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PubMed1995

[Toxoplasmosis and pregnancy--findings from umbilical cord blood screening in 30,000 newborn infants].

Cord blood screening for congenital toxoplasmosis was performed prospectively on 30,000 samples collected between 1986 and 1994 in the region of Basel, Switzerland, covering up to 95% of all births. Congenital infection was suspected in cases of serum with specific antitoxoplasma IgM or IgA or with a level of specific IgG above 300 IU/ml as measured by EIA from Sanofi-Pasteur. The percentage of cases to be screened declined from 2.5 to 1.2% and the cases of confirmed congenital toxoplasmosis from 0.073 to 0.033% during the observation period. This observation may be due to several reasons, such as improved primary prevention or more frequent diagnosis and treatment during pregnancy. In 178 cases of cord blood serology suspicious for acute toxoplasmosis, an enquiry with the gynecologist in charge of the pregnant woman was carried out. 126 mothers (71%) presented with a confirmed immunity against Toxoplasma gondii early in pregnancy and screening of the child was not needed. From 37 pregnancies (21%) no information was available. 15 out of 24 confirmed cases of toxoplasmosis of the mother during pregnancy were detected by cord blood analysis. In 17 of 24 cases of maternal toxoplasmosis treatment with spiramycin, pyrimethamine/sulfadoxine or both was performed. 10 of 17 newborns from mothers treated during pregnancy had elevated toxoplasma IgG titres at birth, but only one child was infected. 7 newborns had an inconspicuous toxoplasma serology at birth and were not infected. 7 cases of toxoplasmosis during pregnancy were detected by the check back and remained untreated; 4 out of 7 newborns had congenital toxoplasmosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Protozoan↗
PubMed1994

[Serological parameters for the diagnosis and follow-up of toxoplasmosis. Experimental models].

BACKGROUND: Toxoplasmosis is a disease of increasing incidence. Its laboratory diagnosis is difficult, specially in acute toxoplasmosis. The data obtained in experimental models attempting to distinguish between acute and chronic toxoplasmosis by the simultaneous study of four serological tests: IgM and IgG antibodies, circulating antigens (CA) and antigens present in immune complexes (IC) are reported. METHODS: The evolution of IgM and IgG antibodies, CA and IC was followed in 3 murine models in acute, subacute and chronic toxoplasmosis, compared with the use of the ELISA technique. RESULTS: Acute toxoplasmosis is characterized by the presence of CA and IC in 100% of the individuals at high concentrations with IgM and IgG only being detectable at low concentrations. In subacute and chronic toxoplasmosis the response to IgG antibodies (100% in animals) is prominent, with detection of IgM being variable and the detection of CA and IC being reduced to the phase considered as acute. CONCLUSIONS: The detection of IgM and IgG antibodies, circulating antigens and immune complexes may be of great usefulness in the differentiation of acute, recently acquired or chronic toxoplasmosis.

Animals↗
PubMed1997

Morphology and diagnostics of human toxoplasmosis.

Toxoplasmosis has regained clinical importance. In addition to intrauterine fetal infections, the acquired toxoplasmosis endangers an increasing number of immunocompromised adults. This disease affects not only oncologic patients, but also organ transplant recipients and, above all, AIDS patients. Toxoplasmosis has five clinical subtypes: lymphadenopathy, encephalitis, chorioretinitis, disseminated toxoplasmosis and congenital toxoplasmosis. In biopsies of different organs and autopsies of persons who died as a result of an infectious disease, the pathologist is involved in the diagnostic procedures. The findings of the parasites in tissue specimens still constitute the morphologic feature of toxoplasmosis. Differential diagnosis has been improved by immunohistologic methods for demonstrating toxoplasmas in tissue specimens and by the use of polymerase chain reaction for identification of toxoplasmatic antigens. This review describes the pathomorphology and possibility regarding the diagnosis of toxoplasmosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Use of the ISAGA method in detection of specific IgM, IgA, IgE antibodies in acquired and congenital toxoplasmosis].

