1
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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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2
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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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3
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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] [Key Words] [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
| | - 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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4
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Fabiani S, Caroselli C, Menchini M, Gabbriellini G, Falcone M, Bruschi F. Ocular toxoplasmosis, an overview focusing on clinical aspects. Acta Trop 2022; 225:106180. [PMID: 34699742 DOI: 10.1016/j.actatropica.2021.106180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
Toxoplasma gondii is a widespread protozoan parasite infecting approximately one third of the world population. After proliferation of tachyzoites during the acute stage, the parasite forms tissue cysts in various anatomical sites and establishes chronic infection. Nowadays the nature of the interplay between the protozoan and its human host remains elusive. This is clearly evident in ocular toxoplasmosis, in which the parasite establishes an ambivalent relationship with the eye, manipulating the immune response and inducing variable initial lesions and further relapses. This review will focus on epidemiology and environmental, parasite and host related risk factors, clinical manifestations and laboratory findings, treatment and prophylaxis approaches in ocular toxoplasmosis. An image collection of patients referred to the Unit of Ophthalmology of Pisa's Hospital will be presented, too.
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5
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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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6
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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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7
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Voide N, Bijon J, Crisinel PA, Truttmann AC, Durig J, Rossi DC. Congenital Toxoplasmosis with Bilateral Macular Chorioretinitis in a Premature Newborn. Klin Monbl Augenheilkd 2021; 238:431-433. [PMID: 33930914 DOI: 10.1055/a-1384-1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nathalie Voide
- Unit of Strabology and Pediatric Ophthalmology, University Department of Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Jacques Bijon
- Unit of Strabology, University Department of Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anita C Truttmann
- Clinic of Neonatology, Department of Women, Mother and Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jacques Durig
- Ophthalmology, Métropole médical, Lausanne, Switzerland.,Department of Women, Mother and Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniele C Rossi
- Unit of Ocular Immuno-Infectiology, University Department of Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
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8
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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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9
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Lago EG, Endres MM, Scheeren MFDC, Fiori HH. Ocular Outcome of Brazilian Patients With Congenital Toxoplasmosis. Pediatr Infect Dis J 2021; 40:e21-e27. [PMID: 33060522 DOI: 10.1097/inf.0000000000002931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retinochoroiditis is the most frequent manifestation of congenital toxoplasmosis. We aimed to describe the ocular outcome and factors that may influence the visual prognosis of these patients. METHODS Cohort of patients with confirmed congenital toxoplasmosis seen between 1996 and 2017 in Porto Alegre, southern Brazil. RESULTS Seventy-seven patients were included, of which 65 (85.5%) were identified by routine screening. Median age at the end of the follow-up was 10 years (minimum 2, maximum 25). Retinochoroiditis was present in 55 patients (71.4%). New retinochoroidal lesions developed after the first year of life in 77.8% of the patients who began treatment after the fourth month of life, compared with 35.2% among those treated before 4 months of life (relative risk = 0.45, 95% confidence intervals: 0.27-0.75, P = 0.02) and 33.3% among those treated before 2 months of life (relative risk = 0.42, 95% confidence intervals: 0.25-0.72, P = 0.01). There was a peak incidence of new retinochoroidal lesions between 4 and 5 years and another peak between 9 and 14 years, the latter only among girls. Thirty-four patients with retinochoroiditis were followed up for 10 years or more, and the school performance was appropriate in 28 (82.4%). CONCLUSIONS The high incidence of new retinochoroidal lesions during the follow-up period indicates the importance of long-term follow-up of patients with congenital toxoplasmosis. Initiating treatment within the first 4 months of life, especially within the first 2 months, was a protective factor against the later development of retinochoroiditis. Despite the usual favorable prognosis, the high morbidity of congenital toxoplasmosis in Brazil was confirmed.
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Affiliation(s)
- Eleonor Gastal Lago
- From the Neonatology Division, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre/RS, Brazil
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10
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Codaccioni C, Picone O, Lambert V, Maurice P, Pomar L, Winer N, Guibaud L, Lavergne RA, Saliou AH, Quinio D, Benachi A, Noel C, Ville Y, Cuillier F, Pomares C, Ferret N, Filisetti D, Weingertner AS, Vequeau-Goua V, Cateau E, Benoist G, Wallon M, Dommergues M, Villena I, Mandelbrot L. Ultrasound features of fetal toxoplasmosis: A contemporary multicenter survey in 88 fetuses. Prenat Diagn 2020; 40:1741-1752. [PMID: 32506432 DOI: 10.1002/pd.5756] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/16/2020] [Accepted: 05/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the lesions detected by prenatal ultrasound examination in congenital toxoplasmosis (CT). METHODS We retrospectively analyzed all cases of fetal infection with Toxoplasma gondii with ultrasound anomalies described by fetal medicine experts in 2009 to 2019 in 30 French centers. RESULTS Eighty-eight cases of CT were included. Forty-five (51.1%) had one or more cerebral signs only, 35 (39.8%) had cerebral plus extracerebral signs and 8 (9.1%) had extracerebral signs only. The main cerebral signs were intracranial hyperechogenic nodular foci (n = 60) of which 20 were isolated, ventriculomegalies (n = 44) which generally increased during follow-up, and periventricular abscesses (n = 12). The main extracerebral signs were hepatomegaly and/or splenomegaly (n = 14), small for gestational age (n = 14), ascites (n = 14, including 2 with hydrops), and hyperechogenic bowel (n = 11). Maternal infection occurred mostly in the first or second trimester (81 cases), periconceptionally in one and in the third trimester in six cases. The first ultrasound signs were detected after a median of 7 weeks (range: 1.4; 24.0) following maternal toxoplasmosis seroconversion. CONCLUSION While no sign was specific of CT, there were typical associations of cerebral signs with or without extracerebral signs. Detailed ultrasound examination could improve prognostic evaluation, as well as diagnosis of CT in settings lacking serological screening.
