Subscribe to RSS
DOI: 10.1055/a-2111-7394
Toxoplasma gondii Infection in Pregnancy – Recommendations of the Working Group on Obstetrics and Prenatal Medicine (AGG – Section on Maternal Disorders)
Article in several languages: English | deutschAbstract
Aim The AGG (Working Group for Obstetrics and Prenatal Diagnostics, Section Maternal Diseases) has issued these recommendations to improve the detection and management of Toxoplasma gondii infection in pregnancy.
Methods Members of the Task Force developed the recommendations and statements presented here using recently published literature. The recommendations were adopted after a consensus process by members of the working group.
Recommendations This article focuses on the epidemiology and pathophysiology of Toxoplasma gondii infection in pregnancy and includes recommendations for maternal and fetal diagnosis, transmission prophylaxis, therapy, prevention, screening, and peripartum management.
Publication History
Received: 14 June 2023
Accepted after revision: 18 July 2023
Article published online:
18 September 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Robert Koch-Institut. RKI-Ratgeber Toxoplasmose. Epidemiol Bull 2018; 42: 451-460
- 2 Wilking H, Thamm M, Stark K. et al. Prevalence, incidence estimations, and risk factors of Toxoplasma gondii infection in Germany: a representative, cross-sectional, serological study. Sci Rep 2016; 6: 22551 DOI: 10.1038/srep22551.
- 3 Pleyer U, Groß U, Schlüter D. et al. Toxoplasmosis in Germany: Epidemiology, Diagnosis, Risk Factors, and Treatment. Dtsch Arztebl Int 2019; 116: 435-444 DOI: 10.3238/arztebl.2019.0435.
- 4 Montoya JG, Liesenfeld O. Toxoplasmosis. Lancet 2004; 363: 1965-1976 DOI: 10.1016/S0140-6736(04)16412-X.
- 5 Beringer T. [Is diagnosis of toxoplasmosis within the scope of prenatal care meaningful?]. Geburtshilfe Frauenheilkd 1992; 52: 740-741 DOI: 10.1055/s-2007-1023804.
- 6 Krings A, Jacob J, Seeber F. et al. Estimates of Toxoplasmosis Incidence Based on Healthcare Claims Data, Germany, 2011–2016. Emerg Infect Dis 2021; 27: 2097-2106 DOI: 10.3201/eid2708.203740.
- 7 Prusa A-R, Kasper DC, Pollak A. et al. The Austrian Toxoplasmosis Register, 1992–2008. Clin Infect Dis 2015; 60: e4-e10 DOI: 10.1093/cid/ciu724.
- 8 Paquet C, Yudin MH. No. 285-Toxoplasmosis in Pregnancy: Prevention, Screening, and Treatment. J Obstet Gynaecol Can 2018; 40: e687-e693 DOI: 10.1016/j.jogc.2018.05.036.
- 9 Leruez-Ville M, Benoist G, Ville Y. Fetal Infections: Clinical Management. In: Kilby MD, Johnson A, Oepkes D, eds. Fetal Therapy. Cambridge University Press; 2019: 224-247
- 10 Hotop A, Hlobil H, Gross U. Efficacy of rapid treatment initiation following primary Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2012; 54: 1545-1552 DOI: 10.1093/cid/cis234.
- 11 Dubey JP, Murata FHA, Cerqueira-Cézar CK. et al. Congenital toxoplasmosis in humans: an update of worldwide rate of congenital infections. Parasitology 2021; 148: 1406-1416 DOI: 10.1017/S0031182021001013.
- 12 Picone O, Fuchs F, Benoist G. et al. Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod 2020; 49: 101814 DOI: 10.1016/j.jogoh.2020.101814.
- 13 Codaccioni C, Picone O, Lambert V. et al. Ultrasound features of fetal toxoplasmosis: A contemporary multicenter survey in 88 fetuses. Prenat Diagn 2020; 40: 1741-1752 DOI: 10.1002/pd.5756.
- 14 Kieffer F, Wallon M, Garcia P. et al. Risk factors for retinochoroiditis during the first 2 years of life in infants with treated congenital toxoplasmosis. Pediatr Infect Dis J 2008; 27: 27-32 DOI: 10.1097/INF.0b013e318134286d.
- 15 SYROCOT (Systematic Review on Congenital Toxoplasmosis) study group. Thiébaut R, Leproust S. et al. Effectiveness of prenatal treatment for congenital toxoplasmosis: a meta-analysis of individual patientsʼ data. Lancet 2007; 369: 115-122 DOI: 10.1016/S0140-6736(07)60072-5.
