Tamaru Shunsuke, Kikuchi Akihiko, Takagi Kimiyo, Wakamatsu Masao, Horikoshi Tsuguhiro, Ogiso Yoshifumi
Department of Obstetrics, Center for Perinatal Medicine, Nagano Children's Hospital, Nagano, Japan.
J Obstet Gynaecol Res. 2011 Jul;37(7):953-7. doi: 10.1111/j.1447-0756.2010.01459.x. Epub 2011 Mar 31.
Severe symptomatic fetal toxoplasmosis rarely occurs after the maternal primary infection of Toxoplasma gondii. We herein report our experience of fetal therapy of symptomatic toxoplasmosis using azithromycin. Ultrasound assessment at 23 weeks' gestation revealed fetal ascites, cardiac effusion, cardiomegaly, enlarged lateral ventricles and thickened placenta. Serum Toxoplasma gondii antibody titer was ×81,920. Toxoplasma immunoglobulin M was 2.4 index (normal, <0.8 index), and immunoglobulin G was ≥240 IU/mL (normal, <6 IU/mL). Maternal oral administration of azithromycin in addition to sulfadoxine, pyrimethamine and acetylspiramycin was conducted. Spontaneous vaginal delivery occurred at 32 weeks and a male infant weighing 2036 g was born. Hepatosplenomegaly, chorioretinitis, hydrocephalus, intracranial calcifications, ascites, and meningitis were confirmed after birth. The infant underwent therapy with pyrimethamine and sulfadiazine. It seems imperative to establish a new drug choice for fetal therapy of severe symptomatic toxoplasmosis in order to reduce the maternal and fetal risks of drug side-effects.
严重症状性胎儿弓形虫病很少在孕妇初次感染弓形虫后发生。我们在此报告使用阿奇霉素进行有症状弓形虫病胎儿治疗的经验。妊娠23周时的超声评估显示胎儿腹水、心包积液、心脏扩大、侧脑室增宽和胎盘增厚。弓形虫血清抗体滴度为×81,920。弓形虫免疫球蛋白M为2.4指数（正常，<0.8指数），免疫球蛋白G≥240 IU/mL（正常，<6 IU/mL）。除了给予周效磺胺、乙胺嘧啶和乙酰螺旋霉素外，还对孕妇口服阿奇霉素。32周时自然阴道分娩，一名体重2036 g的男婴出生。出生后确诊有肝脾肿大、脉络膜视网膜炎、脑积水、颅内钙化、腹水和脑膜炎。该婴儿接受了乙胺嘧啶和磺胺嘧啶治疗。为降低母婴药物副作用风险，为严重症状性弓形虫病的胎儿治疗建立新的药物选择似乎势在必行。