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Affiliation(s)
- Camille Codaccioni
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
| | - Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
| | - Véronique Lambert
- Service de Gynécologie-Obstétrique, Centre Hospitalier de l'Ouest Guyanais, St Laurent du Maroni, France
| | - Paul Maurice
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Foetale, Hôpital Trousseau, APHP Sorbonne, Paris, France
| | - Léo Pomar
- Service de Gynécologie-Obstétrique, Centre Hospitalier de l'Ouest Guyanais, St Laurent du Maroni, France
| | - Norbert Winer
- Centre Hospitalier Universitaire de Nantes, Service de Gynécologie-Obstétrique, NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - Laurent Guibaud
- Centre Hospitalier Universitaire de Nantes, Laboratoire Parasitologie et Mycologie, and NUN, INRA, UMR 1280, Phan, Université de Nantes, Nantes, France
| | - Rose-Anne Lavergne
- Service de Radiologie, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Anne-Hélène Saliou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Dorothée Quinio
- Laboratoire Parasitologie et Mycologie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Alexandra Benachi
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Université Paris-Saclay, Clamart, France
| | - Catherine Noel
- Service de Gynécologie-Obstétrique, Centre Hospitalier René Dubos, Pontoise, France
| | - Yves Ville
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Necker Enfants Malades APHP Centre Université de Paris, Paris, France
| | - Fabrice Cuillier
- Service de Gynécologie-Obstétrique, Centre Hospitalier Régional Félix Guyon, Saint-Denis, Réunion, France
| | - Christelle Pomares
- Centre Hospitalier Universitaire de Nice, Service de Parasitologie-Mycologie, C3M INSERM 1065, Université Côte d'Azur, Nice, France
| | - Nicole Ferret
- Centre Hospitalier Universitaire de Nice, Service de Pédiatrie, Université Côte d'Azur, Nice, France
| | - Denis Filisetti
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Anne-Sophie Weingertner
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Valérie Vequeau-Goua
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Estelle Cateau
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Benoist
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Martine Wallon
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Marc Dommergues
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital de la Pité-Salpêtrière, APHP Sorbonne, Paris, France
| | - Isabelle Villena
- Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, EA 7510, UFR Médecine, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, APHP Nord Université de Paris, Colombes, France.,Inserm, IAME, Université de Paris, Paris, France
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11
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Mandelbrot L. Congenital toxoplasmosis: What is the evidence for chemoprophylaxis to prevent fetal infection? Prenat Diagn 2020; 40:1693-1702. [PMID: 32453454 DOI: 10.1002/pd.5758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/02/2020] [Accepted: 05/23/2020] [Indexed: 12/25/2022]
Abstract
Although prenatal diagnosis and prenatal and neonatal therapy of congenital toxoplasmosis are available, there is controversy concerning the effectiveness of prophylaxis to prevent placental transmission. Experimental, parasitological, and clinical data suggest a "window of opportunity" following maternal infection. Among medications active against Toxoplasma gondii, mainly spiramycin (Spy) and pyrimethamine + sulfonamide combinations (P-S) have been evaluated. Results from observational studies suffered treatment bias, since prescriptions differed according to the gestational age at seroconversion, which is the major risk factor for transmission, and many lacked precise timing. Some large retrospective studies found no difference in transmission according to prophylactic treatment, but transmission was lower when treatment started promptly after maternal seroconversion. A few recent studies adjusting for timing of infection observed lower transmission in case of P-S than other or no prophylaxis. In the only randomized controlled trial, transmission was lower with P-S than S (18.5% vs 30%, P = .147); this association was strengthened when the treatment was started within 3 weeks of seroconversion, and the incidence of fetal cerebral ultrasound signs was significantly reduced in the P-S group. Rapid initiation of prophylactic therapy following maternal infection, which is usually asymptomatic, requires systematic screening for maternal seroconversion during pregnancy.
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Affiliation(s)
- Laurent Mandelbrot
- Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris Nord Université de Paris, Hôpital Louis Mourier, Colombes, France.,Inserm IAME 1137, Université de Paris, Paris, France
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Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M, Wehbe K, Mandelbrot L, Villena I. Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod 2020; 49:101814. [PMID: 32428782 DOI: 10.1016/j.jogoh.2020.101814] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Abstract
Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis.
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Affiliation(s)
- Olivier Picone
- Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris; Inserm IAME-U1137, Paris, France; FHU PREMA; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Florent Fuchs
- Service de Gynécologie Obstétrique CHU de Montpellier, Hopital Arnaud de Villeneuve, Montpellier, France; Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018, Reproduction et Développement de l'enfant, 94807 Villejuif, France; EA2415: Aide à la décision médicale Personnalisée, Axe B: Méthode en épidémiologie Clinique, Université de Montpellier
| | | | - Christine Binquet
- Inserm, CIC1432, module Epidémiologie Clinique, Dijon, France; CHU Dijon-Bourgogne, Centre d'Investigation Clinique, Module Epidémiologie Clinique/Essais Cliniques, Dijon, France
| | - François Kieffer
- Assistance Publique-Hôpitaux de Paris, Service de néonatologie, Hôpital Armand Trousseau, Paris, France
| | - Martine Wallon
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service de Parasitologie - Mycologie Médicale, Lyon, France; Université Lyon-1, Equipe Waking, Physiologie Intégrée du Système d'éveil, Centre de Recherche en Neurosciences de Lyon (INSERM U1028 - CNRS UMR 5292), Bron, France
| | - Karl Wehbe
- Centre Hospitalier Universitaire de Strasbourg, Service de Gynécologie-Obstétrique, Strasbourg, France
| | - 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; Groupe de Recherche sur les Infections pendant la grossesse (GRIG)
| | - Isabelle Villena
- Université Reims Champagne -Ardenne, EA7510 et Centre National de Référence de la Toxoplasmose, Centre de Ressources Biologiques Toxoplasma, Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Reims, Reims, France
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Konstantinovic N, Guegan H, Stäjner T, Belaz S, Robert-Gangneux F. Treatment of toxoplasmosis: Current options and future perspectives. Food Waterborne Parasitol 2019; 15:e00036. [PMID: 32095610 PMCID: PMC7033996 DOI: 10.1016/j.fawpar.2019.e00036] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 02/08/2023] Open
Abstract
Toxoplasmosis is a worldwide parasitic disease infecting about one third of humans, with possible severe outcomes in neonates and immunocompromised patients. Despite continuous and successful efforts to improve diagnosis, therapeutic schemes have barely evolved since many years. This article aims at reviewing the main clinical trials and current treatment practices, and at addressing future perspectives in the light of ongoing researches.
