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Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: Implications for prenatal management and screening

      Objective

      The purpose of this study was to determine whether demographic characteristics, history of exposure to recognized transmission vehicles, or illness that was compatible with acute toxoplasmosis during gestation identified most mothers of infants with congenital toxoplasmosis.

      Study design

      Mothers of 131 infants and children who were referred to a national study of treatment for congenital toxoplasmosis were characterized demographically and questioned concerning exposure to recognized risk factors or illness.

      Results

      No broad demographic features identified populations that were at risk. Only 48% of mothers recognized epidemiologic risk factors (direct or indirect exposure to raw/undercooked meat or to cat excrement) or gestational illnesses that were compatible with acute acquired toxoplasmosis during pregnancy.

      Conclusion

      Maternal risk factors or compatible illnesses were recognized in retrospect by fewer than one half of North American mothers of infants with toxoplasmosis. Educational programs might have prevented acquisition of Toxoplasma gondii by those mothers who had clear exposure risks. However, only systematic serologic screening of all pregnant women at prenatal visits or of all newborn infants at birth would prevent or detect a higher proportion of these congenital infections.

      Key words

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      References

        • Roberts T.
        • Frenkel J.K.
        Estimating income losses and other preventable costs caused by congenital toxoplasmosis in people in the United States.
        JAMA. 1990; 2: 249-256
        • Wilson C.B.
        • Remington J.S.
        • Stagno S.
        • Reynolds D.W.
        Development of adverse sequelae in children born with subclinical congenital Toxoplasma infection.
        Pediatrics. 1980; 66: 767-774
        • Koppe J.G.
        • Kloosterman G.J.
        • de Roever-Bonnet H.
        • Eckert-Stroink J.A.
        • Loewer-Sieger D.H.
        • De Bruijne J.I.
        Toxoplasmosis and pregnancy, with a long-term follow-up of the children.
        Eur J Obstet Gynecol Reprod Biol. 1974; 4: 101-110
        • Koppe J.G.
        • Loewer-Sieger D.H.
        • de Roever-Bonnet H.
        Results of 20-year follow-up of congenital toxoplasmosis.
        Lancet. 1986; 1: 254-256
        • Saxon S.A.
        • Knight W.
        • Reynolds D.W.
        • Stagno S.
        • Alford C.A.
        Intellectual deficits in children born with subclinical congenital toxoplasmosis: a preliminary report.
        J Pediatr. 1973; 8: 2792
        • Eichenwald H.F.
        A study of congenital toxoplasmosis with particular emphasis on clinical manifestations, sequelae and therapy.
        in: Siim J.C. Human toxoplasmosis. Munksgaard, Copenhagen1960: 41-49
        • Boyer K.M.
        • McLeod R.L.
        Toxoplasma gondii (Toxoplasmosis).
        in: Long S.S. Pickering L.K. Prober C.G. Principles and practice of pediatric infectious diseases. 2nd ed. Churchill Livingstone, New York2003: 1303-1322
        • Roberts F.
        • McLeod R.
        Pathogenesis of toxoplasmic retinochoroiditis.
        Parasitol Today. 1999; 15: 51-57
        • Remington J.S.
        • McLeod R.
        • Thulliez P.
        • Desmonts G.
        Toxoplasmosis.
        in: Remington J.S. Klein J.O. Infectious diseases of the fetus and newborn infant. 5th ed. Saunders, Philadelphia2001: 205-346
        • McGee T.
        • Wolters C.
        • Stein L.
        • Kraus N.
        • Johnson D.
        • Boyer K.
        • et al.
        Absence of sensorineural hearing loss in treated infants and children with congenital toxoplasmosis.
        Ontolaryngol Head Neck Surg. 1992; 106: 75-80
        • McAuley J.
        • Boyer K.
        • Patel D.
        • Mets M.
        • Swisher C.
        • Roizen N.
        • et al.
        Early and longitudinal evaluations of treated infants and children and untreated historical patients with congenital toxoplasmosis: the Chicago Collaborative Treatment Trial.
