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Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy.

Rodrigues IM, Costa TL, Avelar JB, Amaral WN, Castro AM, Avelino MM - BMC Infect. Dis. (2014)

Bottom Line: There is no evidence to prove that maternal treatment reduces the risk of fetal infection.The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease.The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics and Puericulture in the Medical School (MS) of Federal University of Goiás (UFG), Av, s/n Setor Leste Universitário, Goiânia-GO CEP: 74001-970, Brazil. mariza.avelino@gmail.com.

ABSTRACT

Background: The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity. There is no evidence to prove that maternal treatment reduces the risk of fetal infection. The purpose of this study was to assess methods for the confirmation of congenital toxoplasmosis after maternal treatment with spiramycin during pregnancy, and to evaluate the effect of this treatment on clinical manifestations of the disease in newborns (NB).

Methods: This was a community-based, cross-sectional study of acute toxoplasmosis in newborns at risk of acquiring congenital infection. Participating newborns were born in the Clinical Hospital Maternity Ward of the Federal University of Goiás. Eligible participants were divided into 2 groups: group 1 consisted of 44 newborns born to mothers treated with spiramycin during pregnancy and group 2 consisted of 24 newborns born to mothers not treated with spiramycin during pregnancy because the diagnosis of toxoplasmosis was not performed. The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease.

Results: The sensitivity of the markers (T. gondii DNA detected by PCR, and the presence of specific anti-T. gondii IgM and IgA) for congenital toxoplasmosis was higher in group 2 than in group 1 (31.6, 68.4, 36.8% and 3.7, 25.9, 11.1% respectively). Even with a low PCR sensitivity, the group 2 results indicate the importance of developing new techniques for the diagnosis of congenital toxoplasmosis in newborns. Within group 1, 70.4% of the infected newborns were asymptomatic and, in group 2, 68.4% showed clinical manifestations of congenital toxoplasmosis.

Conclusions: The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns. Given the low sensitivity of the tests used, when there is suspicion of congenital transmission several serological and parasitological tests are required in order to confirm or exclude congenital toxoplasmosis in newborns.

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Mentions: From interviews with the mothers, the presence or the absence of specific treatment with spiramycin during pregnancy was investigated. Forty-four of the mothers had been treated with 3 g of spiramycin daily, administered over 3 doses per day (i.e. 3 × 1 g), from the time of acute toxoplasmosis diagnosis until birth. Twenty-four mothers had not been treated because toxoplasmosis testing was not performed during pregnancy (these mothers served as the control group for the treated ones). The NB were divided into two groups: group 1–44 NB born to mothers treated with spiramycin during pregnancy; and group 2–24 newborns born to mothers who did not receive spiramycin treatment during pregnancy.The study was approved by the Human and Animal Experimentation Ethics Committee of the HC/UFG (protocol n. 092/2001 and protocol n. 024/2010) and the mothers of the NB who agreed to participate in the study gave their informed consent after they had been informed of the importance of the research Figure 1.


Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy.

Rodrigues IM, Costa TL, Avelar JB, Amaral WN, Castro AM, Avelino MM - BMC Infect. Dis. (2014)

Flowchart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230641&req=5

Figure 1: Flowchart.
Mentions: From interviews with the mothers, the presence or the absence of specific treatment with spiramycin during pregnancy was investigated. Forty-four of the mothers had been treated with 3 g of spiramycin daily, administered over 3 doses per day (i.e. 3 × 1 g), from the time of acute toxoplasmosis diagnosis until birth. Twenty-four mothers had not been treated because toxoplasmosis testing was not performed during pregnancy (these mothers served as the control group for the treated ones). The NB were divided into two groups: group 1–44 NB born to mothers treated with spiramycin during pregnancy; and group 2–24 newborns born to mothers who did not receive spiramycin treatment during pregnancy.The study was approved by the Human and Animal Experimentation Ethics Committee of the HC/UFG (protocol n. 092/2001 and protocol n. 024/2010) and the mothers of the NB who agreed to participate in the study gave their informed consent after they had been informed of the importance of the research Figure 1.

Bottom Line: There is no evidence to prove that maternal treatment reduces the risk of fetal infection.The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease.The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pediatrics and Puericulture in the Medical School (MS) of Federal University of Goiás (UFG), Av, s/n Setor Leste Universitário, Goiânia-GO CEP: 74001-970, Brazil. mariza.avelino@gmail.com.

ABSTRACT

Background: The different laboratory methods used in the diagnosis of congenital toxoplasmosis have variable sensitivity and specificity. There is no evidence to prove that maternal treatment reduces the risk of fetal infection. The purpose of this study was to assess methods for the confirmation of congenital toxoplasmosis after maternal treatment with spiramycin during pregnancy, and to evaluate the effect of this treatment on clinical manifestations of the disease in newborns (NB).

Methods: This was a community-based, cross-sectional study of acute toxoplasmosis in newborns at risk of acquiring congenital infection. Participating newborns were born in the Clinical Hospital Maternity Ward of the Federal University of Goiás. Eligible participants were divided into 2 groups: group 1 consisted of 44 newborns born to mothers treated with spiramycin during pregnancy and group 2 consisted of 24 newborns born to mothers not treated with spiramycin during pregnancy because the diagnosis of toxoplasmosis was not performed. The sensitivity and specifity of PCR for T. gondii DNA in peripheral blood and serological testing for specific anti-T. gondii IgM and IgA, and the effects of maternal spiramycin treatment on these parameters, were determined by associating test results with clinical manifestations of disease.

Results: The sensitivity of the markers (T. gondii DNA detected by PCR, and the presence of specific anti-T. gondii IgM and IgA) for congenital toxoplasmosis was higher in group 2 than in group 1 (31.6, 68.4, 36.8% and 3.7, 25.9, 11.1% respectively). Even with a low PCR sensitivity, the group 2 results indicate the importance of developing new techniques for the diagnosis of congenital toxoplasmosis in newborns. Within group 1, 70.4% of the infected newborns were asymptomatic and, in group 2, 68.4% showed clinical manifestations of congenital toxoplasmosis.

Conclusions: The higher proportion of infants without clinical symptoms in group 1 (70.4%) suggests the maternal treatment with spiramycin delays fetal infection, reducing the clinical sequelae of the disease in newborns. Given the low sensitivity of the tests used, when there is suspicion of congenital transmission several serological and parasitological tests are required in order to confirm or exclude congenital toxoplasmosis in newborns.

Show MeSH
Related in: MedlinePlus