Division of Pediatric Neonatology, Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.
Neonatology. 2013;103(1):27-34. doi: 10.1159/000342625. Epub 2012 Sep 26.
In Austria, a nationally mandated prenatal serological congenital toxoplasmosis screening program was introduced in 1974 in response to a high incidence of 7.8 per 1,000 infected infants. Maternal prenatal recognition of acute gestational infection and early treatment of infants with congenital infection are important because prenatal and accurate postnatal antibiotic therapy improves the outcomes of infected infants.
To determine the impact of additional maternal and/or fetal cord blood serology at birth on improving current prenatal maternal screening in detecting congenital toxoplasmosis.
In this prospective observational study, 5,545 consecutive women were included over a 19-month period. Routine prenatal maternal toxoplasmosis serology screening was performed along with additional cord blood serology screening at delivery. Fetal cord blood serology included Sabin-Feldman dye and IgM immunosorbent agglutination assay testing.
Based on the initial prenatal maternal screening serology results, there was evidence of a prior chronic infection manifest in 1,830 (33.0%) women and 3,708 (66.9%) were not infected. Seven (0.13%) were diagnosed with acute toxoplasma infection based on seroconversion. Of these, 4 manifested transmission, and 3 did not. Of the seven infected women, routine prenatal maternal screening identified acute infection in only 2 of the women, 1 of whom had an infected fetus with abnormal prenatal ultrasound. Fetal cord blood serology screening identified an additional 5 women, 3 with infected fetuses.
Identification of Toxoplasma gondii infection by prenatal maternal serological testing is significantly improved by the addition of maternal and/or fetal serological testing at birth.
在奥地利，为了应对每千名感染婴儿中 7.8 例的高发病率，1974 年推出了一项全国强制性的产前血清先天性弓形虫病筛查计划。母体在妊娠期间对急性感染的识别以及对先天性感染婴儿的早期治疗非常重要，因为产前和准确的产后抗生素治疗可以改善感染婴儿的结局。
确定在当前产前母体筛查中增加母体和/或胎儿脐带血血清学检查以提高先天性弓形虫病检测的效果。
在这项前瞻性观察性研究中，在 19 个月的时间里纳入了 5545 名连续孕妇。常规进行产前母体弓形虫病血清学筛查，并在分娩时进行额外的脐带血血清学筛查。胎儿脐带血血清学检查包括萨宾-费尔德曼染料和 IgM 免疫吸附凝集试验检测。
根据初始的产前母体筛查血清学结果，有 1830 名（33.0%）妇女存在先前的慢性感染证据，而 3708 名（66.9%）妇女未感染。根据血清学转换，有 7 名（0.13%）妇女被诊断为急性弓形虫感染。其中，4 例表现为传播，3 例没有。在这 7 名感染妇女中，仅在 2 名妇女中常规产前母体筛查发现了急性感染，其中 1 名感染胎儿的产前超声异常。胎儿脐带血血清学筛查还发现了另外 5 名妇女，其中 3 名感染胎儿。
通过产前母体血清学检测来识别弓形体感染，通过在出生时增加母体和/或胎儿的血清学检测，可以显著提高其检出率。