        Clin Infect Dis. 1994; 18: 38-72
        • Roizen N.
        • Swisher C.
        • Stein M.
        • Hopkins J.
        • Boyer K.M.
        • Holfels E.
        • et al.
        Neurologic and developmental outcome in treated congenital toxoplasmosis.
        Pediatrics. 1995; 95: 11-20
        • Mets M.
        • Holfels E.
        • Boyer K.M.
        • Swisher C.N.
        • Roizen N.
        • Stein L.
        • et al.
        Eye manifestations of congenital toxoplasmosis.
        Am J Ophthalmol. 1996; 122: 309-324
        • Patel D.V.
        • Holfels E.M.
        • Vogel N.P.
        • Boyer K.M.
        • Mets M.B.
        • Swisher C.N.
        • et al.
        Resolution of intracranial calcifications in children with treated congenital toxoplasmosis.
        Radiology. 1996; 199: 433-440
        • Desmonts G.
        • Couvreur J.
        Congenital toxoplasmosis: a prospective study of 378 pregnancies.
        N Engl J Med. 1974; 290: 1110-1116
        • Daffos F.
        • Mirlesse V.
        • Hohlfeld P.
        • Jacquemard F.
        • Thulliez P.
        • Forestier F.
        Toxoplasmosis in pregnancy.
        Lancet. 1994; 344: 541
        • Daffos F.
        • Forestier F.
        • Capella-Pavlovsky M.
        • Thulliez P.
        • Aufrant C.
        • Valenti D.
        • et al.
        Prenatal management of 746 pregnancies at risk for congenital toxoplasmosis.
        N Engl J Med. 1988; 318: 271-275
        • Hohlfeld P.
        • Daffos F.
        • Costa J.M.
        • Thulliez P.
        • Forestier F.
        • Vidaud M.
        Prenatal diagnosis of congenital toxoplasmosis with a polymerase-chain reaction test on amniotic fluid.
        N Engl J Med. 1994; 331: 695-699
        • Hohlfeld P.
        • Daffos F.
        • Thulliez P.
        • Aufrant C.
        • Couvreur J.
        • MacAleese J.
        • et al.
        Fetal toxoplasmosis: outcome of pregnancy and infant follow-up after in utero treatment.
        J Pediatr. 1989; 115: 765-769
        • Brezin A.P.
        • Thulliez P.
        • Couvreur J.
        • Nobre R.
        • Mcleod R.
        • Mets M.B.
        Ophthalmic outcome after pre- and post-natal treatment of congenital toxoplasmosis.
        Am J Ophthalmol. 2003; 135: 779-784
        • Couvreur J.
        • Thulliez P.
        • Daffos F.
        • Aufrant C.
        • Bompard Y.
        • Gesquiere A.
        • et al.
        In utero treatment of toxoplasmic fetopathy with the combination pyrimethamine-sulfadizine.
        Fetal Diagn Ther. 1993; 8: 45-50
        • Guerina N.G.
        • Hsu H.W.
        • Meissner H.C.
        • Maguire J.H.
        • Lynfield R.
        • Stechenberg B.
        • et al.
        Neonatal serologic screening and early treatment for congenital Toxoplasma gondii infection: The New England Regional Toxoplasma Working Group.
        N Engl J Med. 1994; 330: 1858-1863
        • Lebech M.
        • Andersen O.
        • Christensen N.C.
        • Hertel J.
        • Nielsen H.E.
        • Peitersen B.
        • et al.
        Feasibility of neonatal screening for Toxoplasma infection in the absence of prenatal treatment: Danish Congenital Toxoplasmosis Study Group.
        Lancet. 1999; 353: 1834-1837
        • Hollingshead A.B.
        Four factor index of social status.
        Yale University Press, New Haven (CT)1975
        • Wong S.Y.
        • Remington J.S.
        Toxoplasmosis in pregnancy.
        Clin Infect Dis. 1994; 18: 853-862
        • Dannemann B.R.
        • McCutchan J.A.
        • Israelski D.
        • Antoniskis D.
        • Leport C.
        • Luft B.J.
        • et al.
        The differential agglutination test for diagnosis of recently acquired infection with Toxoplasma gondii.
        J Clin Microbiol. 1990; 28: 1928-1933
        • Boyer K.
        Pediatric implications of maternal infection.
        in: Jenson H.B. Baltimore R.S. Pediatric infectious diseases: principles and practice. 2nd ed. Sanders, Philadelphia2002: 1085-1098
      1. Miller MA, Conrad P, Gardner I, Kreuder C, Mazet J, Jessup D, et al. Toxoplasma gondii infections in California sea otters [abstract 1]. In: Kim K, Weiss LM, editors. Seventh International Congress of Toxoplasmosis. Tarrytown (NY); 2003.