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Affiliation(s)
- Neda Konstantinovic
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, 11129 Belgrade, Serbia
| | - Hélène Guegan
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000 Rennes, France
| | - Tijana Stäjner
- National Reference Laboratory for Toxoplasmosis, Institute for Medical Research, University of Belgrade, 11129 Belgrade, Serbia
| | - Sorya Belaz
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset - UMR_S 1085, F-35000 Rennes, France
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Khan K, Khan W. Congenital toxoplasmosis: An overview of the neurological and ocular manifestations. Parasitol Int 2018; 67:715-721. [PMID: 30041005 DOI: 10.1016/j.parint.2018.07.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 12/21/2022]
Abstract
Toxoplasma gondii is an obligate intracellular parasite which is known to infect one-third of the total world population chronically though it is asymptomatic in immunocompetent patients. However, in an immunocompromised patient or an infected fetus, it may cause devastating effects. The parasite may cross the placenta of an infected pregnant woman and probably infect the fetus congenitally. The severity of the infection depends on the gestational age at which the infection has occurred i.e., if it has occurred in the early phase, the rate of transmission is low but the severity is high if the fetus is infected and if it has occurred in the later phase then transmission rate is higher while the severity would be low. Congenital toxoplasmosis may result in non-specific consequences like abortion, intra-uterine growth restriction, jaundice, hepatosplenomegaly or even intra-uterine death. It may also result in neurological or ocular manifestations like intracranial calcifications, hydrocephalus or retinochoroiditis. The diagnosis may be done by serological screening of anti-Toxoplasma antibodies (IgM and IgG) while PCR of the amniotic fluid or the placenta is the confirmatory test. Acute or chronic infections may be differentiated by IgG avidity tests. The treatment regimens include spiramycin to prevent congenital transmission from an infected mother, pyrimethamine, sulfadoxine and folinic acid to treat the infected fetus, CSF shunting for the treatment of hydrocephalus and a combination of pyrimethamine, azithromycin, and corticosteroids for treating ocular toxoplasmosis.
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Affiliation(s)
- Khadija Khan
- Department of Zoology, Section of Parasitology, Aligarh Muslim University, India
| | - Wajihullah Khan
- Department of Zoology, Section of Parasitology, Aligarh Muslim University, India.
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Maldonado YA, Read JS. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics 2017; 139:peds.2016-3860. [PMID: 28138010 DOI: 10.1542/peds.2016-3860] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ocular toxoplasmosis in an immunocompetent 8-year-old child: a new active lesion or a late manifestation of a congenital toxoplasmosis? ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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[Role of systematic ophthalmological screening for congenital toxoplasmosis: epidemiological study of an Alsatian cohort from 1990 to 2011]. J Fr Ophtalmol 2014; 37:365-70. [PMID: 24698638 DOI: 10.1016/j.jfo.2013.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Ophthalmologic complications of congenital toxoplasmosis, such as retino-choroiditis, are particularly feared. Any child with confirmed congenital toxoplasmosis is systematically treated and followed regularly with multiple fundus examinations. The goal of our study is to describe the management and monitoring of a cohort of patients with congenital toxoplasmosis in Alsace, and the impact of this disease in terms of parental anxiety using a standardized questionnaire. MATERIALS AND METHODS Our study recorded 35 children with congenital toxoplasmosis, born between 1990 and 2011 in Alsace. All patients were followed by an ophthalmologist. A standardized questionnaire concerning the experience of pregnancy and post-natal follow-up was administered to the parents. RESULTS At birth, retinochoroiditis was detected in 2 of the 35 children, and only one child developed chorioretinitis detected during follow-up monitoring (follow-up ranged from 1 to 22 years). Brain abnormalities were noted in 3 children at birth; none of them have presented with chorioretinitis to this day. An average score of 15 out of 23 was found by our standardized questionnaire, reflecting significant anxiety due to congenital toxoplasmosis. DISCUSSION Parental anxiety due to congenital toxoplasmosis is obvious, as demonstrated by our standardized questionnaire. Follow-up, directed by comprehensive pediatric examination at birth, including fundus examination, and good information on functional signs of ocular toxoplasmosis may improve screening, so as to avoid impact on visual function.
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Ocular toxoplasmosis past, present and new aspects of an old disease. Prog Retin Eye Res 2014; 39:77-106. [DOI: 10.1016/j.preteyeres.2013.12.005] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 12/22/2022]
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Wallon M, Garweg JG, Abrahamowicz M, Cornu C, Vinault S, Quantin C, Bonithon-Kopp C, Picot S, Peyron F, Binquet C. Ophthalmic outcomes of congenital toxoplasmosis followed until adolescence. Pediatrics 2014; 133:e601-8. [PMID: 24534412 DOI: 10.1542/peds.2013-2153] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Congenital toxoplasmosis (CT) can elicit severe damage to several organs, especially the eye, and may be manifested at birth or later. We assessed the long-term ocular prognosis in a cohort of congenitally infected children treated according to a standardized protocol and monitored for up to 22 years. METHODS This prospective study included confirmed cases of CT, which were identified by obligatory antenatal screening at the Lyon (France) reference center between 1987 and 2008. Data obtained through ocular examinations were recorded on a standardized form and confirmed by an independent external committee. Risk factors for retinochoroiditis were identified by using a multivariable Cox model and a flexible model that accounted for changes in the factor effects during follow-up. RESULTS A total of 477 of 485 infected live-born children were followed for a median of 10.5 years (75th percentile: 15.0 years). During the follow-up, 142 patients (29.8%) manifested at least 1 ocular lesion. Lesions were unilateral in 98 individuals (69.0%) and caused no vision loss in 80.6%. Lesions were first manifested at a median age of 3.1 (0.0-20.7) years. In 48 (33.8%) of the children, recurrences or new ocular lesions occurred up to 12 years after the appearance of the first lesion. Early maternal infection and confirmation of CT in children, prematurity, and nonocular CT lesions at baseline were associated with a higher risk of retinochoroiditis. CONCLUSIONS Although the consequences of CT are rarely severe in treated children, regular postnatal monitoring is nevertheless justified because of the lifelong persisting risk of new ocular manifestations.
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Affiliation(s)
- Martine Wallon
- Hospices Civils de Lyon, Institut de Parasitologie et de Mycologie Médicale, Hôpital de la Croix-Rousse, Lyon, France
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Asproudis I, Koumpoulis I, Kalogeropoulos C, Sotiropoulos G, Papassava M, Aspiotis M. Case report of a neonate with ocular toxoplasmosis due to congenital infection: estimation of the percentage of ocular toxoplasmosis in Greece caused by congenital or acquired infection. Clin Ophthalmol 2013; 7:2249-52. [PMID: 24293989 PMCID: PMC3839798 DOI: 10.2147/opth.s51740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of a newborn male child with congenital toxoplasmosis. During pregnancy seroconversion occurred and positive titers of antitoxoplasmic antibodies (immunoglobulin M and G) were found in the mother, in the third trimester. She received treatment with spiramycin. After birth, the neonate presented with chorioretinitis and intracranial calcifications. The neonate received treatment with pyrimethamine, sulfadiazine, and leucovorin for 1 year. In addition to using a previously described method, we report for the first time in Greece an estimation regarding the percentage of ocular toxoplasmosis caused by congenital or acquired infection. We estimate that ocular toxoplasmosis in Greece is caused in 7% of the cases by congenital infection, and in 93% of the cases by acquired infection.
