Search

Introduction: Currently, the status of serological screening for toxoplasmosis in pregnant women in Spain is unknown, and there is no official recommendation. The objective of this study is to show the current practice of gestational screening for toxoplasmosis in hospitals belonging to the Spanish Network for Research on Congenital Toxoplasmosis (REIV-TOXO)., Methods: An electronic survey was sent between April 2021 and September 2021 to investigators from 118 hospitals of REIV-TOXO, representing all Spanish regions. Nine items related to gestational screening for toxoplasmosis were collected. This information was compared with cases of congenital toxoplasmosis (CT) identified in REIV-TOXO to determine if these were diagnosed in the presence of gestational screening., Results: During the study period, serological screening was performed in 53.3% (63/118) hospitals, with variations between regions and even among hospitals within the same region. Testing performed in each trimester was the most common practice (57.7%), followed by a single determination (24.4%). 89.4% of CT cases between January 2015 and September 2021 were diagnosed due to gestational screening., Conclusion: The decision to perform gestational screening for toxoplasmosis in Spain is highly heterogeneous, with significant local and regional differences. Despite this, screening still allows the diagnosis of most CT cases. It is urgent to have current epidemiological data to inform decision-making in public health., (Copyright © 2023 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Published by Elsevier España, S.L.U. All rights reserved.)

The main social impact of toxoplasmosis stems from its ability to be vertically transmitted. Postnatally acquired infection is generally asymptomatic in approximately 70-90% of cases, making diagnosis often dependent on laboratory tests using serological methods to search for anti-T. gondii antibodies. This study aimed to investigate the ability of the VIDAS TOXO IgG avidity and VIDAS TOXO IgM assays to confirm recent toxoplasmosis. In total, 341 pregnant women with suspected acute toxoplasmosis were systematically monitored in the Program for Control of Congenital Toxoplasmosis in Minas Gerais State, Brazil. We conducted an observational analytical-descriptive cross-sectional study and grouped according to clinical and laboratory criteria as having acute or chronic toxoplasmosis. The VIDAS TOXO IgG avidity and VIDAS TOXO IgM assays were evaluated to investigate the capacity to identify acute infection. IgG avidity showed good performance in identifying acute toxoplasmosis when the IgG avidity index was lower than or equal to 0.1. Values greater than or equal to 3.16 according to the TOXO IgM kit were associated with a greater chance of acute infection. These results may contribute to a more adequate diagnosis of acute gestational toxoplasmosis and, consequently, the avoidance of inadequate or unnecessary treatments.

The molecular detection of Toxoplasma gondii DNA is a key tool for the diagnosis of disseminated and congenital toxoplasmosis. This multicentric study from the Molecular Biology Pole of the French National Reference Center for toxoplasmosis aimed to evaluate Toxoplasma gondii Real-TM PCR kit (Sacace). The study compared the analytical and clinical performances of this PCR assay with the reference PCRs used in proficient laboratories. PCR efficiencies varied from 90% to 112%; linearity zone extended over four log units (R 2 > 0.99) and limit of detection varied from 0.01 to ≤1 Tg/mL depending on the center. Determined on 173 cryopreserved DNAs from a large range of clinical specimens, clinical sensitivity was 100% [106/106; 95 confidence interval (CI): 96.5%-100%] and specificity was 100% (67/67; 95 CI: 94.6%-100%). The study revealed two potential limitations of the Sacace PCR assay: the first was the inconsistency of the internal control (IC) when added to the PCR mixture. This point was not found under routine conditions when the IC was added during the extraction step. The second is a lack of practicality, as the mixture is distributed over several vials, requiring numerous pipetting operations. Overall, this study provides useful information for the molecular diagnosis of toxoplasmosis; the analytical and clinical performances of the Sacace PCR kit were satisfactory, the kit having sensitivity and specificity similar to those of expert center methods and being able to detect low parasite loads, at levels where multiplicative analysis gives inconsistently positive results. Finally, the study recommends multiplicative analysis in particular for amniotic fluids, aqueous humor, and other single specimens., Competing Interests: The authors declare no conflict of interest.

To assess the performance of PLATELIA Toxo IgM (Bio-Rad) and Toxo ISAGA (BioMérieux) to detect anti- Toxoplasma IgM in infants at risk of congenital toxoplasmosis, a retrospective multicenter study was conducted comparing serological results obtained in the framework of routine diagnosis work-up for congenital toxoplasmosis. All infants born to mothers infected with T. gondii during pregnancy from 2010 to 2020 with at least 6 months of serological follow-up were included ( n = 1,010). One thousand ten cases were included, of which 250 infants (24.75%) had congenital toxoplasmosis. A total of 1039 sera were included. The concordance between the two techniques was 96%, with kappa coefficient of 0.87, showing an almost perfect agreement between ISAGA and PLATELIA. Cumulative sensitivity and specificity were 73.2% and 99.5.% and 74.8% and 100% for ISAGA and PLATELIA, respectively. The mean time to detect IgM using ISAGA and PLATELIA tests was 6.9 ± 20.1 days and 5.6 ± 14.7 days, respectively not significant (ns). Finally, the sensitivity of ISAGA and PLATELIA to detect IgM antibodies in infected neonates at 5 days of life was 62% and 64%, respectively. Performances of PLATELIA Toxo IgM assay were comparable to the gold standard ISAGA. This enzyme-linked immunosorbent assay is suitable for routine serology for the diagnosis of congenital toxoplasmosis in newborns. IMPORTANCE This study will help clinical microbiologists to chose an alternative serological method for the neonatal diagnosis of congenital toxoplasmosis, once the gold standard technique ISAGA will be withdrawn next year., Competing Interests: The authors declare no conflict of interest.

The ISAGA immunocapture test for the detection of anti-Toxoplasma immunoglobulin M is a manual technique known for its excellent sensitivity and specificity. The purpose of this retrospective, multicenter study was to compare the performances and agreement between ISAGA and other IgM detection techniques before cessation of ISAGA production. The analytic performance of the different tests was evaluated using 1,341 serum samples from adults with positive IgM and negative IgG to Toxoplasma gondii, and 1,206 sera from neonates born to mothers with seroconversion. The agreement between the tests was evaluated on 13,506 adult and 5,795 child serum samples. The sensitivity of Toxo-ISAGA IgM ® (adults 98.7%, neonates 63.1%) was similar to that of Platelia Toxo IgM ® (adults 94.4%, neonates 64.6%), and significantly higher than Liaison Toxo IgM ® (adults 90.6%), Architect/Alinity Toxo IgM ® (adults 95.7%, neonates 48.6%), and Vidas Toxo IgM ® (adults 81.8%, neonates 17.5%). However, the specificities varied between 24.4% (Platelia Toxo IgM ® ) and 95.2% (Liaison Toxo IgM ® ) in adults and were >95% for all tests in neonates. An analysis of the kappa coefficients showed better agreement between ISAGA IgM ® and the other tests in children (0.75-0.83%) than in adults (0.11-0.53%). We conclude that, in the absence of Toxo-ISAGA IgM ® , the association of a very sensitive technique (Platelia Toxo IgM ® or Architect/Alinity Toxo IgM ® ) and a very specific technique (Vidas Toxo IgM ® or Liaison Toxo IgM ® ) is recommended for IgM detection in adult sera. For neonates, Platelia Toxo IgM ® appeared to be the best alternative to replace Toxo-ISAGA IgM ® ., (© A.-S. Deleplancque et al., published by EDP Sciences, 2024.)

