiprotozoal Agents/therapeutic use
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Affiliation(s)
- Marco De Santis
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvio Tartaglia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
| | | | - Daniela Visconti
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
| | - Giuseppe Noia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Pediatria, Rome, Italy
- Istituto di Clinica Pediatrica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosaria Santangelo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Microbiologia, Rome, Italy
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lucia Masini
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Ostetricia e Patologia Ostetrica, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Montoya JG. In defense of children's brain: reshuffling the laboratory toolbox for the diagnosis of congenital toxoplasmosis. J Clin Microbiol 2024; 62:e0169723. [PMID: 38780287 PMCID: PMC11237424 DOI: 10.1128/jcm.01697-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
For decades, an immunosorbent agglutination assay (ISAGA) has been considered the gold standard method for the detection of Toxoplasma gondii-specific IgM in infants for the diagnosis of congenital toxoplasmosis (CT). The Toxoplasma IgM ISAGA was consistently reported as having superior sensitivity. Unfortunately, the commercial kit for the detection of Toxoplasma IgM ISAGA will no longer be available in 2024 and alternatives will only be available at a handful of reference laboratories as in-house or laboratory-developed tests. In a recent study, S. Arkhis, C. Rouges, N. Dahane, H. Guegan, et al. (J Clin Microbiol 62:e01222-23, 2024, https://doi.org/10.1128/jcm.01222-23), reported that the performance of the PLATELIA Toxo IgM was comparable to that of the ISAGA method for the diagnosis of CT. A second study revealing similar results supports the PLATELIA Toxo IgM as the new gold standard for the detection of T. gondii-specific IgM in infants. Although the laboratory toolbox for CT diagnosis has been reshuffled successfully, it is by universally implementing all available serological and molecular tools at the earliest possible time during gestation that we can best defend children's brain from the potential harm caused by trans-placentally transmitted T. gondii.
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Affiliation(s)
- Jose G Montoya
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, National Reference Laboratory for the Study and Diagnosis of Toxoplasmosis, Palo Alto Medical Foundation, Palo Alto, California, USA
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3
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Fortin O, DeBiasi RL, Mulkey SB. Congenital infectious encephalopathies from the intrapartum period to postnatal life. Semin Fetal Neonatal Med 2024:101526. [PMID: 38677956 DOI: 10.1016/j.siny.2024.101526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Congenital infections are a common but often underrecognized cause of fetal brain abnormalities, as well as fetal-neonatal morbidity and mortality, that should be considered by all healthcare professionals providing neurological care to fetuses and newborns. Maternal infection with various pathogens (cytomegalovirus, Toxoplasmosis, Rubella virus, Parvovirus B19, lymphocytic choriomeningitis virus, syphilis, Zika virus, varicella zoster virus) during pregnancy can be transmitted to the developing fetus, which can cause multisystem dysfunction and destructive or malformative central nervous system lesions. These can be recognized on fetal and neonatal imaging, including ultrasound and MRI. Imaging and clinical features often overlap, but some distinguishing features can help identify specific pathogens and guide subsequent testing strategies. Some pathogens can be specifically treated, and others can be managed with targeted interventions or symptomatic therapy based on expected complications. Neurological and neurodevelopmental complications related to congenital infections vary widely and are likely driven by a combination of pathophysiologic factors, alone or in combination. These include direct invasion of the fetal central nervous system by pathogens, inflammation of the maternal-placental-fetal triad in response to infection, and long-term effects of immunogenic and epigenetic changes in the fetus in response to maternal-fetal infection. Congenital infections and their neurodevelopmental impacts should be seen as an issue of public health policy, given that infection and the associated complications disproportionately affect woman and children from low- and middle-income countries and those with lower socio-economic status in high-income countries. Congenital infections may be preventable and treatable, which can improve long-term neurodevelopmental outcomes in children.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | - Roberta L DeBiasi
- Division of Pediatric Infectious Disease, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Tropical Medicine, Microbiology and Infectious Diseases, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA; Department of Neurology and Rehabilitation Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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4
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Chien SC, Chen CP. Genetic Counseling of Fetal Microcephaly. J Med Ultrasound 2024; 32:1-7. [PMID: 38665355 PMCID: PMC11040482 DOI: 10.4103/jmu.jmu_18_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 04/28/2024] Open
Abstract
Fetal microcephaly is a small head with various losses of cerebral cortical volume. The affected cases may suffer from a wide range in severity of impaired cerebral development from slight to severe mental retardation. It can be an isolated finding or with other anomalies depending on the heterogeneous causes including genetic mutations, chromosomal abnormalities, congenital infectious diseases, maternal alcohol consumption, and metabolic disorders during pregnancy. It is often a lifelong and incurable condition. Thus, early detection of fetal microcephaly and identification of the underlying causes are important for clinical staff to provide appropriate genetic counseling to the parents and accurate management.
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Affiliation(s)
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
- Institute of Clinical and Community Health Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Calero-Bernal R, Gennari SM, Cano S, Salas-Fajardo MY, Ríos A, Álvarez-García G, Ortega-Mora LM. Anti- Toxoplasma gondii Antibodies in European Residents: A Systematic Review and Meta-Analysis of Studies Published between 2000 and 2020. Pathogens 2023; 12:1430. [PMID: 38133313 PMCID: PMC10745778 DOI: 10.3390/pathogens12121430] [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: 10/19/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Toxoplasmosis has a major impact on animal and public health. Information regarding the seroprevalence of human Toxoplasma gondii infections from a European perspective has not yet been compiled to date. Thus, the present review summarized available resident data from the period 2000-2020. The overall seroprevalence of anti-T. gondii IgG was 32.1%, with great variability between countries (n = 30). The subgroup analysis identified different pooled prevalence data depending on the geographic area (p < 0.0001), target population (p = 0.0147), and serological diagnosis assays used (p = 0.0059). A high heterogeneity (I2 = 100%, p < 0.001; Q = 3.5e+05, d.f. = 135, p < 0.001) and degree of publication bias (Egger's test = 6.14, p < 0.001) were observed among the 134 studies considered. The occurrence of anti-T. gondii IgM, which was reported in 64.7% of studies, reached a pooled seroprevalence of 0.6%. In addition, among the eight main risk factors identified, "contact with soil", "consumption of undercooked beef", and "intake of unwashed vegetables" were the most significantly associated with infections. The fact that one-third of the European population has been exposed to T. gondii justifies extra efforts to harmonize surveillance systems and develop additional risk-factor analyses based on detailed source attribution assessment.
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Affiliation(s)
- Rafael Calero-Bernal
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Solange María Gennari
- PhD Program in One Health, Faculty of Veterinary Medicine, University of Santo Amaro, São Paulo 04829-300, SP, Brazil;
- Faculty of Veterinary Medicine, University of São Paulo, São Paulo 05508-270, SP, Brazil
| | - Santiago Cano
- Computing Services, Research Support Center, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Martha Ynés Salas-Fajardo
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Arantxa Ríos
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Gema Álvarez-García
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
| | - Luis Miguel Ortega-Mora
- SALUVET, Animal Health Department, Complutense University of Madrid, 28040 Madrid, Spain; (M.Y.S.-F.); (A.R.); (G.Á.-G.); (L.M.O.-M.)
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Curi ALL, de-la-Torre A, Schlaen A, Mahendradas P, Biswas J. Pediatric Posterior Infectious Uveitis. Ocul Immunol Inflamm 2023; 31:1944-1954. [PMID: 38096404 DOI: 10.1080/09273948.2023.2284990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE To describe the most important cause of infectious posterior uveitis in pediatric patients. METHODS Review of the literature. RESULTS The most important causes of infectious uveitis in pediatric patients are: cat-scratch disease, toxocariasis, tuberculosis, viral diseases and toxoplasmosis. Ocular manifestations include retinitis, neuroretinitis, choroidal granulomas, peripheral granulomas and posterior pole granulomas. CONCLUSION Infectious posterior uveitis is a challenging subject and should be considered in the differential diagnosis of any posterior uveitis in children. Infectious uveitis must be excluded before initiating immunosuppressive therapy.
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Affiliation(s)
- André Luiz Land Curi
- Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Disease - INI/Fiocruz, Rio de Janeiro, Brazil
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Ariel Schlaen
- Department of Ophthalmology, Hospital Universitario Austral, Derqui-Pilar, Argentina
| | | | - Jyortimay Biswas
- Uveitis and Ocular Pathology Department, Sankara Nethralaya, Chennai, India
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7
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Schneider MO, Faschingbauer F, Kagan KO, Groß U, Enders M, Kehl S. Toxoplasma gondii Infection in Pregnancy - Recommendations of the Working Group on Obstetrics and Prenatal Medicine (AGG - Section on Maternal Disorders). Geburtshilfe Frauenheilkd 2023; 83:1431-1445. [PMID: 38046526 PMCID: PMC10689109 DOI: 10.1055/a-2111-7394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 12/05/2023] Open
Abstract
Aim The AGG (Working Group for Obstetrics and Prenatal Diagnostics, Section Maternal Diseases) has issued these recommendations to improve the detection and management of Toxoplasma gondii infection in pregnancy. Methods Members of the Task Force developed the recommendations and statements presented here using recently published literature. The recommendations were adopted after a consensus process by members of the working group. Recommendations This article focuses on the epidemiology and pathophysiology of Toxoplasma gondii infection in pregnancy and includes recommendations for maternal and fetal diagnosis, transmission prophylaxis, therapy, prevention, screening, and peripartum management.
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Affiliation(s)
- Michael Oliver Schneider
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Oliver Kagan
- Department for Womenʼs Health, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Groß
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Martin Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - Sven Kehl
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Debbag R, Torres JR, Falleiros-Arlant LH, Avila-Aguero ML, Brea-del Castillo J, Gentile A, Saez-Llorens X, Mascarenas A, Munoz FM, Torres JP, Vazquez L, Safadi MA, Espinal C, Ulloa-Gutierrez R, Pujadas M, Lopez P, López-Medina E, Ramilo O. Are the first 1,000 days of life a neglected vital period to prevent the impact on maternal and infant morbimortality of infectious diseases in Latin America? Proceedings of a workshop of experts from the Latin American Pediatric Infectious Diseases Society, SLIPE. Front Pediatr 2023; 11:1297177. [PMID: 38098643 PMCID: PMC10720332 DOI: 10.3389/fped.2023.1297177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
While the first 1,000 days of life are a critical period in child's development, limited information on the main determinants affecting this period in the Latin America and the Caribbean (LAC) region is available. Therefore, the Latin American Pediatric Infectious Diseases Society (SLIPE) held an ad hoc workshop in May 2022 with an expert panel designed to analyze the main factors impacting the development of childhood in the region during this period and the main causes of maternal infant morbimortality. The aim was to identify priorities, generate recommendations, and advise practical actions to improve this situation. Considerations were made about the challenges involved in bridging the gap that separates the region from more developed countries regarding an optimal early childhood and maternal care. Extensive discussion was conducted to reach consensus recommendations on general strategies intended to reduce maternal and infant mortality associated with infections and immune-preventable diseases during the first 1,000 days of life in LAC.
