When are we going to celebrate the centenary of the discovery of efficient treatment for congenital toxoplasmosis?
In 2008, we have celebrated the centenary of the discovery of Toxoplasma gondii.Although this ubiquitous protozoan can generate devastating damage in foetuses and newborns, its treatment is the only field in which we have made little progress, despite a huge body of research, and has not yet been validated. Pregnant women who seroconvert are generally given spiramycine in order to reduce the risk of vertical transmission. However, to date, we have no evidence of the efficacy of this treatment because no randomized controlled trials have as yet been conducted. When foetal contamination is demonstrated, pyrimethamine, in association with sulfadoxine or sulfadiazine, is normally prescribed, but the effectiveness of this treatment remains to be shown. With regard to postnatal treatment, opinions vary considerably in terms of drugs, regimens and length of therapy. Similarly, we do not have clear evidence to support routine antibiotic treatment of acute ocular toxoplasmosis. We must be aware that pregnant women and newborns are currently being given empirically potentially toxic drugs that have no proven benefit. We must make progress in this field through well-designed collaborative studies and by drawing the attention of policy makers to this disastrous and unsustainable situation.
Laboratoire de Parasitologie et Pathologie Exotique, Hôpital de Croix Rousse, Lyon, France. francois.peyron@chu-lyon.fr
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D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy*; D014122:Toxoplasma; D014125:Toxoplasmosis, Congenital / Q000188:drug therapy* / Q000517:prevention & control
D000981:Antiprotozoal Agents