The diagnosis of congenital toxoplasmosis presents limitations and therefore new options are necessary. The analysis of amniotic fluid by real-time PCR has already proved effective for confirmation of fetal infection. However, its performance in other biological samples is not clear yet. The aim of this study is to better understand the role of real-time PCR in the blood of the mother and newborn as well as in the amniotic fluid and placenta in the diagnosis of congenital toxoplasmosis. This is a descriptive cohort study of pregnant women with toxoplasmosis followed up in Rio de Janeiro, Brazil. Real-time PCR was performed in samples of maternal blood, amniotic fluid, placenta, and blood of newborns. In addition, histopathological examination of placentas was performed, and data collected from babies were collected. 116 pregnant women were followed up and 298 samples were analyzed. One (0.9%) pregnant woman presented positive PCR in the blood, 3 (3.5%) in the amniotic fluid, 1 (2.3%) in the placenta and no newborn had positive PCR in the blood. Histopathological study was suggestive of toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis, and only cases with positive PCR in the amniotic fluid had correlation of the PCR result with the diagnosis of congenital infection. Both maternal and blood samples of newborns and placenta did not prove to be promising in the diagnosis of congenital toxoplasmosis. Further studies are needed to evaluate the real role of molecular diagnosis in other biological materials rather than the amniotic fluid., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)

Toxoplasma gondii can be transmitted vertically during pregnancy and may cause neurological, ocular, and even systemic damage to the offspring. Congenital toxoplasmosis (CT) can be diagnosed during gestation and/or after birth in the postnatal period. The timely diagnosis is highly relevant for efficient clinical management. The most common laboratory methods for diagnosing CT are based on Toxoplasma-specific humoral immune responses. However, these methods are of low sensitivity or specificity. In a previous study with a small number of cases, the comparison of anti-T. gondii IgG subclasses between mothers and their offspring showed promising results for CT diagnosis and prognosis. Thus, in this work, we analyzed specific IgG subclasses and IgA in 40 T. gondii-infected mothers and their children, of which 27 were congenitally infected and 13 uninfected. A higher frequency of anti-Toxoplasma IgG2, IgG3, IgG4, and IgA antibodies was observed in mothers and congenitally infected offspring. Of these, IgG2 or IgG3 were statistically the most conspicuous. In the CT group, maternal IgG3 antibodies were significantly associated with severe disease of the infants and IgG1 and IgG3 with disseminated disease. The results support that maternal anti-T. gondii IgG3, IgG2 and IgG1 are markers of congenital transmission and severity/spread of disease in the offspring., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Background: A new point of care test (POC) was developed that is promising as a tool to enhance impact of prenatal care programs for toxoplasmosis, however, no reports exist about its use or acceptability for healthcare personnel and mothers in Colombia., Methods: This was a translational research - phase III study of the acceptability of a new POC test (Toxoplasma ICT IgG-IgM, LDBio) for qualitative diagnosis of toxoplasmosis in 783 pregnant women and 30 health personnel in primary health care sites in the city of Armenia, Quindío (Colombia). Along with collection of the results of diagnostic POC and confirmatory test and demographic information, we evaluated acceptability through measure of the willingness, credibility, and satisfaction by using questionnaires with a Likert scale during routine prenatal care visits., Results: POC positivity was 46.5% among pregnant participants and was significantly related to socioeconomic factors, including education level (p = 0.00000000) and insurance status (p = 0.00000015). A total of 93-97% of healthcare personnel indicated agreement to positive statements regarding total satisfaction and total credibility of the LDBio test, but qualitative questions identified "Difficulty in the test procedure" as the most common response about barriers to apply the test. Greater than 90% of pregnant participants agree that POC test should be routine for all pregnant woman and permanently implemented., Conclusions: The test had near complete acceptability. In future studies it is necessary to examine the effect of non-differentiation between IgG and IgM isotypes., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Reagents were donated by LDBio (France). The donors do not participate in writing of the paper. Rima McLeod has participated in a patent application in the US to ensure the continued high quality of the ICT., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Primary infection during pregnancy by the protozoan Toxoplasma gondii can be worrisome because transmission to the fetus may lead to congenital toxoplasmosis (CT). Neonatal diagnosis is usually performed by serological profile comparison of the mother and newborn. As previously reported in 2012 by C. L'Ollivier et al., three IgM bands at 75, 90 and 100 kDa called the "IgM triplet" has caught our attention and seems to be pathognomonic of CT. This retrospective multicenter study involved nine reference laboratories included in the French National Reference Center for Toxoplasmosis network and concerned determining the specificity and sensitivity of this IgM triplet. On this basis, we were able to propose a new read of the comparison of IgG and IgM immunoblot profiles of mother and infant to increase the sensitivity of this diagnostic marker. The effect of the trimester of pregnancy at the time of infection, but also of maternal treatment with pyrimethamine/sulfadiazine/folinic acid on the presence of this IgM triplet in the infant, could be studied. The presence of the triplet appears pathognomonic for the diagnosis of CT, and it increased the sensitivity of the immunoblot assay from 55.04% to 72.48%. As a result, it would be wise to enhance conventional immunoblot reading by adding the presence of the three IgM bands in the infant pattern for neonatal diagnosis of CT., (© L. Peyclit et al., published by EDP Sciences, 2023.)