Immunocapture assays ISAGA PLUS IgA/IgM (bioMérieux) and IgE ISAGA were used to determine their usefulness in the diagnosis of acquired and congenital toxoplasmosis. Specific IgM, IgA and IgE antibodies were tested in 134 patients, namely pregnant women who seroconverted during gestation (n = 20), children with congenital toxoplasmosis (n = 5), patients with toxoplasmic lymphadenitis (n = 56) and immunocompetent individuals with chronic Toxoplasma gondii infection (n = 53). Altogether 172 sera were examined. Specific IgM antibodies were detected in all sera from pregnant women (100%) with recent T. gondii infection (1-8 weeks after seroconversion), in all patients with toxoplasmic lymphadenopathy (1-3 months after onset of symptoms) and in their control examinations after 2 and 5 months (100%) and also in 35 (66%) out of 53 patients with chronic infection. In infants with congenital toxoplasmosis IgM were found only in one new-born; equivocal results were obtained in 3 children during the asymptomatic serological reactivation in the second year of life. Specific IgA antibodies were present in sera from 15 (75%) out of 20 women seroconverted during pregnancy; in 3 cases the results were equivocal. IgA antibodies were detected in sera from 30 (81.1%) out of 37 patients with toxoplasmic lymphadenitis examined once; in 19 patients examined 3 times IgA antibodies were present in all the cases in the first serological examination performed when clinical symptoms were first observed (100%), in 17 patients after 2 months (89.5%) and in 11 patients after 5 months (57.9%). IgA antibodies were also detected in 21 sera (39.6%) from patients with chronic T. gondii infection. In children with congenital toxoplasmosis IgA antibodies were found in 3 cases during serological reactivation after discontinuation of pyrimethamine-sulfadiazine therapy; in these cases equivocal results of IgM antibodies were present, and positive result of IgE antibodies in one case. Specific IgE antibodies were detected in sera from 17 (85%) out of 20 women with seroconversion and in 18 patients with lymphadenopathy (32.1%); in the last group IgE antibodies were not present in the follow-up examination after 5 months. IgE antibodies were detected only in 5 cases (9.4%) with chronic infection. IgA and IgE antibodies in ISAGA begin to appear about a week later than IgM antibodies: in sera collected between the 2nd and 3rd week after invasion the positive results were obtained in all cases (100%). Therefore, ISAGA PLUS IgA/IgM (bioMérieux) is useful for the diagnosis of recent T. gondii infection especially in women with suspected seroconversion during pregnancy. ISAGA PLUS IgA/IgM is more sensitive than any conventional method routinely used and so far is a specially efficient technique for newborns and infants suspected for congenital infection and/OR IN DIAGNOSING CONGENITAL TOXOPLASMOSIS DURING IMMUNOLOGICAL RECRUDESCENCE. tHIS TEST HAS A LIMITED VALUE IN TOXOPLASMOSIS WITH LYMPHADENOPATHY BY REASON OF POSSIBILITY OF A LONG PERSISTENCE OF iGm and IgA antibodies detected by ISAGA. Detection of specific IgE antibodies using ISAGA technique may be useful for differential diagnosis of acute and chronic phase of T. gondii infection and also in some cases of serological reactivation of congenital toxoplasmosis.

Female↗
PubMed1993

Prevalence of latent toxoplasmosis and serological diagnosis of active infection in HIV-positive patients.

The seroprevalence of latent Toxoplasma gondii infection was determined in a cohort of 715 HIV-positive patients followed up at an HIV outpatient clinic. Using indirect immunofluorescence and direct agglutination assays for detecting IgG, the prevalence of anti-Toxoplasma gondii antibodies was shown to be 50%. During a four-year period, clinically apparent acute toxoplasmosis occurred in 47 patients (43 with cerebral, 3 with ocular and 1 with bone marrow toxoplasmosis) among the 360 patients positive for anti-Toxoplasma gondii IgG and in one patient (with cerebral toxoplasmosis) among the 355 patients who were serologically negative. A significant rise in IgG levels could be shown during acute toxoplasmosis episodes in only 30% of patients, compared with 3% of patients without active toxoplasmosis. During acute toxoplasmosis, IgM antibodies were detected in only two patients (6%) by an immunosorbent agglutination assay and in one (3%) by an enzymatic immunocapture assay. Specific IgA was detected by a non-enzymatic immunocapture assay in six patients (18%) during acute episodes. The very high predictive value (99.7%) of a negative IgG test remains the best serological parameter for excluding an acute episode of toxoplasmosis in HIV-positive patients.

