Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, Sichuan, China.
BMC Infect Dis. 2021 Sep 6;21(1):920. doi: 10.1186/s12879-021-06619-1.
Most infants infected with Toxoplasma gondii are completely asymptomatic at birth, yet they may develop ocular and neurological sequelae in the first few months of life. Cases of congenital toxoplasmosis with severe jaundice early after birth combined with pancytopenia and splenomegaly are extremely rare. Here, we report on a rare case of congenital toxoplasmosis presenting with severe jaundice and hemolysis early after birth combined with pancytopenia and splenomegaly.
A male preterm infant with severe jaundice and splenomegaly was admitted to our department. Laboratory examinations revealed severe hyperbilirubinemia, increased reticulocytes, and pancytopenia. After comprehensive analysis and examination, the final diagnosis was congenital toxoplasmosis, and the infant was treated with azithromycin and subsequently trimethoprim-sulfamethoxazole. Regular follow-up revealed congenital toxoplasmosis in both eyes, which was surgically treated, while neurofunctional assessment results were unremarkable. In this case of congenital toxoplasmosis combined with severe jaundice, we treated the infant with two courses of azithromycin, followed by trimethoprim-sulfamethoxazole after the jaundice resolved. Clinical follow-up indicated that this treatment was effective with few side effects; thus, this report may serve as a valuable clinical reference.
Timely diagnosis and adequate treatment are closely associated with congenital toxoplasmosis-related prognosis. Infants with congenital toxoplasmosis require long-term follow-up, focusing on nervous system development and ophthalmology.
大多数在出生时感染弓形虫的婴儿完全无症状，但他们可能在生命的头几个月内出现眼部和神经后遗症。出生后早期出现严重黄疸、全血细胞减少和脾肿大的先天性弓形虫病病例极为罕见。在此，我们报告一例罕见的出生后早期出现严重黄疸和溶血、全血细胞减少和脾肿大的先天性弓形虫病病例。
一名男性早产儿因严重黄疸和脾肿大而被收入我科。实验室检查显示严重高胆红素血症、网织红细胞增多和全血细胞减少。经过综合分析和检查，最终诊断为先天性弓形虫病，婴儿接受了阿奇霉素治疗，随后接受了甲氧苄啶-磺胺甲噁唑治疗。定期随访发现双眼均患有先天性弓形虫病，经手术治疗，神经功能评估结果无异常。在本例严重黄疸合并先天性弓形虫病的病例中，我们用两疗程阿奇霉素治疗婴儿，待黄疸消退后再用甲氧苄啶-磺胺甲噁唑治疗。临床随访表明，该治疗方案疗效确切，副作用少，因此，本报告可能为临床提供有价值的参考。
及时诊断和充分治疗与先天性弓形虫病的预后密切相关。先天性弓形虫病患儿需要长期随访，重点关注神经系统发育和眼科。
