scholarly journals Value of Prenatal Diagnosis and Early Postnatal Diagnosis of Congenital Toxoplasmosis: Retrospective Study of 110 Cases

1999 ◽  
Vol 37 (9) ◽  
pp. 2893-2898 ◽  
Author(s):  
Florence Robert-Gangneux ◽  
Marie-Françoise Gavinet ◽  
Thierry Ancelle ◽  
Josette Raymond ◽  
Claudine Tourte-Schaefer ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Cord Blood ◽  
Congenital Toxoplasmosis ◽  
Congenital Infection ◽  
Parasite Load ◽  
Maternal Serum ◽  
Immunoglobulin M ◽  
Postnatal Diagnosis ◽  
First Year Of Life

We reviewed the files of 110 women with Toxoplasmaseroconversion during pregnancy. Prenatal diagnosis was attempted for 94 women by amniotic fluid sampling. Toxoplasma gondii was detected by PCR, with or without tissue culture and mouse inoculation. The early neonatal diagnostic procedure included placental testing by PCR and/or mouse inoculation, cord blood serological testing, and comparison of maternal and newborn antibodies by Western blotting (WB). Serological follow-up of the infants was conducted during the first year of life or until the diagnosis of congenital toxoplasmosis (CT) could be ruled out. Congenital infection was diagnosed in 27 individuals (20 live births) in the prenatal and/or neonatal period. The sensitivity and specificity of prenatal diagnosis were 81 and 100%, respectively. Placental examination was positive for 66.7% of individuals with CT and was always negative for neonates without CT. Cord blood serology detected immunoglobulin M (IgM) and/or IgA in 80% of infected newborns, with respective specificities of 91.2 and 87.7%. By WB we detected bands on IgG and IgM blots recognized by the newborn serum but not by the maternal serum (neosynthesized IgG and/or IgM) for 88.2% of infected infants within the first 2 months of life with a specificity of 100%. Early postnatal diagnosis was negative for 2 of the 20 neonates with CT. Both of these newborns had a negative prenatal diagnosis and were asymptomatic, suggesting a very low parasite load. In conclusion, despite the use of advanced methods, some cases of congenital toxoplasmosis cannot be detected early, which underlines the importance of careful follow-up of newborns who are at risk.

scholarly journals Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group

Pathogens ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 24 ◽  
Author(s):  
François Peyron ◽  
Coralie L’ollivier ◽  
Laurent Mandelbrot ◽  
Martine Wallon ◽  
Renaud Piarroux ◽  
...  
Keyword(s):  
Working Group ◽  
Congenital Toxoplasmosis ◽  
Congenital Infection ◽  
Before And After ◽  
Multidisciplinary Working ◽  
Neurological Alterations ◽  
Multidisciplinary Group ◽  
Toxoplasmosis During Pregnancy

Women infected with toxoplasmosis during pregnancy do not present symptoms in most cases, but the consequences of the congenital infection may be severe for the unborn child. Fetal damage can range from asymptomatic to severe neurological alterations to retinal lesions prone to potential flare up and relapses lifelong. Despite the possible severity of outcome, congenital toxoplasmosis (CT) is a neglected disease. There is no consensus regarding screening during pregnancy, prenatal/postnatal treatment or short or medium term follow-up. Since 1992, France has offered systematic serological testing to non-immune pregnant women, monthly until delivery. Any maternal infection is thus detected; moreover, diagnosis of congenital infection can be made at birth and follow-up can be provided. “Guidelines” drawn up by a multidisciplinary group are presented here, concerning treatment, before and after birth. The recommendations are based on the regular analysis of the literature and the results of the working group. The evaluation of the recommendations takes into account the robustness of the recommendation and the quality of the evidence.

scholarly journals Follow-up of Toxoplasmosis during Pregnancy: Ten-Year Experience in a University Hospital in Southern Brazil

2019 ◽  
Vol 41 (09) ◽  
pp. 539-547 ◽  
Author(s):  
Amanda Andrade Diesel ◽  
Suzana de Azevedo Zachia ◽  
Ana Lúcia Letti Müller ◽  
Amanda Vilaverde Perez ◽  
Flavio Antonio de Freitas Uberti ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Triple Therapy ◽  
Gestational Age ◽  
Congenital Toxoplasmosis ◽  
Immunoglobulin M ◽  
University Hospital ◽  
Pcr Analysis ◽  
Ultrasound Findings