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Affiliation(s)
- Roberto Debbag
- President of Sociedad Latinoamericana de Infectología Pediátrica, SLIPE, Buenos Aires, Argentina
| | - Jaime R. Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central De Venezuela, Caracas, Venezuela
| | - Luiza H. Falleiros-Arlant
- Department of Children’s Health, Faculdade De Medicina, Universidade Metropolitana De Santos, Santos, Brazil
| | - Maria L. Avila-Aguero
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
- Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University, New Haven, CT, United States
| | - Jose Brea-del Castillo
- Associated Researcher, Investigador Asociado Hospital Dr. Hugo Mendoza, Santo Domingo, Republic Dominicana
| | - Angela Gentile
- Epidemiology Department, Hospital de Niños “Ricardo Gutiérrez”, Buenos Aires University, Buenos Aires, Argentina
| | - Xavier Saez-Llorens
- Head of Infectious Diseases and Director of Clinical Research, Hospital del Niño “Dr. José Renán Esquivel”, Panama City, Panama
| | - Abiel Mascarenas
- Department of Pediatric Infectious Diseases, Hospital Universitario “José E. Gonzalez”, Universidad Autónoma De Nuevo León, Nuevo Leon, México
| | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Juan P. Torres
- Department of Pediatrics and Children Surgery, Universidad de Chile, Santiago, Chile
| | - Liliana Vazquez
- Pediatric Infectious Diseases, Clinica y Maternidad Suizo Argentina, Sanatorio Finochietto, Buenos Aires, Argentina
| | - Marco A. Safadi
- Department of Pediatrics, Faculda de de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Carlos Espinal
- Global Health Consortium, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Rolando Ulloa-Gutierrez
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
| | - Monica Pujadas
- Department of Epidemiology and Pediatric Infectious Diseases, Centro Hospitalario Pereira Rossell, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Pio Lopez
- Department of Pediatrics, Hospital Universitario del Valle, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clinica Imbanaco Grupo Quironsalud, Cali, Colombia
| | - Octavio Ramilo
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Briciu V, Ionică AM, Flonta M, Almaș A, Muntean M, Topan A, Horvat M, Ungureanu L, Lupșe M. Toxoplasmosis Screening during Pregnancy in a Romanian Infectious Diseases Tertiary Center: Results of a 15 Years Follow-Up Program. Microorganisms 2023; 11:2189. [PMID: 37764033 PMCID: PMC10537741 DOI: 10.3390/microorganisms11092189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Maternal infection with Toxoplasma gondii during pregnancy may have serious consequences for the fetus. In Romania, screening for toxoplasmosis is included in the first antenatal visit. A retrospective study was performed on all toxoplasmosis antenatal screening patients between May 2008 and February 2023. Twenty-seven thousand one hundred sixty-nine (27,169) pregnant women presented for prenatal screening once (22,858) or several times: during the same pregnancy (209) or during multiple pregnancies (4102). Thirty-one thousand six hundred fifty-eight (31,658) tests for IgM and IgG antibodies were performed. Nine thousand eighty-three (9083) tests (28.69%), corresponding to 7911 women (29.12%), were positive for IgG antibodies. The seroprevalence increased with patients' age, decreased in time intervals, and was more frequently associated with rural residence. At risk for acquiring the infection during the pregnancy were women with negative anti-Toxoplasma IgG antibodies (70.88%), but only 0.9% of them presented for rescreening during the same pregnancy. Acute Toxoplasma infection (ATI) was suspected in 44 patients (0.16%) due to IgG seroconversion and/or low or borderline IgG avidity. A questionnaire follow-up interview was performed, and no congenital toxoplasmosis was identified in children born from mothers with probable ATI. Our study demonstrates poor compliance with the screening program in the Romanian population.
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Affiliation(s)
- Violeta Briciu
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Angela Monica Ionică
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Mirela Flonta
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Ariana Almaș
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Monica Muntean
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Adriana Topan
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Melinda Horvat
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Liviu Ungureanu
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
| | - Mihaela Lupșe
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400348 Cluj-Napoca, Romania
- Clinical Hospital of Infectious Diseases of Cluj-Napoca, 400348 Cluj-Napoca, Romania
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10
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Rząd M, Kanecki K, Lewtak K, Goryński P, Tyszko P, Lewandowska-Andruszuk I, Nitsch-Osuch A. Congenital toxoplasmosis among hospitalized infants in Poland in the years 2007-2021: study based on the national hospital registry. Sci Rep 2023; 13:11060. [PMID: 37422492 PMCID: PMC10329637 DOI: 10.1038/s41598-023-38270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
Congenital toxoplasmosis (CT) is a rare entity and it may pose a life-threatening risk for the newborns. The aim of the study was to evaluate the incidence and other selected factors of CT in Poland. Our study is a population-based study on CT patients in 2007-2021. The study was based on 1504 hospitalization records of first-time diagnosis of CT in newborns. In the study group, we observed 763 males (50.7%) and 741 females (49.3%). The mean and median age was 31 days and 10 days, respectively. Based on the hospital registry, the mean annual CT incidence was estimated to be 2.6 per 10,000 live births (95% CI 2.0-3.2 per 10,000 live births). The incidence of CT cases fluctuated over the years 2007-2021, with the highest incidence in 2010 and the lowest one in 2014. There were no statistically significant differences between the incidence of CT in relation to sex or place of residence. The periodic fluctuations in the number of cases of congenital toxoplasmosis indicates the need to develop effective prevention programs to effectively counteract the disease and its consequences.
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Affiliation(s)
- Michał Rząd
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Str., 02-007, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Str., 02-007, Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Str., 02-007, Warsaw, Poland.
| | - Paweł Goryński
- National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Str., 02-007, Warsaw, Poland
- Institute of Rural Health in Lublin, Lublin, Poland
| | - Izabela Lewandowska-Andruszuk
- Department of Obstetrics, Gynaecology and Gynaecologic Oncology, Mazovian Specialist Hospital, Radom, Poland
- Faculty of Medical Sciences and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Str., 02-007, Warsaw, Poland
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de Melo Fernandes TA, Teixeira SC, Costa TR, Rosini AM, de Souza G, Polloni L, Barbosa BDF, Silva MJB, Ferro EAV, Ávila VDMR. BjussuLAAO-II, an l-amino acid oxidase from Bothrops jararacussu snake venom, impairs Toxoplasma gondii infection in human trophoblast cells and villous explants from the third trimester of pregnancy. Microbes Infect 2023; 25:105123. [PMID: 36870599 DOI: 10.1016/j.micinf.2023.105123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
One-third of the world's population is estimated to be affected by toxoplasmosis. Pregnancy-related Toxoplasma gondii infection can cause vertical transmission, infect the fetus, and cause miscarriage, stillbirth, and fetal death. The current study showed that both human trophoblast cells (BeWo lineage) and human explant villous were resistant to T. gondii infection after incubation with BjussuLAAO-II, an l-amino acid oxidase isolated from Bothrops jararacussu. Almost 90% of the parasite's ability to proliferate in BeWo cells was decreased by the toxin at 1.56 μg/mL and showed an irreversible anti-T. gondii effect. Also, BjussuLAAO-II impaired the key events of adhesion and invasion of T. gondii tachyzoites in BeWo cells. BjussuLAAO-II antiparasitic properties were associated with the intracellular production of reactive oxygen species and hydrogen peroxide, since the presence of catalase restored the parasite's growth and invasion. In addition, T. gondii growth in human villous explants was decreased to approximately 51% by the toxin treatment at 12.5 μg/mL. Furthermore, BjussuLAAO-II treatment altered IL-6, IL-8, IL-10 and MIF cytokines levels, assuming a pro-inflammatory profile in the control of T. gondii infection. This study contributes to the potential use of a snake venom l-amino acid oxidase for the development of agents against congenital toxoplasmosis and the discovery of new targets in parasites and host cells.
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Affiliation(s)
- Thales Alves de Melo Fernandes
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlândia, Campus Umuarama, St. Acre s/n, 38402-902, Uberlândia, MG, Brazil.
| | - Samuel Cota Teixeira
- Laboratory of Immunophysiology of Reproduction, Institute of Biomedical Science, Federal University of Uberlândia, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Tássia Rafaela Costa
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlândia, Campus Umuarama, St. Acre s/n, 38402-902, Uberlândia, MG, Brazil.
| | - Alessandra Monteiro Rosini
- Laboratory of Immunophysiology of Reproduction, Institute of Biomedical Science, Federal University of Uberlândia, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Guilherme de Souza
- Laboratory of Immunophysiology of Reproduction, Institute of Biomedical Science, Federal University of Uberlândia, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Lorena Polloni
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlândia, Campus Umuarama, St. Acre s/n, 38402-902, Uberlândia, MG, Brazil.
| | - Bellisa de Freitas Barbosa
- Laboratory of Immunophysiology of Reproduction, Institute of Biomedical Science, Federal University of Uberlândia, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Marcelo José Barbosa Silva
- Department of Immunology, Institute of Biomedical Sciences, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Eloisa Amália Vieira Ferro
- Laboratory of Immunophysiology of Reproduction, Institute of Biomedical Science, Federal University of Uberlândia, Campus Umuarama, Av. Para, 1720, 38400-239, Uberlândia, MG, Brazil.
| | - Veridiana de Melo Rodrigues Ávila
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlândia, Campus Umuarama, St. Acre s/n, 38402-902, Uberlândia, MG, Brazil.
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12
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Dámek F, Fremaux B, Aubert D, Thoumire S, Delsart M, Martin JL, Vuillermet S, Opsteegh M, Jokelainen P, Le Roux D, Boireau P, Villena I, Blaga R. Inactivation of Toxoplasma gondii in dry sausage and processed pork, and quantification of the pathogen in pig tissues prior to production. Food Waterborne Parasitol 2023; 31:e00194. [PMID: 37250657 PMCID: PMC10209801 DOI: 10.1016/j.fawpar.2023.e00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/04/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023] Open
Abstract
Toxoplasma gondii is an important zoonotic foodborne parasite. Meat of infected animals appears to be a major source of infection in Europe. Pork is the most consumed meat in France, with dry sausages well represented. The risk of transmission via consumption of processed pork products is largely unknown, mainly since processing will affect viability but may not entirely inactivate all T. gondii parasites. We investigated the presence and concentration of T. gondii DNA in the shoulder, breast, ham, and heart of pigs orally inoculated with 1000 oocysts (n = 3) or tissue cysts (n = 3) and naturally infected pigs (n = 2), by means of magnetic capture qPCR (MC-qPCR). Muscle tissues of experimentally infected pigs were further used to evaluate the impact of manufacturing processes of dry sausages, including different concentrations of nitrates (0, 60, 120, 200 ppm), nitrites (0, 60, 120 ppm), and NaCl (0, 20, 26 g/kg), ripening (2 days at 16-24 °C) and drying (up to 30 days at 13 °C), by a combination of mouse bioassay, qPCR and MC-qPCR. DNA of T. gondii was detected in all eight pigs, including in 41.7% (10/24) of muscle samples (shoulder, breast and ham) and 87.5% (7/8) of hearts by MC-qPCR. The number of parasites per gram of tissue was estimated to be the lowest in the hams (arithmetic mean (M) = 1, standard deviation (SD) = 2) and the highest in the hearts (M = 147, SD = 233). However, the T. gondii burden estimates varied on the individual animal level, the tissue tested and the parasitic stage used for the experimental infection (oocysts or tissue cysts). Of dry sausages and processed pork, 94.4% (51/54) were positive for T. gondii by MC-qPCR or qPCR, with the mean T. gondii burden estimate equivalent to 31 parasites per gram (SD = 93). Only the untreated processed pork sample collected on the day of production was positive by mouse bioassay. The results suggest an uneven distribution of T. gondii in the tissues examined, and possibly an absence or a concentration below the detection limit in some of them. Moreover, the processing of dry sausages and processed pork with NaCl, nitrates, and nitrites has an impact on the viability of T. gondii from the first day of production. Results are valuable input for future risk assessments aiming to estimate the relative contribution of different sources of T. gondii human infections.
