Fetal toxoplasmosis and negative amniocentesis: necessity of an ultrasound follow‐up

Gay-Andrieu, Françoise; Marty, Pierre; Pialat, J; Sournies, G.; Laforte, T Drier de; Peyron, François

doi:10.1002/pd.632

Cited by 39 publications

(14 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We therefore determined the effect of prenatal treatment on sensitivity by analysing the duration of any type of treatment before amniocentesis, and by comparing women treated before amniocentesis with spiramycin with those treated with pyrimethamine–sulphonamide, and untreated women. We also determined whether sensitivity increased with the interval between seroconversion and amniocentesis, as would be expected given the hypothesis that parasite transmission from the placenta to fetus is delayed 19–21 …”

Section: Methodsmentioning

confidence: 99%

Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid

Thalib

Gras

Romand³

et al. 2005

BJOG

View full text Add to dashboard Cite

for the European Multicentre Study on Congenital Toxoplasmosis (EMSCOT) 1 Objective To determine the accuracy of polymerase chain reaction (PCR) analysis of amniotic fluid for fetal toxoplasmosis according to clinical predictors of outcome and study centre. Design Prospective cohort study.Setting Nine European centres.Population Women with suspected toxoplasma infection identified by prenatal screening.Methods Logistic regression was used to examine the effects of gestational age at maternal seroconversion, treatment and timing of amniocentesis, on PCR accuracy, and to calculate the post-test probability of congenital toxoplasmosis. Main outcome measures Infants had congenital toxoplasmosis if specific IgG persisted beyond 11.5 months.Uninfected infants had undetectable IgG in the absence of anti-toxoplasma treatment. Results Of 593 PCR results, 64 were positive (57 confirmed infected), and 529 were negative (23 confirmed infected). The likelihood ratio for a positive PCR result decreased significantly with trimester at seroconversion, but did not change significantly for a negative result. Weak associations were detected between sensitivity and, inversely, with specificity, and gestational age at maternal seroconversion. There was no significant association between sensitivity and centre, type or duration of treatment, or timing of amniocentesis. Specificity differed significantly between centres (P < 0.001). The change in pre-to posttest probability of infection was maximal for a positive PCR after first trimester seroconversion, affecting 1% of women tested, and a negative PCR after third trimester seroconversion, affecting half the women tested. Conclusions Prediction of the risk of congenital toxoplasmosis should combine estimates of test accuracy and maternal -fetal transmission, which take account of the gestational age at which the mother seroconverted. Local laboratory standards will affect the generalisability of these results.

show abstract

Section: Methodsmentioning

confidence: 99%

Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid

Thalib

Gras

Romand³

et al. 2005

BJOG

View full text Add to dashboard Cite

show abstract

“…Amniotic fluid is evaluated by specific PCR, and these results are integrated with gestational age at the time of seroconversion to estimate the risk of congenital toxoplasmosis (52,63). Even in cases of a negative amniocentesis, monthly ultrasound monitoring is recommended, as cases of late materno-fetal transmission have been described (64,65). Current guidelines recommend treatment with spiramycin as soon as maternal seroconversion is observed, which can eventually be switched to pyrimethamine-sulfonamides once fetal infection is confirmed.…”

Section: Toxoplasmosismentioning

confidence: 99%

Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes

et al. 2016

View full text Add to dashboard Cite

SUMMARYThe rapid spread of the Zika virus (ZIKV) in the Americas and its potential association with thousands of suspected cases of microcephaly in Brazil and higher rates of Guillain-Barré syndrome meet the conditions for a Public Health Emergency of International Concern, as stated by the World Health Organization in February 2016. Two months later, the Centers for Disease Control and Prevention (CDC) announced that the current available evidence supports the existence of a causal relationship between prenatal Zika virus infection and microcephaly and other serious brain anomalies. Microcephaly can be caused by several factors, and its clinical course and prognosis are difficult to predict. Other pathogens with proven teratogenicity have been identified long before the current ZIKV epidemic. Despite the growing number of cases with maternal signs of infection and/or presence of ZIKV in tissues of affected newborns or fetuses, it is currently difficult to assess the magnitude of increase of microcephaly prevalence in Brazil, as well as the role of other factors in the development of congenital neurological conditions. Meanwhile, health agencies and medical organizations have issued cautious guidelines advising health care practitioners and expectant couples traveling to, returning from, or living in affected areas. Analogous to dengue virus (DENV) epidemics, ZIKV has the potential to become endemic in all countries infested byAedesmosquitoes, while new mutations could impact viral replication in humans, leading to increased virulence and consequently heightened chances of viral transmission to additional naive mosquito vectors. Studies are urgently needed to answer the questions surrounding ZIKV and its role in congenital neurological conditions.

show abstract

“…We treated 74 women with spiramycin (3 g/day) alone up to delivery. After 16 weeks of gestation, a 4-week regimen alternating the combination of pyrimethamine (50 mg/day for the first 3 days and then 25 mg/day) plus sulfadiazine (3 g/day) and folinic acid supplementation (P/S therapy) with spiramycin (3 g/day) was instituted in 19 women and continued up to delivery as follows: (i) first maternal IgM-positive test after 20 weeks of gestation (10,15,16); (ii) positive PCR result on amniotic fluid (22); and (iii) ultrasonographic anomalies (14). In 11 women treatment was lacking since the diagnosis was made close to delivery or because of the patient's refusal.…”

Section: Patientsmentioning

confidence: 99%

Use of Recombinant Antigens for Early Postnatal Diagnosis of Congenital Toxoplasmosis

Buffolano

Beghetto²,

Pezzo

et al. 2005

J Clin Microbiol

View full text Add to dashboard Cite

The main objective of this work was to improve the early serologic diagnosis of toxoplasmosis in children at risk of congenital infection by using recombinant antigens. Serum samples from 104 infants born to mothers with primary Toxoplasma gondii infection acquired during pregnancy, of which 35 were congenitally infected and 22 had clinical silent toxoplasmosis at birth, were included. Immunoglobulin M (IgM), IgG, and IgG subtype antibodies against epitopes carried by fragments of T. gondii MIC2, MIC3, MIC4, M2AP, AMA1, and SAG1 gene products were measured by performing parallel enzyme immunoassays (Rec-ELISAs). Recombinant antigens preferentially reacted with IgG antibodies from infected infants compared to uninfected subjects (P < 0.0001), indicating that sera from infected children recognized a more diverse repertoire of antigens than sera transferred over the placenta from the mothers. Using two serial samples collected within 3 months of life, it was possible to demonstrate a neosynthesis of specific anti-MIC2 and anti-SAG1 immunoglobulin G, mainly of the IgG2 subtype, in 13 out of 20 infants with congenital toxoplasmosis. IgM antibodies in 97% of infected infants reacted with at least one of the recombinant antigens, confirming the diagnosis of congenital infection as soon as 2 months after birth (P < 0.0001). The use of recombinant antigens is effective in distinguishing T. gondii-infected from uninfected infants and shows that assays based on recombinant antigens improve the diagnosis of newborns with congenital toxoplasmosis.

show abstract

Fetal toxoplasmosis and negative amniocentesis: necessity of an ultrasound follow‐up

Cited by 39 publications

References 6 publications

Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid

Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid

Emerging Role of Zika Virus in Adverse Fetal and Neonatal Outcomes

Use of Recombinant Antigens for Early Postnatal Diagnosis of Congenital Toxoplasmosis

Contact Info

Product

Resources

About