Congenital toxoplasmosis is caused by Toxoplasma gondii, a common protozoan parasite [1]. In congenital cases, this organism is transmitted from the mother to the fetus through the placenta. The earlier the infection during pregnancy, the more severe the clinical symptoms [2]. More than half of healthy pregnant women with primary infection are asymptomatic while those with symptoms exhibit low-grade fever, fatigue, myalgia, and lymphadenopathy. Approximately 25% of infected pregnant women will transmit the infection to the fetus [3].

Risk factors include having a cat, exposure to cat litter or contaminated soil, consumption of unfiltered water, raw or insufficiently cooked meat, or raw or dirty fruits or vegetables [3] [4] [5].

While three-quarters of neonates with congenital toxoplasmosis are asymptomatic, the clinical presentation in affected patients is variable and includes a vast array of manifestations [2]. This illness is characterized by a classic triad of hydrocephalus, chorioretinitis, and intracranial calcifications [2]. Moreover, severe cases could feature microcephaly, fever, rash, jaundice, hepatosplenomegaly, seizures, sepsis-like illness, meningitis, and encephalitis [2] [6]. Further possible manifestations include but are not limited to deafness, thrombocytopenia, myocarditis, pneumonitis, respiratory distress, and nephrotic syndrome [2].

Complications

Up to 85% will develop long-term manifestations such as chorioretinitis, blindness, deafness, and developmental delay [2]. These sequelae may occur later in the patient's life [7] [8].

Physical exam

Patients with congenital toxoplasmosis may exhibit findings such as a fever, rash, lymphadenopathy, hepatosplenomegaly. Affected neonates are likely to feature microcephaly or macrocephaly accompanied by bulging fontanelles and abnormal ophthalmologic findings.

• Anemia

  We present a 7-wk-old white male, delivered at 38 wk of gestation, who shortly after birth was found to have hepatosplenomegaly and anemia; he developed liver failure and ascites with persistent anemia during the first week of life. [ncbi.nlm.nih.gov]

  The newborn may have a low birth weight, enlarged liver and spleen, jaundice, anemia, petechiae, and eye damage. [clinicaltrials.gov]

• Epilepsy

  Microencephaly, intellectual disability, vision impairment, hydrocephalus, and epilepsy are common outcomes of congenital toxoplasmosis. [medlink.com]

  Meta-analysis of three case controlled studies and an ecological study into the link between cryptogenic epilepsy and chronic toxoplasmosis infection. Seizure 2007; 16: 657-63 http://dx.doi.org/10.1016/j.seizure.2007.05.010 pmid: 17604653. [who.int]

  Meta-analysis of three case controlled studies and an ecological study into the link between cryptogenic epilepsy and chronic toxoplasmosis infection. [ncbi.nlm.nih.gov]

• Falling

  The majority of strains isolated in North America and Europe fall into one of three clonal lineages, referred to as types I, II, and III. So far, little is known about genetics of Toxoplasma strains in Africa. [ncbi.nlm.nih.gov]

  Consult the holiday schedule to find out if the lab is closed on a holiday that falls during the week. The lab holds a number of laboratory certifications from different agencies. You can download PDFs of these license certifications. [sutterhealth.org]

  It falls in the TORCH group of infections. Please refer on congenital cerebral toxoplasmosis for a specific discussion on this condition. The incidence is highly variable dependent on individual countries. [radiopaedia.org]

• Pneumonia

  He developed central diabetes insipidus as a neonate, followed by interstitial pneumonia, anemia, and hepatosplenomegaly. [ncbi.nlm.nih.gov]

  ) congenital pneumonia ( P23.- ) congenital syphilis ( A50.- ) human immunodeficiency virus [HIV] disease ( B20 ) infant botulism ( A48.51 ) infectious diseases not specific to the perinatal period ( A00-B99, J09, J10.- ) intestinal infectious disease [icd10data.com]

  Despite this treatment, her clinical course was complicated with neonatal sepsis, meningitis and ventilator-associated pneumonia. Death occurred at the age of 11 days. [degruyter.com]

• Diarrhea

  RESULTS: Nine patients (13.8%) presented at least 1 adverse clinical event that was nonspecific, such as diarrhea on the day of drug administration, vomiting and agitation. [ncbi.nlm.nih.gov]