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Affiliation(s)
- Filip Dámek
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
| | - Bastien Fremaux
- IFIP - Institut du Porc, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Dominique Aubert
- National Reference Centre on Toxoplasmosis, Toxoplasma Biological Resources Centre, CHU Reims and EA7510, SFR CAP-Santé, University of Reims Champagne-Ardenne, USC EpiToxo Anses, France
| | - Sandra Thoumire
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
| | - Maxime Delsart
- Anses, Ecole nationale vétérinaire d'Alfort, Laboratoire de Santé Animale USC EPIMAI, Maisons-Alfort, France
| | - Jean-Luc Martin
- IFIP - Institut du Porc, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Sandra Vuillermet
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
| | - Marieke Opsteegh
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Pikka Jokelainen
- Statens Serum Institut, Infectious Disease Preparedness, Copenhagen, Denmark
| | - Delphine Le Roux
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
| | - Pascal Boireau
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
| | - Isabelle Villena
- National Reference Centre on Toxoplasmosis, Toxoplasma Biological Resources Centre, CHU Reims and EA7510, SFR CAP-Santé, University of Reims Champagne-Ardenne, USC EpiToxo Anses, France
| | - Radu Blaga
- Anses, INRAE, Ecole Nationale Vétérinaire d'Alfort, Laboratoire de Santé Animale, BIPAR, Maisons-Alfort, France
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Kamus L, Belec S, Lambrecht L, Abasse S, Olivier S, Combe P, Bonnave PE, Vauloup-Fellous C. Maternal and congenital toxoplasmosis in Mayotte: Prevalence, incidence and management. PLoS Negl Trop Dis 2023; 17:e0011198. [PMID: 36940228 PMCID: PMC10063165 DOI: 10.1371/journal.pntd.0011198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/30/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Toxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte. METHODOLOGY / PRINCIPAL FINDINGS We collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022-0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005-0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants. CONCLUSIONS / SIGNIFICANCE The seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring.
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Affiliation(s)
- Laure Kamus
- Department of Medical Biology, Félix-Guyon Hospital Center, Saint-Denis, La Réunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Saint-Denis, La Réunion, France
- * E-mail:
| | - Sophie Belec
- Department of Obstetrics and Gynaecology, Mayotte Hospital Center, Mayotte, France
| | | | - Soumeth Abasse
- Paediatric Centre, Mayotte Hospital Centre, Mayotte, France
| | - Sophie Olivier
- Department of Medical Biology, Mayotte Hospital Centre, Mayotte, France
| | - Patrice Combe
- Department of Medical Biology, Mayotte Hospital Centre, Mayotte, France
| | | | - Christelle Vauloup-Fellous
- Universite Paris Saclay, INSERM U1193, AP-HP, Hôpital Paul Brousse, Virology Department, Villejuif, France
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14
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Damar Çakırca T, Can İN, Deniz M, Torun A, Akçabay Ç, Güzelçiçek A. Toxoplasmosis: A Timeless Challenge for Pregnancy. Trop Med Infect Dis 2023; 8:tropicalmed8010063. [PMID: 36668970 PMCID: PMC9867407 DOI: 10.3390/tropicalmed8010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
This study aimed to evaluate the prevalence of toxoplasmosis in pregnant women, as well as the general characteristics, clinical and laboratory findings, and pregnancy and fetal outcomes of pregnant women diagnosed with acute toxoplasma infection (ATI). The toxoplasma IgM, IgG, and IgG avidity test results of pregnant women who applied to our referral hospital between January 2016 and June 2022, and among them, those diagnosed with ATI, were analyzed. The 119 patients diagnosed with ATI during this time period were included for further analysis. The prevalence of toxoplasmosis in pregnant women was found to be 46.2%, and the rate of ATI was 4%. The total mother-to-child transmission rate was 5% (5/101). Congenital toxoplasmosis (CT) was observed in 1 (1.1%) child of the 87 pregnant women who received spiramycin prophylaxis, though it was found in 4 (30.8%) of the children of the 13 untreated mothers. With respect to prenatal treatment, CT rates were significantly higher in the children born to untreated mothers (p = 0.001). In conclusion, although toxoplasma seroprevalence was found to be high in our region, there was a paucity in diagnosis, follow-up, and treatment. Our findings support that prenatal spiramycin prophylaxis is effective in preventing the transmission of parasites from mother to child.
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Affiliation(s)
- Tuba Damar Çakırca
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
- Correspondence:
| | - İlkay Nur Can
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Melis Deniz
- Department of Pediatric Infectious Diseases, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ayşe Torun
- Department of Infectious Diseases and Clinical Microbiology, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Çiğdem Akçabay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Sanliurfa Training and Research Hospital, Sanliurfa 63250, Turkey
| | - Ahmet Güzelçiçek
- Department of Pediatrics, Harran University Faculty of Medicine, Sanliurfa 63290, Turkey
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15
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Milne GC, Webster JP, Walker M. Is the incidence of congenital toxoplasmosis declining? Trends Parasitol 2023; 39:26-37. [PMID: 36400672 DOI: 10.1016/j.pt.2022.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Prenatal infection with the protozoan parasite Toxoplasma gondii can cause congenital toxoplasmosis (CT), an often fatal or lifelong-disabling condition. Several studies of human populations have reported temporal decreases in seroprevalence, suggesting declining CT incidence. However, the consistency of this trend among diverse populations remains unclear, as does its implication for prenatal screening programmes, the major intervention against CT. Using temporally resolved data on the seroprevalence of T. gondii in various countries, we discuss how the parasite's changing epidemiology may affect trends in CT incidence in varying and counterintuitive ways. We argue that parasite stage-specific serology could be helpful for understanding underlying causes of secular changes in seroprevalence. Furthermore, we highlight the importance of updating cost-effectiveness estimates of screening programmes, accounting for neuropsychiatric sequelae.
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Affiliation(s)
- Gregory Colin Milne
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Herts, AL9 7TA, UK; London Centre for Neglected Tropical Disease Research, Imperial College London Faculty of Medicine, London, UK.
| | - Joanne P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Herts, AL9 7TA, UK; London Centre for Neglected Tropical Disease Research, Imperial College London Faculty of Medicine, London, UK
| | - Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Herts, AL9 7TA, UK; London Centre for Neglected Tropical Disease Research, Imperial College London Faculty of Medicine, London, UK
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Sawers L, Wallon M, Mandelbrot L, Villena I, Stillwaggon E, Kieffer F. Prevention of congenital toxoplasmosis in France using prenatal screening: A decision-analytic economic model. PLoS One 2022; 17:e0273781. [PMID: 36331943 PMCID: PMC9635746 DOI: 10.1371/journal.pone.0273781] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Toxoplasma gondii is one of the world’s most common parasites. Primary infection of the mother during pregnancy can lead to transmission to the fetus with risks of brain and eye lesions, which may cause lifelong disabilities. France instituted a national program based on monthly retesting of susceptible pregnant women to reduce the number of severe cases through prompt antenatal and postnatal treatment and follow-up. Objective To evaluate the ability of the French prenatal retesting program to reduce the lifetime costs of congenital toxoplasmosis. Methods We measured and then compared the costs and benefits of screening vs. not screening using decision-tree modelling. It included direct and indirect costs to society of treatment and care, and the lifetime lost earnings of children and caregivers. A probabilistic sensitivity analysis was carried out. Findings Total lifetime costs per live born child identified as congenitally infected were estimated to be €444 for those identified through prenatal screening vs €656 for those who were not screened. Estimates were robust to changes in all costs of diagnosis, treatment, and sequelae. Interpretation Screening for the prevention of the congenital T. gondii infection in France is cost saving at €212 per birth. Compared with no screening, screening every pregnant woman in France for toxoplasmosis in 2020 would have saved the country €148 million in addition to reducing or eliminating the devastating physical and emotional suffering caused by T. gondii. Our findings reinforce the conclusions of other decision-analytic modelling of prenatal toxoplasmosis screening.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, D.C., United States of America
| | - Martine Wallon
- Department of Parasitology and Medical Mycology, Hospices Civils de Lyon, Lyon, France
- Walking Team, Centre for Research in Neuroscience, Lyon, Bron, France
| | - Laurent Mandelbrot
- Obstetrics and Gynecology Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
- Université de Paris, Paris, France
- INSERM, IAME, UMR 1137, Paris, France
| | - Isabelle Villena
- Department of Parasitology and Medical Mycology, National Reference Centre on Toxoplasmosis, Hôpital Reims, Reims, France
- Team EA 7510, SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
| | - Eileen Stillwaggon
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - François Kieffer
- Department of Neonatology, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- * E-mail:
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Lee PF, Lee CY, Tsai CC, Chu LC, Huang KL, Cheng HH, You HL, Huang HN, Lan KC, Hsu TY. Assessment of the clinical benefits of prenatal screening for toxoplasmosis in southern Taiwan. Taiwan J Obstet Gynecol 2022; 61:830-836. [PMID: 36088052 DOI: 10.1016/j.tjog.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2021] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE The present study aimed to investigate the seroprevalence and risk factors for toxoplasmosis among pregnant women in southern Taiwan and to determine the clinical benefits of screening for the same. MATERIALS AND METHODS The current study included 458 pregnant women who received prenatal care from the first trimester at the Kaohsiung and Chiayi Chang Gung Memorial Hospitals during the time period from 2014 to 2015. Serological tests performed to detect the presence of Toxoplasma IgG and IgM antibodies. Amniocentesis was scheduled and real-time polymerase chain reaction (PCR) was employed to detect Toxoplasma DNA. Moreover, the maternal characteristics and risk factors, perinatal outcomes related to the seropositivity for Toxoplasma infection were analyzed. RESULTS Among the pregnant patients included in the current study, 39/458 (8.5%) were IgG+ and 2/458 (0.6%) were IgM+. The present study analyzed the maternal characteristics and risk factors, perinatal outcome pertaining to the IgG seropositive group by means of the multiple logistic regression analysis revealed a female predominance (10.8%), compared to the males (6.4%), (adjusted OR = 0.48 (95%, 0.24-0.98), P = 0.043∗). The number cases with gestational age above 37 weeks at the time of delivery was significantly lower, compared to the cases below 37 weeks (adjusted OR = 0.32 (0.12-0.94), P = 0.038∗). Among one case with low avidity cannot exclude recent infection, the amniocentesis did not show any evidence of vertical transmission. CONCLUSION The scenario may not warrant general screening and the results will not influence the clinical decisions. Although the present study failed to identify the maternal risk factors related to Toxoplasma infection, the results imply that health education is essential, owing to the slightly higher rate of preterm delivery in the IgG seropositive group.