- 16 Berrébi A, Assouline C, Bessières M-H. et al. Long-term outcome of children with congenital toxoplasmosis. Am J Obstet Gynecol 2010; 203: 552.e1-552.e6 DOI: 10.1016/j.ajog.2010.06.002.
- 17 Dunn D, Wallon M, Peyron F. et al. Mother-to-child transmission of toxoplasmosis: risk estimates for clinical counselling. Lancet 1999; 353: 1829-1833 DOI: 10.1016/S0140-6736(98)08220-8.
- 18 Wallon M, Peyron F, Cornu C. et al. Congenital toxoplasma infection: monthly prenatal screening decreases transmission rate and improves clinical outcome at age 3 years. Clin Infect Dis 2013; 56: 1223-1231 DOI: 10.1093/cid/cit032.
- 19 Gilbert RE, Freeman K, Lago EG. et al. Ocular sequelae of congenital toxoplasmosis in Brazil compared with Europe. PLoS Negl Trop Dis 2008; 2: e277 DOI: 10.1371/journal.pntd.0000277.
- 20 Tan HK, Schmidt D, Stanford M. et al. Risk of visual impairment in children with congenital toxoplasmic retinochoroiditis. Am J Ophthalmol 2007; 144: 648-653 DOI: 10.1016/j.ajo.2007.07.013.
- 21 Wallon M, Kodjikian L, Binquet C. et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113: 1567-1572 DOI: 10.1542/peds.113.6.1567.
- 22 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: 597-600 DOI: 10.1097/INF.0b013e31820bb5f3.
- 23 Roizen N, Kasza K, Karrison T. et al. Impact of visual impairment on measures of cognitive function for children with congenital toxoplasmosis: implications for compensatory intervention strategies. Pediatrics 2006; 118: e379-e390 DOI: 10.1542/peds.2005-1530.
- 24 Eichenwald HF. A study of congenital toxoplasmosis, with particular emphasis on clinical manifestations, sequelae and therapy. In: Siim JC. ed. Human toxoplasmosis. Copenhagen: Munksgaard; 1960: 41-49
- 25 Hutson SL, Wheeler KM, McLone D. et al. Patterns of Hydrocephalus Caused by Congenital Toxoplasma gondii Infection Associate With Parasite Genetics. Clin Infect Dis 2015; 61: 1831-1834 DOI: 10.1093/cid/civ720.
- 26 McLone D, Frim D, Penn R. et al. Outcomes of hydrocephalus secondary to congenital toxoplasmosis. J Neurosurg Pediatr 2019; DOI: 10.3171/2019.6.PEDS18684.
- 27 Anand R, Jones CW, Ricks JH. et al. Acute primary toxoplasmosis in travelers returning from endemic countries. J Travel Med 2012; 19: 57-60 DOI: 10.1111/j.1708-8305.2011.00564.x.
- 28 Rudzinski M, Khoury M, Couto C. et al. Reactivation of Ocular Toxoplasmosis in Non-Hispanic Persons, Misiones Province, Argentina. Emerg Infect Dis 2016; 22: 912-913 DOI: 10.3201/eid2205.150025.
- 29 Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008; 47: 554-566 DOI: 10.1086/590149.
- 30 Fricker-Hidalgo H, Cimon B, Chemla C. et al. Toxoplasma seroconversion with negative or transient immunoglobulin M in pregnant women: myth or reality? A French multicenter retrospective study. J Clin Microbiol 2013; 51: 2103-2111 DOI: 10.1128/JCM.00169-13.
- 31 Elbez-Rubinstein A, Ajzenberg D, Dardé M-L. et al. Congenital toxoplasmosis and reinfection during pregnancy: case report, strain characterization, experimental model of reinfection, and review. J Infect Dis 2009; 199: 280-285 DOI: 10.1086/595793.
- 32 Low incidence of congenital toxoplasmosis in children born to women infected with human immunodeficiency virus. European Collaborative Study and Research Network on Congenital Toxoplasmosis. Eur J Obstet Gynecol Reprod Biol 1996; 68: 93-96 DOI: 10.1016/0301-2115(96)02497-9.
- 33 Liesenfeld O, Montoya JG, Tathineni NJ. et al. Confirmatory serologic testing for acute toxoplasmosis and rate of induced abortions among women reported to have positive Toxoplasma immunoglobulin M antibody titers. Am J Obstet Gynecol 2001; 184: 140-145 DOI: 10.1067/mob.2001.108341.