Abstract Objective To describe a population of pregnant women diagnosed with toxoplasmosis and their respective newborns, describing the hospital protocol for treatment and follow-up. Methods Retrospective cohort of pregnant women with acute toxoplasmosis infection and risk of transplacental transmission who were sent to the Fetal Medicine Group of Hospital de Clínicas de Porto Alegre (HCPA) between - January 1, 2006 and December 31, 2016. All patients with confirmed disease were included. The diagnostic protocol and treatment were applied; a polymerase chain reaction (PCR) analysis of the amniotic fluid was used to diagnose toxoplasmosis and determine the treatment. The newborns were followed up at the pediatric outpatient clinic specializing in congenital infection. The patients who were not followed up or were not born in the HCPA were excluded. Results A total of 65 patients were confirmed to have gestational toxoplasmosis; 40 performed amniocentesis, and 6 (15%) were identified as having positive PCR in the amniotic fluid. In five of those cases, this result associated with the gestational age defined the triple therapy during pregnancy, and in one case, it defined the monotherapy (advanced gestational age). A total of 4 of these newborns were treated from birth with triple therapy for 10 months, 1 was not treated (due to maternal refusal), and 1 progressed to death within the first 54 hours of life due to complications of congenital toxoplasmosis. Of the 34 remaining cases with a negative PCR, 33 were treated with monotherapy and 1 was treated with triple therapy (ultrasound findings); of these children, 9 (26.5%) presented negative immunoglobulin G (IgG), 24 (70.6%) presented positive IgG (but none presented positive immunoglobulin M [IgM]), and 1 (2,9%) presented alterations compatible with congenital disease and started treatment with the triple therapy soon after birth. Out of the total sample of 60 patients, among the 25 who did not perform amniotic fluid PCR, 5 were treated with triple therapy (ultrasound findings/prior treatment) and 20 patients were submitted to monotherapy; only two newborns underwent treatment for congenital toxoplasmosis. Among the 65 cases of gestational toxoplasmosis, 6 (9,2%) children had a diagnosis of congenital toxoplasmosis, and 2 patients with triple therapy felt severe adverse effects of the medications. Conclusions The present study suggests that research on PCR screening of the amniotic fluid may be useful to identify patients with a higher potential for fetal complications, who may benefit from the poly-antimicrobial treatment. Patients with negative PCR results must continue to prevent fetal infection with monotherapy, without risk of fetal or maternal impairment.

scholarly journals Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

2002 ◽  
Vol 15 (4) ◽  
pp. 680-715 ◽  
Author(s):  
Maria Grazia Revello ◽  
Giuseppe Gerna
Keyword(s):  
Prenatal Diagnosis ◽  
Human Cytomegalovirus ◽  
Primary Infection ◽  
Hcmv Infection ◽  
Prognostic Markers ◽  
Recurrent Infection ◽  
Congenital Infection ◽  
Immunoglobulin M ◽  
Hcmv Disease ◽  
The Impact

SUMMARY Human cytomegalovirus (HCMV) is the leading cause of congenital viral infection and mental retardation. HCMV infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary (and also recurrent) infection to the fetus. Hence, careful diagnosis of primary infection is required in the pregnant woman based on the most sensitive serologic assays (immunoglobulin M [IgM] and IgG avidity assays) and conventional virologic and molecular procedures for virus detection in blood. Maternal prognostic markers of fetal infection are still under investigation. If primary infection is diagnosed in a timely manner, prenatal diagnosis can be offered, including the search for virus and virus components in fetal blood and amniotic fluid, with fetal prognostic markers of HCMV disease still to be defined. However, the final step for definite diagnosis of congenital HCMV infection is detection of virus in the blood or urine in the first 1 to 2 weeks of life. To date, treatment of congenital infection with antiviral drugs is only palliative both prior to and after birth, whereas the only efficacious preventive measure seems to be the development of a safe and immunogenic vaccine, including recombinant, subunit, DNA, and peptide-based vaccines now under investigation. The following controversial issues are discussed in the light of the most recent advances in the field: the actual perception of the problem; universal serologic screening before pregnancy; the impact of correct counseling on decision making by the couple involved; the role of prenatal diagnosis in ascertaining transmission of virus to the fetus; the impact of preconceptional and periconceptional infections on the prevalence of congenital infection; and the prevalence of congenitally infected babies born to mothers who were immune prior to pregnancy compared to the number born to mothers undergoing primary infection during pregnancy.

