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Toxoplasmosis in pregnancy: test, treatment and outcome

Year 2022, Volume: 8 Issue: 2, 296 - 303, 04.03.2022
https://doi.org/10.18621/eurj.1039212

Abstract

Objectives: The aim of this study was to share the results, follow-up, and treatment characteristics of our pregnant women who were followed-up with anti-Toxoplasma gondii Immunoglobulin (Ig) M positivity during pregnancy.

Methods: Anti-T. gondii IgM- and IgG-positive pregnant women were evaluated between 2014-2018. Demographic characteristics, treatment, and information about pregnancy were obtained from the electronic database. Pregnant women were divided into three groups; primary infection, no infection, and suspected infection in pregnancy. Primary and suspected infection in pregnancy were followed up congenital toxoplasmosis risky pregnancy. Fetal ultrasonography (USG), T. gondii DNA polymerase chain reaction (PCR) result in amniotic fluid were recorded.


Results:
Twenty-four pregnant women with a mean age of 27.9 years were followed up. IgG avidity results were low in 37.5% (n = 9), intermediate avidity in 8.3% (n = 2), and high avidity in 54.2% (n = 13) of pregnant women. Eleven (45.9%) pregnant women had congenital toxoplasmosis risky pregnancy. Fetal USG was performed on ten pregnant women, and no signs of congenital toxoplasmosis were found. Amniocentesis was performed in 72.7% (n = 8) of the participants, and the amniotic fluid T. gondii DNA-PCR result was negative in all of them. Ten (90.9%) pregnancies resulted in mature birth and one (9.1%) resulted in miscarriage.


Conclusions:
Anti-T. gondii IgM positivity is an indication of acute infection. But IgM can persist for years, and be false-positive in pregnancy. Therefore, additional tests are required, and leading to emotional distress and unnecessary interventions in pregnacy women. These results can aid in developing an approach to screening and diagnosis of T. gondii infection in pregnancy.

