Congenital toxoplasmosis: Treatment, outcome, and prevention
- Nicholas G Guerina, MD, PhD
Nicholas G Guerina, MD, PhD
- Adjunct Assistant Clinical Professor
- Tufts University School of Medicine
- Jennifer Lee, MD, MS
Jennifer Lee, MD, MS
- Instructor in Pediatrics
- Harvard Medical School
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
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 . 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 . 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].
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 :
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- NATURAL HISTORY OF UNTREATED DISEASE
- Antiparasitic therapy
- - Indications
- - Treatment regimen
- Special considerations
- - Efficacy
- - Adverse effects
- - Therapeutic monitoring
- Disease monitoring
- Treatment of new-onset chorioretinitis
- Avoidance of exposure
- Maternal screening
- Prenatal treatment
- Newborn screening
- SUMMARY AND RECOMMENDATIONS