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Affiliation(s)
- Ioannis Asproudis
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
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It is not only the cat that did it: how to prevent and treat congenital toxoplasmosis. J Infect 2013; 68 Suppl 1:S125-33. [PMID: 24119928 DOI: 10.1016/j.jinf.2013.09.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/22/2022]
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over one hundred years ago and was soon recognized as a pathogen responsible for congenital infection. But detailed understanding of its epidemiology emerged only after 1970 with the discovery of its life cycle. In the last ten years, high resolution molecular tools have allowed the characterization of various strain types with different virulence patterns, and current studies are exploring the distribution of these different genotypes. In parallel, sophisticated diagnostic tools have been developed and awareness of disease burden has led some European countries with high prevalence rates to implement screening of pregnant women. In this article, the screening options and therapies used to prevent congenital toxoplasmosis are dissected in the light of recent data from cohort studies and other epidemiological data.
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Baquero-Artigao F, del Castillo Martín F, Fuentes Corripio I, Goncé Mellgren A, Fortuny Guasch C, de la Calle Fernández-Miranda M, González-Tomé M, Couceiro Gianzo J, Neth O, Ramos Amador J. Guía de la Sociedad Española de Infectología Pediátrica para el diagnóstico y tratamiento de la toxoplasmosis congénita. An Pediatr (Barc) 2013; 79:116.e1-116.e16. [DOI: 10.1016/j.anpedi.2012.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022] Open
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Mandelbrot L. Prévention de la transmission mère-enfant de la toxoplasmose : perspectives. ACTA ACUST UNITED AC 2012; 40:591-8. [DOI: 10.1016/j.gyobfe.2012.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 07/05/2012] [Indexed: 10/27/2022]
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Evaluation of the liaison automated testing system for diagnosis of congenital toxoplasmosis. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 19:1859-63. [PMID: 23015644 DOI: 10.1128/cvi.00489-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital toxoplasmosis is a worldwide health problem, and different screening strategies exist. Testing of toxoplasma-specific antibodies in infants identifies congenital toxoplasmosis during the first year of life. However, experience with commercial available immunoassays is limited. The aim of this study was to evaluate both the performance and analytical characteristics of the Liaison diagnostic system in infants. In a retrospective study, serum Toxoplasma gondii antibodies were measured in samples from 333 infants, including 212 noninfected infants and 121 infants with congenital toxoplasmosis. A total of 1,157 umbilical cord blood and peripheral serum samples were analyzed. Liaison toxoplasma-specific IgG and IgM antibodies and the IgG avidity index were compared to the infection status of the infant, determined by the Sabin-Feldman dye test and immunosorbent agglutination assay--IgM. All noninfected infants were seronegative by Liaison IgG within the first year of life. The Liaison system showed a sensitivity of 81.8%, a specificity of 100.0%, a positive predictive value of 100.0%, a negative predictive value of 90.6%, and overall agreement of 84.4% by comparison with the dye test. Overall agreement of both IgM test systems was 96.0%. In this study cohort, avidity did not show a potential diagnostic benefit for the detection of congenital infection. In conclusion, the Liaison system is a valuable tool to monitor the serologic course of infants at risk. A final serologic confirmatory test is recommended to improve the rate of detection of congenital toxoplasmosis at 1 year of life. Protocols of routine follow-up testing in infants and accurate diagnostic tools after acute gestational infections are needed to improve medical care.
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Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev 2012; 25:264-96. [PMID: 22491772 PMCID: PMC3346298 DOI: 10.1128/cmr.05013-11] [Citation(s) in RCA: 990] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The apicomplexan parasite Toxoplasma gondii was discovered a little over 100 years ago, but knowledge of its biological life cycle and its medical importance has grown in the last 40 years. This obligate intracellular parasite was identified early as a pathogen responsible for congenital infection, but its clinical expression and the importance of reactivations of infections in immunocompromised patients were recognized later, in the era of organ transplantation and HIV infection. Recent knowledge of host cell-parasite interactions and of parasite virulence has brought new insights into the comprehension of the pathophysiology of infection. In this review, we focus on epidemiological and diagnostic aspects, putting them in perspective with current knowledge of parasite genotypes. In particular, we provide critical information on diagnostic methods according to the patient's background and discuss the implementation of screening tools for congenital toxoplasmosis according to health policies.
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Affiliation(s)
- Florence Robert-Gangneux
- Service de Parasitologie, Faculté de Médecine et Centre Hospitalier Universitaire de Rennes, Rennes, France.
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de-la-Torre A, Stanford M, Curi A, Jaffe GJ, Gomez-Marin JE. Therapy for ocular toxoplasmosis. Ocul Immunol Inflamm 2012; 19:314-20. [PMID: 21970662 DOI: 10.3109/09273948.2011.608915] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To review current evidence for the treatment of ocular toxoplasmosis (OT). DESIGN Narrative review and expert recommendations. METHODS Meta-analysis and selected original articles from the medical literature were reviewed critically. Expert recommendations were analyzed. RESULTS Numerous observational studies suggest a benefit of short-term antimicrobial therapy for toxoplasmic retinochoroiditis in immunocompetent patients, although its efficacy has not been proven in randomized clinical trials. A randomized clinical trial revealed that intermittent trimethoprim/sulfamethoxazole treatment could decrease the rate of recurrence in high-risk patients. Intravitreal injection of clindamycin and dexamethasone was an acceptable alternative to the classic treatment for OT in a randomized clinical trial. CONCLUSIONS Opinions about therapy differ and controversy remains about its type, efficacy, and length. Intravitreal therapy may be promising for OT. A recent description of the presence of parasitemia in patients with active and inactive ocular toxoplasmosis raises new questions that need to be explored.
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Affiliation(s)
- Alejandra de-la-Torre
- Grupo de Estudio en Parasitología Molecular, Centro de Investigaciones Biomédicas, Universidad del Quindío, Armenia, Colombia.
