Uzorka J W, Arend S M
Department of Infectious Diseases, C5P-40, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Faculty of Medicine, Leiden University, Leiden, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2017 Jul;36(7):1111-1117. doi: 10.1007/s10096-016-2897-0. Epub 2017 Jan 12.
While postnatal toxoplasmosis in immune-competent patients is generally considered a self-limiting and mild illness, it has been associated with a variety of more severe clinical manifestations. The causal relation with some manifestations, e.g. myocarditis, has been microbiologically proven, but this is not unequivocally so for other reported associations, such as with epilepsy. We aimed to systematically assess causality between postnatal toxoplasmosis and epilepsy in immune-competent patients. A literature search was performed. The Bradford Hill criteria for causality were used to score selected articles for each component of causality. Using an arbitrary but defined scoring system, the maximal score was 15 points (13 for case reports). Of 704 articles, five case reports or series and five case-control studies were selected. The strongest evidence for a causal relation was provided by two case reports and one case-control study, with a maximal causality score of, respectively, 9/13, 10/13 and 10/15. The remaining studies had a median causality score of 7 (range 5-9). No selection bias was identified, but 6/10 studies contained potential confounders (it was unsure whether the infection was pre- or postnatal acquired, or immunodeficiency was not specifically excluded). Based on the evaluation of the available literature, although scanty and of limited quality, a causal relationship between postnatal toxoplasmosis and epilepsy seems possible. More definite proof requires further research, e.g. by performing Toxoplasma serology in all de novo epilepsy cases.
虽然免疫功能正常的患者产后弓形虫病通常被认为是一种自限性的轻症疾病，但它与多种更严重的临床表现有关。与某些表现（如心肌炎）的因果关系已得到微生物学证实，但对于其他报道的关联（如与癫痫的关联）并非如此明确。我们旨在系统评估免疫功能正常的患者产后弓形虫病与癫痫之间的因果关系。进行了文献检索。使用布拉德福德·希尔因果关系标准对所选文章的因果关系各组成部分进行评分。采用一个任意但已定义的评分系统，最高分为15分（病例报告为13分）。在704篇文章中，选取了5篇病例报告或系列研究以及5篇病例对照研究。两篇病例报告和一篇病例对照研究提供了最强的因果关系证据，因果关系最高得分分别为9/13、10/13和10/15。其余研究的因果关系得分中位数为7（范围5 - 9）。未发现选择偏倚，但10项研究中有6项存在潜在混杂因素（不确定感染是产前还是产后获得，或者未专门排除免疫缺陷）。基于对现有文献的评估，尽管文献稀少且质量有限，但产后弓形虫病与癫痫之间似乎可能存在因果关系。更确切的证据需要进一步研究，例如对所有新发癫痫病例进行弓形虫血清学检测。
