Artikel
Primary toxoplasmosis in pregnancy – results of a multidisciplinary approach
Primäre Toxoplasmose in der Schwangerschaft – Ergebnisse eines multidisziplinär Behandlungsansatzes
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Veröffentlicht: | 2. Juni 2010 |
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Objective: Primary toxoplasmosis in pregnancy is an immanent problem for pregnant women and their caregivers. Despite of a low index clinical manifestations are severe and may lead to permanent disabilities in affected children. Incidences are ranging from 0.12–2 per 1,000 pregnancies. Evidence-based treatments are not available.
Goal: Prospective longitudinal evaluation of efficacy, safety and outcomes using short-term anti-protozoal treatment (21 to 28 days) for primary toxoplasmosis in pregnant women.
Patients and methods: All women attending an infectious diseases outpatient clinic having serologically confirmed primary toxoplasmosis (documented seroconversion within four weeks, IgM antibody positivity with low or absent IgG antibody avidity or positive Toxoplasma gondii-PCR in plasma) between 2001 and 2009 were scheduled to treatment in a standardized manner using pyrimethamine and sulfadiazine with folinate rescue for three to four weeks. Postpartum newborn testing was performed. If available, follow-up interviews of mothers as well as children's medical records were assessed at one to eight years after birth.
Results: Information was available for 125/133 (94%) mother-child pairs (mother's median age 25 yrs, range 17–40 yrs). Diagnosis of toxoplasmosis was established in pregnancy week 21 (range 6–35). Treatment was either instituted immediately or week 12. In all pregnancies no toxoplasmosis-related complication occurred (child delivery in median week 38; child AGGAR score 10, range 6–10). In 66/134 children (49.3%, one sibling birth) postnatal serologies were available: 5 out of 67 children (7.5%) showed evidence of infection: 4/5 IgM antibody positive, one PCR positive (control PCR after one week negative). No newborn was given pre-emptive treatment. All five children are up to now without evidence for congenital toxoplasmosis (follow up 1, 2, 3, 4, and five years, respectively).
Conclusions: In this prospectively evaluated large case series short-term treatment of primary toxoplasmosis in pregnancy compares well to continuous or intermittent treatment regimen with regard to childrens and mothers outcomes. Short-term treatment is clearly able to provide more patient comfort in comparison to other recommended regimes which have to be taken permanently or intermittently during pregnancy.
Conflict of interest: None.