Background: Toxoplasma gondii is one of the world's most common parasites. Primary infection of the mother during pregnancy can lead to transmission to the fetus with risks of brain and eye lesions, which may cause lifelong disabilities. France instituted a national program based on monthly retesting of susceptible pregnant women to reduce the number of severe cases through prompt antenatal and postnatal treatment and follow-up., Objective: To evaluate the ability of the French prenatal retesting program to reduce the lifetime costs of congenital toxoplasmosis., Methods: We measured and then compared the costs and benefits of screening vs. not screening using decision-tree modelling. It included direct and indirect costs to society of treatment and care, and the lifetime lost earnings of children and caregivers. A probabilistic sensitivity analysis was carried out., Findings: Total lifetime costs per live born child identified as congenitally infected were estimated to be €444 for those identified through prenatal screening vs €656 for those who were not screened. Estimates were robust to changes in all costs of diagnosis, treatment, and sequelae., Interpretation: Screening for the prevention of the congenital T. gondii infection in France is cost saving at €212 per birth. Compared with no screening, screening every pregnant woman in France for toxoplasmosis in 2020 would have saved the country €148 million in addition to reducing or eliminating the devastating physical and emotional suffering caused by T. gondii. Our findings reinforce the conclusions of other decision-analytic modelling of prenatal toxoplasmosis screening., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Sawers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Congenital toxoplasmosis is reportable disease in Europe. To prevent it antibody serological tests were introduced in several European countries as a part of screening programmes. Immunoglobulin G (IgG) avidity index testing is one of these tests for diagnosing acute infection with Toxoplasma gondii (Nicolle et Manceaux, 1908) in pregnant women. However, a low or moderate IgG avidity index can give inconclusive results for predicting woman's status. From June 2012 until the end of 2014, 17,990 women were included in the national screening program to prevent congenital toxoplasmosis. One hundred and twenty-six women were consecutively included in the study because they had low or moderate IgG avidity. Every woman with possible acute toxoplasmosis was followed up every month till delivery. Fifty-eight of 126 (46%) women got infected in months before current pregnancy, 39 women (31%) were infected early in pregnancy. Twenty-nine pregnant women of 126 (23%) got infected in the second/third trimester of pregnancy. New cut off for IgG avidity index was 0.11. With this cut off, we were able to exclude T. gondii acute infection in the first trimester with very good diagnostic accuracy (area under the curve (AUC) = 0.95, 95% confidence Interval (CI) 0.91-0.99, sensitivity 0.95, specificity 0.86). If an IgG avidity index above 0.11 is measured in a woman's serum and she is in the first trimester of pregnancy, then a odds ratio (OR) for acute infection with T. gondii is below 1 (OR 0.11, 95% CI 0.05-0.25, P < 0.0001). If we measure IgG avidity index that is ≥ 0.11 in the first trimester of pregnancy, we can exclude infection with T. gondii with good diagnostic accuracy in our cohort of women. With a new cut off we could reduce number of invasive procedures such as amniocentesis and put less pregnant women in distress.

The diagnostic accuracy of a commercial Toxoplasma gondii IgA antibody enzyme-linked immunosorbent assay (ELISA) was evaluated in the context of routine practice on 289 newborns with congenital toxoplasmosis (CT) and 220 healthy controls. The performance of this assay was compared to that of the current gold-standard test for anti- Toxoplasma IgM detection, an immunosorbent agglutination assay (ISAGA). IgM and IgA sensitivity and specificity were assessed in cord and postnatal samples. The sensitivity of IgA detection by ELISA on all serum and peripheral blood samples was 60.56% and 56.52%, respectively, which is low compared with the sensitivity of IgM detection by ISAGA (73.26% on serum samples, 82.35% on peripheral blood). Adding the T. gondii IgA antibody ELISA to the diagnostic panel did not significantly increase the overall performance of the serological diagnosis based on IgM detection.

For postnatal diagnosis of congenital toxoplasmosis (CT), the gold standard for the detection of anti- Toxoplasma IgM in newborns relies on the immunosorbent agglutination assay (ISAGA), which is manufactured from whole Toxoplasma parasites that become difficult to maintain. For IgG, only the Platelia assay provides a validated assay for cord blood according to the manufacturer, allowing its use in this context. We compared the analytical performance of four commercialized automated assays, Platelia, Abbott, Vidas, and Liaison, for the detection of IgG and IgM in the cord blood or peripheral blood of newborns from women infected during pregnancy. The assays were performed on samples from 509 newborns, collected from the university hospitals of Montpellier, Nîmes, and Toulouse. For IgM, the four assays appeared to be sufficiently informative to be used for congenital toxoplasmosis diagnosis (area under the curve [AUC] > 0.8, receiver operating characteristic [ROC] analysis), with Platelia showing the best performance, similar to ISAGA with regard to accuracy (83%). For the Vidas (76%), Abbott (75%), and Liaison (74%) assays, the accuracy was significantly lower. Maternal treatment significantly decreased the sensitivity of all the assays. For IgG, the four evaluated assays showed a sensitivity of over 90%, with Abbott (95%) and Liaison (94%), exhibiting a significantly higher sensitivity than Platelia (90%). Furthermore, Abbott showed its superiority in the cases of maternal infection during the third trimester. In the context of the newborns of mothers infected by Toxoplasma gondii during pregnancy, to ensure efficient care, Platelia and Abbott seemed to be the most suitable reference tests for the detection of IgM for the former and IgG for the latter.

The performance of Toxoplasma rGra8, rMic1, and the chimeric rGra4-Gra7 antigens for early congenital toxoplasmosis (CT) diagnosis was evaluated. Sera from CT patients showed high IgG reactivity to rMic1, rGra8, and rGra4-Gra7. The seroreactivity of samples from uninfected infants was lost within 2 months of age., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021. Published by Elsevier Inc.)

The aim of the study was to describe the pregnancy outcome of a large cohort of women with toxoplasmosis seroconversion in pregnancy and to investigate the relation between maternal lymphadenopathy and risk of congenital toxoplasmosis (CT). This was a retrospective study involving women with confirmed toxoplasmosis seroconversion in pregnancy between 2001 and 2017. Women were clinically evaluated for lymphadenopathy and classified as follows: lymphadenopathy absent (L-) or lymphadenopathy present (L+). The mothers were treated and followed-up according to local protocol, and neonates were monitored at least for 1 year in order to diagnose CT. A total of 218 women (one twin pregnancy) were included in the analysis. Pregnancy outcome was as follows: 149 (68%) of children not infected, 62 (28.3%) infected, 4 (1.8%) first trimester termination of pregnancy, 2 (0.9%) first trimester miscarriages, and 3 (1.4%) stillbirths (of which one already counted in the infected cohort). 13.8% of women were L+ , and they were nearly three times more likely to have a child with CT compared to L- women (aOR, 2.90; 95%CI, 1.28-6.58). Moreover, the result was still statistically significant when the analysis was restricted to 81 children whose mothers were clinically examined and received treatment within 5 weeks from estimated time of infection. In conclusion, there is a positive association between L+ status in pregnant women, and risk of CT also confirmed when restricting the analysis to women with early diagnosis of seroconversion and treatment. This data could be very useful in counselling pregnant women with toxoplasmosis seroconversion and lead to direct a more specific therapeutic and diagnostic protocol., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Toxoplasmosis is a globally distributed parasitic infection that can be particularly severe when opportunistic or congenital. Its diagnosis requires accurate and rapid techniques that rely mainly on serology and molecular methods., Areas Covered: The aim of this review was to discuss the positioning of the molecular diagnosis of toxoplasmosis according to the different clinical situations possibly resulting from infection with T. gondii , and to detail recent developments in this technique. The English and French literature were searched with the following keywords: 'Toxoplasmosis', "Molecular diagnosis" and 'PCR'., Expert Opinion: Molecular techniques have revolutionized the diagnosis of toxoplasmosis, and practices have considerably evolved over the past decades. However, there is still a high degree of inter-laboratory heterogeneity which impairs comparisons between results and studies. Efforts to standardize practices are underway.