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Affiliation(s)
- Pei-Fang Lee
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Yuan Lee
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Ching-Chang Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Li-Ching Chu
- Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Kun-Long Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Hsin Cheng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huey-Ling You
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Ning Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chung Lan
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Ma Y, Cao X, Wang H, Song X, Hu D. In Vitro and In Vivo Activities of Tilmicosin and Acetylisovaleryltylosin Tartrate against Toxoplasma gondii. Int J Mol Sci 2022; 23:ijms23179586. [PMID: 36076987 PMCID: PMC9455974 DOI: 10.3390/ijms23179586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Toxoplasma gondii is a widespread intracellular pathogen that infects humans and a variety of animals. The current therapeutic strategy for human toxoplasmosis is a combination of sulphadiazine and pyrimethamine. However, this combination still has a high failure rate and is ineffective against chronic infections. Therefore, it is important to discover a new anti-T. gondii drug that is safer and more effective in both humans and animals. In this study, we describe the anti-T. gondii activities of the 16-membered macrolide tilmicosin and acetylisovaleryltylosin tartrate (ATLL). Both tilmicosin and ATLL potently inhibited T. gondii with a half-maximal effective concentration (EC50) of 17.96 μM and 10.67 μM, respectively. Interestingly, tilmicosin and ATLL had different effects on the parasites. ATLL exhibited a potent inhibitory effect on intracellular parasite growth, while tilmicosin suppressed parasites extracellularly. By studying the lytic cycle of T. gondii after treatment, we found that ATLL potently inhibited the intracellular proliferation of tachyzoites, while tilmicosin affected the invasion of tachyzoites. Immunofluorescence analysis using ATLL-treated T. gondii showed morphologically abnormal parasites, which may be due to the inhibition of tachyzoite proliferation and division. In addition, tilmicosin and ATLL significantly delayed the death of mice caused by acute toxoplasmosis. Our results suggest that ATLL has potent anti-Toxoplasma activity both in vitro and in vivo and may be an alternative to toxoplasmosis in the future.
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Ardabili S, Kohl J, Gül G, Hodel M. Republished: What obstetricians should be aware of - serious side effects of antibiotic toxoplasmosis treatment in pregnancy. Drug Ther Bull 2022; 60:92-95. [PMID: 35351681 DOI: 10.1136/dtb.2022.240809rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Ardabili
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Joachim Kohl
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Gülseven Gül
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Markus Hodel
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
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20
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Petersen E, Meroni V, Vasconcelos-Santos DV, Mandelbrot L, Peyron F. Congenital toxoplasmosis: Should we still care about screening? Food Waterborne Parasitol 2022; 27:e00162. [PMID: 35782022 PMCID: PMC9249550 DOI: 10.1016/j.fawpar.2022.e00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Prenatal systematic screening for congenital toxoplasmosis has been performed in Austria and France since 1975 and neonatal screening for congenital toxoplasmosis has been part of the New England Newborn screening program since 1986. In this narrative review we review the data leading up to the systematic screening programs in Austria and France, highlighting the main finding of the European Union funded research in the 1990s and early 2000s. Different descriptive studies of the effect of pre- or postnatal treatment are discussed. Toxoplasma gondii has different genetic lineages with different pathogenicity in humans. This means that results in areas with a low pathogenic lineage cannot be extrapolated to an area with highly pathogenic lineages. The importance of meat as a source of infection is discussed in the light of an increased prevalence of T.gondii in organic livestock production .
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Affiliation(s)
- Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark
- European Society for Clinical Microbiology and Infectious Diseases, Emerging Infections Task Force, Basel, Switzerland
- Correspondong author at: Institute for Clinical Medicine, University of Aarhus, Denmark.
| | - Valeria Meroni
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | | | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA, Paris, France
| | - Francois Peyron
- Institut de Parasitologie et de Mycologie Médicale Hôpital de la Croix Rousse, Lyon, France
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21
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Spyramicine and Trimethoprim-Sulfamethoxazole Combination to Prevent Mother-To-Fetus Transmission of Toxoplasma gondii Infection in Pregnant Women: A 28-Years Single-center Experience. Pediatr Infect Dis J 2022; 41:e223-e227. [PMID: 35175992 DOI: 10.1097/inf.0000000000003469] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is weak evidence on the best treatment of pregnant women with Toxoplasma gondii infection to prevent the vertical transmission to the fetus. METHODS We conducted a 28-year retrospective study aiming to compare the efficacy of three therapeutic regimens [Spiramicyn alone (Spy) vs. Pyrimethamine-Sulfadiazine (P/S) vs. Spiramicyn with Trimethoprim-Sulfamethoxazole (Spy+TMP-SMX)] for the prevention of mother-to-fetus transmission of T. gondii infection. RESULTS 170 women were included: 58 (34.1%) had certain congenital toxoplasmosis (CT), 61 (35.9%) a probable infection and 41 (24.1%) possible infection. In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001). CONCLUSIONS The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. A prospective trial comparing the combination Spy+TMP-SMX with P/S would be necessary to provide definitive evidence on the best regimen for pregnant women with T. gondii infection.
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22
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Idro R, Ogwang R, Barragan A, Raimondo JV, Masocha W. Neuroimmunology of Common Parasitic Infections in Africa. Front Immunol 2022; 13:791488. [PMID: 35222377 PMCID: PMC8866860 DOI: 10.3389/fimmu.2022.791488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Parasitic infections of the central nervous system are an important cause of morbidity and mortality in Africa. The neurological, cognitive, and psychiatric sequelae of these infections result from a complex interplay between the parasites and the host inflammatory response. Here we review some of the diseases caused by selected parasitic organisms known to infect the nervous system including Plasmodium falciparum, Toxoplasma gondii, Trypanosoma brucei spp., and Taenia solium species. For each parasite, we describe the geographical distribution, prevalence, life cycle, and typical clinical symptoms of infection and pathogenesis. We pay particular attention to how the parasites infect the brain and the interaction between each organism and the host immune system. We describe how an understanding of these processes may guide optimal diagnostic and therapeutic strategies to treat these disorders. Finally, we highlight current gaps in our understanding of disease pathophysiology and call for increased interrogation of these often-neglected disorders of the nervous system.
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Affiliation(s)
- Richard Idro
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala, Uganda.,Centre of Tropical Neuroscience, Kitgum, Uganda.,Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Antonio Barragan
- Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden
| | - Joseph Valentino Raimondo
- Division of Cell Biology, Department of Human Biology, Neuroscience Institute and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willias Masocha
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Safat, Kuwait
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23
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Parvin I, Das SK, Ahmed S, Rahman A, Shahid ASMSB, Shahrin L, Afroze F, Ackhter MM, Alam T, Jahan Y, Palit P, Sarker MHR, Das J, Hoque ME, Magalhães RJS, Mamun AA, Faruque ASG, Ahmed T, Chisti MJ. Toxoplasma gondii Infection Is Associated with Low Birth Weight: Findings from an Observational Study among Rural Bangladeshi Women. Pathogens 2022; 11:pathogens11030336. [PMID: 35335660 PMCID: PMC8954211 DOI: 10.3390/pathogens11030336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational Toxoplasma gondii (T. gondii) infection may cause substantial adverse effects on developing fetuses, newborns and also mothers. This study aims to estimate the seroprevalence of T. gondii among rural Bangladeshi pregnant women and determine the risk of a low birth weight (LBW). We followed a longitudinal design where 208 pregnant women were followed until the birth of their infants. Levels of IgG and IgM of T. gondii were assessed using chemiluminescent immunoassay. Modified Poisson regression was used to estimate crude and adjusted associations and multiple regression analysis was performed to understand the confounding and modifying effects of the variables. Thirty-nine (19%) children were born with LBW, among whom 15 (39%) mothers were positive for T. gondii IgG during pregnancy. After adjusting for several confounders and modifiers, pregnant women with T. gondii IgG or IgM seropositivity were significantly associated with LBW of infants (aRR: 2.00, 95% CI: 1.17–3.42). The strength of this association increased after adjusting for maternal education (aRR: 4.88, 95% CI: 1.74–13.69). The final model had an AROC of 0.84 with a sensitivity of 36% and specificity of 97%. Although causality is yet to be established, the study observed an association between T. gondii infection during pregnancy among rural Bangladeshi women and LBW of newborns.
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Affiliation(s)
- Irin Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Sumon Kumar Das
- Menzies—School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Shahnawaz Ahmed
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Aminur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mst. Mahmuda Ackhter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Tahmina Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Parag Palit
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammad Habibur Rahman Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Jui Das
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Mohammad Enamul Hoque
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW 2006, Australia;
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Ricardo J. Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia;
- Children’s Health and Environment Program, UQ Child Health Research Centre, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Abu Syed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
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24
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Bieńkowski C, Aniszewska M, Kowalczyk M, Popielska J, Zawadka K, Ołdakowska A, Pokorska-Śpiewak M. Analysis of Preventable Risk Factors for Toxoplasma gondii Infection in Pregnant Women: Case-Control Study. J Clin Med 2022; 11:jcm11041105. [PMID: 35207377 PMCID: PMC8880619 DOI: 10.3390/jcm11041105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Toxoplasma gondii (TG) is a parasitic protozoon that may cause miscarriages or birth defects if the infection occurs during pregnancy. The study’s aim was to evaluate the risk factors associated with TG infection in pregnant women. Materials: Medical charts for all 273 pregnant women with suspected TG infection consecutively admitted to the Hospital of Warsaw between 2019 and 2020 were retrospectively analyzed. The presumptive TG diagnosis was verified by a serologic assessment of IgM and IgG titers, and IgG affinity tests. Results: The median age was 32 years (range: 19–42 years). The diagnosis of primary TG infection was confirmed in 74/273 (27.1%) women. In 114/273 (41.8%) there was evidence of past infection. In 71/273 (26%) women, an infection was excluded. In 172/273 (62%) women the recommended testing for other infectious diseases putting fetus development at risk was performed correctly. Logistic regression model analysis revealed that living in rural areas and eating raw meat were independent factors associated with increased risk of TG infection during pregnancy (OR 2.89, 95% CI: 1.42–5.9, p = 0.004; and OR 2.07, 95% CI: 1.03–4.18, p = 0.04, respectively). Conclusions: The independent risk factors for TG infection during pregnancy include living in rural areas and eating raw meat. The physician’s educational role here is crucial for the efficient prevention of congenital toxoplasmosis.
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Affiliation(s)
- Carlo Bieńkowski
- Doctoral School, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
- Correspondence:
| | - Małgorzata Aniszewska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
| | - Monika Kowalczyk
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health NIH—National Research Institute, 00-791 Warsaw, Poland;
| | - Jolanta Popielska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
| | - Konrad Zawadka
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
| | - Agnieszka Ołdakowska
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Wolska 37, 02-091 Warsaw, Poland; (M.A.); (J.P.); (K.Z.); (A.O.); (M.P.-Ś.)
- Hospital of Infectious Diseases, 01-201 Warsaw, Poland
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25
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Zhao NO, Crowell EL. Epidemiology and Long-term Sequelae of Pediatric Uveitis. Int Ophthalmol Clin 2022; 62:131-142. [PMID: 34965231 DOI: 10.1097/iio.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Ludwig A, D'ambroso Fernandes F, Rojas Guerra R, Braünig P, Silva Ramos L, Souto Pacheco L, Sangioni LA, Silveira Flores Vogel F. Molecular detection of Toxoplasma gondii in placentas of women who received therapy during gestation in a toxoplasmosis outbreak. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 97:105145. [PMID: 34798319 DOI: 10.1016/j.meegid.2021.105145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
Toxoplasmosis is a disease caused by T. gondii, a protozoa which affects humans and animals and is widely distributed worldwide. In humans, there is great concern due to the serious consequences that can occur in the infection of pregnant women and the newborn. The early diagnosis of gestational toxoplasmosis is important for treatment to be carried out in order to prevent vertical transmission or reduce damage. The diagnosis can be made through the detection of antibodies in pregnant women or neonates and PCR of amniotic fluid. Previous studies have also reported PCR of the placenta as a good diagnostic test. Our study evaluated the detection of T. gondii DNA in placenta samples from parturients seen at the University Hospital of Santa Maria, Southern Brazil and treated during the pregnancy. We performed PCR in forty samples and five were positive, representing 12.5%. When correlating the treatment time and the detection of DNA in the placentas, no significant result was found. The prevalence of positive samples was lower than in other studies in the literature. The data reaffirm the importance of carrying out the analysis of the placenta.
