diagnostic problems and postnatal

Diagnostic problems and postnatal follow-up in congenital toxoplasmosis

Minerva Pediatr. 2007 Jun;59(3):207-13.

Diagnostic problems and postnatal follow-up in congenital

toxoplasmosis

Mazzola A, Casuccio A, Romano A, Schimmenti MG, Titone L, Di Carlo P.

RNAS Civico Benfratelli, G. Di Cristina and M. Ascoli, Palermo, Italy.

AIM: In order to assess the consequences of different clinical

approaches in the prenatal management of congenital toxoplasmosis, we

retrospectively reviewed 58 pregnant women with Toxoplasma

seroconversion and prospectively enrolled their 59 infants, referred

to us from 1999 to 2004. METHODS: Data on clinical, laboratory and

demographic characteristics of the pregnant women were collected.

Their children were entered into a 48-month follow-up programme in

which clinical, instrumental, ophthalmologic and serologic evaluations

were carried out at birth, at 1, 3, 6, 9, 15, 18, 24, 36 and at 48

months of life. Paediatric treatment with Spiramycin alone or

alternated with Pyrime-thamine-Sulphadiazine was administered

according to the different clinical cases. RESULTS: Time of infection

was dated in the first trimester for 24 women (41%), in the second

trimester for 18 women (31%) and in the third trimester for 16 (28%).

In the first trimester of pregnancy 20 of the 24 infected women had

undergone amniocentesis, while the test had not been performed on any

of the women infected in the third trimester. Serological follow-up

revealed that 11 (19%) of the infants had been infected. An

alternating regimen with Pyrimethamine-Sulphadoxine was administered

to the infected children. All the infants were clinically

asymptomatic, and the instrumental follow-up revealed specific

toxoplasmosis anomalies in 4/11 infected children. CONCLUSION: Our

results highlight issues and problems concerning current prenatal

diagnostic tests and the therapeutic approach based on PCR testing of

amniotic fluid alone. The incidence of ocular-cerebral lesions

observed in children born to women with seroconversion in the third

trimester raises questions about the diagnostic and therapeutic

approach for these women and their offspring. Paediatric therapeutic

protocol, with alternating Pyrime-thamine-Sulphadiazine regimen,

applied also to asymptomatic children born to women with inadequate

prenatal diagnostic management, could prevent severe sequelae.