  ) infectious neonatal diarrhea ( A00-A09 ) necrotizing enterocolitis in newborn ( P77.- ) noninfectious neonatal diarrhea ( P78.3 ) ophthalmia neonatorum due to gonococcus ( A54.31 ) tetanus neonatorum ( A33 ) Other congenital infectious and parasitic [icd10data.com]

• Hepatosplenomegaly

  He developed central diabetes insipidus as a neonate, followed by interstitial pneumonia, anemia, and hepatosplenomegaly. [ncbi.nlm.nih.gov]

  Physical exam Patients with congenital toxoplasmosis may exhibit findings such as a fever, rash, lymphadenopathy, hepatosplenomegaly. [symptoma.com]

• Jaundice

  Because biliary atresia can coexist with either congenital infection or inborn errors of metabolism, evaluation for an obstructive etiology of jaundice in infants with a recognized cause of intrahepatic cholestasis is necessary. [ncbi.nlm.nih.gov]

  Because biliary atresia can coexist with either congenital infection or inborn errors of metabolism, evaluation for an obstructive etiology of jaundice in infants with a recognized cause of intrahepatic cholestasis is necessary. © Lippincott-Raven Publishers [journals.lww.com]

  The newborn may have a low birth weight, enlarged liver and spleen, jaundice, anemia, petechiae, and eye damage. [clinicaltrials.gov]

  Moreover, severe cases could feature microcephaly, fever, rash, jaundice, hepatosplenomegaly, seizures, sepsis-like illness, meningitis, and encephalitis. [symptoma.com]

• Hepatomegaly

  Intracranial calcifications, micro- or macrocephaly, ventricular dilatation and hydrocephalus, hepatomegaly, splenomegaly, cardiomegaly, ascites and intrauterine growth retardation can be observed in infected fetuses. [orpha.net]

• Erythema

  In 1 patient, erythema appeared at the end of the treatment and resolved within 10 days. None of these events was attributed to the treatment. [ncbi.nlm.nih.gov]

• Seizure

  A case of congenital toxoplasmosis is reported in which the patient died at 32 days following seizures, coma and respiratory disturbances. Neuropathological examination showed numerous foci of softening throughout the brain. [ncbi.nlm.nih.gov]

  In people with immunity problems, it can lead to seizures, lung problems, blurred vision and other more severe problems. What are toxoplasmosis care options? Minor cases of toxoplasmosis don’t require treatment. [nicklauschildrens.org]

  For example, a person who is HIV-infected and who has reactivated Toxoplasma infection can have symptoms that include fever, confusion, headache, seizures, nausea, and poor coordination. [cdc.gov]

• Cerebral Calcification

  Congenital toxoplasmosis was suspected after finding hydrocephalus, cerebral calcification, and chorioretinitis. Serology tests with the ELISA technique were highly positive for antibodies against IgG, whereas anti-IgM was negative. [ncbi.nlm.nih.gov]

• Neurologic Manifestation

  The first neurologic manifestation is seizures; nystagmus, hypotonia and, later, delay of developmental milestones acquisition can be seen. The chorioretinitis - intracranial calcifications - hydrocephalus triad is present in 10% of cases. [orpha.net]

  manifestations. 8 Even patients with a subclinical infection run a major risk of developing long-term sequelae, including retinochoroiditis and neurological abnormalities. 8, 9, 10, 11, 12, 13 Ocular lesions are the most frequent manifestations of congenital [nature.com]

• Confusion

  For example, a person who is HIV-infected and who has reactivated Toxoplasma infection can have symptoms that include fever, confusion, headache, seizures, nausea, and poor coordination. [cdc.gov]

• Agitation

  RESULTS: Nine patients (13.8%) presented at least 1 adverse clinical event that was nonspecific, such as diarrhea on the day of drug administration, vomiting and agitation. [ncbi.nlm.nih.gov]

In neonates and infants suspected to have congenital toxoplasmosis, the workup should include a careful consideration of the maternal history and all possible risk factors, a thorough physical exam including ophthalmologic assessment, and the appropriate studies.