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Affiliation(s)
- Aline Ludwig
- Laboratório de Doenças Parasitárias (LADOPAR), Departamento de Medicina Veterinária Preventiva (DMVP), Centro de Ciências Rurais (CCR), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 63C, Bairro Camobi, CEP: 97105-900 Santa Maria, RS, Brazil
| | - Fagner D'ambroso Fernandes
- Laboratório de Doenças Parasitárias (LADOPAR), Departamento de Medicina Veterinária Preventiva (DMVP), Centro de Ciências Rurais (CCR), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 63C, Bairro Camobi, CEP: 97105-900 Santa Maria, RS, Brazil.
| | - Renata Rojas Guerra
- Departamento de Estatística (DE), Centro de Ciências Naturais e Exatas (CCNE), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 13, Bairro Camobi, CEP: 97105-900 Santa Maria, Brazil
| | - Patricia Braünig
- Laboratório de Doenças Parasitárias (LADOPAR), Departamento de Medicina Veterinária Preventiva (DMVP), Centro de Ciências Rurais (CCR), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 63C, Bairro Camobi, CEP: 97105-900 Santa Maria, RS, Brazil
| | | | | | - Luis Antonio Sangioni
- Laboratório de Doenças Parasitárias (LADOPAR), Departamento de Medicina Veterinária Preventiva (DMVP), Centro de Ciências Rurais (CCR), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 63C, Bairro Camobi, CEP: 97105-900 Santa Maria, RS, Brazil
| | - Fernanda Silveira Flores Vogel
- Departamento de Estatística (DE), Centro de Ciências Naturais e Exatas (CCNE), Universidade Federal de Santa Maria (UFSM), Av. Roraima, n°1000, Prédio 13, Bairro Camobi, CEP: 97105-900 Santa Maria, Brazil
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27
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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.
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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
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28
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Montoya JG, Laessig K, Fazeli MS, Siliman G, Yoon SS, Drake-Shanahan E, Zhu C, Akbary A, McLeod R. A fresh look at the role of spiramycin in preventing a neglected disease: meta-analyses of observational studies. Eur J Med Res 2021; 26:143. [PMID: 34895348 PMCID: PMC8665510 DOI: 10.1186/s40001-021-00606-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 11/14/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We aimed to investigate the effect of antepartum treatment with spiramycin with or without subsequent pyrimethamine-sulfonamide-folinic acid, compared to no treatment, on the rate of mother-to-child transmission (MTCT) of Toxoplasma gondii (T. gondii) and incidence/severity of sequelae in the offspring. METHODS Embase and PubMed were searched for literature on spiramycin in pregnant women suspected/diagnosed with T. gondii infection. Meta-analyses were performed using random-effects model. RESULTS Thirty-three studies (32 cohorts and 1 cross-sectional study), with a total of 15,406 mothers and 15,250 offspring, were pooled for analyses. The MTCT rate for all treated patients was significantly lower than the untreated [19.5% (95% CI 14-25.5%) versus 50.7% (95% CI 31.2-70%), p < 0.001]. The transmission rate in patients on spiramycin monotherapy was also significantly lower than untreated [17.6% (95% CI 9.9-26.8%) versus 50.7% (95% CI 31.2-70%), p < 0.001]. CONCLUSION Results indicate significant reduction in MTCT rates following spiramycin treatment of suspected/diagnosed maternal T. gondii infection.
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Affiliation(s)
- Jose G Montoya
- Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto, CA, USA
| | | | | | | | | | | | - Chengyue Zhu
- Department of General Medicines, Sanofi S.A, Bridgewater, NJ, USA
| | - Akbar Akbary
- Department of General Medicines, Sanofi S.A, Bridgewater, NJ, USA
| | - Rima McLeod
- Division of Biologic Sciences, Departments of Pediatrics (Infectious Diseases) and Ophthalmology and Visual Sciences, University of Chicago, Chicago, IL, USA.
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Trotta M, Trotta A, Spataro E, Giache S, Borchi B, Zammarchi L, Campolmi I, Galli L, Pasquini L. Primary toxoplasmosis acquired during early pregnancy: Is it currently overestimated? Eur J Obstet Gynecol Reprod Biol 2021; 267:285-289. [PMID: 34839251 DOI: 10.1016/j.ejogrb.2021.11.019] [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: 09/02/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Toxoplasmosis acquired in early pregnancy is a potentially severe complication for the fetus. Evaluating the risk of transplacental infection in pregnant women accessing the Tuscany Reference Center for Infectious Diseases in Pregnancy during the last 20 years with suspected or confirmed toxoplasmosis acquired in early pregnancy was the aim of the study. STUDY DESIGN We retrospectively enrolled all pregnant women undergoing amniocentesis for toxoplasmosis acquired in the first 16 gestational weeks in the period 1999-2019, comparing patients with certain acute infection (seroconversion occurred in pregnancy, CAIP) with those with suspected acute infection (IgG positive with low/intermediate IgG avidity index, SAIP). RESULTS 237 patients were enrolled, 187 (78.9%) with SAIP and 50 (21.1%) with CAIP. Specific IgM was detected in 47.5% and 76.7% (p-value 0.001), and the mean IgG avidity index was 22.7% and 7.1% (p-value < 0.001) in the SAIP and in the CAIP group, respectively. The mean delay from diagnosis to antibiotic initiation was 14.6 in SAIP and 11 days in CAIP group. Toxoplasma DNA was detected in the amniotic fluid in one case in a patient with CAIP. Excluding 24 newborns with not available data, prevalence of congenital infection was 0.47% [1/213 (95% CI 0.08%-2.61%)], 0% [0/178 (95% CI 0%-2.11%)] in SAIP and 2.8% [1/35 (95% CI 0.51%-14.53%)] in CAIP group. CONCLUSIONS Toxoplasmosis acquired in early pregnancy has a low risk of fetal infection. Actively discussing case-by-case amniocentesis indication with patients, especially when a recent toxoplasmosis is not properly confirmed, is desirable.
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Affiliation(s)
- Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy.
| | - Alessandra Trotta
- School of Human Health Sciences, Degree Course in Medicine and Surgery, University of Florence, Florence, Italy
| | - Elisa Spataro
- Fetal Medicine Unit, Department for Women and Children Health, Careggi University and Hospital, Florence, Italy
| | - Susanna Giache
- Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy.
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy.
| | - Lorenzo Zammarchi
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Center for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence, Paediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy.
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, Careggi University and Hospital, Florence, Italy.
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Dubey JP, Murata FHA, Cerqueira-Cézar CK, Kwok OCH, Villena I. Congenital toxoplasmosis in humans: an update of worldwide rate of congenital infections. Parasitology 2021; 148:1406-1416. [PMID: 34254575 PMCID: PMC11010219 DOI: 10.1017/s0031182021001013] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/07/2022]
Abstract
The morbidity due to congenital toxoplasmosis in humans is very high. Most of these infected children are likely to develop symptoms of clinical toxoplasmosis. Sequelae in fetus resulting from Toxoplasma gondii infections in women who become infected with this parasite during pregnancy can be devastating and enormous efforts are directed in some countries to prevent these consequences. Here, an update on congenital toxoplasmosis in humans, especially the rate of congenital infections in humans worldwide, is provided. Although several countries have surveillance programmes, most information on the rate of congenital transmission is from France and Brazil. Because of compulsory national screening programme in France to detect and treat women with recently acquired T. gondii infection with anti-toxoplasma therapy, the rate of congenital transmission and the severity of disease in children are declining. Infections by this parasite are widely prevalent in Brazil. The severity of clinical toxoplasmosis in Brazilian children is very high and may be associated with the genetic characteristics of T. gondii isolates prevailing in animals and humans in Brazil. Virtually little or no information is available on this topic from China, India and other countries in Asia.
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Affiliation(s)
- J. P. Dubey
- United States Department of Agriculture, Agricultural Research Service, Animal Parasitic Diseases Laboratory, Beltsville Agricultural Research Center, Building 1001, Beltsville, MD20705-2350, USA
| | - F. H. A. Murata
- United States Department of Agriculture, Agricultural Research Service, Animal Parasitic Diseases Laboratory, Beltsville Agricultural Research Center, Building 1001, Beltsville, MD20705-2350, USA
| | - C. K. Cerqueira-Cézar
- United States Department of Agriculture, Agricultural Research Service, Animal Parasitic Diseases Laboratory, Beltsville Agricultural Research Center, Building 1001, Beltsville, MD20705-2350, USA
| | - O. C. H. Kwok
- United States Department of Agriculture, Agricultural Research Service, Animal Parasitic Diseases Laboratory, Beltsville Agricultural Research Center, Building 1001, Beltsville, MD20705-2350, USA
| | - I. Villena
- Parasitology, Mycology Laboratory, National Reference Centre for Toxoplasmosis, Toxoplasma Biological Resources Centre, CHU Reims and University Reims Champagne Ardenne ESCAPE EA7510, 51097, Reims, France
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Nano DNA Vaccine Encoding Toxoplasma gondii Histone Deacetylase SIR2 Enhanced Protective Immunity in Mice. Pharmaceutics 2021; 13:pharmaceutics13101582. [PMID: 34683874 PMCID: PMC8538992 DOI: 10.3390/pharmaceutics13101582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022] Open
Abstract
The pathogen of toxoplasmosis, Toxoplasma gondii (T. gondii), is a zoonotic protozoon that can affect the health of warm-blooded animals including humans. Up to now, an effective vaccine with completely protection is still inaccessible. In this study, the DNA vaccine encoding T. gondii histone deacetylase SIR2 (pVAX1-SIR2) was constructed. To enhance the efficacy, chitosan and poly (d, l-lactic-co-glycolic)-acid (PLGA) were employed to design nanospheres loaded with the DNA vaccine, denoted as pVAX1-SIR2/CS and pVAX1-SIR2/PLGA nanospheres. The pVAX1-SIR2 plasmids were transfected into HEK 293-T cells, and the expression was evaluated by a laser scanning confocal microscopy. Then, the immune protections of pVAX1-SIR2 plasmid, pVAX1-SIR2/CS nanospheres, and pVAX1-SIR2/PLGA nanospheres were evaluated in a laboratory animal model. The in vivo findings indicated that pVAX1-SIR2/CS and pVAX1-SIR2/PLGA nanospheres could generate a mixed Th1/Th2 immune response, as indicated by the regulated production of antibodies and cytokines, the enhanced maturation and major histocompatibility complex (MHC) expression of dendritic cells (DCs), the induced splenocyte proliferation, and the increased percentages of CD4+ and CD8+ T lymphocytes. Furthermore, this enhanced immunity could obviously reduce the parasite burden in immunized animals through a lethal dose of T. gondii RH strain challenge. All these results propose that pVAX1-SIR2 plasmids entrapped in chitosan or PLGA nanospheres could be the promising vaccines against acute T. gondii infections and deserve further investigations.
