Prenatal Diagnosis of Congenital Toxoplasmosis

Abstract

Prenatal diagnosis of congenital toxoplasmosis was attempted in 50 pregnant women at risk for giving birth to an affected child. Fifteen of these patients seroconverted during pregnancy and 35 had a high initial antibody level in their first serum sample. Prenatal diagnosis consisted of a combination of ultrasound screening, amniocentesis, and funipuncture at about 20 weeks' gestation. Diagnosis of congenital toxoplasmosis was based on a positive toxoplasma culture of amniotic fluid or fetal blood and on the presence of specific immunoglobulin M antibodies in fetal blood. In addition, alterations in fetal hematology, cellular immunology, and fetal liver tests were indicative of infection. Fetal infection was detected in six fetuses; two died in utero as a consequence of the infection and four were born after 37 weeks' gestation. Despite antibiotic treatment with pyrimethamine and sulfadiazine, one child has internal hydrocephalus and chorioretinitis and another has unilateral chorioretinitis. In the two other children, the disease is still subclinical. Of the 44 children born after a negative prenatal diagnosis, 35 have reached the age of 1 year; toxoplasma antibodies have disappeared in all of them. Investigation of the remaining nine children showed a decrease in toxoplasma antibodies, suggesting that none of them are affected. Prenatal diagnosis was never associated with fetal loss, and premature delivery occurred in only two cases. We conclude that prenatal diagnosis of congenital toxoplasmosis is safe and reliable.

Evaluation of the Possibilities for Preventing Congenital Toxoplasmosis

“…5 Congenital toxoplasmosis will be found in 5% of the children born to mothers with high initial antibody levels. 4 Most of these infections will have taken place before 20 weeks' gestation and will result in a proportion of affected children similar to that observed in patients with a seroconversion before the 20th week.…”

“…Although the acquisition of toxoplasmosis in pregnancy was reduced by 34%, this reduction was not statistically significant. In another survey, 4 we investigated the possibilities of detecting antenatally congenital toxoplasmosis with a combination of ultrasound, amniocentesis, and funipuncture in women with a proven or a suspected infection. From this study, we conclude that prenatal diagnosis in the second trimester was safe and reliable.…”

Prevalence of infections affecting the child among pregnant women in Yaounde, Cameroon

“…Toxoplasmosis in pregnancy may lead to consequences such as fetal loss, premature delivery, chorioretinitis and hydrocephalus (Leke et al 1983;Remington 1990). Prevention of congenital toxoplasmosis is obtained by educating pregnant women at risk about how to prevent the infection and by diagnosing acute infection of the mother (Foulon et al 1990). Treatment with spiramycine which reaches high concentrations in the placenta or with pyrimethamine and sulphonamides (in cases of fetal infection) have been reported to show good results (Jeannel et al 1990).…”

Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States

“…172 Crino 172 reported a pooled sensitivity of 49% and a pooled specificity of 99% of any fetal ultrasonographic findings for CT on the basis of results from 4 studies. 121,[173][174][175] …”