Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy

Abstract

Congenital toxoplasmosis occurs following transplacental transfer of Toxoplasma gondii. Irrespective of symptom status at birth, infants with congenital infection may develop serious long-term sequelae, including learning disability, seizures, hydrocephalus, motor and hearing deficits, chorioretinitis and retinal scarring with impaired vision. Timely diagnosis facilitates early initiation of therapy, aimed at prevention or amelioration of adverse clinical consequences. Diagnosis can be difficult, however, since acutely infected mothers are often asymptomatic and laboratory testing can be complex. Moreover, any decision to start treatment in the newborn must include careful consideration of the benefits and risks. This paper outlines a structured approach for managing an infant born to a woman with possible or confirmed T. gondii infection during pregnancy, including key aspects of the antenatal history, interpretation and timing of investigations, treatment and appropriate follow-up. Our recommendations are based on current evidence in the literature, consensus from two UK paediatric infectious disease centres and the UK specialist Toxoplasma Reference Unit.

Congenital toxoplasmosis the overlooked disease: a case report

“…5 The estimated incidence of CT globally, ranges from 0.1 to 6/1000 live births, with the highest being in the Middle East and South America. 6 During maternal parasitemia toxoplasma may invade the placenta with the subsequent passage into the fetal circulation and tissues. The severity of CT is inversely proportional to the gestational age, but the rate of transmission to the fetus increases with the gestational age progress.…”

Tubulointerstitial nephritis and uveitis syndrome following meningitis and systemic lymphadenopathy with persistent Toxoplasma immunoglobulin M: a case report

“…However, reappearance of IgM is not always detected in reinfection-presumed cases [75][76][77]. Increased IgG of Toxoplasma observed at reinfection [74,76,77] or at reactivation [93] should be interpreted carefully, because such a rise is also observed in a delayed serological response to antigens after treatment of toxoplasmosis [97]. Serological variations in each infection profile are summarized in tables in Fig.…”

Antimalarial Agents as Therapeutic Tools Against Toxoplasmosis—A Short Bridge between Two Distant Illnesses

“…Pyrimethamine + Sulfadiazine + Folinic acid Congenital toxoplasmosis can be approached therapeutically in two distinct ways, whether it is intended for prophylaxis from transplacental transmission or for the treatment of acquired progressive fetal infection, although therapeutic regimens may vary in different geographic regions [15]. Spiramycin is the most recommended drug for a prophylactic approach, usually in the earlier stages of pregnancy where no definitive fetal exams can be performed to confirm the disease.…”

“…Infection with T. gondii acquired during pregnancy or just before conception places the mother at risk of accumulation of tachyzoites in the placenta, which are transmitted to the fetus. Quite interestingly, congenital transmission rates appear to be lower in cases where the mother contracts the parasite in the earlier stages of the pregnancy rather than in the later stages, whereas the consequences to the fetus are far more detrimental in the cases involving an early onset of infection [15]. Specific measures, such as screening tests for early detection of maternal infection and early initiation of treatment, are therefore mandatory for the prevention of vertical transmission.…”