Toxoplasma gondii is an obligate intracellular parasite that infects all animals, including humans, and causes toxoplasmosis. If toxoplasmosis occurs during pregnancy, it may affect the foetus owing to transplacental transmission. Such transmission may lead to foetal complications, some of which can be very serious, e.g. hydrocephaly and chorioretinitis; however, not all cases of acute toxoplasmosis during pregnancy result in foetal complications. The decision whether to continue or terminate the pregnancy is a difficult problem for families as well as healthcare professionals, thus making it important. Here we present a case of acute toxoplasmosis at 6 weeks of pregnancy. The patient was directly advised to terminate the pregnancy. However, with detailed laboratory analyses, close follow-up and treatment to prevent transplacental transmission, she successfully completed the pregnancy and eventually delivered a healthy baby. By presenting this case, we aimed to review acute toxoplasmosis during pregnancy.

Background: The diagnosis of congenital toxoplasmosis can be inconclusive in many cases. Despite the several serological tests developed, the literature on biomarkers that can assist in the diagnosis of congenital an acute toxoplasmosis is limited. The objective of this study was to analyze the immunoreactive profile of Toxoplasma gondii protein bands with the potential to be biomarkers for diagnosis and prognosis of congenital and acute toxoplasmosis., Methods: Peripheral blood samples from women of childbearing age and/or pregnant women diagnosed with acquired toxoplasmosis as well as from congenitally infected children were selected and submitted to immunoblotting for analysis of the immunoreactive bands profile by immunoglobulin G (IgG) antibodies., Results: When comparing the immunoreactive bands profile for antibodies present in samples from different groups and subgroups, the 150, 18.5, and 16.96-kDa bands were more immunoreactive with the antibodies present in serum samples from the acquired infection group. The 343, 189, 150, 75, and 42-kDa bands showed more chance to be detected by the symptomatic congenital infection subgroup samples, while the 61, 50, and 16.96-kDa bands were significantly immunoreactive with the acute infection subgroup samples., Conclusions: The identification of these potential biomarkers can assist in early diagnosis and treatment of congenital toxoplasmosis., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objective:  Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil., Methods:  A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzyme-linked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program., Results:  The dried blood spot test was able to discriminate positive and negative results of pregnant women when compared with the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM)., Conclusion:  Dried blood samples are easy to collect, store, and transport, and they have a good performance, making this a promising method for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Infection with Toxoplasma gondii is usually an asymptomatic or oligosymptomatic, self-limiting disease in immunocompetent individuals. However, during the pregnancy, primary infection can lead to transplacental vertical transmission resulting in congenital toxoplasmosis with possible severe sequelae. The efficacy of systematic screening remains controversial and the effect of antibiotic treatment is unclear. Although main side effects of antibiotic drugs used for toxoplasmosis are well known, mostly from malaria treatment, there is a lack of information about occurrence in pregnant woman treated for toxoplasmosis. We report a case of a healthy pregnant woman with primary toxoplasmosis infection in the second trimester, who developed a severe adverse reaction in form of hypersensitivity pneumonia after antibiotic treatment with pyrimethamine and sulfadiazine and discuss the literature., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Identify missed opportunities for the prevention and early diagnosis of congenital toxoplasmosis (CT) in infants followed up in a reference center for pediatric infectious diseases (PID) in Rio de Janeiro between January 2007 and December 2016., Methods: Descriptive study including infants with CT, diagnosis established based on Brazil's Ministry of Health's criteria. All data regarding the infants and their mother's prenatal care were collected from the medical records of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG)-a tertiary public pediatric university hospital. The study enrolled infants aged between 0 and 12 months followed up in the PID department of IPPMG and with confirmed infection by Toxoplasma gondii in the period between January 2007 and December 2016. All patients with diagnosis of CT registered in the PID database of the IPPMG and admitted in the above-mentioned period were included in the study. Patients whose records were not available, or who went to just one clinic appointment were excluded., Results: The obstetric history of all 44 women, whose infants (45) were diagnosed with CT, was analyzed. Their median age was 22 years. None had undergone preconception serological testing for toxoplasmosis. Only 20 (45%) of them started antenatal care during the first trimester of gestation, a total of 24 (55%) had more than six antenatal care visits, and 16% of those did not undergo serological testing for toxoplasmosis. None were adequately informed of preventive measures. The diagnosis of acute toxoplasmosis was made in 50% of these pregnancies but 32% of the women were not treated. Only 10 children of these mothers were adequately screened and treated at birth., Conclusion: Despite the existence of national recommendations, several opportunities were missed to prevent CT during the antenatal period and to diagnose and treat this condition in the neonatal period., (© The Author(s) [2020]. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Toxoplasmosis is one of the common chronic infections caused by the parasite Toxoplasma gondii. Even though its infection in healthy non-pregnant women is self-limited and largely asymptomatic, the main concern is the risk to the fetus by vertical transmission in pregnancy. Congenital toxoplasmosis can result in permanent neurological damage and even serious morbidity such as blindness. Screening programs are implemented in various countries depending on the prevalence and virulence of the parasite in the respective regions. Upon diagnosis of infection, appropriate antibiotic therapy should be initiated as it has been proven to reduce the risk of fetal transmission. Primary prevention remains the key intervention to avoid the infection and hence patient education is an important aspect of the management., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financialinterestsor personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To evaluate the association between treatment and mother-to-child transmission of acute Toxoplasma gondii infection in pregnancy., Methods: This was a concurrent cohort study of 26 pregnant women diagnosed with acute toxoplasmosis. Transmission of T. gondii to the fetus was characterized by detection of the parasite in the amniotic fluid by polymerase chain reaction (PCR). Congenital toxoplasmosis was diagnosed by a positive serological test for IgM, intracranial calcification, chorioretinitis, hydrocephalus, and/or microcephaly in the newborn., Results: There was direct correlation between acute toxoplasmosis and low socioeconomic status and inadequate hygienic/health conditions. The MCT rate in adequately and inadequately treated patients was 17.4% and 33.3%, respectively. PCR analysis of the amniotic fluid was performed for 15 women, with 1 positive result; the pregnant woman was adequately treated, and her infant had no complications. Congenital infection occurred in 4 newborns, who had hydrocephalus, intracranial calcifications, and chorioretinitis. Cerebrospinal fluid alteration was found in 3 of the 16 infants tested. Transmission was more frequent in the third quarter of pregnancy (P = 0.04)., Conclusion: The rate of mother-to-child transmission of T. gondii is higher in untreated pregnant women and those who acquired the infection later in pregnancy., (Copyright © 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Toxoplasmosis in pregnant women can cause significant morbidity and mortality in the fetus, which may be mitigated by early diagnosis and treatment. Social factors have also been related to the risk of developing the congenital form of toxoplasmosis, since some of these factors interfere directly in the quality of prenatal care. This study aimed to describe the clinical, laboratory, and epidemiological data of pregnant women diagnosed with toxoplasmosis and their newborns followed up at a referral hospital in Rio de Janeiro, Brazil. This was descriptive cohort study of 334 pregnant women with toxoplasmosis followed from May 2014 to December 2017. We conducted interviews to assess knowledge about the disease and its preventive measures, analyzed clinical and laboratory data during antenatal visits, and collected data from the newborns' medical charts. RESULTS: This was a predominantly low-income women cohort study, with little schooling, mainly referred from public health services late in pregnancy (178; 53.3%), in the second and third trimesters (286; 85.6%). Diagnosis of acute toxoplasmosis had not been confirmed in 171 cases (51.2%). Out of 183 (54.9%) women who had initiated treatment at the original health services, 45 (24.6%) received an incorrect prescription. Seventy-two amniocenteses were performed, with positive real-time polymerase chain reaction (qPCR) in the amniotic fluid in two cases (2.8%). Congenital toxoplasmosis at birth was identified in eight newborns (5.4%). CONCLUSION: Late referral to specialized medical services, inadequate toxoplasmosis management at the original prenatal care services, and social vulnerabilities are contributing factors to the persistent occurrence of congenital toxoplasmosis cases., (Copyright © 2020 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)