Acute Disease↗
PubMed1994

Histopathology of cerebral toxoplasmosis in human immunodeficiency virus infection: a comparison between patients with early-onset and late-onset acquired immunodeficiency syndrome.

We reviewed the histological features of untreated toxoplasmosis in 18 cases with the acquired immunodeficiency syndrome (AIDS), eight of which were surgical biopsies and 10 of which were autopsy specimens. The results were compared according to the clinical status of the patient at the time the diagnosis of toxoplasmosis was made (early-onset v late-onset AIDS) and according to the source of the specimen (surgical biopsy specimen v autopsy specimen). Cerebral toxoplasmosis was the AIDS-defining illness in half of the cases (six surgical biopsy specimens and three autopsy specimens). Inflammation in these cases was moderate in 44% and severe in 56%. Fibrous capsules were found in five cases. Lymphocytes and plasma cells were more prominent than neutrophils. Cerebral toxoplasmosis developed in or was part of the terminal AIDS illness in the remaining nine cases (two surgical biopsy specimens and seven autopsy specimens). In this group inflammation was sparse in 44%, moderate in 55%, and severe in only 11%. Fibrous capsules were usually absent and neutrophils were the predominant cell type. Comparisons between surgical biopsy specimens and autopsy specimens showed moderate to severe inflammation and frequent fibrous encapsulation in all of the former specimens but only in those autopsy specimens in which toxoplasmosis was the initial manifestation of AIDS. Thus, this study demonstrates varied neuropathological patterns of untreated cerebral toxoplasmosis in patients with AIDS and correlates the inflammatory response in the brain with the clinical stage of the patient's human immunodeficiency syndrome (HIV) infection. Inflammation and fibrous encapsulation were common only in patients with early-onset AIDS in whom cerebral toxoplasmosis was the first manifestation of the illness. This study highlights important differences between the histology of this infection at surgical biopsy and at autopsy, and stresses the need to consider toxoplasma as a potential cause of encapsulated brain abscesses.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Retinal detachment in ocular toxoplasmosis.

PURPOSE: To report on the clinical course and prognosis of retinal breaks and detachment occurring in patients with ocular toxoplasmosis. DESIGN: Retrospective cross-sectional observational study. PARTICIPANTS: One hundred fifty consecutive patients with ocular toxoplasmosis. INTERVENTION: A review of all records of patients with ocular toxoplasmosis who had consulted our department from 1990 through 1997 was performed. MAIN OUTCOME MEASURES: The presence of retinal detachment or breaks and possible risk factors, such as age, myopia, the interval between the last recurrence of inflammation and the onset of retinal detachment, severity of vitritis, previous treatment methods, and the location of the retinal abnormalities, were analyzed. RESULTS: We found a frequency of 6% (9/150) for retinal detachment and an additional 5% (7/150) for retinal breaks among our patients with ocular toxoplasmosis. Attacks of active ocular toxoplasmosis preceding the retinal detachment or retinal breaks were characterized by severe intraocular inflammation. The frequency of myopia in our patients with retinal detachment or retinal breaks was significantly higher than in patients with ocular toxoplasmosis without retinal detachment or retinal breaks. The functional prognosis for the patients with retinal detachment was poor; legal blindness (visual acuity < or = 20/200) resulting from retinal detachment occurred in five of the nine patients. CONCLUSIONS: Careful retinal examination in ocular toxoplasmosis is warranted, especially in patients with myopia and severe intraocular inflammation.

Adolescent↗
PubMed1999

Neurocysticercosis and acquired cerebral toxoplasmosis in children.

