The Significance of the Dynamics of Serological and PCR Diagnostic Data for the Likelihood of Congenital Toxoplasmosis in Children Born to Toxoplasma Seropositive Mothers
Authors:
P. Prášil 1; Z. Čermáková 2; S. Plíšek 1
Authors‘ workplace:
Klinika infekčních nemocí Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice, Hradec Králové
přednosta MUDr. S. Plíšek, Ph. D.
1; Ústav klinické mikrobiologie Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice, Hradec Králové
vedoucí doc. RNDr. V. Buchta, CSc.
2
Published in:
Čes-slov Pediat 2010; 65 (7-8): 432-440.
Category:
Original Papers
Overview
Specific aim:
The study was focused on monitoring the dynamics of specific antibodies against Toxoplasma gondii in children born to mothers, who were treated during pregnancy for toxoplasmosis and where an infection of the fetus was not proven. The analysis of the data serves as a basis for discussion of the issues pertaining to the necessary length of the observation of such children and leads to recommendations regarding the suitability of particular laboratory and clinical parameters in the follow-up of these patients.
Material and methods:
A retrospective study was conducted with a cohort of newborns and infants (45 children in the time period of 8 years), whose mothers had been treated for toxoplasmosis during pregnancy because of the positivity of at least one class of specific acute antibodies (IgM, IgE, IgA) against T. gondii, but also had shown anamnestic positivity of specific IgG antibodies. Infection of the fetuses was not proven in these mothers as the examination showed normal fetal ultrasonography and negativity of T. gondii DNA in maternal blood or amniotic fluid. In this cohort, the dynamics of antibodies and clinical picture were being followed-up depending on the interval elapsed from birth. An ultrasound examination of the brain and PCR detection of T. gondii DNA from blood were carried out before release from maternal hospital. The first analysis of specific antibody titers was performed on the day of the birth, the second one between 2 to 10 weeks after birth, and the following antibody analysis was scheduled based on the dynamics of the titers. The infants were followed for approximately 35.6 weeks.
Results:
The PCR data for T. gondii DNA were negative in all newborns. The ultrasound examinations of the brain and clinical examination did not show any brain damage related to congenital toxoplasmosis in these children. Titres of the complement fixation antibodies (CFR) showed a decreasing tendency, which correlated with decreases of the specific IgG antibody titers. The titers of CFR were constantly lower than 1:64 from week 25 after birth and these titers were always lower than 1:8 after week 32. Specific IgG antibody titers showed a continuous decrease since birth and were negative from week 33 after the childbirth. The titers of the acute antibodies did not show significant dynamics. Only in one case there were borderline titers of the specific IgA antibodies. Repeated clinical examinations did not detect any signs of congenital toxoplasmosis.
Conclusion:
The pregnancies of women showing both significant titers of the specific acute antibodies against T. gondii and IgG class titers should be followed both during pre- and post-natal period. However, if the infection of the fetus is not proven prenatally, the newborn shows normal ultrasound of the brain, decrease of the specific IgG antibody titers and is PCR negative for the T. gondii, DNA, the diagnosis of congenital toxoplasmosis is highly unlikely.
Key words:
Toxoplasma gondii, pregnancy, newborn, infant, congenital toxoplasmosis
Sources
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Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2010 Issue 7-8
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