title: Fetal therapy of severe symptomatic toxoplasmosis using azithromycin.
abstract: Severe symptomatic fetal toxoplasmosis rarely occurs after the maternal primary infection of Toxoplasma gondii. We herein report our experience of fetal therapy of symptomatic toxoplasmosis using azithromycin. Ultrasound assessment at 23 weeks' gestation revealed fetal ascites, cardiac effusion, cardiomegaly, enlarged lateral ventricles and thickened placenta. Serum Toxoplasma gondii antibody titer was ×81,920. Toxoplasma immunoglobulin M was 2.4 index (normal, <0.8 index), and immunoglobulin G was ≥240 IU/mL (normal, <6 IU/mL). Maternal oral administration of azithromycin in addition to sulfadoxine, pyrimethamine and acetylspiramycin was conducted. Spontaneous vaginal delivery occurred at 32 weeks and a male infant weighing 2036 g was born. Hepatosplenomegaly, chorioretinitis, hydrocephalus, intracranial calcifications, ascites, and meningitis were confirmed after birth. The infant underwent therapy with pyrimethamine and sulfadiazine. It seems imperative to establish a new drug choice for fetal therapy of severe symptomatic toxoplasmosis in order to reduce the maternal and fetal risks of drug side-effects.
authors: Department of Obstetrics, Center for Perinatal Medicine, Nagano Children's Hospital, Nagano, Japan.
authors: Shunsuke
authors: S
authors: Tamaru
authors: Akihiko
authors: A
authors: Kikuchi
authors: Kimiyo
authors: K
authors: Takagi
authors: Masao
authors: M
authors: Wakamatsu
authors: Tsuguhiro
authors: T
authors: Horikoshi
authors: Yoshifumi
authors: Y
authors: Ogiso
mesh_terms: D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D050498:Live Birth; D012720:Severity of Illness Index; D014125:Toxoplasmosis, Congenital / Q000188:drug therapy*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D017963:Azithromycin