scholarly journals Evaluation of the Liaison Automated Testing System for Diagnosis of Congenital Toxoplasmosis

2012 ◽  
Vol 19 (11) ◽  
pp. 1859-1863 ◽  
Author(s):  
Andrea-Romana Prusa ◽  
Michael Hayde ◽  
Arnold Pollak ◽  
Kurt R. Herkner ◽  
David C. Kasper
Keyword(s):  
Predictive Value ◽  
Congenital Toxoplasmosis ◽  
Congenital Infection ◽  
Confirmatory Test ◽  
Diagnostic Tools ◽  
First Year ◽  
Study Cohort ◽  
Serum Samples ◽  
Content Type ◽  
First Year Of Life

ABSTRACTCongenital toxoplasmosis is a worldwide health problem, and different screening strategies exist. Testing of toxoplasma-specific antibodies in infants identifies congenital toxoplasmosis during the first year of life. However, experience with commercial available immunoassays is limited. The aim of this study was to evaluate both the performance and analytical characteristics of the Liaison diagnostic system in infants. In a retrospective study, serumToxoplasma gondiiantibodies were measured in samples from 333 infants, including 212 noninfected infants and 121 infants with congenital toxoplasmosis. A total of 1,157 umbilical cord blood and peripheral serum samples were analyzed. Liaison toxoplasma-specific IgG and IgM antibodies and the IgG avidity index were compared to the infection status of the infant, determined by the Sabin-Feldman dye test and immunosorbent agglutination assay—IgM. All noninfected infants were seronegative by Liaison IgG within the first year of life. The Liaison system showed a sensitivity of 81.8%, a specificity of 100.0%, a positive predictive value of 100.0%, a negative predictive value of 90.6%, and overall agreement of 84.4% by comparison with the dye test. Overall agreement of both IgM test systems was 96.0%. In this study cohort, avidity did not show a potential diagnostic benefit for the detection of congenital infection. In conclusion, the Liaison system is a valuable tool to monitor the serologic course of infants at risk. A final serologic confirmatory test is recommended to improve the rate of detection of congenital toxoplasmosis at 1 year of life. Protocols of routine follow-up testing in infants and accurate diagnostic tools after acute gestational infections are needed to improve medical care.

scholarly journals Repertoire of Naturally Acquired Maternal Antibodies Transferred to Infants for Protection Against Shigellosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Esther Ndungo ◽  
Liana R. Andronescu ◽  
Andrea G. Buchwald ◽  
Jose M. Lemme-Dumit ◽  
Patricia Mawindo ◽  
...  
Keyword(s):  
Cord Blood ◽  
Placental Transfer ◽  
Disease Incidence ◽  
Shigella Flexneri ◽  
Maternal Serum ◽  
Maternal Antibodies ◽  
Endemic Region ◽  
Specific Antibodies ◽  
Epidemiological Trend ◽  
First Year Of Life

Shigella is the second leading cause of diarrheal diseases, accounting for >200,000 infections and >50,000 deaths in children under 5 years of age annually worldwide. The incidence of Shigella-induced diarrhea is relatively low during the first year of life and increases substantially, reaching its peak between 11 to 24 months of age. This epidemiological trend hints at an early protective immunity of maternal origin and an increase in disease incidence when maternally acquired immunity wanes. The magnitude, type, antigenic diversity, and antimicrobial activity of maternal antibodies transferred via placenta that can prevent shigellosis during early infancy are not known. To address this knowledge gap, Shigella-specific antibodies directed against the lipopolysaccharide (LPS) and virulence factors (IpaB, IpaC, IpaD, IpaH, and VirG), and antibody-mediated serum bactericidal (SBA) and opsonophagocytic killing antibody (OPKA) activity were measured in maternal and cord blood sera from a longitudinal cohort of mother-infant pairs living in rural Malawi. Protein-specific (very high levels) and Shigella LPS IgG were detected in maternal and cord blood sera; efficiency of placental transfer was 100% and 60%, respectively, and had preferential IgG subclass distribution (protein-specific IgG1 > LPS-specific IgG2). In contrast, SBA and OPKA activity in cord blood was substantially lower as compared to maternal serum and varied among Shigella serotypes. LPS was identified as the primary target of SBA and OPKA activity. Maternal sera had remarkably elevated Shigella flexneri 2a LPS IgM, indicative of recent exposure. Our study revealed a broad repertoire of maternally acquired antibodies in infants living in a Shigella-endemic region and highlights the abundance of protein-specific antibodies and their likely contribution to disease prevention during the first months of life. These results contribute new knowledge on maternal infant immunity and target antigens that can inform the development of vaccines or therapeutics that can extend protection after maternally transferred immunity wanes.