Neurocysticercosis, prevalent wherever pigs are raised in the presence of poor sanitation, is the most common identifiable cause of new-onset epilepsy throughout the developing world. As immigration patterns have changed, children with neurocysticercosis are seen throughout the United States. Acute cysticercosis, the most common manifestation in children, reflects the host response to the dying parasite. Children typically present with seizures and have an excellent prognosis. Neuroimaging demonstrates a single ring or nodular enhancing lesion surrounded by edema. Short-term anticonvulsant therapy is indicated, but treatment with antiparasitic agents is not required. Other forms, such as active cysts (intact organism), intraventricular or subarachnoid racemous cysticercosis, and cysticercal meningoencephalitis, are less common manifestations of parasitic infection. Toxoplasmosis, caused by the parasite Toxoplasma gondii, can be acquired by ingestion of infected undercooked meat or from oocytes shed in cat feces. Acquired cerebral toxoplasmosis, due to primary or reactivated infections, rarely occurs in immunocompetent children. In children who are immunodeficient as the result of AIDS, chemotherapy, tissue transplantation, or congenital immunodeficiency, toxoplasmosis may be difficult to distinguish from cerebral lymphoma. A variety of techniques, including neuroimaging, Thallium-201 SPECT, polymerase chain reaction analysis of CSF, and special histological methods, may be used to diagnose acquired toxoplasmosis. Antiparasitic therapy, using pyrimethamine and sulfadiazine, and serial neuroimaging often enable clinicians to differentiate toxoplasmosis from other central nervous system lesions. Toxoplasmosis may respond to other antimicrobials, including macrolide antibiotics, dapsone, clinidamycin, and atovaquone. Suppressive treatment is generally required for life in immunodeficient patients. Immunodeficient children with acquired toxoplasmosis have high rates of mortality and neurological sequelae.

Anti-Inflammatory Agents↗
PubMed2001

Impact of health education on knowledge and prevention behavior for congenital toxoplasmosis: the experience in Poznań, Poland.

In 1991-1997 educational activities were undertaken in the Poznań region of Poland to promote health education for the prevention of toxoplasmosis. The effect of education was measured in 2710 pregnant women by a questionnaire survey. Knowledge of toxoplasmosis and its prevention was almost doubled within 4 years. Similarly, the proportion of women having antenatal serological tests for toxoplasmosis significantly increased. In the examined population the knowledge of how Toxoplasma gondii is transmitted/acquired was better than the knowledge of individual risk factors for congenital toxoplasmosis. Correct hygienic behaviors in pregnancy were often practised by women who lacked good knowledge of toxoplasmosis. The experience from this study suggests the possible effectiveness of including prevention of toxoplasmosis into the whole package of preventing infectious diseases in pregnancy and into healthy lifestyle promotion. Health educational activities need to be realized by modern promotional technologies in addition to making available traditional written educational texts. There is a considerable role of medical services in promotion of a hygienic behavior in pregnant women preventing congenital toxoplasmosis in their offspring. Health education should be especially tailored to the population of pregnant women below the age of 21.

Adult↗
PubMed1982

Malignant lymphoma simulating lymph node toxoplasmosis.

On histological examination of 667 cases originally suspected of lymph node toxoplasmosis, 12 cases were diagnosed as malignant lymphoma and 15 cases as atypical hyperplasia (AH), suspicious of malignant lymphoma. All 12 malignant cases were of Hodgkin's disease: eight of the lymphocyte predominant nodular type, two of lymphocyte predominant diffuse type, and two of the nodular sclerosis type. In all cases, the lymph nodes contained small groups of epithelioid cells which were virtually indistinguishable from those seen in toxoplasmosis. In the differential diagnosis between lymph node toxoplasmosis and malignant lymphoma, the following features were found helpful. In toxoplasmosis the general structure is preserved and germinal centres are frequent, while in malignant lymphoma and in AH the general structure is destroyed. However, in some cases of toxoplasmosis germinal centres may be difficult to identify because their margins are indistinct due to clusters of epithelioid cells. Also, in some types of Hodgkin's disease and in some cases of AH with epithelioid cells, the general structure of the lymph node may be partially preserved. The occurrence of epithelioid cells within germinal centres seems to be a specific feature for toxoplasmosis; it was never seen in malignant lymphoma nor in AH. The occurrence of strands of monocytoid cells (unreife Sinushistiocytose) though a fairly typical feature of toxoplasmosis, was also occasionally seen in Hodgkin's disease or AH.

Adult↗
PubMed1986

Serology in ocular toxoplasmosis.