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Galamb A, Langmár Z. [Practical aspects of connatal infections--prevention, diagnostics and therapy]. Orv Hetil 2011; 152:1849-54. [PMID: 22030362 DOI: 10.1556/oh.2011.29235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Adám Galamb
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Szülészeti és Nőgyógyászati Klinika Budapest Üllői út 78/A 1082
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Toxoplasmosis: diagnosis, treatment, and prevention in congenitally exposed infants. J Pediatr Health Care 2011; 25:355-64. [PMID: 22018426 DOI: 10.1016/j.pedhc.2010.04.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/22/2010] [Accepted: 04/10/2010] [Indexed: 11/23/2022]
Abstract
Toxoplasmosis is a rare disease caused by the obligate intracellular protozoan parasite, Toxoplasma gondii. Most persons with toxoplasmosis in the United States are asymptomatic, but if a woman is infected during pregnancy, the parasite can cross the placenta and cause congenital toxoplasmosis in the fetus. The severity of congenital toxoplasmosis depends on when in the pregnancy the mother is exposed, but it can cause ocular and central nervous system disease as well as lead to growth failure and hearing and vision abnormalities. Congenital toxoplasmosis is treated with a combination of pyrimethamine, sulfadiazine, and leucovorin. It is important for pediatric nurse practitioners to be aware of the clinical presentation and treatment of congenital toxoplasmosis.
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Faucher B, Garcia-Meric P, Franck J, Minodier P, Francois P, Gonnet S, L'ollivier C, Piarroux R. Long-term ocular outcome in congenital toxoplasmosis: a prospective cohort of treated children. J Infect 2011; 64:104-9. [PMID: 22051915 DOI: 10.1016/j.jinf.2011.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Congenital toxoplasmosis remains a public health problem throughout the world. Long-term longitudinal studies are still needed to argument controversial screening and treatment strategies and to enable to accurately counsel parents. METHODS We conducted a prospective cohort study over 16 years in Marseilles, France. Seronegative pregnant women underwent monthly serological testing. Children were treated antenatally with rovamycine as soon as maternal infection was detected and with pyrimethamine and sulfadoxine in case of positive Toxoplasma PCR on amniotic fluid. Postnatal treatment with pyrimethamine and sulfadoxine was systematically prescribed for one year and possibly continued at the physician discretion. RESULTS 127 children were included. 24 children (18.9%) presented ocular lesions causing visual impairment in eight cases. Eleven children (8.7%) presented with ocular lesions at birth, mostly macular. Sixteen children (12.6%) developed ocular lesions during follow-up, mostly peripheral. The first ocular lesion could occur as late as 12 years after birth. No significant risk factor of chorioretinitis was identified including gestational age at infection, type of antenatal treatment and shorter postnatal treatment. CONCLUSIONS These results confirm the overall good prognosis of congenital toxoplasmosis in Europe but highlight though a low risk of late ocular manifestation. Chorioretinitis affected 18.9% of children suffering from congenital toxoplasmosis despite antenatal and neonatal screening associated with early treatment. Long-standing follow-up is needed because first lesion can occur as late as 12 years after birth. Late lesions were less often macular but nevertheless caused sometimes visual impairment.
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Affiliation(s)
- B Faucher
- Laboratoire de Parasitologie et Mycologie, Hôpital de la Timone, Centre Hospitalo-Universitaire de la Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), 264 rue St-Pierre, 13385 Marseille cedex 05, France.
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di Carlo P, Romano A, Casuccio A, Cillino S, Schimmenti MG, Mancuso G, la Chiusa S, Novara V, Ingrassia D, li Vecchi V, Trizzino M, Titone L. Investigation and management of Toxoplasma gondii infection in pregnancy and infancy: a prospective study. Acta Pharmacol Sin 2011; 32:1063-70. [PMID: 21743484 DOI: 10.1038/aps.2011.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches. METHODS Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes. RESULTS Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described. CONCLUSION Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.
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Abstract
BACKGROUND Long-term evolution of congenital toxoplasmosis is not documented. We assessed the outcome of treated congenital toxoplasmosis in a cohort of adult individuals who had undergone ante- and postnatal treatment to provide information for pediatricians and parents on the evolution of the disease. METHODS We conducted a questionnaire study on 126 adults with congenital toxoplasmosis (mean age: 22.2 years; age range: 18-31 years) monitored regularly until the time of inclusion. The main outcome measures were quality of life (Psychological General Well-Being Index) and visual function (VF14 questionnaire), and the outcomes were correlated with disease-specific factors. RESULTS Of the 102 patients (80.9%) who were finally included in the study, 12 (11.8%) presented neurologic effects and 60 (58.8%) manifested ocular lesions; in the latter category, 13 individuals (12.7%) had reduced visual function. The overall global quality-of-life score (74.7 ± 14.2) was close to the expected normal range for the general population (73.7 ± 15.3). Overall, visual function was only slightly impaired (M = 97.3; 95% confidence interval, 95.8-98.8). Although disease-independent critical life circumstances were associated with a reduced Psychological General Well-Being Index, this index was not influenced by any of the clinical characteristics of congenital toxoplasmosis. Neurologic pathologies, reduced visual acuity, foveal location of the retinal lesion, and squinting contributed to decreased visual function at follow-up. CONCLUSIONS Our data reveal that treated congenital toxoplasmosis has little effect on the quality of life and visual function of the affected individuals. These encouraging findings may help to alleviate the anxiety of affected individuals and their parents.
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Berrébi A, Assouline C, Bessières MH, Lathière M, Cassaing S, Minville V, Ayoubi JM. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010; 203:552.e1-6. [PMID: 20633868 DOI: 10.1016/j.ajog.2010.06.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 03/28/2010] [Accepted: 06/01/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Maternal toxoplasmosis infection acquired during pregnancy carries significant risk of fetal damage. We aimed to assess the long-term outcome of children and young adults with congenital toxoplasmosis diagnosed and treated in utero. STUDY DESIGN This was a 20 year prospective study (1985-2005). All mothers received spiramycin, alone or associated with pyrimethamine-sulfadoxine, and underwent amniocentesis and monthly ultrasound screening. Infected children were followed every 3-6 months. RESULTS Of 666 liveborn children (676 mothers), 112 (17%) had congenital toxoplasmosis. Among these, 107 were followed up for 12-250 months: 79 were asymptomatic (74%) and 28 had chorioretinitis (26%). Only 1 child had a serious neurological involvement. CONCLUSION The percentage of chorioretinitis in treated children depends on length of follow-up, but this complication occurs mainly before the age of 5 years and almost always before the age of 10 years. Visual impairment was infrequently severe, and outcome appears consistently good. Long-term follow-up is recommended to monitor ocular and neurological prognosis, whatever the practical difficulties.