scholarly journals Prenatal maternal and cord blood vitamin D concentrations and negative affectivity in infancy

2021 ◽  
Author(s):  
Sara Sammallahti ◽  
Elisa Holmlund-Suila ◽  
Runyu Zou ◽  
Saara Valkama ◽  
Jenni Rosendahl ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cord Blood ◽  
Negative Affectivity ◽  
Maternal Serum ◽  
Maternal Vitamin ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
Standard Deviations ◽  
Temperamental Trait

AbstractHigher maternal vitamin D concentration during pregnancy is associated with better child mental health. Negative affectivity, an early-emerging temperamental trait, indicates an increased risk of psychopathology. We investigated if maternal early/mid-pregnancy 25-hydroxyvitamin D (25(OH)D) and neonatal cord blood 25(OH)D concentrations are associated with Negative affectivity in infancy. We studied term-born infants from the vitamin D Intervention in Infants study (VIDI, n = 777, follow-up rate 80%, Finland), and the Generation R Study (n = 1505, follow-up rate 40%, Netherlands). We measured maternal serum 25(OH)D at 6–27 weeks (VIDI) or 18–25 weeks (Generation R) of pregnancy, and cord blood 25(OH)D at birth (both cohorts). Caregivers rated infant Negative affectivity at 11.7 months (VIDI) or 6.5 months (Generation R) using the Revised Infant Behavior Questionnaire. Using linear regression, we tested associations between 25(OH)D and Negative affectivity adjusted for infant age, sex, season of 25(OH)D measurement, maternal age, education, smoking, and body-mass-index. Per 10 nmol/l increase in maternal early/mid-pregnancy 25(OH)D, infant Negative affectivity decreased by 0.02 standard deviations (95% confidence interval [CI] − 0.06, − 0.004) in VIDI, and 0.03 standard deviations (95% CI − 0.03, − 0.01) in Generation R. Cord blood 25(OH)D was associated with Negative affectivity in Generation R (− 0.03, 95% CI − 0.05, − 0.01), but not VIDI (0.00, 95% CI − 0.02, 0.02). Lower maternal 25(OH)D concentrations were consistently associated with higher infant Negative affectivity, while associations between cord blood 25(OH)D concentrations and Negative affectivity were less clear. Maternal vitamin D status during early- and mid-pregnancy may be linked with early-emerging differences in offspring behavior.

scholarly journals Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy

2020 ◽  
Vol 105 (5) ◽  
pp. 262-269 ◽  
Author(s):  
Anja Saso ◽  
Alasdair Bamford ◽  
Karen Grewal ◽  
Muna Noori ◽  
James Hatcher ◽  
...  
Keyword(s):  
Congenital Toxoplasmosis ◽  
Congenital Infection ◽  
Careful Consideration ◽  
Current Evidence ◽  
Clinical Consequences ◽  
Initiation Of Therapy ◽  
The Uk ◽  
Key Aspects

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.