The diagnostic value of toxoplasma serology in ocular disease was evaluated in the following groups of patients: (I) uveitis cases of various causes (n = 291); (II) consecutive posterior and panuveitis patients (n = 60); (III) patients with definite congenital and ocular toxoplasmosis (n = 8); (IV) cases of clinical ocular toxoplasmosis (n = 25); and control patients with uveitis of non-toxoplasma origin (n = 12). No relation was observed between the level of the dye test titres and the diagnosis of ocular toxoplasmosis (groups I and II). During the active stages of the disease no typical change of the titres occurred in several longitudinally studied patients with toxoplasmosis. In group III one case was discovered to be negative by the dye test despite active ocular disease; however, IgG antibodies against toxoplasma were detected by the ELISA technique. In group IV, which was investigated by the ELISA technique, 100% of the toxoplasmosis patients were positive for IgG versus 58% of the control patients. Circulating immune complexes containing IgG and toxoplasma antigen were detected in seven of 25 toxoplasmosis patients (28%) and in two of 12 control patients (16%). Our study shows that the definite diagnosis of ocular toxoplasmosis or its exclusion by serological means only is not yet feasible. The possible superiority of the ELISA test to the dye test warrants further investigation.

Adolescent↗
PubMed1993

Choroid plexus infection in cerebral toxoplasmosis in AIDS patients.

We evaluated the postmortem incidence of choroid plexus infection in cerebral toxoplasmosis in 17 patients with acquired immune deficiency syndrome (AIDS) and cerebral toxoplasmosis and, by immunohistochemistry, identified Toxoplasma gondii tachyzoites in this structure in 53% of all cases. They were present in 78% of the nine cases with the acute necrotizing stages of CNS toxoplasmosis but were less frequent (20%) in patients with only the healed cystic lesions of toxoplasmosis. Large necrotizing abscesses of the choroid plexus were found in three of the patients. In one of these, the choroid plexus was the sole site of CNS infection, which presented as radiographically documented masses in the third and fourth ventricles associated with obstructive hydrocephalus. These results demonstrate that infection of the choroid plexus is common with cerebral toxoplasmosis and suggest that this infection should be included in the differential diagnosis of intra- or periventricular lesions in patients with AIDS. In addition, the high frequency of choroid plexus infection with acute cerebral toxoplasmosis suggests that cerebral toxoplasmosis in the immunosuppressed patient may be due to hematogenous spread to the choroid plexus from reactivation of latent organisms from systemic organs rather than to reactivation of latent organisms within the brain itself. Furthermore, the high frequency of choroid plexitis offers the potential for CSF dissemination of this infection.

AIDS-Related Opportunistic Infections↗
PubMed1998

The ocular manifestations of congenital infection: a study of the early effect and long-term outcome of maternally transmitted rubella and toxoplasmosis.

PURPOSE: To study the spectrum of adverse ocular effects which result from maternally transmitted rubella and toxoplasma infection; further, to record the long-term visual and neurodevelopmental outcomes of these 2 major causes of fetal infection. STUDY DESIGN AND PATIENTS: A series of 55 patients with congenital infection have been studied prospectively on a long-term basis. The study group included a cohort of 34 cases with congenital rubella syndrome demonstrated by virus isolation, and 21 cases with a clinical diagnosis of congenital toxoplasmosis and serologic confirmation. All patients had specific disease-related ocular defects. Rubella patients were first identified during or following the last major rubella epidemic in 1963-1964, and some have been followed serially since that time. A separate study group of representative toxoplasmosis patients presented for examination and diagnosis at varying time periods between 1967 and 1991. OBSERVATIONS AND RESULTS: This study confirms that a broad spectrum of fetal injury may result from intrauterine infection and that both persistent and delayed-onset effects may continue or occur as late as 30 years after original infection. Many factors contribute to the varied outcome of prenatal infection, the 2 most important being the presence of maternal immunity during early gestation and the stage of gestation during which fetal exposure occurs in a nonimmune mother. RUBELLA: As a criteria of inclusion, all 34 rubella patients in this study exhibited one or more ocular defects at the time of birth or in the immediate neonatal period. Cataracts were present in 29 (85%) of the 34, of which 21 (63%) were bilateral. Microphthalmia, the next most frequent defect, was present in 28 (82%) of the 34 infants and was bilateral in 22 (65%). Glaucoma was recorded in 11 cases (29%) and presented either as a transient occurrence with early cloudy cornea in microphthalmic eyes (4 patients), as the infantile type with progressive buphthalmos (1 patient), or as a later-onset, aphakic glaucoma many months or years following cataract aspiration in 11 eyes of 6 patients. Rubella retinopathy was present in the majority of patients, although an accurate estimate of its incidence or laterality was not possible because of the frequency of cataracts and nystagmus and the difficulty in obtaining adequate fundus examination. TOXOPLASMOSIS: Twenty-one patients with congenital toxoplasmosis have been examined and followed for varying time periods, 7 for 20 years or more. The major reason for initial examination was parental awareness of an ocular deviation. Twelve children (57%) presented between the ages of 3 months and 4 years with an initial diagnosis of strabismus, 9 of whom had minor complaints or were diagnosed as part of routine examinations. All cases in this study have had evidence of retinochoroiditis, the primary ocular pathology of congenital toxoplasmosis. Two patients had chronic and recurrent inflammation with progressive vitreal traction bands, retinal detachments, and bilateral blindness. Macular lesions were always associated with central vision loss; however, over a period of years visual acuity gradually improved in several patients. Individuals with more severe ocular involvement were also afflicted with the most extensive central nervous system deficits, which occurred following exposure during the earliest weeks of gestation. CONCLUSIONS: Although congenital infection due to rubella virus has been almost completely eradicated in the United States, the long-term survivors from the prevaccination period continue to experience major complications from their early ocular and cerebral defects. They may be afflicted by the persistence of virus in their affected organs and the development of late manifestations of their congenital infection. Congenital toxoplasmosis continues to be the source of major defects for 3,000 to 4,100 infants in the United States each year; the spectrum of defects is wide and may vary from blindness and severe mental retardation to minor retinochoroidal lesions of little consequence. Effective solutions for either the prevention or treatment of congenital toxoplasmosis have not been developed in this country but are under intensive and continuing investigation.

Child↗
PubMedDate not supplied

[Dwarfism and the Shereshevskiĭ-Turner syndrome in patients with congenital toxoplasmosis].

Fifty five patients with cerebral and hypophyseal nanism and Shereshevsky-Turner syndrome were examined for toxoplasmosis. The diagnosis of toxoplasmosis was established on the basis of epidemiological and obstetrical anamnesis, clinical and roentgenological data and serological tests (complement fixation test in 2 modifications--by common and droplet method; precipitation test, fluorescent antibody test) and intradermal allergic test with toxoplasmin (ATT). Of 48 patients with cerebral and hypophyseal nanism ATT proved to be positive in 17 (35.4 per cent); it was positive in 3 of 7 patients with Shereshevsky-Turner syndrome. In some of the patients and their mothers serological tests for toxoplasmosis were also positive. Thus, toxoplasmosis infection among the patients examined was 2.5-3 times more incident than the corresponding indices in healthy children. It is supposed that there is pathology of hypothalamic regulation of hypophyseal functions in toxoplasmosis and nanism. A possibility of pathology of the generative apparatus in maternal toxoplasmosis leading to development of chromosomal embryopathies could not be excluded. The authors consider that further studies are necessary for ascertaining (in some of the cases) of the pathogenetic association between toxoplasmosis and growth and developmental disturbances.

Adolescent↗
PubMed1995

Toxoplasmosis in England and Wales 1981 to 1992.

We have examined laboratory reports of toxoplasmosis received by the PHLS Communicable Disease Surveillance Centre between January 1981 and December 1992 in order to describe epidemiological trends in the three main clinical manifestations of toxoplasmosis-lymphadenopathy, eye disease, and neurological disease; and the two most important risk groups-fetuses and people whose immunity is impaired. The total numbers of reports each year did not change significantly between 1981 and 1992 and were similar to the numbers between 1976 and 1980, but different trends emerged in each subgroup. Reports of acute lymphadenopathic toxoplasmosis declined in children and young adults and eye disease associated with toxoplasmosis fell markedly in all age groups. Reports of neurological disease and severe toxoplasmosis complicating impaired immunity, due mainly to HIV infection or transplant surgery, rose. Reports of infections diagnosed in pregnancy rose steeply in the late 1980s although reports of congenital toxoplasmosis were no more common than in 1975 to 1980. Reports of acute toxoplasmosis came mainly from southern England. The emergence of these diverse trends from apparently unchanging totals emphasises the importance of surveillance systems capable of discrimination.

