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Congenital Toxoplasmosis with Bilateral Macular Chorioretinitis in a Premature NewbornKongenitale Toxoplasmose mit bilateraler Makulachorioretinitis bei einem Frühgeborenen
Toxoplasmosis is a widespread parasitic disease that can be transmitted transplacentally. Maternal toxoplasmosis infection acquired during pregnancy is rare but carries a significant risk of fetal damage, i.e., severe visual impairment and neurologic sequelae. In Lausanne, a retrospective review made between 1995 and 2006 reported a total number of 37 serologically confirmed cases of congenital toxoplasmosis (CT), accounting for 1 case in 2270 live births, including 1 symptomatic case in infancy per 14 000 live births. It can thereof be anticipated that among 73 000 pregnancies 130 women will have toxoplasmosis during pregnancy each year in Switzerland, of which 4.5 symptomatic cases of CT will be expected. Therefore, the Swiss working group on CT recommended in 2008 to cease systematically testing for toxoplasma antibodies before and during the pregnancy and to insist on recommendations to prevent toxoplasmosis seroconversion during pregnancy, as a fairly high number of pregnant women had to be screened to find one symptomatic case (i.e., one symptomatic case every 16 222 patients tested) , . Despite these new recommendations, a significant number of pregnant women continue to be tested for toxoplasmosis in Switzerland .
Fetal damage caused by CT is detectable by ultrasound screening when severe central nervous system lesions are present. However, toxoplasmic chorioretinitis (TCR), which occurs mainly after late maternal infection, is commonly isolated and thus not accessible to prenatal diagnosis. Indeed, the diagnosis of TCR is established by ocular funduscopy carried out at birth and regularly thereafter, as TCR can occur at any time in fetal or postnatal life .
Received: 25 September 2020
Accepted: 25 January 2021
30 April 2021 (online)
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- 1 Boubaker K, Raeber PA, Vaudaux B. et al. Toxoplasmosis during pregnancy and infancy. A new approach for Switzerland. Swiss Med Wkly 2008; 138 (49 – 50 Suppl. 168): 1-8
- 2 Peyron F, Wallon M, Liou C. et al. Treatments for toxoplasmosis in pregnancy. Cochrane Database Syst Rev 2000; (02) CD001684
- 3 Frischknecht F, Sell W, Trummer I. et al. Serological testing for infectious diseases in pregnant women: are the guidelines followed?. Swiss Med Wkly 2011; 140: w13138
- 4 Berrébi A, Assouline C, Bessières MH. et al. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010; 203: 552.e1-552.e6
- 5 Kodjikian L, Wallon M, Fleury J. et al. Ocular manifestations in congenital toxoplasmosis. Graefes Arch Clin Exp Ophthalmol 2006; 244: 14-21
- 6 Freeman K, Tan HK, Prusa A. et al. Predictors of retinochoroiditis in children with congenital toxoplasmosis: European, prospective cohort study. Pediatrics 2008; 121: e1215-e1222
- 7 Mets MB, Holfels E, Boyer KM. et al. Eye manifestations of congenital toxoplasmosis. Am J Ophthalmol 1997; 123: 1-16
- 8 Brézin AP, Thulliez P, Couvreur J. et al. Ophthalmic outcomes after prenatal and postnatal treatment of congenital toxoplasmosis. Am J Ophthalmol 2003; 135: 779-784
- 9 Wallon M, Garweg JG, Abrahamowicz M. et al. Ophthalmic outcomes of congenital toxoplasmosis followed until adolescence. Pediatrics 2014; 133: e601-e608
- 10 Phan L, Kasza K, Jalbrzikowski J. et al. Longitudinal study of new eye lesions in children with toxoplasmosis who were not treated during the first year of life. Am J Ophthalmol 2008; 115: 553-559
- 11 Dunay IR, Gajurel K, Dhakal R. et al. Treatment of toxoplasmosis: historical perspective, animal models, and current clinical practice. Clin Microbiol Rev 2018; 31: e00057-17