National Reference Laboratory for Toxoplasmosis, Centre for Parasitic Zoonoses, University of Belgrade, Institute for Medical Research, Belgrade, Serbia.
Wien Klin Wochenschr. 2011 Oct;123 Suppl 1:43-6. doi: 10.1007/s00508-011-0069-x. Epub 2011 Oct 20.
Toxoplasma gondii infection acquired during pregnancy may lead to transplacental transmission and jeopardize the course and outcome of pregnancy, leading to life-threatening disease in the fetus and the newborn.
Here we present a case of medically terminated pregnancy due to clinically manifested congenital toxoplasmosis (CT) which was proven serologically, as well as by bioassay. Ultrasonographically visualized severe fetal ventriculomegaly in a seven-month pregnant 33-year-old woman with a history of three months of lymphadenopathy was an indication for extensive testing for toxoplasmosis. Based on the serological results obtained (high specific IgG antibodies of borderline but close-to-low avidity, along with the finding of specific IgM antibodies), maternal infection was dated to the second trimester. Cord blood serology revealed IgG levels lower than those of the mother's, but both specific IgM and IgA antibodies were detected, indicating fetal infection. Although Toxoplasma DNA was not detected in the cord blood sample by real-time PCR, fetal infection was definitely confirmed after six weeks by cord blood bioassay results. While no morphologically recognizable Toxoplasma cysts were found, murine serology was positive. Since fetal morphological abnormalities, which could not be reversed by subsequent treatment, were already advanced at the time of serological testing, the patient opted for termination of pregnancy.
This case demonstrates the potentially severe outcome of CT as a result of central nervous system affection, emphasizing the need for prompt and precise prenatal diagnosis in case of maternal seroconversion, so that proper treatment may be introduced in a timely manner.
孕妇感染弓形虫可能导致宫内传播，危及妊娠过程和结局，导致胎儿和新生儿出现危及生命的疾病。
我们在此报告了一例因临床表现为先天性弓形虫病（CT）而终止妊娠的病例，该病例通过血清学和生物测定得到证实。一名 33 岁的女性，有三个月的淋巴结病病史，超声显示七个月大的胎儿严重脑室扩张，这是进行广泛弓形虫病检测的指征。根据获得的血清学结果（高特异性 IgG 抗体边界但接近低亲和力，同时发现特异性 IgM 抗体），母亲的感染发生在孕中期。脐血血清学显示 IgG 水平低于母亲，但均检测到特异性 IgM 和 IgA 抗体，提示胎儿感染。虽然实时 PCR 未在脐血样本中检测到弓形虫 DNA，但在六周后通过脐血生物测定结果明确证实了胎儿感染。虽然未在胎儿组织中发现可识别的弓形虫囊肿，但鼠血清学呈阳性。由于在进行血清学检测时，胎儿的形态异常已经无法逆转，且无法进行后续治疗，因此患者选择终止妊娠。
本病例表明 CT 可能导致中枢神经系统受累，后果严重，强调在母体血清学转换时需要及时进行准确的产前诊断，以便及时引入适当的治疗。
