[Strategies for the diagnosis and treatment of prenatal toxoplasmosis - a survey].
Today, a decreasing number of infants with prenatal toxoplasmosis present with clinical signs of severe, generalised infection and cerebral involvement. The favourable clinical outcome - mild or subclinical infection - is considered to be an effect of early maternofetal treatment with spiramycin and pyrimethamine/sulfadiazine (PS). However, a Cochrane Review and a recently published European multicentre study on congenital toxoplasmosis did not only question this positive effect but also the efficiency of a postnatal long-term therapy. Both studies caused much confusion among neonatologists and paediatricians. The new setting requires an update of the diagnostic possibilities and different therapeutic strategies for prenatal toxoplasmosis. Only few prospective studies are available to compare the efficiency of different drug regimens in infected infants. However, clinical data demonstrate that the available therapeutics are not curative and cannot prevent late sequelae. Follow-up studies in pregnant women and their offspring show that prenatal parasite detection does not predict an unfavourable clinical outcome when treatment is initiated early after diagnosis. In Germany, prenatal screening is not obligatory. In case of primary maternal infection, materno-fetal therapy is recommended. A combination therapy consisting of PS is considered more effective than a spiramycin monotherapy. Treatment is recommended for all infected newborns with different strategies for infants with or without clinical symptoms. The treatment strategies of different European countries are discussed. This paper provides recommendations for the diagnosis and treatment of newborn toxoplasmosis and materno-fetal infection as well as recommendations for the clinical management of infected neonates and their follow-up, including drug monitoring.
Christoph
J
J
Kinderkrankenhaus auf der Bult, Hannover. christoph@hka.de
Kattner
E
E
Seitz
H M
HM
Reiter-Owona
I
I
D003049:Coccidiostats / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011739:Pyrimethamine / Q000008:administration & dosage; D012307:Risk Factors; D015572:Spiramycin / Q000008:administration & dosage; D013411:Sulfadiazine / Q000008:administration & dosage; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome
D003049:Coccidiostats; D013411:Sulfadiazine; D015572:Spiramycin; D011739:Pyrimethamine