Department of Sciences for Health Promotion, University of Palermo, Italy.
Acta Pharmacol Sin. 2011 Aug;32(8):1063-70. doi: 10.1038/aps.2011.55. Epub 2011 Jul 11.
Toxoplasma gondii infection during pregnancy poses a serious risk to the fetus, therefore timely and accurate diagnosis is essential. The aim of this study was to estimate the frequency of congenital infection via evaluating mother's immunological status and the possibility to improving the diagnostic and therapeutic approaches.
Eighty five mothers with Toxoplasma seroconversion and their offspring were enrolled (among them, 2 spontaneous abortions were documented in the first trimester). Prenatal PCR diagnosis was carried out on 50 patients (60%), with 7 positive cases (14%). Morphological ultrasound scanning revealed anomalies in one fetus. Long-term follow-up included general physical examinations, serological status tested using Western blot, neuro-radiological, ophthalmologic and neurologic examinations, psychological and developmental tests, visual evoked potential tests and audiology tests, as well as anti-Toxoplasma treatment regimes.
Fourteen (17%) of the infants were infected at one-year serological follow-up. Chi-square for linear trend of vertical transmission from the first to the third trimester was significant (P=0.009). Western blot analysis showed IgM and IgA in half of the infected infants. In 69 uninfected infants, anti-Toxoplasma IgG immunoblot analysis excluded infection within the 3 months in 18 infants (26%) and in the others within 6 months of life. The most relevant instrumental findings are described.
Western blot analysis may help to evaluate infection within the 6 months of life. The accuracy of ultrasound imaging to determine the brain damage in the fetus and newborns is doubtful, and should be combined with MR imaging. Multistep approaches can improve the timing of postnatal follow-up.
妊娠期间弓形虫感染对胎儿构成严重威胁，因此及时、准确的诊断至关重要。本研究旨在通过评估母体的免疫状态来评估先天性感染的频率，并探讨改善诊断和治疗方法的可能性。
纳入了 85 名弓形虫血清转化的母亲及其后代（其中，有 2 例在孕早期自然流产）。对 50 名患者（60%）进行了产前 PCR 诊断，其中 7 例阳性（14%）。形态超声扫描发现 1 例胎儿异常。长期随访包括一般体格检查、使用 Western blot 检测血清状态、神经放射学、眼科和神经学检查、心理和发育测试、视觉诱发电位测试和听力学测试，以及抗弓形虫治疗方案。
在 1 年的血清随访中，14 名（17%）婴儿感染。从第一到第三孕期垂直传播的线性趋势的卡方检验具有统计学意义（P=0.009）。Western blot 分析显示，一半感染婴儿的 IgM 和 IgA 呈阳性。在 69 名未感染的婴儿中，抗弓形虫 IgG 免疫印迹分析排除了 18 名婴儿（26%）在 3 个月内感染，其余婴儿在 6 个月内感染。描述了最相关的仪器检查结果。
Western blot 分析有助于评估 6 个月内的感染情况。超声成像确定胎儿和新生儿脑损伤的准确性值得怀疑，应结合磁共振成像。多步骤方法可以改善产后随访的时机。