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MESH Headings
- Age Factors
- Child
- Child Development/physiology
- Child, Preschool
- Chorioretinitis/drug therapy
- Chorioretinitis/etiology
- Chorioretinitis/physiopathology
- Cohort Studies
- Drug Combinations
- Female
- Follow-Up Studies
- Humans
- Infant
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Male
- Monitoring, Physiologic
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Prospective Studies
- Pyrimethamine/therapeutic use
- Risk Assessment
- Spiramycin/therapeutic use
- Sulfadoxine/therapeutic use
- Time Factors
- Toxoplasmosis, Congenital/complications
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/drug therapy
- Toxoplasmosis, Ocular/drug therapy
- Toxoplasmosis, Ocular/etiology
- Toxoplasmosis, Ocular/physiopathology
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Affiliation(s)
- Alain Berrébi
- Fédération de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse, France.
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Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W, Malm G, Salt A, Freeman K, Petersen E, Gilbert RE. Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS Med 2010; 7:e1000351. [PMID: 20967235 PMCID: PMC2953528 DOI: 10.1371/journal.pmed.1000351] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 09/01/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effectiveness of prenatal treatment to prevent serious neurological sequelae (SNSD) of congenital toxoplasmosis is not known. METHODS AND FINDINGS Congenital toxoplasmosis was prospectively identified by universal prenatal or neonatal screening in 14 European centres and children were followed for a median of 4 years. We evaluated determinants of postnatal death or SNSD defined by one or more of functional neurological abnormalities, severe bilateral visual impairment, or pregnancy termination for confirmed congenital toxoplasmosis. Two-thirds of the cohort received prenatal treatment (189/293; 65%). 23/293 (8%) fetuses developed SNSD of which nine were pregnancy terminations. Prenatal treatment reduced the risk of SNSD. The odds ratio for prenatal treatment, adjusted for gestational age at maternal seroconversion, was 0.24 (95% Bayesian credible intervals 0.07-0.71). This effect was robust to most sensitivity analyses. The number of infected fetuses needed to be treated to prevent one case of SNSD was three (95% Bayesian credible intervals 2-15) after maternal seroconversion at 10 weeks, and 18 (9-75) at 30 weeks of gestation. Pyrimethamine-sulphonamide treatment did not reduce SNSD compared with spiramycin alone (adjusted odds ratio 0.78, 0.21-2.95). The proportion of live-born infants with intracranial lesions detected postnatally who developed SNSD was 31.0% (17.0%-38.1%). CONCLUSION The finding that prenatal treatment reduced the risk of SNSD in infected fetuses should be interpreted with caution because of the low number of SNSD cases and uncertainty about the timing of maternal seroconversion. As these are observational data, policy decisions about screening require further evidence from a randomized trial of prenatal screening and from cost-effectiveness analyses that take into account the incidence and prevalence of maternal infection. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Mario Cortina-Borja
- Centre for Pediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, United Kingdom
| | - Hooi Kuan Tan
- Centre for Pediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, United Kingdom
| | - Martine Wallon
- Hospices Civils de Lyon, Service de Parasitologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Malgorzata Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznan, Poland
| | - Andrea Prusa
- Medical University of Vienna, Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neonatology, Intensive Care and Neuropaediatrics, Vienna, Austria
| | - Wilma Buffolano
- Perinatal Infection Unit, Department of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Gunilla Malm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Division of Paediatrics, Karolinska University Hospital, Huddinge, Sweden
| | - Alison Salt
- Wolfson Centre, UCL Institute of Child Health, London, United Kingdom
| | - Katherine Freeman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N., Denmark
| | - Ruth E. Gilbert
- Centre for Pediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, United Kingdom
- * E-mail:
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Chêne G, Thiébaut R. Options for clinical trials of pre and post-natal treatments for congenital toxoplasmosis. Mem Inst Oswaldo Cruz 2010; 104:299-304. [PMID: 19430657 DOI: 10.1590/s0074-02762009000200025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 02/06/2009] [Indexed: 11/21/2022] Open
Abstract
Clinical trials comparing different drug regimens and strategies for the treatment of congenital toxoplasmosis and its clinical manifestations in the liveborn child in different clinical settings should aim at formally evaluating the net benefit of existing treatments and at developing new therapeutic options. Currently, there is no ideal drug for congenital toxoplasmosis; future research should focus on the screening of new active drugs and on their pre-clinical and early clinical development, with a focus on pharmacokinetic/dynamic studies and teratogenicity. For the prenatal treatment of congenital toxoplasmosis, a trial comparing spiramycine to pyrimethamine-sulphadiazine and placebo would allow a formal estimation of the effect of both drugs in infected pregnant women. In newborn children, the net benefit of pyrimethamine-sulphadiazine should also be formally assessed. These trials will be implemented in settings where prenatal screening for Toxoplasma gondii is currently implemented. Trials should be carefully designed to allow for translation to other settings and modelling tools like cost-effectiveness analysis should be used to provide clinicians and founders with the best available evidence to establish recommendations.
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Affiliation(s)
- Geneviève Chêne
- INSERM U897 Epidemiology and Biostatistics, Bordeaux School of Public Health, Bordeaux University, Bordeaux, France.
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Stanford MR, Gilbert RE. Treating ocular toxoplasmosis: current evidence. Mem Inst Oswaldo Cruz 2010; 104:312-5. [PMID: 19430659 DOI: 10.1590/s0074-02762009000200027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 10/29/2008] [Indexed: 11/21/2022] Open
Abstract
The current treatment of ocular toxoplasmosis is controversial. The mainstay of treatment has been pyrimethamine and sulphonamides with or without systemic corticosteroids, but the actual evidence that antibiotics have a beneficial effect in recurrent toxoplasmic retinochoroiditis is unsupported by randomised placebo controlled trials. Thus far there have only been three studies looking at the efficacy of antibiotic treatment, all of which were methodologically weak and two of which were perfomed more than 30 years ago. All studies reported adverse effects from treatment. There is an urgent need for further randomised, double blind, placebo controlled studies for lesions in all parts of the retina and to test the efficacy of adjunctive corticosteroid treatment.
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Affiliation(s)
- M R Stanford
- Rayne Institute, Dept. Academic Ophthalmology, King's College London, St. Thomas' Campus, Lambeth Palace Road, SE1 7EH London, England.
