REIV-TOXO Project: Results from a Spanish cohort of congenital toxoplasmosis (2015-2022). The beneficial effects of prenatal treatment on clinical outcomes of infected newborns.

Autor: Guarch-Ibáñez B; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Catalonia, Spain.; Universitat de Girona (UDG), Girona, Catalonia, Spain.; Congenital Infections Working Group, Spanish Society of Pediatric Infectious Diseases (SEIP), Spain., Carreras-Abad C; Congenital Infections Working Group, Spanish Society of Pediatric Infectious Diseases (SEIP), Spain.; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain., Frick MA; Congenital Infections Working Group, Spanish Society of Pediatric Infectious Diseases (SEIP), Spain.; Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain.; Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain., Blázquez-Gamero D; Congenital Infections Working Group, Spanish Society of Pediatric Infectious Diseases (SEIP), Spain.; Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain., Baquero-Artigao F; Congenital Infections Working Group, Spanish Society of Pediatric Infectious Diseases (SEIP), Spain.; Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain.; Universidad Autónoma de Madrid, Madrid, Spain.; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain., Fuentes I; Toxoplasmosis and Intestinal Protozoa Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain., Soler-Palacin P; Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Infantil Vall d'Hebron, Barcelona, Catalonia, Spain.; Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2024 Oct 22; Vol. 18 (10), pp. e0012619. Date of Electronic Publication: 2024 Oct 22 (Print Publication: 2024).
DOI: 10.1371/journal.pntd.0012619
Abstrakt: Background: Some regions of Spain are withdrawing their pregnancy screening program for congenital toxoplasmosis (CT). The Spanish Research Network of Congenital Toxoplasmosis (REIV-TOXO) was created to describe the current status of CT in Spain. The aims of this study were to describe the epidemiological and clinical characteristics of CT and to evaluate the effect of prenatal treatment on clinical outcomes to inform decision-making policies.
Methods: Ambispective observational study including CT cases recorded in the REIV-TOXO database that includes 122 hospitals (2015-2022). Inclusion criteria were one or more of the following: positive PCR in maternal amniotic fluid; positive Toxoplasma gondii-specific IgM or IgA antibodies at birth; positive PCR in the placenta, newborn blood, urine or CSF; increase of specific IgG levels during infant follow-up; or specific IgG persistence beyond age 12 months.
Findings: Fifty-six newborns (54 pregnancies) were included. Prenatal screening allowed 92.8% of cases to be identified. The time of maternal infection was well documented in 90.7% of cases, with 61.1% occurring in the third trimester. A total of 66.6% (36/54) pregnant women received antiparasitic treatment: 24/36 spiramycin, 8/36 pyrimethamine, sulfadiazine, and folinic acid, and 4/36 both treatments sequentially. Most cases were asymptomatic at birth (62.5%, 35/56), and 84% (47/56) newborns completed one year of treatment. Median follow-up was 24 months (IQR = 3-72): 14.2% children exhibited new complications, mainly ocular. Newborns born to mothers treated prenatally had four-fold lower risk of CT clinical features at birth (p = 0.03) and six-fold lower risk of further complications during follow-up (p = 0.04) with no treatment-related differences during pregnancy.
Conclusions: While diagnosis based only on neonatal assessment misses a significant number of CT cases, prenatal screening allows treatment to be started during pregnancy, with better clinical outcomes at birth and during follow-up. REIV-TOXO provides valuable information about CT in Spain, highlighting the need for universal maternal screening.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Guarch-Ibáñez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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