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Diagnostic and therapeutic considerations in pediatric uveitis. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00503-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Li J, Zhao J, Yang X, Wen Y, Huang L, Ma D, Shi J. One severe case of congenital toxoplasmosis in China with good response to azithromycin. BMC Infect Dis 2021; 21:920. [PMID: 34488656 PMCID: PMC8422759 DOI: 10.1186/s12879-021-06619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Most infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly. CASE PRESENTATION A male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference. CONCLUSIONS Timely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.
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Affiliation(s)
- Jiao Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoyan Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liang Huang
- Department of Pharmacy/Evidence-based Pharmacy Center, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Dan Ma
- Department of Rehabilitation Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Shi
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China.
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Voyiatzaki C, Orovas C, Trapali M, Chaniotis DI, Kriebardis AG, Beloukas A, Thalassinos ND, Orovou E, Iatrakis G, Antoniou E. The Importance of Use of the On-line Databases as a Source for Systematic Review of Toxoplasmosis Screening During Pregnancy. Acta Inform Med 2021; 29:216-223. [PMID: 34759463 PMCID: PMC8563042 DOI: 10.5455/aim.2021.29.216-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Infection with the parasite Toxoplasma gondii is a common infection in animals and humans worldwide. This infection can occur after ingestion of water or food contaminated with cat oocytes, ingestion of tissue cysts in mammalian and avian meat and congenitally. The prenatal infection can lead to Congenital Toxoplasmosis with miscarriage or stillbirth. After infection, laboratory tests are positive within 2-3 weeks and remain positive throughout life. However, testing for Toxoplasma infection during pregnancy is necessary in some countries, while in others it is not a mandatory "screening" test. OBJECTIVE The aim of this study was to review systematically the screening of toxoplasmosis in pregnancy in different countries worldwide. METHODS Cohorts, retrospective and cross-sectional studies were incorporated in our review, finally including 11 articles from an initial pool of 1532 related papers. RESULTS The seroprevalence of pregnant women varies from countries with low prevalence to regions with high prevalence and screening policies also differ. Most countries worldwide have control policies, while Germany and Mexico that do not have systematic screening for Toxoplasma during the prenatal period. CONCLUSION Our results show that Congenital Toxoplasmosis is very rare in some countries and it is very difficult to find a balance between potential risk and benefit of a screening program. For this reason, some countries are limited to prenatal counseling to reduce CT. In addition, the reduction of major sources of contamination especially in developing countries is the most important prevention measure.
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35
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Donadono V, Saccone G, Sarno L, Esposito G, Mazzarelli LL, Sirico A, Guida M, Martinelli P, Zullo F, Maruotti GM. Association between lymphadenopathy after toxoplasmosis seroconversion in pregnancy and risk of congenital infection. Eur J Clin Microbiol Infect Dis 2021; 41:45-51. [PMID: 34458947 DOI: 10.1007/s10096-021-04337-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
The aim of the study was to describe the pregnancy outcome of a large cohort of women with toxoplasmosis seroconversion in pregnancy and to investigate the relation between maternal lymphadenopathy and risk of congenital toxoplasmosis (CT). This was a retrospective study involving women with confirmed toxoplasmosis seroconversion in pregnancy between 2001 and 2017. Women were clinically evaluated for lymphadenopathy and classified as follows: lymphadenopathy absent (L-) or lymphadenopathy present (L+). The mothers were treated and followed-up according to local protocol, and neonates were monitored at least for 1 year in order to diagnose CT. A total of 218 women (one twin pregnancy) were included in the analysis. Pregnancy outcome was as follows: 149 (68%) of children not infected, 62 (28.3%) infected, 4 (1.8%) first trimester termination of pregnancy, 2 (0.9%) first trimester miscarriages, and 3 (1.4%) stillbirths (of which one already counted in the infected cohort). 13.8% of women were L+ , and they were nearly three times more likely to have a child with CT compared to L- women (aOR, 2.90; 95%CI, 1.28-6.58). Moreover, the result was still statistically significant when the analysis was restricted to 81 children whose mothers were clinically examined and received treatment within 5 weeks from estimated time of infection. In conclusion, there is a positive association between L+ status in pregnant women, and risk of CT also confirmed when restricting the analysis to women with early diagnosis of seroconversion and treatment. This data could be very useful in counselling pregnant women with toxoplasmosis seroconversion and lead to direct a more specific therapeutic and diagnostic protocol.
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MESH Headings
- Adult
- Antibodies, Protozoan/blood
- Female
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/parasitology
- Infectious Disease Transmission, Vertical
- Lymphadenopathy/blood
- Lymphadenopathy/diagnosis
- Lymphadenopathy/parasitology
- Male
- Pregnancy
- Pregnancy Complications, Infectious/blood
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/parasitology
- Pregnancy Outcome
- Prenatal Exposure Delayed Effects/diagnosis
- Prenatal Exposure Delayed Effects/parasitology
- Retrospective Studies
- Seroconversion
- Toxoplasmosis/blood
- Toxoplasmosis/diagnosis
- Toxoplasmosis/parasitology
- Toxoplasmosis/transmission
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/parasitology
- Young Adult
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Affiliation(s)
- Vera Donadono
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppina Esposito
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Laura L Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Angelo Sirico
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry , University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Yu Z, Cao W, Gao X, Aleem MT, Liu J, Luo J, Yan R, Xu L, Song X, Li X. With Chitosan and PLGA as the Delivery Vehicle, Toxoplasma gondii Oxidoreductase-Based DNA Vaccines Decrease Parasite Burdens in Mice. Front Immunol 2021; 12:726615. [PMID: 34512659 PMCID: PMC8430031 DOI: 10.3389/fimmu.2021.726615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/06/2021] [Indexed: 01/02/2023] Open
Abstract
Toxoplasma gondii (T. gondii) is an intracellular parasitic protozoan that can cause serious public health problems. However, there is no effectively preventive or therapeutic strategy available for human and animals. In the present study, we developed a DNA vaccine encoding T. gondii oxidoreductase from short-chain dehydrogenase/reductase family (TgSDRO-pVAX1) and then entrapped in chitosan and poly lactic-co-glycolic acid (PLGA) to improve the efficacy. When encapsulated in chitosan (TgSDRO-pVAX1/CS nanospheres) and PLGA (TgSDRO-pVAX1/PLGA nanospheres), adequate plasmids were loaded and released stably. Before animal immunizations, the DNA vaccine was transfected into HEK 293-T cells and examined by western blotting and laser confocal microscopy. Th1/Th2 cellular and humoral immunity was induced in immunized mice, accompanied by modulated secretion of antibodies and cytokines, promoted the maturation and MHC expression of dendritic cells, and enhanced the percentages of CD4+ and CD8+ T lymphocytes. Immunization with TgSDRO-pVAX1/CS and TgSDRO-pVAX1/PLGA nanospheres conferred significant immunity with lower parasite burden in the mice model of acute toxoplasmosis. Furthermore, our results also lent credit to the idea that TgSDRO-pVAX1/CS and TgSDRO-pVAX1/PLGA nanospheres are substitutes for each other. In general, the current study proposed that TgSDRO-pVAX1 with chitosan or PLGA as the delivery vehicle is a promising vaccine candidate against acute toxoplasmosis.
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Affiliation(s)
- Zhengqing Yu
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Wandi Cao
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Xuchen Gao
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Muhammad Tahir Aleem
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Junlong Liu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Jianxun Luo
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Ruofeng Yan
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Lixin Xu
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Xiaokai Song
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
| | - Xiangrui Li
- Ministry of Education (MOE) Joint International Research Laboratory of Animal Health and Food Safety, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China
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Robert MG, Brenier-Pinchart MP, Garnaud C, Fricker-Hidalgo H, Pelloux H. Molecular diagnosis of toxoplasmosis: recent advances and a look to the future. Expert Rev Anti Infect Ther 2021; 19:1529-1542. [PMID: 34112045 DOI: 10.1080/14787210.2021.1941867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Toxoplasmosis is a globally distributed parasitic infection that can be particularly severe when opportunistic or congenital. Its diagnosis requires accurate and rapid techniques that rely mainly on serology and molecular methods. AREAS COVERED The aim of this review was to discuss the positioning of the molecular diagnosis of toxoplasmosis according to the different clinical situations possibly resulting from infection with T. gondii, and to detail recent developments in this technique. The English and French literature were searched with the following keywords: 'Toxoplasmosis', "Molecular diagnosis" and 'PCR'. EXPERT OPINION Molecular techniques have revolutionized the diagnosis of toxoplasmosis, and practices have considerably evolved over the past decades. However, there is still a high degree of inter-laboratory heterogeneity which impairs comparisons between results and studies. Efforts to standardize practices are underway.
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Affiliation(s)
- Marie Gladys Robert
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France
| | - Marie-Pierre Brenier-Pinchart
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
| | - Cécile Garnaud
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Hervé Pelloux
- Service de Parasitologie-Mycologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Institut pour l'Avancée des Biosciences (IAB), Grenoble, France.,Centre National de Référence Toxoplasmose - Pôle Biologie Moléculaire, France
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Reed G, Agarwal-Sinha S. Atypical Bilateral Multifocal Congenital Toxoplasmosis Retinochoroiditis: Case Report With Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620961615. [PMID: 33054439 PMCID: PMC7570296 DOI: 10.1177/2324709620961615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Toxoplasmosis gondii is ubiquitously present on earth and infection, including congenital infection, is common. Neurological, developmental, and ocular effects can be devastating in the congenital toxoplasmosis population. At present, there is no standard, nation-wide neonatal screening for this disease in the United States. Case Presentation A 17-month-old Caucasian female presented to our institution by way of referral for macular scarring. She was diagnosed with intrauterine growth retardation and born with low birth weight and microcephaly at an outside institution, but no systemic workup was conducted at that time. On ocular examination, she was found to have nystagmus and extensive multifocal chorioretinal pigmented scars involving the macula and peripheral retina in both eyes with fibrous vitreous strands extending between scars in the right eye. Toxoplasmosis immunoglobulin G was found to be highly positive. Magnetic resonance imaging of the brain showed supratentorial intracranial calcifications. Conclusions Our patient presented with severe chorioretinal lesions, microcephaly, and nystagmus with a positive immunoglobulin G toxoplasmosis titer. She did not receive any evaluation, including TORCH infectious panel workup, on being born with low birth weight and microcephaly. There are currently no national programs in place for toxoplasmosis to be included in routine neonatal screening, despite the grave sequelae of congenital infection or that studies in other countries have shown cost-effectiveness in early screening and treatment.
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Affiliation(s)
- Gavin Reed
- University of Florida, Gainesville, FL, USA
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39
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Krull E, Taraschi G, El Amari EB, Pellegrinelli JM, Martinez de Tejada B. Congenital toxoplasmosis after adalimumab treatment before pregnancy. J Obstet Gynaecol Res 2021; 47:4055-4059. [PMID: 34382299 PMCID: PMC9292430 DOI: 10.1111/jog.14973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/11/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
We present a case of congenital toxoplasmosis (TXP) in a woman with Toxoplasma gondii infection more than 6 months before conception. The woman has been treated with adalimumab for ankylosing spondylitis for 4 years until 5 months before conception. TXP serology at the first trimester was compatible with infection prior pregnancy. An ultrasound performed at 26 weeks gestation (WG) showed cerebral echogenic lesions compatible with intrauterine infection. Amniocentesis was performed which confirmed TXP fetal infection. Termination of the pregnancy was performed upon parent's requests and the fetal autopsy confirmed the diagnosis. Here, we discuss the potential role of immunosuppressive treatments, such as adalimumab, in the risk of congenital toxoplasmosis and the importance of counseling before pregnancy.