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Blood and tissue protozoa. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Garcia-Méric P, Franck J, Dumon H, Piarroux R. [Management of congenital toxoplasmosis in France: current data]. Presse Med 2009; 39:530-8. [PMID: 19926248 DOI: 10.1016/j.lpm.2009.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 09/04/2009] [Accepted: 09/11/2009] [Indexed: 11/30/2022] Open
Abstract
Congenital toxoplasmosis is caused by transplacental contamination of the fetus withToxoplasma gondiifollowing maternal primary infection. The risk of mother-to-child transmission depends on the term of pregnancy at the time of maternal infection. The risk is lower than 5% in the first trimester but can reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when contamination occurs early in pregnancy. The French prevention program officially recommends monthly serological screening of susceptible women during pregnancy and information about hygiene and dietary rules. Prenatal diagnosis of congenital toxoplasmosis is based on a combination of examinations: PCR testing for the parasite in amniotic fluid, mouse inoculation, fetal ultrasonography, and magnetic resonance imaging. Neonatal screening consists of PCR of the placenta, mouse inoculation, detection of specific IgM and IgA in the newborn, ocular fundus examinations by indirect ophthalmoscopy, and transfontanellar ultrasonography. As soon as maternal infection is suspected, preventive treatment with spiramycin begins; the treatment is changed to a combination of pyrimethamine-sulfonamide if fetal infection is proved. Some teams are using this combination as first-line treatment after 30 weeks of gestation, without performing amniocentesis. Recent European multicenter studies raise questions about the effectiveness of prenatal treatment on mother-to-child transmission and on the reduction in the number and severity of fetal sequelae. A randomized controlled trial is required to prove the efficacy of prenatal treatment in general and of specific drugs, in particular. As soon as infection is confirmed, infected children are treated with the pyrimethamine-sulfonamide combination for 12 to 24 months. Recent multicenter studies show that postnatal treatment does not prevent ocular lesions: 5% of treated children had choroiditis lesions at birth, 20% at 5 years, and 30% at 8 years of age. Furthermore no consensus exists about the duration of postnatal treatment (3 months in Denmark versus 12 months in France). A multicenter randomized controlled trial is necessary to assess the efficacy of postnatal treatment and determine its duration. A surveillance system was set up in 2007 by the National Reference Center for Toxoplasmosis to determine the perinatal burden of this infection and to assess the national policy.
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Affiliation(s)
- Patricia Garcia-Méric
- Département de médecine néonatale, CHU de la Conception, F-13385 Marseille Cedex, France.
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Gilbert R. Treatment for congenital toxoplasmosis: finding out what works. Mem Inst Oswaldo Cruz 2009; 104:305-11. [DOI: 10.1590/s0074-02762009000200026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 10/29/2008] [Indexed: 11/22/2022] Open
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McLeod R, Kieffer F, Sautter M, Hosten T, Pelloux H. Why prevent, diagnose and treat congenital toxoplasmosis? Mem Inst Oswaldo Cruz 2009; 104:320-44. [PMID: 19430661 PMCID: PMC2735102 DOI: 10.1590/s0074-02762009000200029] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 10/20/2008] [Indexed: 11/21/2022] Open
Abstract
Evidence that prevention, diagnosis and treatment of toxoplasmosis is beneficial developed as follows: anti-parasitic agents abrogate Toxoplasma gondii tachyzoite growth, preventing destruction of infected, cultured, mammalian cells and cure active infections in experimental animals, including primates. They treat active infections in persons who are immune-compromised, limit destruction of retina by replicating parasites and thereby treat ocular toxoplasmosis and treat active infection in the fetus and infant. Outcomes of untreated congenital toxoplasmosis include adverse ocular and neurologic sequelae described in different countries and decades. Better outcomes are associated with treatment of infected infants throughout their first year of life. Shorter intervals between diagnosis and treatment in utero improve outcomes. A French approach for diagnosis and treatment of congenital toxoplasmosis in the fetus and infant can prevent toxoplasmosis and limit adverse sequelae. In addition, new data demonstrate that this French approach results in favorable outcomes with some early gestation infections. A standardized approach to diagnosis and treatment during gestation has not yet been applied generally in the USA. Nonetheless, a small, similar experience confirms that this French approach is feasible, safe, and results in favorable outcomes in the National Collaborative Chicago-based Congenital Toxoplasmosis Study cohort. Prompt diagnosis, prevention and treatment reduce adverse sequelae of congenital toxoplasmosis.
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Affiliation(s)
- Rima McLeod
- Department of Ophthalmology and Visual Sciences, Committees on Immunology, Genetics, Molecular Medicine, The College, University of Chicago, Chicago, IL 60637, USA.
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Gilbert RE, Freeman K, Lago EG, Bahia-Oliveira LMG, Tan HK, Wallon M, Buffolano W, Stanford MR, Petersen E. Ocular sequelae of congenital toxoplasmosis in Brazil compared with Europe. PLoS Negl Trop Dis 2008; 2:e277. [PMID: 18698419 PMCID: PMC2493041 DOI: 10.1371/journal.pntd.0000277] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 07/17/2008] [Indexed: 11/18/2022] Open
Abstract
Background Toxoplasmic retinochoroiditis appears to be more severe in Brazil, where it is a leading cause of blindness, than in Europe, but direct comparisons are lacking. Evidence is accumulating that more virulent genotypes of Toxoplasma gondii predominate in South America. Methods We compared prospective cohorts of children with congenital toxoplasmosis identified by universal neonatal screening in Brazil and neonatal or prenatal screening in Europe between 1992 and 2003, using the same protocol in both continents. Results Three hundred and eleven (311) children had congenital toxoplasmosis: 30 in Brazil and 281 in Europe, where 71 were identified by neonatal screening. Median follow up was 4.1 years in Europe and 3.7 years in Brazil. Relatively more children had retinochoroiditis during the first year in Brazil than in Europe (15/30; 50% versus 29/281; 10%) and the risk of lesions by 4 years of age was much higher: the hazard ratio for Brazil versus Europe was 5.36 (95%CI: 3.17, 9.08). Children in Brazil had larger lesions, which were more likely to be multiple and to affect the posterior pole (p<0.0001). In Brazil, visual impairment (<6/12 Snellen) was predicted for most affected eyes (87%, 27/31), but not in Europe (29%; 20/69, p<0.0001). The size of newly detected lesions decreased with age (p = 0.0007). Conclusions T. gondii causes more severe ocular disease in congenitally infected children in Brazil compared with Europe. The marked differences in the frequency, size and multiplicity of retinochoroidal lesions may be due to infection with more virulent genotypes of the parasite that predominate in Brazil but are rarely found in Europe. Toxoplasma gondii is found throughout the world and is the most common parasitic infection in humans. Infection can cause inflammatory lesions at the back of the eye, which sometimes affect vision. These complications appear to be more common and more severe when people acquire infection in Brazil than in Europe or North America, but there have been no direct comparisons of patients identified and followed up in the same way. In this report, we compare children with congenital toxoplasmosis diagnosed at birth by universal screening in Europe and Brazil and followed up until the age of 4. We found that Brazilian children had a 5 times higher risk than European children of developing eye lesions and their lesions were larger, more numerous and more likely to affect the part of the area of the retina responsible for central vision. Two-thirds of Brazilian children infected with congenital toxoplasmosis had eye lesions by 4 years of age compared with 1 in 6 in Europe. These stark differences are likely to be due to the predominance of more virulent genotypes of the parasite in Brazil, which are rarely found in Europe.