The study analysed the trend of toxoplasmosis infection in pregnancy by using antenatal serological screening and the incidence of the congenital condition in newborns in the province of Trento, Italy. Data from pregnant women who gave birth at local maternity units between 2009 and 2018 were obtained. The serological test results were collected from birth attendance certificates (BACs), the main - and mandatory - source of information used to monitor pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of serological tests for a vast range of infections in pregnancy. The data collected from the BACs were integrated with those provided by the Hospital Information System (HIS), which was also used to collect data on the trimester in which the seroconversion occurred. A total of 45,492 pregnant women were analysed, of whom 24% were foreigners. The average coverage of serological screening in pregnancy was 99.7%. Mean overall prevalence of Toxoplasma gondii infection was 21.7% (95% CI: 21.3-22.1): in Italians the prevalence was 17.9% (95% CI: 17.5-18.30) and in foreign nationals 32.7% (95% CI: 32.26-33.13). The mean annual seroconversion rate was 0.35% (95% CI: 3.0-4.2) of susceptible women and 0.27% (95% CI: 2.2-3.4) of all pregnant women who were screened. The seroconversion rate was higher amongst foreign women (0.32%, 95% CI: 3.0-3.6) than Italian women (0.24%, 95% CI: 2.1-2.8). In all, 91.0% of seroconverted women were treated during pregnancy in accordance with the anti-toxoplasma protocol. Five cases of congenital infection were identified (2 amongst Italians and 3 amongst foreign women), amounting to an overall transmission rate of 4.0% (2.3% in Italians and 8.8% in foreigners). Transmission risk ranged from 0.0% in the first trimester to 19% in the third. The incidence of congenital toxoplasmosis, over the entire study period, was 0.012% live births (0.011% in Italians and 0.016% in foreigners). Data collection on infections in pregnancy through BAC allows area-based assessment. Although the quality of the data recorded in the BAC can be considered satisfactory, it was also necessary to access other information sources. The screening coverage was very high. The prevalence of toxoplasmosis infection was found to be higher in foreign mothers than in Italians, as well as seroconversion. The extent of serological screening and the high treatment rate helped to keep the risk of infection transmission to the foetus low and to achieve a very low rate of congenital infection.

Objective: The aim of this study was to propose a classification in order to stratify the probability of an acute Toxoplasma infection in pregnancy and to estimate the risk of vertical transmission. Study design: We evaluated the likelihood of a primary maternal infection according to the Lebech classification and to the modified-Lebech classification proposed for our group of 375 patients referred for a suspected primary maternal infection. Fetal diagnosis included the examination of amniotic fluid by PCR to detect Toxoplasma DNA as a confirmation test. Results: Differences between the old and new classification resulted statistically significant for old classes defined as probable and unlikely with a clear shift of cases from the unlikely to the probable class in the new classification. Transmission rate showed a significant ( p  < .05) increase of the transmission rate in the probable class in our new classification as compared with the Lebech one. Conclusions: Results obtained in the present study suggest that the new IgG avidity-based classification herein proposed could estimate more precisely the likelihood of a primary maternal Toxoplasma infection as well as the risk of fetal infection, when compared with the historical Lebech Classification.

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Due to the growing importance of toxoplasmosis worldwide, simple methods of diagnosis are important for epidemiologic studies. Dried blood spot (DBS) is a useful tool that surpasses venipuncture. DBS- Toxoplasma testing via a finger-stick could also be used in setting where phlebotomies might not be feasible, such as worldwide prenatal and newborn screening for congenital toxoplasmosis. This study included 101 study subjects were occupationally at-risk to Toxoplasma gondii infection and 33 as controls. Serum was collected from both groups for the detection of anti- Toxoplasma IgG antibodies by ELISA as a reference gold standard test. For the occupational at-risk group, capillary finger stick derived blood was blotted onto five sets of Whatman protein saver cards. Discs were stored as four sets; three sets at 4°C and eluted 1, 2 and 3 months of storage and one set at -20°C for 3 months then eluted. Additionally, one set was eluted immediately. Anti- Toxoplasma IgG antibodies were evaluated by ELISA from DBS eluted samples and compared to matched sera. DBS elutes from discs that were freshly prepared for anti- Toxoplasma IgG showed 100% sensitivity, specificity and diagnostic accuracy. Serologic testing using DBS showed very good diagnostic accuracy under all mentioned conditions of storage. Higher stability was obtained when the blood discs stored at 4°C for 1 month and up to 3 months at -20°C, with 98.18% sensitivity, 100% specificity and 99% diagnostic accuracy. DBS- Toxoplasma testing is characterized by simplicity in performance, cost-effectiveness and the ease of handling, to store and to transport, with high diagnostic accuracy.