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Affiliation(s)
- Eloïse Krull
- Obstetrics Service, Department of Pediatrics, Gynecology, and Obstetrics Geneva University Hospitals, Geneva, Switzerland
| | - Gianmarco Taraschi
- Obstetrics Service, Department of Pediatrics, Gynecology, and Obstetrics Geneva University Hospitals, Geneva, Switzerland
| | | | - Jean-Marie Pellegrinelli
- Obstetrics Service, Department of Pediatrics, Gynecology, and Obstetrics Geneva University Hospitals, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Service, Department of Pediatrics, Gynecology, and Obstetrics Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW This article provides an overview of congenital infections affecting the central nervous system (CNS), discussing the epidemiology, clinical features, diagnostic tools, and preventive and treatment measures for a variety of pathogens with the potential to infect the developing fetal brain. RECENT FINDINGS Contrary to popular belief, many congenital CNS infections are preventable and treatable. Treatment options exist for congenital cytomegalovirus, human immunodeficiency virus (HIV), herpes simplex virus, toxoplasmosis, and syphilis, although the efficacy of these treatments and the populations that may benefit from treatment are variable. Zika virus has recently emerged as a pathogen affecting the fetal brain, and new data suggest that the pathogenesis of Zika virus involves direct infection of neuronal progenitor cells leading to destruction of CNS tissue. The incidence of congenital syphilis has been increasing in the United States over the past decade as a direct result of new syphilis cases among adults and poor access to adequate maternal health care. SUMMARY Congenital CNS infections often result in significant neurologic morbidity in pediatric patients. Therefore, early identification of maternal illness and implementation of preventive measures are important in improving developmental outcomes and quality of life.
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Austhof E, Boyd K, Schaefer K, McFadden C, Owusu-Dommey A, Hoffman S, Villa-Zapata L, McClelland DJ, Pogreba-Brown K. Scoping Review of Toxoplasma Postinfectious Sequelae. Foodborne Pathog Dis 2021; 18:687-701. [PMID: 34292763 DOI: 10.1089/fpd.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous economic estimates of infection with Toxoplasma gondii and chronic sequelae following infection lack sufficient data to establish the true burden of disease and its chronic sequelae. This scoping review aims to fill this gap by updating existing literature regarding the development of postinfectious sequelae following T. gondii infection. Literature published between January 1, 2000, and November 6, 2018, in PubMed, EMBASE, and Scopus was searched for a wide range of postinfectious sequelae and economic estimate terms. This scoping review includes summaries from the 108 articles covering 5 main groupings of outcomes (categories are not exclusive) including vision disorders (n = 58), psychological and mental health disorders (n = 27), neurological disorders (n = 17), fetal death and infection (n = 15), and hearing loss (n = 6), as well as a description of other outcomes reported. While the majority of the included studies assessed the incidence of these outcomes postinfection, very few followed participants long-term. These prospective studies are needed to understand the true burden of postinfectious sequelae over the life course, particularly because congenital infection with Toxoplasma can lead to severe outcomes for newborns. This scoping review can be used as an important resource for other researchers wishing to conduct future systematic reviews and meta-analyses, as well as for policy makers interested in developing guidance for public and health care partners.
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Affiliation(s)
- Erika Austhof
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kylie Boyd
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kenzie Schaefer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Caitlyn McFadden
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Ama Owusu-Dommey
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Sandra Hoffman
- United States Department of Agriculture, Economic Research Service, Washington, District of Columbia, USA
| | - Lorenzo Villa-Zapata
- Department of Pharmacy Practice, College of Pharmacy, Mercer University, Atlanta, GA
| | | | - Kristen Pogreba-Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Mejia-Oquendo M, Marulanda-Ibarra E, Gomez-Marin JE. Evaluation of the impact of the first evidence-based guidelines for congenital toxoplasmosis in Armenia (Quindío) Colombia: An observational retrospective analysis. LANCET REGIONAL HEALTH. AMERICAS 2021; 1:100010. [PMID: 36776756 PMCID: PMC9904040 DOI: 10.1016/j.lana.2021.100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
Background Colombia implemented the world's first evidence-based guidelines for congenital toxoplasmosis in 2013, no evaluation of its impact has been reported. Methods We reviewed the clinical charts of cases referred to the specialized consultation of the health care centre at Universidad del Quindío during an 18-year period (2001-2019), where the diagnosis criteria and the correlation between prenatal treatment and symptoms at birth were analysed. Additionally, we described the diagnosis criteria and treatment for mothers during pregnancy at a primary prenatal care centre in the city of Armenia during 2018. Institutional consent was obtained to review clinical charts. Findings At the referral centre, we found that before the implementation, 27.3% did not have prenatal diagnosis but after implementing the clinical practice guidelines, all mothers were diagnosed during pregnancy. In addition, we observed that prenatal treatment was associated with fewer symptoms and this improved significantly over time after implementing the guidelines. At the primary health care centre in 2018, we found that all mothers were diagnosed and treated, as recommended by the national guideline. Interpretation The national guideline has had a positive impact by improving early diagnosis and treatment of prenatal toxoplasmosis and reducing severe forms, as observed at the referral centre. Funding Colombian Ministry of Science.
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Vivacqua DPF, Paz AB, Frota ACC, Penna CRR, Martins MG, Abreu TF, Hofer CB. Antenatal factors related to congenital toxoplasmosis in Rio De Janeiro, Brazil. J Matern Fetal Neonatal Med 2021; 35:7200-7206. [PMID: 34219602 DOI: 10.1080/14767058.2021.1946507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Toxoplasmosis is one of the main preventable congenital infections in Brazil. This manuscript aims to describe antenatal factors possibly associated with congenital toxoplasmosis (CT). METHODS This is a case-control study, with data collected from medical records, from infants admitted under one year of age at the Infectious Diseases Clinic of Instituto de Puericultura e Pediatria Martagão Gesteira, reference center from Rio de Janeiro, exposed to toxoplasmosis during their antenatal period. Patients diagnosed with CT were classified as cases and those exposed without infection as controls. RESULTS A total of 289 patients were followed up in 10 years. CT was confirmed in 43 (14.9%) of which six (14%) were asymptomatic, five (12%) had the classic triad (retinochoroiditis, hydrocephalus and intracranial calcifications), 27/42 (64.3%) had reactive IgM. Even after adjusted for prematurity, cases were born with lower weight (OR 0.49 - IC95% 0.33-0.73). There was a 13% increase in chance of CT per gestational week of the maternal diagnosis. Maternal fever, consumption of poorly washed vegetables during pregnancy, and diagnosis in the third trimester were associated with CT (OR: 6.43, 6.55, and 2.16, respectively). CONCLUSION Fever during pregnancy, consumption of poorly washed vegetables and diagnosis in the third trimester were associated with CT. Infants with diagnosis of CT were born with lower weight than the controls.
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Affiliation(s)
| | - Adriana Barbosa Paz
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Cristina Cisne Frota
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Renata Rezende Penna
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Guerreiro Martins
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thalita Fernandes Abreu
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristina Barroso Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Bertachini ALL, Januario GC, Novi SL, Mesquita RC, Silva MAR, Andrade GMQ, de Resende LM, de Miranda DM. Hearing brain evaluated using near-infrared spectroscopy in congenital toxoplasmosis. Sci Rep 2021; 11:10135. [PMID: 33980948 PMCID: PMC8115034 DOI: 10.1038/s41598-021-89481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/20/2021] [Indexed: 12/11/2022] Open
Abstract
Congenital toxoplasmosis (CT) is a known cause of hearing loss directly caused by Toxoplasma gondii. Hearing loss might result from sensory, neural, or sensorineural lesions. Early treated infants rarely develop hearing loss, but retinochoroidal lesions, intracranial calcifications and hydrocephalus are common. In this study, we aimed to evaluate the brain evoked hemodynamic responses of CT and healthy infants during four auditory stimuli: mother infant directed speech, researcher infant directed speech, mother reading and researcher recorded. Children underwent Transitionally Evoked Otoacoustic Emission Auditory Testing and Automated Brainstem Auditory Response tests with normal auditory results, but with a tendency for greater latencies in the CT group compared to the control group. We assessed brain hemodynamics with functional near-infrared spectroscopy (fNIRS) measurements from 61 infants, and we present fNIRS results as frequency maps of activation and deactivation for each stimulus. By evaluating infants in the three first months of life, we observed an individual heterogeneous brain activation pattern in response to all auditory stimuli for both groups. Each channel was activated or deactivated in less than 30% of children for all stimuli. There is a need of prospective studies to evaluate if the neurologic or auditory changes course with compromise of children outcomes.
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Affiliation(s)
- Ana Lívia Libardi Bertachini
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NUPAD - Center for Newborn Screening and Genetic Diagnostics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriela Cintra Januario
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NUPAD - Center for Newborn Screening and Genetic Diagnostics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sergio Luiz Novi
- "Gleb Wataghin'' Institute of Physics, University of Campinas, Campinas, Brazil
| | | | | | - Gláucia Manzan Queiroz Andrade
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NUPAD - Center for Newborn Screening and Genetic Diagnostics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Macedo de Resende
- Department of Speech and Hearing Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,NUPAD - Center for Newborn Screening and Genetic Diagnostics, UFMG - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,Centro de Tecnologia Em Medicina Molecular, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil.
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A First Report on Experience in Managing Infants with Congenital Toxoplasmosis in Ethiopia: Case Reports and a Review of Evaluation and Treatment. Case Rep Infect Dis 2021; 2021:9934391. [PMID: 33953996 PMCID: PMC8062199 DOI: 10.1155/2021/9934391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background. Congenital toxoplasmosis is a major sequela of untreated primary maternal infection. With or without symptoms, untreated infections eventually lead to multiple neurologic complications. Despite the high Toxoplasma gondii seroprevalence in the Ethiopian population, there are no reports of newborns diagnosed and treated for congenital toxoplasmosis. Presentation of Cases. The clinical presentation, evaluation, and management of three infants with congenital toxoplasmosis are described. Two were symptomatic at birth. All three had confirmed diagnoses using Toxoplasma serologic tests. Two completed their treatment with one infant developing complications of strabismus and seizure disorder. Discussion and Conclusions. There is little experience in managing congenital toxoplasmosis in Ethiopia due to constraints in diagnostics and therapy. The description of this first such report underscores the need for risk assessment and evaluation during antenatal care to obtain favorable fetal outcomes.