        • Bowie W.R.
        • King A.S.
        • Werker D.H.
        • Isaac-Renton J.L.
        • Bell A.
        • Eng S.B.
        • et al.
        Outbreak of toxoplasmosis associated with municipal drinking water.
        Lancet. 1997; 350: 1255-1256
        • Bahia-Oliveira L.M.G.
        • Jones J.L.
        • Azevedo-Silva J.
        • Alves C.C.F.
        • Oréfice F.
        • Addiss D.G.
        Highly endemic, waterborne toxoplasmosis in North Rio de Janeiro state, Brazil.
        Emerg Infect Dis. 2003;
        • Lindsay D.S.
        • Phelps K.K.
        • Smith S.A.
        • Flick G.
        • Sumner S.S.
        • Dubey J.P.
        Removal of Toxoplasma gondii oocysts from sea water by eastern oysters (Crassostrea virginica).
        J Eukaryot Microbiol Suppl. 2001; : 197S-198S
        • McCabe R.E.
        • Remington J.S.
        Toxoplasmosis: the time has come.
        N Engl J Med. 1988; 318: 313-315
        • Gilbert R.
        • Dunn D.
        • Wallon M.
        • Hayde M.
        • Prusa A.
        • Lebech M.
        • et al.
        Epidemiological comparison of the risks of mother-to-child transmission and clinical manifestations of congenital toxoplasmosis according to prenatal treatment protocol.
        Epidemiol Infect. 2001; 127: 113-120
        • Gilbert R.E.
        • Gras L.
        • Wallon M.
        • Peyron F.
        • Ades A.E.
        • Dunn D.T.
        Effect of prenatal treatment on mother to child transmission of Toxoplasma gondii: retrospective cohort study of 554 mother-child pairs in Lyon, France.
        Int J Epidemiol. 2001; 30: 1303-1308
        • Gras L.
        • Gilbert R.E.
        • Ades A.E.
        • Dunn D.T.
        Effect of prenatal treatment on the risk of intracranial and ocular lesions in children with congenital toxoplasmosis.
        Int J Epidemiol. 2001; 30: 1309-1313
        • Foulon W.
        • Pinon J.M.
        • Stray-Pedersen B.
        • Pollak A.
        • Lappalainen M.
        • Decoster A.
        • et al.
        Prenatal diagnosis of congenital toxoplasmosis: a multicenter evaluation of different diagnostic parameters.
        Am J Obstet Gynecol. 1999; 181: 843-847
        • Munoz C.
        • Izquierdo C.
        • Parra J.
        • Ginovart G.
        • Margall N.
        Recommendation for prenatal screening for congenital toxoplasmosis.
        Eur J Clin Microbiol Infect Dis. 2000; 19: 324-325
        • Logar J.
        • Petrovec M.
        • Novak-Antolic Z.
        • Premru-Srsen T.
        • Cizman M.
        • Arnez M.
        • et al.
        Prevention of congenital toxoplasmosis in Slovenia by serological screening of pregnant women.
        Scand J Infect Dis. 2002; 34: 201-204
        • Thulliez P.
        Commentary: efficacy of prenatal treatment for toxoplasmosis: a possibility that cannot be ruled out.
        Int J Epidemiol. 2001; 30: 1315-1316
      2. Scott RD II, Jones JL, Meltzer MI, Lopez A, Hsu H, Eaton R. An economic analysis of newborn screening for congenital toxoplasmosis. Proceedings of the 1st annual conference of the National Center on Birth Defects and Developmental Disabilities; 2002 Sept.

        • Liesenfeld O.
        • Montoya J.G.
        • Kinney S.
        • Press C.
        • Remington J.S.
        Effect of testing for IgG avidity in the diagnosis of Toxoplasma gondii infection in pregnant women: experience in a US reference laboratory.
        J Infect Dis. 2001; 183: 1248-1253
        • Montoya J.G.
        • Liesenfeld O.
        • Kinney S.
        • Press C.
        • Remington J.S.
        VIDAS test for avidity of Toxoplasma-specific immunoglobulin G for confirmatory testing of pregnant women.
        J Clin Microbiol. 2002; 40: 2504-2508
        • Romand S.
        • Wallon M.
        • Franck J.
        • Thulliez P.
        • Peyron F.
        • Dumon H.
        Prenatal diagnosis using polymerase chain reaction on amniotic fluid for congenital toxoplasmosis.
        Obstet Gynecol. 2001; 97: 296-300