- 34 Maldonado YA, Read JS. COMMITTEE ON INFECTIOUS DISEASES. Diagnosis, Treatment, and Prevention of Congenital Toxoplasmosis in the United States. Pediatrics 2017; 139: e20163860 DOI: 10.1542/peds.2016-3860.
- 35 Peyron F, Lʼollivier C, Mandelbrot L. et al. Maternal and Congenital Toxoplasmosis: Diagnosis and Treatment Recommendations of a French Multidisciplinary Working Group. Pathogens 2019; 8: 24 DOI: 10.3390/pathogens8010024.
- 36 Khalil A, Sotiriadis A, Chaoui R. et al. ISUOG Practice Guidelines: role of ultrasound in congenital infection. Ultrasound Obstet Gynecol 2020; 56: 128-151 DOI: 10.1002/uog.21991.
- 37 de Oliveira Azevedo CT, do Brasil PEAA, Guida L. et al. Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis. PloS One 2016; 11: e0149938 DOI: 10.1371/journal.pone.0149938.
- 38 Sterkers Y, Pratlong F, Albaba S. et al. Novel Interpretation of Molecular Diagnosis of Congenital Toxoplasmosis According to Gestational Age at the Time of Maternal Infection. J Clin Microbiol 2012; 50: 3944-3951 DOI: 10.1128/JCM.00918-12.
- 39 Wallon M, Franck J, Thulliez P. et al. Accuracy of real-time polymerase chain reaction for Toxoplasma gondii in amniotic fluid. Obstet Gynecol 2010; 115: 727-733 DOI: 10.1097/AOG.0b013e3181d57b09.
- 40 Rabilloud M, Wallon M, Peyron F. In utero and at birth diagnosis of congenital toxoplasmosis: use of likelihood ratios for clinical management. Pediatr Infect Dis J 2010; 29: 421-425 DOI: 10.1097/INF.0b013e3181c80493.
- 41 Thalib L, Gras L, Romand S. et al. Prediction of congenital toxoplasmosis by polymerase chain reaction analysis of amniotic fluid. BJOG Int J Obstet Gynaecol 2005; 112: 567-574 DOI: 10.1111/j.1471-0528.2005.00486.x.
- 42 Prusa A-R, Kasper DC, Pollak A. et al. Amniocentesis for the detection of congenital toxoplasmosis: results from the nationwide Austrian prenatal screening program. Clin Microbiol Infect 2015; 21: 191.e1-191.e8 DOI: 10.1016/j.cmi.2014.09.018.
- 43 Salomon LJ, Sotiriadis A, Wulff CB. et al. Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis. Ultrasound Obstet Gynecol 2019; 54: 442-451 DOI: 10.1002/uog.20353.
- 44 Patel DV, Holfels EM, Vogel NP. et al. Resolution of intracranial calcifications in infants with treated congenital toxoplasmosis. Radiology 1996; 199: 433-440 DOI: 10.1148/radiology.199.2.8668790.
- 45 Blondiaux E, Garel C. Fetal cerebral imaging – ultrasound vs. MRI: an update. Acta Radiol 2013; 54: 1046-1054 DOI: 10.1258/ar.2012.120428.
- 46 Berrebi A, Bardou M, Bessieres M-H. et al. Outcome for children infected with congenital toxoplasmosis in the first trimester and with normal ultrasound findings: a study of 36 cases. Eur J Obstet Gynecol Reprod Biol 2007; 135: 53-57 DOI: 10.1016/j.ejogrb.2006.11.002.
- 47 Mandelbrot L, Kieffer F, Wallon M. et al. Toxoplasmose pendant la grossesse: proposition actuelle de prise en charge pratique. Gynecol Obstet Fertil Senol 2021; 49: 782-791 DOI: 10.1016/j.gofs.2021.03.003.
- 48 Di Mascio D, Rizzo G, Khalil A. et al. Role of fetal magnetic resonance imaging in fetuses with congenital cytomegalovirus infection: multicenter study. Ultrasound Obstet Gynecol 2023; 61: 67-73 DOI: 10.1002/uog.26054.
- 49 Mandelbrot L, Kieffer F, Sitta R. et al. Prenatal therapy with pyrimethamine + sulfadiazine vs. spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial. Am J Obstet Gynecol 2018; 219: 386.e1-386.e9 DOI: 10.1016/j.ajog.2018.05.031.