References

  • 1. Saadatnia G, Golkar M. A review on human toxoplasmosis. Scand J Infect Dis 2012; 44: 805-14.
  • 2. National Center for Health Statistics. Plan and operation of the third National Health and Nutrition Examination Survey, 1988-94. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; series 1, no. 32).
  • 3. Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004;363:1965-76.
  • 4. Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009;39:1385-94.
  • 5. Akyar I. Seroprevalence and coinfections of Toxoplasma gondii in childbearing age women in Turkey. Iranian J Publ Health 2011;40:63-7.
  • 6. Karabulut A, Polat Y, Türk M, Balcı YI. Evaluation of rubella, Toxoplasma gondii, and cytomegalovirus seroprevalences among pregnant women in Denizli province. Turk J Med Sci 2011;41:159-64.
  • 7. Tekay F, Özbek E. [The Seroprevalence of Toxoplasma gondii in women from Sanlıurfa, a province with a high raw meatball consumption]. Türkiye Parazitol Derg 2007;31:176-79. [Article in Turkish]
  • 8. De Paschale M, Agrappi C, Manco MT, Cerulli T, Clerici P. Implementation of screening for Toxoplasma gondii infection in pregnancy. J Clin Med Res 2010;2:112-6.
  • 9. Villena I, Ancelle T, Delmas C, Garcia P, Brezin AP, Thulliez P, et al.; Toxosurv network and National Reference Centre for Toxoplasmosis. Congenital toxoplasmosis in France in 2007: first results from a national surveillance system. Euro Surveill 2010;15:19600.
  • 10. Aspöck H, Pollak A. Prevention of prenatal toxoplasmosis by serological screening of pregnant women in Austria. Scand J Infect Dis 1992; 84 (Suppl):32-7.
  • 11. Mumcuoğlu İ, Toyran A, Çetin F, Alaca Coşkun F, Baran I, Aksu N, et al. [Evaluation of the Toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm]. Mikrobiyol Bul 2014;48: 283-91.
  • 12. McLeod R, Kieffer F, Sautter M, Hosten T, Pelloux H. Why prevent, diagnose and treat congenital toxoplasmosis? Mem Inst Oswaldo Cruz. 2009;104:320-44.
  • 13. Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis 2009;49:878-84.
  • 14. Lopez A, Dietz VJ, Wilson M, Navin TR, Jones JL. Preventing congenital toxoplasmosis. MMWR Recomm Rep. 2000;49(RR-2):59-68.
  • 15. “Doğum Öncesi Bakım Yönetim Rehberi” T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Yayın No: 924. Ankara, 2014. Available at: https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/dogumonubakim.pdf. Accessed Kasım 13. 2021.
  • 16. Müngen E. Gebelikte toksoplazma taraması. Perinatoloji Dergisi 2010;18:69-71.
  • 17. Çetin M, Çetin Ş. [Age-related prevalence of toxoplasmosis among pregnant women in Hatay: estimation depending on model]. Mikrobiyol Bul 2017;51:361-9. [Article in Turkish]
  • 18. Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ 2013;91:501-8.
  • 19. Gras L, Gilbert RE, Wallon M, Peyron F, Cortina-Borja M. Duration of the IgM response in women acquiring Toxoplasma gondii during pregnancy: implications for clinical practice and cross-sectional incidence studies. Epidemiol Infect 2004;132:541-8.
  • 20. Hampton MM. Congenital Toxoplasmosis: a review. Neonatal Netw 2015;34:274-8.
  • 21. Nascimento FS, Suzuki LA, Rossi CL. Assessment of the value of detecting specific IgA antibodies for the diagnosis of a recently acquired primary Toxoplasma infection. Prenat Diagn 2008;28:749-52.
  • 22. Montoya JG, Liesenfeld O, Kinney S, Press C, Remington JS. VIDAS test for avidity of Toxoplasma-specific immunoglobulin G for confirmatory testing of pregnant women. J Clin Microbiol 2002;40:2504-8.
  • 23. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004;42:941-5.
  • 24. Li XL, Wei HX, Zhang H, Peng HJ, Lindsay DS. A meta analysis on risks of adverse pregnancy outcomes in Toxoplasma gondii infection. PLoS One 2014;9:e97775.
  • 25. Khoshnood B, De Vigan C, Goffinet F, Leroy V. Prenatal screening and diagnosis of congenital toxoplasmosis: a review of safety issues and psychological consequences for women who undergo screening. Prenat Diagn 2007;27:395-403.
  • 26. Liesenfeld O, Montoya JG, Tathineni NJ, Davis M, Brown BW Jr, Cobb KL, et al. Confirmatory serologic testing for acute toxoplasmosis and rate of induced abortions among women reported to have positive Toxoplasma immunoglobulin M antibody titers. Am J Obstet Gynecol 2001;184:140-5.
  • 27. Donadono V, Saccone G, Maruotti GM, Berghella V, Migliorini S, Esposito G, et al. Incidence of toxoplasmosis in pregnancy in Campania: a population-based study on screening, treatment, and outcome. Eur J Obstet Gynecol Reprod Biol 2019;240:316-21.
  • 28. Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008;47:554-66.
  • 29. Mandelbrot L, Kieffer F, Sitta R. Laurichesse-Delmas H, Winer N, Mesnard L, et al. Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial. Am J Obstet Gynecol 2018;219:386.e1-9.
  • 30. Serranti D, Buonsenso D, Valentini P. Congenital toxoplasmosis treatment. Eur Rev Med Pharmacol Sci 2011;15:193-8.
  • 31. Greco P, Vimercati A, Angelici MC, Carbonara S, Doria G, Nappi L, et al. Toxoplasmosis in pregnancy is still an open subject. J Perinat Med 2003;31:36-40.
  • 32. Barsan Kaya T, Sürmeli Onay Ö, Aydemir Ö, Güneş D , Tekin AN. Toksoplazma Seropozitifliği Olan Anne Bebeklerinin Klinik Bulguları: Tek Merkez Deneyimi. IV. Başkent Pediatri Günleri, Ankara, Türkiye, 16 - 17 Nisan 2021, ss.38-39.
  • 33. Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999;353:1829-33.
  • 34. Avelino MM, Amaral WN, Rodrigues IM, Rassi Ar, Gomes MBF, Costa TL, et al. Congenital toxoplasmosis and prenatal care state programs. BMC Infect Dis 2014;18:33.
  • 35. Findal G, Stray-Pedersen B, Holter EK. Persistent low toxoplasma IgG avidity is common in pregnancy: experience from antenatal testing in Norway. PLoS One 2015;10: e0145519.
  • 36. Hotop A, Hlobil H, Gross U. Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2012;54:1545-52.
  • 37. McAuley J, Boyer KM, Patel D, Mets M, Swisher C, Roizen N, et al. Early longitudinal evaluation of treated infants and children of untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial. Clin Infect Dis 1994;18:38-72.
  • 38. Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon JM, et al. Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol 1999;180(2 Pt 1):410-5.
  • 39. Gomella T, Cunningham MD, Eyal FG. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. New York, NY: McGraw-Hill Education; 2013.
Year 2022, Volume: 8 Issue: 2, 296 - 303, 04.03.2022
https://doi.org/10.18621/eurj.1039212

