[Postnatal follow-up of infants born to mothers with certain Toxoplasma gondii infection: evaluation of prenatal management].
The clinical management of perinatal toxoplasmosis involves a gynaecologist during pregnancy and a neonatologist after delivery. Then, in the absence of a uniform approach, early evaluation of infected infants requires a thorough long-term follow-up also in asymptomatic children, who have to be observed for at least one year due to unpredictable sequelae in later life. We retrospectively analyzed pregnancy management of 54 women with certain infection from Toxoplasma gondii (TG) and prospectively enrolled their infants to compare prenatal management with postnatal clinical outcome. All mothers with seroconversion for TG infection were from the Palermo area and were retrospectively analyzed, whereas their newborns referred to G. Di Cristina Children Clinical Hospital between 1999-2004 were prospectively enrolled in a 48-month follow-up. Timing of infection was dated for 24 women (45%) to the first trimester, 18 (33%) to the second and 12 (22%) the third. The maternal-fetal transmission rate was 17.2%. Prenatal diagnosis from amniotic fluid was performed in 25/54 pregnant subjects and showed positive results in 6. Despite diagnosis of TG infection, 9 women were untreated and only 2 with positive amniocentesis received combined therapy. 10/55 enrolled infants were infected and half of them were preterm and/or SGA at birth. None showed peculiar signs of TG at birth but 4 had abnormalities during the follow-up. 9/10 infected children were born to mothers who had undergone neither amniocentesis nor combined therapy.


CONCLUSIONS
Our work confirms the difficulty of applying standardized therapeutic protocol for TG infection during pregnancy. The asymptomatic course of TG infection at birth confirms the importance of an instrumental long-term follow-up to identify typical TG lesion to prevent sequelae.
Di Carlo
Paola
P
Istituto di Patologia Infettiva, Universita di Palermo, Divisione di Malattie Infettive, ARNAS Civico e Benfratelli, G. Di Cristina e M. Ascoli, Unita Operativa di Ginecologia e Ostetricia, ARNAS Civico e Benfratelli, G. Di Cristina e M. Ascoli, Italy.
Mazzola
Angela
A
Romano
Amelia
A
Schimmenti
Maria Gabriella
MG
Colicchia
Paola
P
Bellipanni
Piero
P
Titone
Lucina
L
D000293:Adolescent; D000328:Adult; D000649:Amniocentesis; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002825:Chorioretinitis / Q000151:congenital / Q000209:etiology / Q000469:parasitology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007074:Immunoglobulin G / Q000097:blood; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D007236:Infant, Small for Gestational Age; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007558:Italy / Q000453:epidemiology; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters; D011295:Prenatal Care; D011446:Prospective Studies; D011739:Pyrimethamine / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D015572:Spiramycin / Q000627:therapeutic use; D013411:Sulfadiazine / Q000008:administration & dosage / Q000627:therapeutic use*; D014122:Toxoplasma / Q000276:immunology; D014123:Toxoplasmosis / Q000188:drug therapy / Q000453:epidemiology*; D016781:Toxoplasmosis, Cerebral / Q000150:complications; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D014126:Toxoplasmosis, Ocular / Q000188:drug therapy / Q000209:etiology
D000913:Antibodies, Protozoan; D000981:Antiprotozoal Agents; D007074:Immunoglobulin G; D013411:Sulfadiazine; D015572:Spiramycin; D002955:Leucovorin; D011241:Prednisone; D011739:Pyrimethamine