Adult↗
PubMed1999

Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling.

BACKGROUND: Women who acquire toxoplasmosis infection during pregnancy (in most cases detected through serological screening) require counselling about the risk of congenital infection and its clinical sequelae. Reliable estimates of risk are not currently available. We undertook an analysis of data from women referred to the toxoplasmosis reference laboratory, Lyon, France, between 1987 and 1995. METHODS: Information was collected from clinical notes kept at the laboratory and, where necessary, from the relevant obstetrician or paediatrician via telephone. Methods were developed to derive estimates of the risk of congenital toxoplasmosis by exact duration of gestation at maternal seroconversion. FINDINGS: We analysed obstetric and paediatric data on 603 confirmed maternal toxoplasmosis infections. At least 564 women received antiparasitic drugs according to a standard protocol. Congenital infection status was ascertained in 554 cases, and infected children were followed-up for a median of 54 months. The overall maternal-fetal transmission rate was 29% (95% CI 25-33), which masked a sharp increase in risk with duration of gestation from 6% at 13 weeks to 72% at 36 weeks. However, fetuses infected in early pregnancy were much more likely to show clinical signs of infection. These effects counterbalance, and women who seroconverted at 24-30 weeks of gestation carried the highest risk (10%) of having a congenitally infected child with early clinical signs who was thus at risk of long-term complications. INTERPRETATION: This information will assist the clinical counselling of pregnant women diagnosed with acute toxoplasmosis and may guide individual decisions on investigative and therapeutic options. Further studies are required to determine the long-term risks of clinical symptoms and disability due to congenital toxoplasmosis.

Adult↗
PubMed2002

Toxoplasmosis in bone marrow transplantation: a report of two cases and systematic review of the literature.

Toxoplasma infection represents a rare but often fatal complication in bone marrow transplant (BMT) recipients. We report two cases of toxoplasmosis: one of successfully treated cerebral toxoplasmosis after peripheral blood stem cell transplantation, and a fatal case of pulmonary toxoplasmosis in a BMT recipient. We have systematically reviewed the 110 published cases of toxoplasmosis following BMT. We analyzed the pre-transplant and clinical features of BMT recipients developing toxoplasmosis, together with the diagnostic procedures used and treatment given. By univariate and multivariate statistical analysis we analyzed the risk factors for diagnosis (during life vs post-mortem) and Toxoplasma-related mortality. Ante-mortem diagnosis was made in 47% of cases. Site of infection (P = 0.02; odds ratio 10.8), presence of symptoms at onset (P = 0.01) and conditioning regimen (P = 0.04) were factors influencing whether the diagnosis was made before or after death. Overall mortality rate was 80% and that attributed to toxoplasmosis was 66%. Variables influencing outcome were: site of infection (P = 0.02; odds ratio 5.28), day of onset (P = 0.04) and conditioning regimen (P = 0.04). Underlying disease (P = 0.02; odds ratio 9.45), among patients diagnosed before death, was the most significant factor influencing outcome.

Adult↗
PubMed1989

[Diagnosis of toxoplasmosis in pregnancy].

Even today, toxoplasmosis infection during pregnancy is an unsolved problem. In studies of 2206 pregnant women, toxoplasmosis specific IgM-antibodies have been detected in 69 cases (3.1%). Using more sophisticated serological techniques only 12 active toxoplasmosis cases needing therapy remained. Decisive discrimination criteria of the various tests were exact time of the examination as well as the level of the antibody titer. Although only 12 toxoplasmosis infections were treated, no connatal infections have been observed. On the other hand, in some outpatients, referred to our clinic, cases of severe connatal toxoplasmosis infections were found although they had undergone therapy. To solve the problem of toxoplasmosis, we recommend a general screening before pregnancy if possible. For optimal results of this screening, serologic reference laboratories and efficient sonography units must be established to obtain, when required, umbilical venous blood.

Animals↗