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Ades AE, Soriano-Arandes A, Alarcon A, Bonfante F, Thorne C, Peckham CS, Giaquinto C. Vertical transmission of Zika virus and its outcomes: a Bayesian synthesis of prospective studies. THE LANCET. INFECTIOUS DISEASES 2021; 21:537-545. [PMID: 33068528 PMCID: PMC7992034 DOI: 10.1016/s1473-3099(20)30432-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prospective studies of Zika virus in pregnancy have reported rates of congenital Zika syndrome and other adverse outcomes by trimester. However, Zika virus can infect and damage the fetus early in utero, but clear before delivery. The true vertical transmission rate is therefore unknown. We aimed to provide the first estimates of underlying vertical transmission rates and adverse outcomes due to congenital infection with Zika virus by trimester of exposure. METHODS This was a Bayesian latent class analysis of data from seven prospective studies of Zika virus in pregnancy. We estimated vertical transmission rates, rates of Zika-virus-related and non-Zika-virus-related adverse outcomes, and the diagnostic sensitivity of markers of congenital infection. We allowed for variation between studies in these parameters and used information from women in comparison groups with no PCR-confirmed infection, where available. FINDINGS The estimated mean risk of vertical transmission was 47% (95% credible interval 26 to 76) following maternal infection in the first trimester, 28% (15 to 46) in the second, and 25% (13 to 47) in the third. 9% (4 to 17) of deliveries following infections in the first trimester had symptoms consistent with congenital Zika syndrome, 3% (1 to 7) in the second, and 1% (0 to 3) in the third. We estimated that in infections during the first, second, and third trimester, respectively, 13% (2 to 27), 3% (-5 to 14), and 0% (-7 to 11) of pregnancies had adverse outcomes attributable to Zika virus infection. Diagnostic sensitivity of markers of congenital infection was lowest in the first trimester (42% [18 to 72]), but increased to 85% (51 to 99) in trimester two, and 80% (42 to 99) in trimester three. There was substantial between-study variation in the risks of vertical transmission and congenital Zika syndrome. INTERPRETATION This preliminary analysis recovers the causal effects of Zika virus from disparate study designs. Higher transmission in the first trimester is unusual with congenital infections but accords with laboratory evidence of decreasing susceptibility of placental cells to infection during pregnancy. FUNDING European Union Horizon 2020 programme.
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Affiliation(s)
- A E Ades
- Department of Population Health Science, University of Bristol Medical School, Bristol, UK,Correspondence to: Prof A E Ades, Department of Population Health Science, University of Bristol Medical School, Bristol BS8 2PS, UK
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Ana Alarcon
- Department of Neonatology, Hospital Universitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Claire Thorne
- Population Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Catherine S Peckham
- Population Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Carlo Giaquinto
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, Padua, Italy
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Conceição AR, Belucik DN, Missio L, Gustavo Brenner L, Henrique Monteiro M, Ribeiro KS, Costa DF, Valadão MCDS, Commodaro AG, de Oliveira Dias JR, Belfort R. Ocular Findings in Infants with Congenital Toxoplasmosis after a Toxoplasmosis Outbreak. Ophthalmology 2021; 128:1346-1355. [PMID: 33711379 DOI: 10.1016/j.ophtha.2021.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE We investigated the prevalence of ocular abnormalities in infants vertically exposed to Toxoplasma gondii infection during an outbreak in Santa Maria City, Brazil. DESIGN Consecutive case series. PARTICIPANTS A total of 187 infants were included. METHODS The infants were recruited from January 2018 to November 2019. All mothers were screened for syphilis and human immunodeficiency virus before delivery. Toxoplasmosis infection was confirmed in all mothers and infants based on the presence of serum anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies. All infants underwent an ophthalmologic examination; ocular abnormalities were documented using a wide-field digital imaging system. Neonatal cranial sonography or head computed tomography was performed in 181 infants, and the cerebrospinal fluid (CSF) was screened for anti-T. gondii IgG and IgM antibodies in 159 infants. Peripheral blood samples from 9 infants and their mothers were analyzed for the presence of T. gondii DNA by real-time polymerase chain reaction. MAIN OUTCOME MEASURES Ocular abnormalities associated with congenital toxoplasmosis. RESULTS A total of 187 infants were examined. Twenty-nine infants (15.5%) had congenital toxoplasmosis, of whom 19 (10.2%) had ocular abnormalities, including retinochoroiditis in 29 of 38 eyes (76.3%), optic nerve abnormalities in 5 eyes (13.2%), microphthalmia in 1 eye (2.6%), and cataract in 2 eyes (5.3%). Bilateral retinal choroidal lesions were found in 10 of 19 infants (52.6%). Nine eyes of 6 infants had active lesions, with retinal choroidal cellular infiltrates at the first examination. Thirteen (7.2%) of 181 infants screened presented with cerebral calcifications. Eighty-three percent of the screened infants were positive for anti-T. gondii IgG and negative for IgM antibodies in the CSF. Congenital toxoplasmosis was higher in mothers infected during the third pregnancy trimester, and maternal treatment during pregnancy was not associated with a lower rate of congenital toxoplasmosis. CONCLUSIONS High prevalence rates of clinical manifestations were observed in infants with congenital toxoplasmosis after a waterborne toxoplasmosis outbreak, the largest yet described. Cerebral calcifications were higher in infants with ocular abnormalities, and maternal infection during the third pregnancy trimester was associated with a higher rate of congenital toxoplasmosis independent of maternal treatment.
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Affiliation(s)
| | | | - Lilian Missio
- Federal University of Santa Maria, Santa Maria, RS, Brazil
| | | | | | - Kleber Silva Ribeiro
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil
| | - Deise Fialho Costa
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil; Vision Institute, São Paulo, SP, Brazil
| | | | | | | | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo, Paulista Medical School, São Paulo, SP, Brazil; Vision Institute, São Paulo, SP, Brazil
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Mandelbrot L, Kieffer F, Wallon M, Winer N, Massardier J, Picone O, Fuchs F, Benoist G, Garcia-Meric P, L'Ollivier C, Paris L, Piarroux R, Villena I, Peyron F. [Toxoplasmosis in pregnancy: Practical Management]. ACTA ACUST UNITED AC 2021; 49:782-791. [PMID: 33677120 DOI: 10.1016/j.gofs.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 11/28/2022]
Abstract
The burden of congenital toxoplasmosis has become small in France today, in particular as a result of timely therapy for pregnant women, fetuses and newborns. Thus, the French screening and prevention program has been evaluated and recently confirmed despite a decline over time in the incidence of toxoplasmosis. Serological diagnosis of maternal seroconversion is usually simple but can be difficult when the first trimester test shows the presence of IgM, requiring referral to an expert laboratory. Woman with confirmed seroconversion should be referred quickly to an expert center, which will decide with her on treatment and antenatal diagnosis. Although the level of proof is moderate, there is a body of evidence in favor of active prophylactic prenatal treatment started as early as possible (ideally within 3 weeks of seroconversion) to reduce the risk of maternal-fetal transmission, as well as symptoms in children. The recommended therapies to prevent maternal-fetal transmission are: (1) spiramycin in case of maternal infection before 14 gestational weeks; (2) pyrimethamine and sulfadiazine (P-S) with folinic acid in case of maternal infection at 14 WG or more. Amniocentesis is recommended to guide prenatal and neonatal care. If fetal infection is diagnosed by PCR on amniotic fluid, therapy with P-S should be initiated as early as possible or continued in order reduce the risk of damage to the brain or eyes. Further research is required to validate new approaches to preventing congenital toxoplasmosis.
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Affiliation(s)
- L Mandelbrot
- AP-HP hôpital Louis-Mourier service de gynécologie-obstétrique, 178, rue des Renouillers, 92700 Colombes France; Université de Paris, Paris, France; Inserm IAME-U1137, Paris, France; FHU PREMA, Paris, France.
| | - F Kieffer
- FHU PREMA, Paris, France; Assistance Publique-hôpitaux de Paris, hôpital Armand Trousseau, Service de néonatologie, Paris, France
| | - M Wallon
- Hospices Civils de Lyon, hôpital de la Croix-Rousse, service de parasitologie-Mycologie Médicale, Lyon, France; INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France
| | - N Winer
- Centre hospitalier universitaire de Nantes, service de gynécologie-obstétrique, et NUN, INRA, UMR 1280, Phan Université de Nantes, 44000 Nantes, France
| | - J Massardier
- INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France; Hospices civils de Lyon, hôpital de la Croix-Rousse, service de gynécologie-obstétrique, Lyon, France
| | - O Picone
- AP-HP hôpital Louis-Mourier service de gynécologie-obstétrique, 178, rue des Renouillers, 92700 Colombes France; Université de Paris, Paris, France; Inserm IAME-U1137, Paris, France; FHU PREMA, Paris, France
| | - F Fuchs
- Service de gynécologie obstétrique CHU de Montpellier, Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston-Giraud, 34295 Montpellier Cedex 5, France; Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, 94807 Villejuif, France; Institut Desbrest d'epidemiologie et de santé publique, UMR inserm - université de Montpellier, Montpellier, France
| | - G Benoist
- Obstetrics and gynecology, Caen university Hospital, 14000 Caen, France
| | - P Garcia-Meric
- Assistance Publique-hôpitaux de Marseille, service de médecine néonatale, hôpital de la Conception, Marseille, France
| | - C L'Ollivier
- Aix Marseille Université, IRD, AP-HM, SSA, VITROME, IHU Méditerranée Infection, Marseille, France
| | - L Paris
- Assistance Publique-hôpitaux de Paris, hôpital Pitié-Salpêtrière, service de Parasitologie, Paris, France
| | - R Piarroux
- Assistance Publique-hôpitaux de Paris, hôpital Pitié-Salpêtrière, service de Parasitologie, Paris, France; Sorbonne Université, IPLESP UMR 1136, inserm, Paris, France
| | - I Villena
- Service de parasitologie-mycologie, centre national de référence de la toxoplasmose, centre de ressources biologiques toxoplasma, CHU Reims, Reims, France; EA 7510, laboratoire parasitologie-mycologie, université Reims Champagne -Ardenne, Reims, France
| | - F Peyron
- Hospices Civils de Lyon, hôpital de la Croix-Rousse, service de parasitologie-Mycologie Médicale, Lyon, France; INSERM U1028-CNRS UMR 5292, université Claude-Bernard, université Lyon-1, Bron, France
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49
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Faure-Bardon V, Ville Y. Maternal infections: revisiting the need for screening in pregnancy. BJOG 2021; 128:304-315. [PMID: 32937015 DOI: 10.1111/1471-0528.16509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/09/2022]
Abstract
The decision to implement screening for infections during pregnancy depends upon epidemiological, economic, therapeutic and test performance criteria. It therefore varies with public health priorities from country to country. When screening is implemented, the first trimester has become the best time slot to build individual care pathways in this field. This is most relevant for evaluating the risk of embryonic consequences, planning diagnostic testing, initiating primary or secondary prevention and optimising the accuracy of ultrasound follow-up. This article is a critical appraisal of epidemiological data and current international screening recommendations for infections in pregnancy. TWEETABLE ABSTRACT: Screening for infections in pregnancy: a critical review of current epidemiological evidence and international guidelines.
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Ardabili S, Kohl J, Gül G, Hodel M. What obstetricians should be aware of: serious side effects of antibiotic toxoplasmosis treatment in pregnancy. BMJ Case Rep 2021; 14:e240809. [PMID: 33649030 PMCID: PMC7929819 DOI: 10.1136/bcr-2020-240809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 11/04/2022] Open
Abstract
Infection with Toxoplasma gondii is usually an asymptomatic or oligosymptomatic, self-limiting disease in immunocompetent individuals. However, during the pregnancy, primary infection can lead to transplacental vertical transmission resulting in congenital toxoplasmosis with possible severe sequelae. The efficacy of systematic screening remains controversial and the effect of antibiotic treatment is unclear. Although main side effects of antibiotic drugs used for toxoplasmosis are well known, mostly from malaria treatment, there is a lack of information about occurrence in pregnant woman treated for toxoplasmosis. We report a case of a healthy pregnant woman with primary toxoplasmosis infection in the second trimester, who developed a severe adverse reaction in form of hypersensitivity pneumonia after antibiotic treatment with pyrimethamine and sulfadiazine and discuss the literature.
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Affiliation(s)
- Sara Ardabili
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Joachim Kohl
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Gülseven Gül
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
| | - Markus Hodel
- Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Luzern, Switzerland
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