UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Congenital toxoplasmosis: Treatment, outcome, and prevention

Authors
Nicholas G Guerina, MD, PhD
Jennifer Lee, MD, MS
Section Editors
Sheldon L Kaplan, MD
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Toxoplasma gondii is a ubiquitous protozoan parasite that infects animals and humans. Toxoplasma infection typically is asymptomatic in immunocompetent hosts. However, serious disease can occur, most frequently in the setting of immunosuppression or congenital infection. The fetus, newborn, and young infant with congenital Toxoplasma infection are at risk of infection-associated complications, particularly retinal disease that can occur into adulthood.

The treatment, outcome, and prevention of congenital toxoplasmosis will be discussed here. The clinical features and diagnosis of congenital toxoplasmosis and acquired toxoplasmosis in pregnancy, immunocompetent hosts, and human immunodeficiency virus-infected patients are discussed separately. (See "Congenital toxoplasmosis: Clinical features and diagnosis" and "Toxoplasmosis and pregnancy" and "Toxoplasmosis in immunocompetent hosts" and "Toxoplasmosis in HIV-infected patients".)

NATURAL HISTORY OF UNTREATED DISEASE

The natural history of untreated symptomatic congenital toxoplasmosis was demonstrated in a case series of 156 patients from the 1940s, of whom 152 had overt neurologic or generalized manifestations of disease [1]. Mortality was 12 percent. The majority of patients developed intellectual disability (93 percent), seizures (81 percent), spasticity/palsies (70 percent), and severely impaired vision (60 percent). Other sequelae included hydrocephalus or microcephaly (33 percent) and deafness (15 percent).

Children with subclinical infection also may develop cognitive, motor, auditory, and visual defects [2-5], but it is not possible to predict the likelihood of these complications [6]. It has been shown, however, that severe sequelae may occur and new-onset chorioretinitis, in particular, may occur in up to 90 percent of untreated children with congenital Toxoplasma infection [2,3].

TREATMENT

Antiparasitic therapy

Indications — We recommend treatment with antiparasitic therapy for infants (<12 months old) in whom a diagnosis of congenital toxoplasmosis is confirmed or highly likely, including [7]:

               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Oct 12 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Eichenwald HF. A study of congenital toxoplasmosis with particular emphasis on clinical manifestations, sequelae and therapy. In: Human Toxoplasmosis, Siim JC (Ed), Munksgaard, Copenhagen 1959.
  2. Wilson CB, Remington JS, Stagno S, Reynolds DW. Development of adverse sequelae in children born with subclinical congenital Toxoplasma infection. Pediatrics 1980; 66:767.
  3. Koppe JG, Loewer-Sieger DH, de Roever-Bonnet H. Results of 20-year follow-up of congenital toxoplasmosis. Lancet 1986; 1:254.
  4. Labadie MD, Hazemann JJ. [Contribution of health check-ups in children to the detection and epidemiologic study of congenital toxoplasmosis]. Ann Pediatr (Paris) 1984; 31:823.
  5. Stagno S, Reynolds DW, Amos CS, et al. Auditory and visual defects resulting from symptomatic and subclinical congenital cytomegaloviral and toxoplasma infections. Pediatrics 1977; 59:669.
  6. Remington JS, McLeod R, Wilson CB, Desmonts G. Toxoplasmosis. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington, JS, Klein, JO, Wilson, CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.918.
  7. McAuley J, Boyer KM, Patel D, et al. Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial. Clin Infect Dis 1994; 18:38.
  8. American Academy of Pediatrics. Toxoplasma gondii infections (Toxoplasmosis). In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.787.
  9. Contopoulos-Ioannidis D, Montoya JG. Toxoplasma gondii (toxoplasmosis). In: Principles and Practice of Pediatric Infectious Diseases, 4th, Long SS, Pickering LK, Prober CG. (Eds), Elsevier Saunders, Edinburgh 2012. p.1308.
  10. Department of Health and Human Services. Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. Available at: aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf (Accessed on November 20, 2013).
  11. McAuley JB, Boyer KM, Remington JS, McLeod RL. Toxoplasmosis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrison GJ, Kaplan SL, et al. (Eds), Elsevier Saunders, Philadelphia 2014. p.2987.
  12. Guerina NG, Hsu HW, Meissner HC, et al. Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection. The New England Regional Toxoplasma Working Group. N Engl J Med 1994; 330:1858.
  13. McLeod R, Boyer K, Karrison T, et al. Outcome of treatment for congenital toxoplasmosis, 1981-2004: the National Collaborative Chicago-Based, Congenital Toxoplasmosis Study. Clin Infect Dis 2006; 42:1383.
  14. Roizen N, Swisher CN, Stein MA, et al. Neurologic and developmental outcome in treated congenital toxoplasmosis. Pediatrics 1995; 95:11.
  15. Dannemann B, McCutchan JA, Israelski D, et al. Treatment of toxoplasmic encephalitis in patients with AIDS. A randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. The California Collaborative Treatment Group. Ann Intern Med 1992; 116:33.
  16. McLeod R, Mack D, Foss R, et al. Levels of pyrimethamine in sera and cerebrospinal and ventricular fluids from infants treated for congenital toxoplasmosis. Toxoplasmosis Study Group. Antimicrob Agents Chemother 1992; 36:1040.
  17. Katlama C, De Wit S, O'Doherty E, et al. Pyrimethamine-clindamycin vs. pyrimethamine-sulfadiazine as acute and long-term therapy for toxoplasmic encephalitis in patients with AIDS. Clin Infect Dis 1996; 22:268.
  18. Dannemann BR, Israelski DM, Remington JS. Treatment of toxoplasmic encephalitis with intravenous clindamycin. Arch Intern Med 1988; 148:2477.
  19. Gilbert R, Dezateux C. Newborn screening for congenital toxoplasmosis: feasible, but benefits are not established. Arch Dis Child 2006; 91:629.
  20. Kravetz J. Congenital toxoplasmosis. BMJ Clin Evid 2008; 2008.
  21. Mack DG, McLeod R. New micromethod to study the effect of antimicrobial agents on Toxoplasma gondii: comparison of sulfadoxine and sulfadiazine individually and in combination with pyrimethamine and study of clindamycin, metronidazole, and cyclosporin A. Antimicrob Agents Chemother 1984; 26:26.
  22. Weiss LM, Harris C, Berger M, et al. Pyrimethamine concentrations in serum and cerebrospinal fluid during treatment of acute Toxoplasma encephalitis in patients with AIDS. J Infect Dis 1988; 157:580.
  23. Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin Infect Dis 1992; 15:211.
  24. Kieffer F, Thulliez P, Brézin A, et al. [Treatment of subclinical congenital toxoplasmosis by sulfadiazine and pyrimethamine continuously during 1 year: apropos of 46 cases]. Arch Pediatr 2002; 9:7.
  25. Guerina NG. Congenital infection with Toxoplasma gondii. Pediatr Ann 1994; 23:138.
  26. Wallon M, Cozon G, Ecochard R, et al. Serological rebound in congenital toxoplasmosis: long-term follow-up of 133 children. Eur J Pediatr 2001; 160:534.
  27. Lynfield R, Ogunmodede F, Guerina NG. Toxoplasmosis. In: Oski's Pediatrics Principles and Practice, 4th ed, McMillan JA, Feigin RD, DeAngelis CD, Jones MD (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1351.
  28. Mets MB, Holfels E, Boyer KM, et al. Eye manifestations of congenital toxoplasmosis. Am J Ophthalmol 1996; 122:309.
  29. Wallon M, Kodjikian L, Binquet C, et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113:1567.
  30. Berrébi A, Assouline C, Bessières MH, et al. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010; 203:552.e1.
  31. Peyron F, Garweg JG, Wallon M, et al. Long-term impact of treated congenital toxoplasmosis on quality of life and visual performance. Pediatr Infect Dis J 2011; 30:597.
  32. Wallon M, Garweg JG, Abrahamowicz M, et al. Ophthalmic outcomes of congenital toxoplasmosis followed until adolescence. Pediatrics 2014; 133:e601.
  33. Patel DV, Holfels EM, Vogel NP, et al. Resolution of intracranial calcifications in infants with treated congenital toxoplasmosis. Radiology 1996; 199:433.
  34. Bessières MH, Berrebi A, Rolland M, et al. Neonatal screening for congenital toxoplasmosis in a cohort of 165 women infected during pregnancy and influence of in utero treatment on the results of neonatal tests. Eur J Obstet Gynecol Reprod Biol 2001; 94:37.