Toxoplasmosis is a common infection worldwide caused by Toxoplasma gondii , an intracellular parasite. The prevalence of Toxoplasmosis ranges from 17.5% to 69.5% in Turkey. Toxoplasmosis is mostly asymptomatic. It may cause fetal mortality in case of vertical passage. The most common clinical findings in congenital toxoplasmosis are chorioretinitis, hydrocephalus and cerebral calcification. Another group of susceptible patients for Toxoplasma gondii are immunesuppressive patients. Reactivation of a latent infection in the case of immunodeficiency can lead to fatal toxoplasmic encephalitis. Serological diagnostic methods based on the detection of specific antibodies for Toxoplasma gondii are the most commonly used diagnostic methods. However, it may be difficult to interpret the results in pregnant women, neonates, and the patients receiving treatment. It is stated that using more than one method together to improve the reliability of the diagnosis is a more accurate approach. In the prenatal diagnosis of congenital toxoplasmosis, in patients with immunodeficiency, in ocular toxoplasmosis, the polymerase chain reaction is seen as having a higher sensitivity. The aim of this review is to present the general features, diagnostic methods and current approaches in toxoplasma infection, an important public health problem.

Primary infection with Toxoplasma gondii in pregnant women can lead to vertical transmission of the parasites resulting in congenital toxoplasmosis. The frequency of foetal infection increases with gestational age at maternal infection, but the risk of developing clinical sequelae decreases. Data on antiparasitic treatment suggest, that maternal treatment reduces the risk of serious neurological sequelae or death in congenitally infected offspring. Aspects of diagnosis and antimicrobial treatment of T. gondii infection during pregnancy are summarised in this review.

Serological monitoring and prevention of toxoplasmosis during pregnancy. Determination of the serological status against toxoplasmosis is mandatory in France during pregnancy. Recently, the national social welfare system decided to include new exams (IgG avidity and western-blot) useful to assess the serological status and to date the infection with a better accuracy. The role of the attending doctor is essential, particularly at the beginning of pregnancy and after delivery. We summarize here key points which must be known by a general practitioner to understand serological results and take care of his patients., Competing Interests: L. Paris déclare des liens ponctuels avec Roche Diagnostics et DiaSorin (rapports d’expertise, conférences et/ou prise en charge lors de congrès…). S. Imbert déclare n’avoir aucun lien d’intérêts.

Background: Due to the lack of prospective data, there is an ongoing debate about the need for screening and prevention programs for congenital toxoplasmosis in Europe. Accordingly, individual countries have chosen different public health strategies., Methods: A cord-blood screening program for congenital toxoplasmosis was established in 1982 in obstetric units of hospitals in North-Western Switzerland. Samples were tested for specific immunoglobulin G (IgG) and IgM, and after 1992 also for IgA antibodies. Suspicious test results triggered additional investigations to identify children with congenital toxoplasmosis., Results: From 1982 to 2015, 119,166 cord-blood samples have been collected and analyzed for the presence of Toxoplasma-specific antibodies. Although maternal age rose from 28.2 to 32.2 years during this period, a decrease of seroprevalence from 53% to 20% was observed. The incidence of congenital toxoplasmosis decreased by 85% (from 0.08% to 0.012%) and remained low despite abandoning prevalent nonsystematic screening during pregnancy in Switzerland., Conclusions: Our data document a steady decline of both Toxoplasma gondii seroprevalence and congenital toxoplasmosis incidence in Switzerland even after abolition of the nonsystematic prenatal screening a decade ago. The data support abandoning toxoplasmosis screening programs in low-incidence, high-income countries such as Switzerland.

The purpose of our study was to report the particularities of the management of toxoplasmosis seroconversion cases occurred during the third trimester of pregnancy and diagnosed in the Institute Pasteur of Tunis. The study was conducted in the Laboratory of Parasitology-Mycology of the Institute Pasteur of Tunis between January 2005 and December 2017. A total of 27 cases of toxoplasmosis seroconversion during the third trimester were included. Prenatal diagnosis was performed in five cases. PCR was positive in one case. Pyrimethamine-sulfadoxine was prescribed in one case with positive PCR and in another case as soon as maternal infection was confirmed. Spiramycine was prescribed in 24 cases for the duration of the pregnancy. One woman did not take any treatment because seroconversion was diagnosed just before delivery. Twenty newborns had congenital toxoplasmosis: 19 cases were diagnosed by serology and one case was diagnosed after amniocentesis. Two newborns (10%) were symptomatic at birth. All the newborns had neither clinical nor radiological signs during the follow-up., Competing Interests: The authors have no conflicts of interest to declare

Objectives: The aim of the study was to evaluate obstetric care of pregnant women with regard to prevention of congenital toxoplasmosis. Additionally, we attempted to determine the frequency of markers for past infection with Toxoplasma gondii in order to characterize the current significance of preventive measures in the Polish population., Material and Methods: The analysis of the medical records - pregnancy charts of women who presented for delivery - was performed. Patient age, place of residence, and toxoplasmosis test (or lack of it) were evaluated. Also, further diagnostic management, depending on the serologic result, was investigated., Results: Out of 670 pregnant women, 628 (93.73%) underwent at least one toxoplasmosis diagnostic test. Out of those, 502 (73%) had a negative result (IgG -, IgM -), and 2 (0.32%) had a positive result (IgG +, IgM +), while history of infection with Toxoplasma gondii was confirmed (IgG +, IgM -) in 124 (19.75%) cases. Repeat testing was required in 183 (29.14%) out of the 628 women., Conclusions: A high rate of women in whom IgG antibodies were not detected in the first test and a low rate of women who required repeat testing later in pregnancy are noteworthy. Regardless of the healthcare policy, parents should receive reliable information about the nature of the disease and possibilities of prevention, while medical professionals ought to have easy access to research data about the epidemiologic status and recommendations.

