Clinical relevance of placenta examination for the diagnosis of congenital toxoplasmosis.
BACKGROUND
Neonates with congenital toxoplasmosis, even asymptomatic at birth, should be treated early to reduce long-term sequelae. Postnatal diagnosis of congenital toxoplasmosis is essential because prenatal diagnosis fails to detect approximately 15% of cases or cannot be performed when maternal infection is acquired in late pregnancy. Detection of parasites in the placenta is one diagnostic approach to the early neonatal diagnosis of congenital toxoplasmosis.


METHODS
The parasitic analyses of 102 placentas from cases of toxoplasmosis acquired during gestation were reviewed, with complete biologic follow-up of neonates. The value of quantitative PCR and mouse inoculation was assessed, and results are discussed in light of prenatal treatment and postnatal outcome.


RESULTS
Congenital toxoplasmosis was diagnosed in 28 of the 102 cases. A prenatal diagnosis was obtained in only 16 cases. Specific IgM was detected in 57% of the babies at birth. A positive placental examination by PCR and mouse inoculation was the only evidence of infection in 3 neonates (11%) who were asymptomatic at birth. The sensitivities of PCR and mouse inoculation were 71% and 67%, respectively, and the specificities were 97% and 100%. Parasites were detected more often when maternal infection was acquired during the third trimester of pregnancy (P < 0.01), regardless the type of treatment. The sensitivity of IgM detection appeared to be related to maternal treatment since IgM was positive in 43% and 75% when mothers were treated or not, respectively (P < 0.01). Though 5/7 symptomatic infants had a positive placenta examination, there was no correlation between a positive placenta and the presence of clinical signs during the first year of life. The positive and negative predictive values of placental examination were 91% and 90%, respectively.


CONCLUSIONS
Placental examination is an efficient tool for the early diagnosis of congenital toxoplasmosis.
Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Université Rennes 1, 2 Avenue Pr Léon Bernard, 35043 Rennes cedex, France. florence.robert-gangneux@univ-rennes1.fr
Florence
F
Robert-Gangneux
Peggy
P
Dupretz
Chantal
C
Yvenou
Dorothé
D
Quinio
Patrice
P
Poulain
Claude
C
Guiguen
Jean-Pierre
JP
Gangneux
D032761:Animal Experimentation; D000818:Animals; D016054:DNA, Protozoan / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D051379:Mice; D010920:Placenta / Q000469:parasitology*; D016133:Polymerase Chain Reaction / Q000379:methods; D011247:Pregnancy; D012680:Sensitivity and Specificity; D014122:Toxoplasma / Q000302:isolation & purification*; D014125:Toxoplasmosis, Congenital / Q000175:diagnosis*
D016054:DNA, Protozoan