Abstract

References

  • 1. Saadatnia G, Golkar M. A review on human toxoplasmosis. Scand J Infect Dis 2012; 44: 805-14.
  • 2. National Center for Health Statistics. Plan and operation of the third National Health and Nutrition Examination Survey, 1988-94. Hyattsville, MD: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Monthly vital statistics report; series 1, no. 32).
  • 3. Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004;363:1965-76.
  • 4. Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009;39:1385-94.
  • 5. Akyar I. Seroprevalence and coinfections of Toxoplasma gondii in childbearing age women in Turkey. Iranian J Publ Health 2011;40:63-7.
  • 6. Karabulut A, Polat Y, Türk M, Balcı YI. Evaluation of rubella, Toxoplasma gondii, and cytomegalovirus seroprevalences among pregnant women in Denizli province. Turk J Med Sci 2011;41:159-64.
  • 7. Tekay F, Özbek E. [The Seroprevalence of Toxoplasma gondii in women from Sanlıurfa, a province with a high raw meatball consumption]. Türkiye Parazitol Derg 2007;31:176-79. [Article in Turkish]
  • 8. De Paschale M, Agrappi C, Manco MT, Cerulli T, Clerici P. Implementation of screening for Toxoplasma gondii infection in pregnancy. J Clin Med Res 2010;2:112-6.
  • 9. Villena I, Ancelle T, Delmas C, Garcia P, Brezin AP, Thulliez P, et al.; Toxosurv network and National Reference Centre for Toxoplasmosis. Congenital toxoplasmosis in France in 2007: first results from a national surveillance system. Euro Surveill 2010;15:19600.
  • 10. Aspöck H, Pollak A. Prevention of prenatal toxoplasmosis by serological screening of pregnant women in Austria. Scand J Infect Dis 1992; 84 (Suppl):32-7.
  • 11. Mumcuoğlu İ, Toyran A, Çetin F, Alaca Coşkun F, Baran I, Aksu N, et al. [Evaluation of the Toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm]. Mikrobiyol Bul 2014;48: 283-91.
  • 12. McLeod R, Kieffer F, Sautter M, Hosten T, Pelloux H. Why prevent, diagnose and treat congenital toxoplasmosis? Mem Inst Oswaldo Cruz. 2009;104:320-44.
  • 13. Jones JL, Dargelas V, Roberts J, Press C, Remington JS, Montoya JG. Risk factors for Toxoplasma gondii infection in the United States. Clin Infect Dis 2009;49:878-84.
  • 14. Lopez A, Dietz VJ, Wilson M, Navin TR, Jones JL. Preventing congenital toxoplasmosis. MMWR Recomm Rep. 2000;49(RR-2):59-68.
  • 15. “Doğum Öncesi Bakım Yönetim Rehberi” T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu. Yayın No: 924. Ankara, 2014. Available at: https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/dogumonubakim.pdf. Accessed Kasım 13. 2021.
  • 16. Müngen E. Gebelikte toksoplazma taraması. Perinatoloji Dergisi 2010;18:69-71.
  • 17. Çetin M, Çetin Ş. [Age-related prevalence of toxoplasmosis among pregnant women in Hatay: estimation depending on model]. Mikrobiyol Bul 2017;51:361-9. [Article in Turkish]
  • 18. Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ 2013;91:501-8.
  • 19. Gras L, Gilbert RE, Wallon M, Peyron F, Cortina-Borja M. Duration of the IgM response in women acquiring Toxoplasma gondii during pregnancy: implications for clinical practice and cross-sectional incidence studies. Epidemiol Infect 2004;132:541-8.
  • 20. Hampton MM. Congenital Toxoplasmosis: a review. Neonatal Netw 2015;34:274-8.
  • 21. Nascimento FS, Suzuki LA, Rossi CL. Assessment of the value of detecting specific IgA antibodies for the diagnosis of a recently acquired primary Toxoplasma infection. Prenat Diagn 2008;28:749-52.
  • 22. Montoya JG, Liesenfeld O, Kinney S, Press C, Remington JS. VIDAS test for avidity of Toxoplasma-specific immunoglobulin G for confirmatory testing of pregnant women. J Clin Microbiol 2002;40:2504-8.
  • 23. Remington JS, Thulliez P, Montoya JG. Recent developments for diagnosis of toxoplasmosis. J Clin Microbiol 2004;42:941-5.