- 50 Schoondermark-van de Ven EM, Melchers WJ, Galama JM. et al. Prenatal diagnosis and treatment of congenital Toxoplasma gondii infections: an experimental study in rhesus monkeys. Eur J Obstet Gynecol Reprod Biol 1997; 74: 183-188 DOI: 10.1016/s0301-2115(97)00119-x.
- 51 Cortina-Borja M, Tan HK, Wallon M. et al. Prenatal Treatment for Serious Neurological Sequelae of Congenital Toxoplasmosis: An Observational Prospective Cohort Study. PLoS Med 2010; 7: 11
- 52 Gras L, Wallon M, Pollak A. et al. European Multicenter Study on Congenital Toxoplasmosis. Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres. Acta Paediatr 2005; 94: 1721-1731 DOI: 10.1111/j.1651-2227.2005.tb01844.x.
- 53 Schuster S, Janatzek S, Chittka L. IGeLMonitor- Evidenz ausführlich – Toxoplasmose-Test in der Schwangerschaft. Accessed September 10, 2022 at: https://www.igel-monitor.de/fileadmin/user_upload/Toxoplasmosetest_Schwangerschaft_Evidenz_ausfuehrlich.pdf
- 54 Katlama C, De Wit S, OʼDoherty 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: 268-275 DOI: 10.1093/clinids/22.2.268.
- 55 Araujo FG, Remington JS. Effect of Clindamycin on Acute and Chronic Toxoplasmosis in Mice. Antimicrob Agents Chemother 1974; 5: 647-651 DOI: 10.1128/AAC.5.6.647.
- 56 Buonsenso D, Pata D, Turriziani Colonna A. et al. Spyramicine and Trimethoprim-Sulfamethoxazole Combination to Prevent Mother-To-Fetus Transmission of Toxoplasma gondii Infection in Pregnant Women: A 28-Years Single-center Experience. Pediatr Infect Dis J 2022; 41: e223-e227 DOI: 10.1097/INF.0000000000003469.
- 57 EACSociety. EACS Guidelines. Accessed September 17, 2022 at: https://www.eacsociety.org/guidelines/eacs-guidelines/
- 58 Reiter-Owona I, Hlobil H, Enders M. et al. Sulfadiazine plasma concentrations in women with pregnancy-acquired compared to ocular toxoplasmosis under pyrimethamine and sulfadiazine therapy: a case-control study. Eur J Med Res 2020; 25: 59 DOI: 10.1186/s40001-020-00458-7.
- 59 Peytavin G, Leng JJ, Forestier F. et al. Placental transfer of pyrimethamine studied in an ex vivo placental perfusion model. Biol Neonate 2000; 78: 83-85 DOI: 10.1159/000014254.
- 60 Wehbe K, Pencole L, Lhuaire M. et al. Hygiene measures as primary prevention of toxoplasmosis during pregnancy: A systematic review. J Gynecol Obstet Hum Reprod 2022; 51: 102300 DOI: 10.1016/j.jogoh.2021.102300.
- 61 Gemeinsamer Bundesausschuss. Mutterschafts-Richtlinien. 2021. Accessed April 18, 2023 at: https://www.g-ba.de/downloads/62-492-2676/Mu-RL_2021-09-16_iK-2022-01-01.pdf
- 62 Prusa A-R, Kasper DC, Sawers L. et al. Congenital toxoplasmosis in Austria: Prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis 2017; 11: e0005648 DOI: 10.1371/journal.pntd.0005648.
- 63 SGGG. Expertenbrief 31 – Verzicht auf das Toxoplasmose-Screening in der Schwangerschaft – kurze zusammenfassende Begründung. 2010. Accessed September 17, 2022 at: https://www.sggg.ch/fileadmin/user_upload/PDF/31_Toxoplasmose-Screening_2010.pdf
- 64 Wallon M, Kieffer F, Huissoud C. et al. Cesarean delivery or induction of labor does not prevent vertical transmission of toxoplasmosis in late pregnancy. Int J Gynaecol Obstet 2015; 129: 176-177 DOI: 10.1016/j.ijgo.2014.10.026.
- 65 Arbeitsgruppe Infektiologie der Österreichischen Gesellschaft für Kinderheilkunde. Österreichische Richtlinie für das Toxoplasmose-Screening in der Schwangerschaft und frühen Kindheit. 2013. Accessed January 21, 2021 at: https://www.oeghmp.at/media/richtlinie_toxoplasmose-screening.pdf
- 66 Wichtige humane Parasitosen: Toxoplasmose. Z Gastroenterol 2020; 58: 742-746 DOI: 10.1055/a-1120-1338.