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AN UPDATE
DR. OANA FALUP-PECURARIU MD. PHD.
TRANSILANIA UNIVERSITY FACULTY OF
MEDICINE
CHILDRENS CLINIC HOSPITAL, BRASOV,
ROMANIA
Toxoplasmosis cycle of
maturation
ULTRASTRUCTURE OF A
TACHYZOITE
EXAMINED(n)
Prematurity 210
birth weight <
2500 g
birth weight
25003000 g
210
POSITIVE%
(n)
8(3,8)
5(7,1)
Dysmaturity
(intrauterine
growth
retardation)
13(6,2)
Postmaturity
108
9(8,3)
Icterus
201
20(10)
Hepatosplenomeg
aly
210
9(4,2)
Thrombocytopeni
c purpura
210
3(1,4)
Abnormal blood
count (anemia,
eosinophilia)
102
9(4,4)
Microcephaly 210
11 (5.2)
210
Chorioretinitis
unilateral
210
11(5,2)
34(16,1)
EXAMINED(n)
POSITIVE%
(n)
Hydrocephalus
210
8(3,8)
Hypotonia
210
2(5,7)
Convulsions
210
8(3,8)
Psychomotor
retardation
210
11(5,2)
Intracranial
calcifications on
radiography 210 24
(11.4
210
24(11,4)
Abnormal
ultrasound
examination
49
5(10)
Abnormal computed
tomography scan of
brain
13
11(84)
Abnormal
electroencephalogr
aphic result
191
16(8,3)
Abnormal
cerebrospinal fluid
163
56(34,2)
Microphthalmia
210
6(2,8)
Strabismus
210
11(5,2)
86
Unilateral blindness
81
Bilateral blindness
70
Recurrent chorioretinitis
60
33
Mentally retarded
14
86
Trimester of
maternal
acquisition
Incidence of
transmission %
Relative severity
of disease
17
severe
II
25
intermediate
III
65
Milder/ asymptomatic
Gestational
age
at maternal
seroconversio
n,
weeks
Risk of
congenital
infection (95%
CI), %
Development
of clinical
signs in the
infected
offspring
(95% CI), %
Risk of
development
of clinical
signs when
infection
status is
unknown,a %
13
6(3-9)
61(34-85)
26
40(33-47)
25(18-33)
10
38
72(60-81)
9(4-17)
Eurico Camargo Neto et al. Newborn screening for congenital infectious diseases. Emerg Inf Dis.
Jun2004;10(6):1069-1073.
Jose G Montoya and J S Remington. Management of Toxoplasma Gondii Infection during Pregnancy. Clin
inf dis 2008; 47:554-566
TREATMENT DECISION
Eurico Camargo Neto et al. Newborn screening for congenital infectious diseases. Emerg Inf Dis.
Jun2004;10(6):1069-1073.
TREATMENT
Anti-parasitic agents that restrict the growth of
actively proliferating parasites, which destroy cells and
tissues, thereby prevent damage to the brain and eye
The combination of pyrimethamine and sulfadiazine is
8-fold more active than either pyrimethamine or
sulfadiazine alone and has been the gold standard to
which other antimicrobial agents alone, and in
combination, have been compared
By the year 1981 the medical community started to
treat congenital toxoplasmosis with pyrimethamine
and sulfadiazine for 1 year given with leukovorin found
to be effective.
NO. OF
DEATHS/NO. OF
CHILDREN %
MEAN AGE AT
DEATH IN
YEARS
AGES AT DEATH
RANDOMIZED
TREATMENT 1
3/47 (6.4)
7.3
RANDOMIZED
TREATMENT 2
5/38(13)
3.6
FEASIBILITY/OB
SERVATIONAL
TREATMEN1
1/14(7)
9.3
9.3
FEASIBILITY/OB
SERVATIONAL
TREATMEN2
2/21(9.5)
2.5
0.5; 4.5
Outcome of treatment for congenital toxoplasmosis 1981-2004; The national collaborative Chicago based congenital
toxoplasmosis study. Clin Infect Dis. Vol42; 10: 1383-94. Rima McLeod et al.