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MESH Headings
- Brazil/epidemiology
- Child, Preschool
- Europe/epidemiology
- Female
- Genotype
- Humans
- Infant
- Infant, Newborn
- Male
- Neonatal Screening
- Pregnancy
- Pregnancy Complications, Parasitic/diagnosis
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/parasitology
- Toxoplasma/genetics
- Toxoplasma/pathogenicity
- Toxoplasmosis, Congenital/diagnosis
- Toxoplasmosis, Congenital/epidemiology
- Toxoplasmosis, Congenital/parasitology
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/epidemiology
- Toxoplasmosis, Ocular/parasitology
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Affiliation(s)
- Ruth E Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, United Kingdom.
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Jamieson SE, de Roubaix LA, Cortina-Borja M, Tan HK, Mui EJ, Cordell HJ, Kirisits MJ, Miller EN, Peacock CS, Hargrave AC, Coyne JJ, Boyer K, Bessieres MH, Buffolano W, Ferret N, Franck J, Kieffer F, Meier P, Nowakowska DE, Paul M, Peyron F, Stray-Pedersen B, Prusa AR, Thulliez P, Wallon M, Petersen E, McLeod R, Gilbert RE, Blackwell JM. Genetic and epigenetic factors at COL2A1 and ABCA4 influence clinical outcome in congenital toxoplasmosis. PLoS One 2008; 3:e2285. [PMID: 18523590 PMCID: PMC2390765 DOI: 10.1371/journal.pone.0002285] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 04/11/2008] [Indexed: 01/26/2023] Open
Abstract
Background Primary Toxoplasma gondii infection during pregnancy can be transmitted to the fetus. At birth, infected infants may have intracranial calcification, hydrocephalus, and retinochoroiditis, and new ocular lesions can occur at any age after birth. Not all children who acquire infection in utero develop these clinical signs of disease. Whilst severity of disease is influenced by trimester in which infection is acquired by the mother, other factors including genetic predisposition may contribute. Methods and Findings In 457 mother-child pairs from Europe, and 149 child/parent trios from North America, we show that ocular and brain disease in congenital toxoplasmosis associate with polymorphisms in ABCA4 encoding ATP-binding cassette transporter, subfamily A, member 4. Polymorphisms at COL2A1 encoding type II collagen associate only with ocular disease. Both loci showed unusual inheritance patterns for the disease allele when comparing outcomes in heterozygous affected children with outcomes in affected children of heterozygous mothers. Modeling suggested either an effect of mother's genotype, or parent-of-origin effects. Experimental studies showed that both ABCA4 and COL2A1 show isoform-specific epigenetic modifications consistent with imprinting. Conclusions These associations between clinical outcomes of congenital toxoplasmosis and polymorphisms at ABCA4 and COL2A1 provide novel insight into the molecular pathways that can be affected by congenital infection with this parasite.
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Affiliation(s)
- Sarra E. Jamieson
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Lee-Anne de Roubaix
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Mario Cortina-Borja
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom
| | - Hooi Kuan Tan
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom
| | - Ernest J. Mui
- Departments of Ophthalmology, Medicine, Pediatrics, Committees on Immunology, Molecular Medicine, and Genetics, University of Chicago, and Michael Reese Hospital and Medical Center, Chicago, Illinois, United States of America
| | - Heather J. Cordell
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
- Institute of Human Genetics, Newcastle University, International Centre for Life, Newcastle upon Tyne, United Kingdom
| | - Michael J. Kirisits
- Departments of Ophthalmology, Medicine, Pediatrics, Committees on Immunology, Molecular Medicine, and Genetics, University of Chicago, and Michael Reese Hospital and Medical Center, Chicago, Illinois, United States of America
| | - E. Nancy Miller
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Christopher S. Peacock
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Aubrey C. Hargrave
- Departments of Ophthalmology, Medicine, Pediatrics, Committees on Immunology, Molecular Medicine, and Genetics, University of Chicago, and Michael Reese Hospital and Medical Center, Chicago, Illinois, United States of America
| | - Jessica J. Coyne
- Departments of Ophthalmology, Medicine, Pediatrics, Committees on Immunology, Molecular Medicine, and Genetics, University of Chicago, and Michael Reese Hospital and Medical Center, Chicago, Illinois, United States of America
| | - Kenneth Boyer
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Rush University Medical Center, Chicago, Illinois, United States of America
| | | | - Wilma Buffolano
- Department of Paediatrics, University of Naples "Frederico II", Naples, Italy
| | - Nicole Ferret
- Service de Parasitologie et Mycologie, Hopital Archet II, Nice, France
| | | | - François Kieffer
- Department of Paediatrics, Institut de Puériculture, Paris, France
| | - Paul Meier
- Department of Biostatistics, Columbia University, New York, New York, United States of America
| | - Dorota E. Nowakowska
- Department of Fetal-Maternal Medicine and Gynecology, Medical University, Lodz, Rzgowska, Poland
| | - Malgorzata Paul
- Department and Clinic of Tropical and Parasitic Diseases, University of Medical Sciences, Poznań, Poland
| | - François Peyron
- Hospices Civils de Lyon, Service de Parasitologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Babill Stray-Pedersen
- Department of Obstetrics and Gynaecology, University of Oslo, Rikshospitalet-Radiumhospitalet, Sognsvannsvn, Oslo, Norway
| | - Andrea-Romana Prusa
- Department of Pediatrics, Division of Neonatology, Congenital Disorders and Intensive Care, Medical University of Vienna, Vienna, Austria
| | | | - Martine Wallon
- Hospices Civils de Lyon, Service de Parasitologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Rima McLeod
- Departments of Ophthalmology, Medicine, Pediatrics, Committees on Immunology, Molecular Medicine, and Genetics, University of Chicago, and Michael Reese Hospital and Medical Center, Chicago, Illinois, United States of America
| | - Ruth E. Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom
| | - Jenefer M. Blackwell
- Cambridge Institute for Medical Research and Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
- * E-mail:
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