Diagnostic problems and postnatal follow-up in congenital toxoplasmosis

Abstract

Aim. In order to assess the consequences of different clinica] approaches in the prenata] management of congenital toxoplasmosis, we retrospectively reviewed 58 pregnant women with Toxoplasma seroconversion and prospec­ tively enrolled their 59 infants, referred to us from 1999 to 2004. Metbods. Data on clinica!, laboratocy and de­ mographic characteristics of the pregnant women were collected. Their children were entered intoa 48-month follow-up progcamme in which clinica , instrumental, ophthalmo­ logic 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 ac­ cording to the different clinica! cases. Resu/Js. Time of infection was dated in the tlrst trimester for 24 women (41%), in the second trimester for 18women (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 in­ fected in the third trimester. Serological fol­ low-up revealed that 11(19%) of the infants had been infected. An alternating regimen with Pyrimethamine-Sulphadoxine was adminis­ tered to the infected children.Ali the infantswere clinically asymptomatic, and the instru­ mental follow-up revealed specific toxoplas­ mosis anomalies in 4/11infected children. Conclusion. Ouc results highlight issues and problems concerning current prenata! diag­ nostic tests and the therapeutic approachbased on PCR testing of amniotic fluid alone. Thein­ cidence of ocular-cerebral lesions obsecved 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 ther.tpeutic protocol,with alternating Pyrime­ thamine-Sulphadiazine regimen, applied also to asymptomatic children born to women with inadequate prenata] diagnostic management, could prevent severe sequelae.