title: Incidence of toxoplasmosis in 5532 pregnant women in Crete, Greece: management of 185 cases at risk.
abstract: OBJECTIVE
  To study the incidence of toxoplasmosis in pregnant women in Crete and to test a designed protocol for handling those at risk of delivering congenitally infected infants.
  
  
  METHODS
  Pregnant women were screened serologically over a period of 5 years. Cases with suspected acute toxoplasmosis were treated, peripheral blood (PB), and amniotic fluid (AF) tested by polymerase chain reaction (PCR) and culture, and fetuses monitored by ultrasonography. The absence of congenital infection in infants was confirmed by serology and clinical evaluation.
  
  
  RESULTS
  Of the 5532 pregnant women followed, 70.57% remained seronegative, 29.45% were seropositive, and there was direct evidence of seroconversion in six cases. Acute toxoplasmosis was suspected in 185 cases, maternal parasitemia was detected in five cases and positive amniotic fluid in one case. Congenital infection was excluded in all infants followed, based on the absence of ultrasound findings in utero, lack of clinical symptoms at birth, negative Western blotting (WB) at birth and 3 months later, and descending serology for a year.
  
  
  CONCLUSIONS
  Overall, 29.45% of the pregnant women followed were seropositive, 3.3% with suspected acute toxoplasmosis, and in 0.02% cases there was evidence of maternofetal transmission. The protocol tested allowed differentiation between acute and latent toxoplasmosis, safe management of the cases at risk and assisted in avoidance of unwarranted pregnancy terminations.
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Heraklion, Crete, Greece. antoniou@med.uoc.gr
authors.forename: Maria
authors.initials: M
authors.lastname: Antoniou
authors.forename: Haris
authors.initials: H
authors.lastname: Tzouvali
authors.forename: Stavros
authors.initials: S
authors.lastname: Sifakis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Galanakis
authors.forename: Effie
authors.initials: E
authors.lastname: Georgopoulou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Liakou
authors.forename: Christina
authors.initials: C
authors.lastname: Giannakopoulou
authors.forename: Evgenios
authors.initials: E
authors.lastname: Koumantakis
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Tselentis
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008403:Mass Screening; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D014123:Toxoplasmosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy