title: Prematurity and severity are associated with Toxoplasma gondii alleles (NCCCTS, 1981-2009).
abstract: BACKGROUND
  Congenital toxoplasmosis is a severe, life-altering disease in the United States. A recently developed enzyme-linked immunosorbent assay (ELISA) distinguishes Toxoplasma gondii parasite types (II and not exclusively II [NE-II]) by detecting antibodies in human sera that recognize allelic peptide motifs of distinct parasite types.
  
  
  METHODS
  ELISA determined parasite serotype for 193 congenitally infected infants and their mothers in the National Collaborative Chicago-based Congenital Toxoplasmosis Study (NCCCTS), 1981-2009. Associations of parasite serotype with demographics, manifestations at birth, and effects of treatment were determined.
  
  
  RESULTS
  Serotypes II and NE-II occurred in the United States with similar proportions during 3 decades. For persons diagnosed before or at birth and treated in infancy, and persons diagnosed after 1 year of age who missed treatment in infancy, proportions were similar (P = .91). NE-II serotype was more common in hot, humid regions (P = .02) but was also present in other regions. NE-II serotype was associated with rural residence (P < .01), lower socioeconomic status (P < .001), and Hispanic ethnicity (P < .001). Prematurity (P = .03) and severe disease at birth (P < .01) were associated with NE-II serotype. Treatment with lower and higher doses of pyrimethamine with sulfadizine improved outcomes relative to those outcomes of persons in the literature who did not receive such treatment.
  
  
  CONCLUSIONS
  Type II and NE-II parasites cause congenital toxoplasmosis in North America. NE-II serotype was more prevalent in certain demographics and associated with prematurity and severe disease at birth. Both type II and NE-II infections improved with treatment.
  
  
  BACKGROUND
  NCT00004317.
authors.affiliation: Department of Opthalmology and Visual Sciences, University of Chicago, Chicago, Illinois 60637, USA. rmcleod@midway.uchicago.edu
authors.forename: Rima
authors.initials: R
authors.lastname: McLeod
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boyer
authors.forename: Daniel
authors.initials: D
authors.lastname: Lee
authors.forename: Ernest
authors.initials: E
authors.lastname: Mui
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.forename: Theodore
authors.initials: T
authors.lastname: Karrison
authors.forename: A Gwendolyn
authors.initials: AG
authors.lastname: Noble
authors.forename: Shawn
authors.initials: S
authors.lastname: Withers
authors.forename: Charles N
authors.initials: CN
authors.lastname: Swisher
authors.forename: Peter T
authors.initials: PT
authors.lastname: Heydemann
authors.forename: Mari
authors.initials: M
authors.lastname: Sautter
authors.forename: Jane
authors.initials: J
authors.lastname: Babiarz
authors.forename: Peter
authors.initials: P
authors.lastname: Rabiah
authors.forename: Paul
authors.initials: P
authors.lastname: Meier
authors.forename: Michael E
authors.initials: ME
authors.lastname: Grigg
mesh_terms: D000293:Adolescent; D000483:Alleles; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012703:Serotyping; D014122:Toxoplasma / Q000145:classification* / Q000472:pathogenicity*; D014125:Toxoplasmosis, Congenital / Q000453:epidemiology* / Q000469:parasitology* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D014774:Virulence
chemical_list: D000913:Antibodies, Protozoan