Background: In Vietnam, no systematic prenatal toxoplasmosis screening is in place, and only few studies have assessed the prevalence and importance of this zoonotic parasite infection. In addition, no studies have been conducted to assess the risk factors associated with toxoplasmosis. This study protocol was developed to determine the seroprevalence of toxoplasmosis in pregnant women in Hanoi and Thai Binh, Northern Vietnam, and to evaluate the association with risk factors and congenital toxoplasmosis. The protocol was developed in a way that it could potentially evolve into a countrywide prenatal diagnosis and prevention program, with the main focus on primary prevention., Methods: The collaborating gynaecologists will invite eligible pregnant women attending antenatal care for the first time to participate in the study. At first consult, information about toxoplasmosis and its prevention will be provided. All participants will be asked to fill in a questionnaire, which is designed to analyse socio-demographic and biologically plausible risk factors associated with toxoplasmosis, and blood samples will be collected to determine the seroprevalence of toxoplasmosis in pregnant women. In case there is suspicion of a primary infection during pregnancy, the concerned women will be followed-up by the gynaecologists according to a predefined protocol. Every participant will be informed on her serological status, risk factors and prevention measures and is offered appropriate medical information and medical follow-up if required., Discussion: The hypothesis is that congenital toxoplasmosis is an important but currently under-diagnosed public health problem in Vietnam. This study can strengthen sustainable control of toxoplasmosis in Vietnam, provide a protocol for prenatal diagnosis, boost overall awareness, improve the knowledge about toxoplasmosis prevention and can be essential for evidence-based health policy.

Antibody-based serological tests are currently the most common diagnostic methods for detection of Toxoplasma gondii; however, these tests bear several limitations. Recently, Interferon-gamma release assay (IGRA), a T-cell-based test, was introduced as an in vitro test for detection of T. gondii infection. Few studies have investigated the potential role of cell immunity in diagnosis of toxoplasmosis. IGRA accurately distinguished infected from uninfected individuals, showing strong lymphocyte activation after in vitro stimulation with T. gondii antigens, even during the first days of life. IGRA is an easy-operation and low-cost method to measure cell mediated immunity against T. gondii. The results of this review underline the importance of evaluating cellular immunity to establish an early diagnosis particularly for congenital toxoplasmosis. Therefore, ELISA-based IGRA holds the potential to become a useful diagnostic tool for early detection of T. gondii infection., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aforesaid recommendations for the management of T.gondii infection, elaborated by the group of experts, are intended for physicians of various specialties in order to standardize and facilitate diagnostic and therapeutic management. Early diagnosis of congenital toxoplasmosis, both symptomatic and asymptomatic, in neonatal period, initiation of adequate treatment and long-term, multispecialist monitoring, including multi-organ rehabilitation of children may prevent or reduce the complications of congenital toxoplasmosis. Health education, whose role is often underestimated, should be targeted mainly on girls and women at reproductive age as to prevent from infection during pregnancy.

Acute infection of toxoplasmosis during pregnancy is detrimental to the developing fetus. In the United States, approximately 1 in 10,000 live births are affected by congenital toxoplasmosis. Although multifactorial in etiology, maternal infection is primarily attributed to the consumption of contaminated meat or water. Infection and transmission to the fetus may result in devastating neurologic impairment. Screening methods for all pregnant women should be implemented in routine prenatal care. This article will highlight the inherent dangers of congenital toxoplasmosis, while including general care of the fetus for prevention of transmission, medical management, and long-term outcomes.

Objectives: The objectives of this study were to estimate the risk of maternal-fetal transmission of toxoplasmosis and its consequences on the fetus and to emphasize the importance of follow-up of newborns in Tunisia., Patients and Methods: It was a retrospective study of 94 cases of pergravidic toxoplasmic seroconversion who were diagnosed and followed in the Laboratory of Parasitology of Pasteur Institute of Tunis between 2005 and 2010., Results: In our series, amniocentesis was performed for 60 parturients. Among the amniotic fluid tested, research of toxoplasmosis DNA by PCR was positive in 12 cases (12/60, 20 %). Twenty-six cases of congenital toxoplasmosis were diagnosed with 14 postnatal cases. The rate of maternal-fetal transmission of Toxoplasma gondii was 27.6 % (26/94). This risk increases with gestational age, from 19 % at seroconversion of the 1st quarter to 29.4 % in the 2nd quarter and 44.4 % in the 3rd trimester. Monitoring of newborns with congenital toxoplasmosis showed that only 3 children were symptomatic. There were 2 cases of toxoplasmic chorioretinitis and a case of brain damage. Under serological monitoring of newborns, 21 cases were lost to follow-up and monitoring was stopped for 29 after decrease of anti-toxoplasmic IgG., Discussion and Conclusion: The prenatal diagnosis allowed to decrease the severe forms of congenital toxoplasmosis in Tunisia. Nevertheless, it is always necessary to raise the problem of the significant number of newborn children whose follow-up is incomplete., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Toxoplasmosis acquired during pregnancy is a serious disease that may significantly affect fetal development and cause irreversible or therapeutically hardly influenced damage to the newborn. Early and correct diagnosis of the disease in the mother is essential for determining prognosis and further diagnostic and therapeutic procedures. The case study combines a number of factors to be encountered in clinical practice which may complicate diagnostic considerations. One of them is the existence of a rare phenomenon of reinfection - its possible effects on prenatal screening and other interpretations of such findings. Another problem is the evaluation of the origin of sonographically confirmed fetopathy in relation to Toxoplasma etiology and the choice of next steps that should follow in this situation. Finally, the text discusses the selection of postnatal examinations so that they sufficiently contribute to decision-making about the newborn's treatment initiation.

Toxoplasmosis when occurring during pregnancy can be transmitted to the fetus and lead to congenital toxoplasmosis (CT). Therefore, pregnant women are a risk group, for which it is necessary to determine the serologic profile. The objective of this study is to determine the serologic profile of toxoplasmosis in pregnant women followed at the Parasitology Laboratory of the Pasteur Institute in Tunis, to establish the prevalence of toxoplasmic infections during pregnancy and the incidence of the CT, noting the difficulties faced in the interpretation of serological results. This is a retrospective study concerning 2833 toxoplasmic serologies practiced on 2070 pregnant women, followed at the Parasitology-Mycology Laboratory of the Pasteur Institute of Tunis, between 2007 and 2010. Serological diagnosis of toxoplasmosis was done by ELISA (Enzyme Linked Immunosorbent Assay) for the detection of Immunoglobulin (Ig) G and M and the study of toxoplasmosis IgG avidity. Prenatal diagnosis was performed for 58 women by amniotic fluid sampling. Toxoplasma gondii was detected by Polymerase Chain Reaction (PCR). At birth, the diagnosis of congenital toxoplasmosis was established based on serology. The toxoplasmic serologies carried out have shown that 45.6% of the pregnant women were formerly immunized while 49.6% had a negative serology. A toxoplasmosis primary infection acquired during pregnancy was detected in 79 cases (3.8%). Among them, 33% had a true seroconversion while 67% had a recent toxoplasmosis infection in view of the positivity of IgG and IgM on the first sample with a low index of avidity (IA). For 21 parturients whose serology showed the presence of IgG, IgM and an intermediate or high IA. Among the 58 parturients in whom prenatal diagnosis was performed, PCR was positive in four cases. After birth, six cases of congenital toxoplasmosis were detected by serology.

