Fetal toxoplasmosis: outcome of pregnancy and infant follow- up after in utero treatment

Toxoplasmosis is caused by a parasite known as Toxoplasma gondii which, when passed from the mother to her fetus, causes severe complications. Affected fetuses can have calcium deposits in the brain causing blindness, convulsions and mental retardation. Prenatal testing techniques can be used to confirm a diagnosis of toxoplasmosis in the fetus. Fetal outcome was determined after diagnosis and treatment of fetal toxoplasmosis. Out of 1,270 cases of maternal toxoplasmosis infection, 89 infections appeared in the fetus. Consequences experienced by the fetus depend on the period of fetal growth during which the infection was acquired. Patients were grouped on the basis of the week of pregnancy that the mother acquired the infection. Pregnancies were terminated in 34 (2.7 percent) of the infected fetuses because of detected severe fetal brain abnormalities. Most of these fetuses contracted toxoplasmosis early in the pregnancy. All 53 patients received treatment with spiramycin; additional treatment with pyrimethamine and sulfonamides was given to 43 patients. Of the 54 infants born, no indication of brain or eye abnormalities were found in 44 infants (81 percent), although 41 infants had evidence of infection and 12 had a benign form of toxoplasma infection. Three of the infants had slight calcifications, while a severe condition was found in one infant not receiving the additional treatment. It is recommended that drug therapy with spiramycin for the mother start as early as possible to decrease the chances of a toxoplasmosis infection reaching the fetus. It was found that the longer the fetus was exposed to the infection, the more complications developed. Additional drug therapy appears to reduce the incidence of severe fetal complications.