Congenital cytomegalovirus infection after maternal persistent immunoglobulin-M antibodies against cytomegalovirus prior to conception

2013 ◽  
Vol 2 (1-2) ◽  
Author(s):  
Yoshiyuki Nakajima ◽  
Naoki Masaoka ◽  
Tatsuo Yamamoto
Keyword(s):  
Cytomegalovirus Infection ◽  
Congenital Infection ◽  
Maternal Serum ◽  
Immunoglobulin M ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Congenital Cmv Infection ◽  
Infant Girl ◽  
Congenital Cmv

AbstractWe describe a case of congenital cytomegalovirus (CMV) infection transmitted by an immunocompetent woman infected before conception with continuous hyper CMV-immunoglobulin M (IgM). A 33-year-old woman whose CMV-IgM levels were stable more than 8 months before conception was referred at 35 gestational weeks due to fetal unilateral cerebral ventriculomegaly. The maternal serum CMV-IgG was 61.7 U/mL, and the CMV-IgM was 3.89 U/mL. An infant girl weighing 2297 g was delivered transvaginally. The neonate was found to have congenital CMV infection. After delivery, the high maternal CMV-IgM level has continued for more than 2 years. In conclusion, although continuous hyper CMV-IgM is rare, the infants of infected women may develop congenital infection. It is our hope that the information provided in the present case will further aid clinicians in counseling patients who find themselves in this situation.

Considerations over a cytomegalovirus induced hepatitis in an infant with prolonged jaundice

2015 ◽  
Vol 18 (4) ◽  
pp. 157-159
Author(s):  
Valeriu V. Lupu ◽  
◽  
Irina Manuela Mucenica ◽  
Gabriela Păduraru ◽  
Ancuţa Ignat ◽  
...  
Keyword(s):  
Congenital Infection ◽  
Immunoglobulin M ◽  
Perinatal Infection ◽  
Cmv Infection ◽  
Immune Mediated ◽  
Breast Milk Jaundice ◽  
The Moment ◽  
Hepatic Cytolysis ◽  
Prolonged Jaundice

Human cytomegalovirus (CMV) is a herpesvirus, a member of the beta-herpesvirus subfamily. Infection with CMV represents a major cause of congenital infection, and also a cause of perinatal infection. We present the case of a 3 months-old sugar with breast milk jaundice and hepatic cytolysis, in our evidence from one month. At the age of 6 weeks, at the second evaluation, the laboratory tests showed a mild increase of lymphocytes and monocytes, minimum hepatic cytolysis and positive CMV immunoglobulin M (IgM) assays. Our decision was to follow up the case, without antiviral therapy, because the acute CMV infection was asymptomatic. Therefore, the hepatic cytolysis may precede the presence of CMV in blood, because the immune mediated response to CMV involve specific antibodies type IgM few weeks after the moment of infection.

scholarly journals Incidence of Toxoplasma gondii Infection in 35,940 Pregnant Women in Norway and Pregnancy Outcome for Infected Women

1998 ◽  
Vol 36 (10) ◽  
pp. 2900-2906 ◽  
Author(s):  
Pål A. Jenum ◽  
Babill Stray-Pedersen ◽  
Kjetil K. Melby ◽  
Georg Kapperud ◽  
Andrew Whitelaw ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Pregnant Women ◽  
Screening Program ◽  
Transmission Rate ◽  
Congenital Infection ◽  
First Trimester ◽  
Immunoglobulin M ◽  
Capital City ◽  
Toxoplasma Gondii Infection

From 1992 to 1994 a screening program for detection of specific Toxoplasma gondii antibodies involving 35,940 pregnant women was conducted in Norway. For women with serological evidence of primary T. gondii infection, amniocentesis and antiparasitic treatment were offered. The amniotic fluid was examined for T. gondii by PCR and mouse inoculation to detect fetal infection. Infants of infected mothers had clinical and serological follow-up for at least 1 year to detect congenital infection. Of the women 10.9% were infected before the onset of pregnancy. Forty-seven women (0.17% among previously noninfected women) showed evidence of primary infection during pregnancy. The highest incidence was detected (i) among foreign women (0.60%), (ii) in the capital city of Oslo (0.46%), and (iii) in the first trimester (0.29%). Congenital infection was detected in 11 infants, giving a transmission rate of 23% overall, 13% in the first trimester, 29% in the second, and 50% in the third. During the 1-year follow-up period only one infant, born to an untreated mother, was found to be clinically affected (unilateral chorioretinitis and loss of vision). At the beginning of pregnancy 0.6% of the previously uninfected women were falsely identified as positive by the Platelia Toxo-IgM test, the percentage increasing to 1.3% at the end of pregnancy. Of the women infected prior to pregnancy 6.8% had persisting specific immunoglobulin M (IgM). A positive specific-IgM result had a low predictive value for identifying primaryT. gondii infection.

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