Background: Toxoplasma infection during pregnancy exposes the fetus to risks of congenital infection and sequelae that depend heavily on gestational age (GA) at time of infection. Accurate risk estimates by GA are necessary to counsel parents and improve clinical decisions., Methods: We analyzed data from pregnant women diagnosed with acute Toxoplasma infection in Lyon (France) from 1987 to 2008 and assessed how the risks of congenital toxoplasmosis and of clinical signs at age 3 years vary depending on GA at the time of maternal infection., Results: Among 2048 mother-infant pairs, 93.2% of mothers received prenatal treatment and 513 (24.7%) fetuses were infected. Because of a significant reduction in risk since 1992 when monthly screening was introduced (59.4% vs 46.6% at 26 GA weeks; P = .038), probabilities of infection were estimated on the basis of maternal infections diagnosed after mid-1992 (n = 1624). Probabilities of congenital infection were <10% for maternal infections before 12 weeks of gestation, rose to 20.0% at 19 weeks, and then continued increasing to 52.3% and almost 70% at 28 and 39 GA weeks, respectively. Because of a significant reduction in risk of clinical signs of congenital toxoplasmosis in infected children born from mothers diagnosed after 1995 when polymerase chain reaction testing on amniotic fluid was initiated (87/794 vs 46/1150; P = .012), probabilities of clinical signs at 3 years were estimated based on 1015 maternal infections diagnosed after 1995 including 207 infected children, with symptoms in 46 (22.2%)., Conclusions: These analyses demonstrated that introduction of monthly prenatal screening and improvement in antenatal diagnosis were associated with a significant reduction in the rate of congenital infection and a better outcome at 3 years of age in infected children. Our updated estimates will improve individual management and counseling in areas where genotype II Toxoplasma is predominant.

The prevention of congenital toxoplasmosis is based on providing information to women, serologic diagnosis and treatment of the infected mother and child. In this article we present the results of 12 years of implementation of a congenital toxoplasmosis prevention program in which we measured the mother's infection incidence rate, the transmission rate and the number and severity of infection in newborns. The study was performed on 12035 pregnant women in the period 2000-2011. The prevalence rate of antibodies against Toxoplasma gondii was 18.33% (2206/12035). Thirty-seven out of 9792 susceptible women presented acute infection and the mother's infection incidence rate was 3.78 per 1000 births. The transplacental transmission rate was 5.4% (2/37). Two newborns presented congenital toxoplasmosis infection, one had no clinical signs while the other presented strabismus and chorioretinitis. Thirty-five infected mothers and the two children with congenital infection were treated. The transmission rates obtained allow consider this prevention program as a valid resource to minimize the impact of congenital toxoplasmosis.

Background: In Austria, a nationally mandated prenatal serological congenital toxoplasmosis screening program was introduced in 1974 in response to a high incidence of 7.8 per 1,000 infected infants. Maternal prenatal recognition of acute gestational infection and early treatment of infants with congenital infection are important because prenatal and accurate postnatal antibiotic therapy improves the outcomes of infected infants., Objective: To determine the impact of additional maternal and/or fetal cord blood serology at birth on improving current prenatal maternal screening in detecting congenital toxoplasmosis., Methods: In this prospective observational study, 5,545 consecutive women were included over a 19-month period. Routine prenatal maternal toxoplasmosis serology screening was performed along with additional cord blood serology screening at delivery. Fetal cord blood serology included Sabin-Feldman dye and IgM immunosorbent agglutination assay testing., Results: Based on the initial prenatal maternal screening serology results, there was evidence of a prior chronic infection manifest in 1,830 (33.0%) women and 3,708 (66.9%) were not infected. Seven (0.13%) were diagnosed with acute toxoplasma infection based on seroconversion. Of these, 4 manifested transmission, and 3 did not. Of the seven infected women, routine prenatal maternal screening identified acute infection in only 2 of the women, 1 of whom had an infected fetus with abnormal prenatal ultrasound. Fetal cord blood serology screening identified an additional 5 women, 3 with infected fetuses., Conclusions: Identification of Toxoplasma gondii infection by prenatal maternal serological testing is significantly improved by the addition of maternal and/or fetal serological testing at birth., (Copyright © 2012 S. Karger AG, Basel.)

Two weeks after delivery of a healthy term neonate, the mother developed lymph node syndrome, which corresponded serologically to acute toxoplasmosis. The blood of the newborn showed positive IgM, IgG and IgA antibody titers against Toxoplasma gondii with a low avidity of IgG. The newborn did not show any clinical signs or organ damage connected to toxoplasmosis either at the beginning or during the follow-up. The IgA and IgM titers exhibited a decrease over time, while the KFR, IgG antibody titers and avidity had an increasing trend. A sharp increase of KFR, IgE and IgA antibody titers was detected during the sixth month of life, probably due to maturation of the immune system in the setting of an asymptomatic infection with T. gondii. This short increase was followed by a subsequent decrease in titers of these antibodies until they reached negative levels during the 21st month of life. The evaluation of serological results in newborns infected with T. gondii is always difficult and should be performed by an expert physician. Children at risk should be placed under a long-term follow-up to avoid potential development of toxoplasma chorioretinitis.

Objective: Toxoplasmosis is a cosmopolitan zoonose led by an intracellular protozoon, Toxoplasma gondii. Severe fetal consequences can be encountered in case of infection during pregnancy. Since 1978, a specific screening program has been implemented in France during pregnancy. The purpose of our study is to evaluate the fetal consequences of a maternal contamination during the periconceptional period., Material and Methods: We retrospectively analyzed, over a 10-year period, the outcome of all the pregnancies with a suspicion of periconceptional seroconversion. Periconceptional seroconversion was defined as infection occurring during the two months prior to or following the assumed date of the conception. The obstetric care, the fetal ultrasound scan and the neonatal features were all closely looked at., Results: Seventy-nine patients (81 fetus) showed evidence of the diagnosis criteria of periconceptional infection. Three cases (3.8%) of congenital infection were observed: two late miscarriages (at 15 weeks and 24 weeks) and one case of an alive child with infraclinic toxoplasmosis., Conclusion: In our study, the rate of congenital toxoplasmosis (3.8%) in the event of a periconceptional infection is slightly above the rate previously described in the literature (0.6 to 3.3%). The rate of miscarriage is also high: 66% in case of congenital infection. A regular ultrasound follow-up until the end of the pregnancy is necessary to ensure the best care available. The decision whether to carry out an amniocentesis is discussed in that case., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)