  • 24. Li XL, Wei HX, Zhang H, Peng HJ, Lindsay DS. A meta analysis on risks of adverse pregnancy outcomes in Toxoplasma gondii infection. PLoS One 2014;9:e97775.
  • 25. Khoshnood B, De Vigan C, Goffinet F, Leroy V. Prenatal screening and diagnosis of congenital toxoplasmosis: a review of safety issues and psychological consequences for women who undergo screening. Prenat Diagn 2007;27:395-403.
  • 26. Liesenfeld O, Montoya JG, Tathineni NJ, Davis M, Brown BW Jr, Cobb KL, et al. Confirmatory serologic testing for acute toxoplasmosis and rate of induced abortions among women reported to have positive Toxoplasma immunoglobulin M antibody titers. Am J Obstet Gynecol 2001;184:140-5.
  • 27. Donadono V, Saccone G, Maruotti GM, Berghella V, Migliorini S, Esposito G, et al. Incidence of toxoplasmosis in pregnancy in Campania: a population-based study on screening, treatment, and outcome. Eur J Obstet Gynecol Reprod Biol 2019;240:316-21.
  • 28. Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008;47:554-66.
  • 29. Mandelbrot L, Kieffer F, Sitta R. Laurichesse-Delmas H, Winer N, Mesnard L, et al. Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial. Am J Obstet Gynecol 2018;219:386.e1-9.
  • 30. Serranti D, Buonsenso D, Valentini P. Congenital toxoplasmosis treatment. Eur Rev Med Pharmacol Sci 2011;15:193-8.
  • 31. Greco P, Vimercati A, Angelici MC, Carbonara S, Doria G, Nappi L, et al. Toxoplasmosis in pregnancy is still an open subject. J Perinat Med 2003;31:36-40.
  • 32. Barsan Kaya T, Sürmeli Onay Ö, Aydemir Ö, Güneş D , Tekin AN. Toksoplazma Seropozitifliği Olan Anne Bebeklerinin Klinik Bulguları: Tek Merkez Deneyimi. IV. Başkent Pediatri Günleri, Ankara, Türkiye, 16 - 17 Nisan 2021, ss.38-39.
  • 33. Dunn D, Wallon M, Peyron F, Petersen E, Peckham C, Gilbert R. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999;353:1829-33.
  • 34. Avelino MM, Amaral WN, Rodrigues IM, Rassi Ar, Gomes MBF, Costa TL, et al. Congenital toxoplasmosis and prenatal care state programs. BMC Infect Dis 2014;18:33.
  • 35. Findal G, Stray-Pedersen B, Holter EK. Persistent low toxoplasma IgG avidity is common in pregnancy: experience from antenatal testing in Norway. PLoS One 2015;10: e0145519.
  • 36. Hotop A, Hlobil H, Gross U. Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2012;54:1545-52.
  • 37. McAuley J, Boyer KM, Patel D, Mets M, Swisher C, Roizen N, et al. Early longitudinal evaluation of treated infants and children of untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial. Clin Infect Dis 1994;18:38-72.
  • 38. Foulon W, Villena I, Stray-Pedersen B, Decoster A, Lappalainen M, Pinon JM, et al. Treatment of toxoplasmosis during pregnancy: a multicenter study of impact on fetal transmission and children's sequelae at age 1 year. Am J Obstet Gynecol 1999;180(2 Pt 1):410-5.
  • 39. Gomella T, Cunningham MD, Eyal FG. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. New York, NY: McGraw-Hill Education; 2013.
There are 39 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Original Articles
Authors

Ayşe Kaya Kalem 0000-0002-4759-0066

İmran Hasanoğlu 0000-0001-6692-3893

Müge Ayhan 0000-0002-4821-5559

Bircan Kayaaslan 0000-0002-2502-3810

Fatma Eser 0000-0002-0282-6346

Yüksel Oğuz 0000-0001-6019-6429

Filiz Avşar 0000-0003-3699-7757

Rahmet Güner 0000-0002-1029-1185

Publication Date March 4, 2022
Submission Date December 24, 2021
Acceptance Date February 5, 2022
Published in Issue Year 2022 Volume: 8 Issue: 2

Cite

AMA Kaya Kalem A, Hasanoğlu İ, Ayhan M, Kayaaslan B, Eser F, Oğuz Y, Avşar F, Güner R. Toxoplasmosis in pregnancy: test, treatment and outcome. Eur Res J. March 2022;8(2):296-303. doi:10.18621/eurj.1039212

e-ISSN: 2149-3189 


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