Diagnostic tests

Prenatal diagnosis is confirmed by the demonstration of Toxoplasma gondii in the amniotic fluid and/or fetal tissue through various techniques [9]. Polymerase chain reaction (PCR) of the amniotic fluid is the most commonly used method and is typically diagnostic [9] [10]. Moreover, PCR can be performed on cerebrospinal fluid (CSF), blood, or other bodily fluids [11]. Other serologic tests include the Sabin-Feldman dye test, which is a reference study and not widely available, and the indirect fluorescent antibody (IFA) and indirect hemagglutination tests. Also, the organism can be isolated with mouse inoculation.

Of importance, Toxoplasma gondii - specific IgM antibodies have a prolonged presence, which makes it difficult to interpret whether the current infection is acute of chronic [2]. However, an IgG avidity test is more accurate in diagnosing an acute infection and pinpointing the time of infection [12] [13]. This is best performed early in pregnancy.

The diagnosis of congenital toxoplasmosis in an infant is confirmed by the persistent presence of Toxoplasma gondii - specific IgG by the twelveth month of life [9]. Note that IgA and IgE enzyme-linked immunosorbent assay (ELISA) should be obtained once the infant's Toxoplasma gondii - specific IgM is negative.

Further laboratory studies are also essential. For example, a complete blood count (CBC) with a differential analysis in affected individuals is associated with thrombocytopenia, lymphocytosis, and monocytosis [2]. Additionally, CSF analysis typically reveals xanthochromia and pleocytosis. Other important tests include plasma creatinine levels, liver function tests (LFTs), as well as urinalysis and urine culture.

Imaging

Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain are useful for demonstrating intracranial calcifications, lesions, and other pathologies such as hydrocephalus.

Fetal assessment should include prenatal ultrasonography, which detects associated abnormalities.

• Xanthochromia

  Additionally, CSF analysis typically reveals xanthochromia and pleocytosis. Other important tests include plasma creatinine levels, liver function tests (LFTs), as well as urinalysis and urine culture. [symptoma.com]

Treatment of pregnant women by spiramycin resulted in reduced vertical transmission. When infected pregnant women did not undergo proper treatment, the risk of severe infection (neural-optical) in NB was significantly increased. [ncbi.nlm.nih.gov]

We aimed to evaluate whether treatment of pregnant women with spiramycin associated with a lack of monitoring for toxoplasmosis seroconversion affects the prognosis of patients. [ncbi.nlm.nih.gov]

Fortunately, serious neonatal forms and severe neurological impairment have become rare, but prompt treatment of children with convulsions, abnormal muscle tone, hydrocephalus, may improve the prognosis and result in almost normal outcome. [jpnim.com]

Prognosis Prognosis is highly dependent on the parasite genotype, the gestational age at maternal infection and on the timing of prenatal and postnatal treatment. The documents contained in this web site are presented for information purposes only. [orpha.net]

Although multifactorial in etiology, maternal infection is primarily attributed to the consumption of contaminated meat or water. Infection and transmission to the fetus may result in devastating neurologic impairment. [ncbi.nlm.nih.gov]

Because biliary atresia can coexist with either congenital infection or inborn errors of metabolism, evaluation for an obstructive etiology of jaundice in infants with a recognized cause of intrahepatic cholestasis is necessary. © Lippincott-Raven Publishers [journals.lww.com]

Etiology CTX is caused by the mother's primo-infection by Tg, an intracellular protozoan parasite of the Apicomplexa phylum, and transmission to the fetus by trans-placental infection. Nearly 25% of exposed fetuses are infected. [orpha.net]

But detailed understanding of its epidemiology emerged only after 1970 with the discovery of its life cycle. [ncbi.nlm.nih.gov]

A Network Resource will be needed for: i) the development of epidemiological study protocols for the network; ii) the day to day management of the epidemiological studies, including data collection, liaison with clinicians and monitoring data collection [cordis.europa.eu]

Pathophysiology Infection with Toxoplasma gondii. Physical Examination List of classic and atypical findings which have been reported. [eyewiki.aao.org]

The mothers were not immunocompromised, thus excluding toxoplasmosis reactivation due to immunodeficiency. 2 Different pathophysiological mechanisms may be suggested and may be illustrated by our two cases. [bjo.bmj.com]

OBJECTIVES: The aim of the study was to evaluate obstetric care of pregnant women with regard to prevention of congenital toxoplasmosis. [ncbi.nlm.nih.gov]

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