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DOI 10.1007/s10096-008-0612-5
BRIEF REPORT
Received: 17 February 2008 / Accepted: 25 July 2008 / Published online: 21 August 2008
# Springer-Verlag 2008
Introduction
Toxoplasmosis during pregnancy can cause a severe foetal
infection with possible central nervous system (CNS) and
eye damage. In recent years, there has been increasing
controversy surrounding the efficacy of treatment of the
mother during gestation to prevent congenital transmission,
as well as regarding the cost benefit of such treatment.
The standard therapy of toxoplasmosis is pyrimethamine + sulphadiazine, but the most often used antibiotic
in pregnant women is spiramycin, because of the potential
teratogenic effects of pyrimethamine. The pyrimethamine/
sulphadiazine association is used in the presence of prenatal
infection diagnosis [1, 2].
Cotrimoxazole is not usually used for the prevention of
congenital toxoplasmosis because the anti-Toxoplasma
activity of trimethoprim is lower than that of pyrimethamine. However, experimental and clinical studies provide
evidence of the efficacy of cotrimoxazole and its potential
use in the prevention of congenital toxoplasmosis [3, 4].
The purpose of this study is to evaluate the efficacy and
safety of spiramycin/cotrimoxazole association in the
mother-to-child transmission of Toxoplasma gondii infection.
298
Results
Out of 212 newborn infants, 76 (35.8%) were considered to
be eligible for the study because they were born to mothers
treated with spiramycin/cotrimoxazole/folinic acid, 86
(40.6%) were from women treated with different protocols,
28 (13.2%) from untreated women and 22 (10.4%) from
mothers in which it was not possible to evaluate the time of
infection.
Of the 76 eligible cases, 2/76 (2.6%) children acquired
the infection in utero. The infected children, a male and a
female, were born at term (40 and 38 weeks GA,
respectively) and their growth parameters were normal:
weight 3,580 g (75th centile) and 2,920 g (25th centile);
head circumference 37 cm (90th centile) and 34 cm (50th
centile). They were asymptomatic at birth, were given
Discussion
The usual treatment protocols of toxoplasmosis during
pregnancy include spiramycin started immediately after the
confirmation of maternal infection and pyrimethamine/
sulphadiazine following the diagnosis of foetal infection. In
some centres, pyrimethamine/sulphadiazine is prescribed
immediately if maternal infection occurs in the 3rd trimester.
Desmonts and Couvreur demonstrated that, using spiramycin precociously, the mother-to-child transmission
crude risk of infection was reduced from 56 to 24% [1].
Several studies could not show any significant difference
in the incidence of congenital infection between treated and
non-treated groups. However, metanalysis suggest that the
efficacy of prenatal treatment could not be ruled out
completely, because many of the studies were not carried
on in the appropriate way. These studies do not exclude a
possible clinical effect of the prenatal treatment.
A recent systematic review shows that the estimated rate
of mother-to-child transmission by gestational age at
seroconversion is 15% at 13 weeks, 44% at 26 weeks and
71% at 36 weeks. The odds of transmission increases by
Table 1 Mother-to-child transmission according to maternal gestational age (GA) at the time of infection
Time of maternal
infection (weeks)
Infected
newborns
Non-infected
newborns
Total
<14
1426
>26
Total
0
1
1
2
54
20
0
74
54
21
1
76
299
300
References
1. Desmonts G, Couvreur J (1974) Toxoplasmosis in pregnancy and
its transmission to the fetus. Bull N Y Acad Med 50:146159
2. SYROCOT (Systematic Review on Congenital Toxoplasmosis)
study group (2007) Effectiveness of prenatal treatment for
congenital toxoplasmosis: a meta-analysis of individual patients
data. Lancet 369:115122. doi:10.1016/S0140-6736(07)60072-5
3. Masini L, De Santis M, Noia G et al (2003) Maternal therapy in
prevention of congenital toxoplasmosis. In: Program and abstracts
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