Congenital Toxoplasmosis: The State of the Art

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.

Anti-Toxoplasma gondii screening of MMV pandemic response box and evaluation of RWJ-67657 efficacy in chronically infected mice

“…Although there are medications available for the treatment of toxoplasmosis, they may not always be suitable due to adverse reactions or therapeutic failures related to toxicity and parasite resistance to the drugs. For example, pyrimethamine cannot be used before 14 weeks of gestation for the potential risk of teratogenicity (Bollani et al ., 2022). This risk has been highlighted also in silico , indicating that pyrimethamine carries toxicity alerts, including potential risks of tumorigenicity, mutagenicity and reproductive effects.…”

Is Childhood Immune Thrombocytopenia Associated With Acquired Toxoplasmosis? An Unusual Case of Infection That Led to Acute ITP in a Greek Male Toddler and Implications for Guidelines

“…Currently, testing for toxoplasmosis occurs routinely in pregnancy, due to the 1.5 in a 1,000 prevalence of congenital toxoplasmosis in live births. 30 As a result, although a causal association with childhood ITP is not definitely confirmed, it is of high importance for physicians to remain both inquisitive for such unusual potential ITP triggers-considering it for inclusion in a routine ITP workup-and investigative regarding the impact that a potential decision towards infection treatment might have to a child's overall quality of life.…”

Manejo Clínico Das Fases Subaguda E Crônica Da Chikungunya

“…Ao contrário do risco de contaminação fetal, a gravidade da manifestação da infecção no feto é inversamente proporcional ao período gestacional, visto que as consequências são piores no início da gravidez. Durante o primeiro trimestre, a infecção pode levar ao aborto espontâneo, ao passo que fetos no segundo trimestre podem ser afetados principalmente por distúrbios neurológicos, malformações, além de outras manifestações, enquanto na fase final da gravidez a doença neonatal pode ser menos grave ou assintomática (BOLLANI et al, 2022).…”