Buonsenso Danilo, Pata Davide, Turriziani Colonna Arianna, Iademarco Mariella, De Santis Marco, Masini Lucia, Conti Guido, Molle Fernando, Baldascino Antonio, Acampora Anna, Luciano Rita, Gallini Francesca, Valentini Piero
From the Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Dipartimento di Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Pediatr Infect Dis J. 2022 May 1;41(5):e223-e227. doi: 10.1097/INF.0000000000003469.
There is weak evidence on the best treatment of pregnant women with Toxoplasma gondii infection to prevent the vertical transmission to the fetus.
We conducted a 28-year retrospective study aiming to compare the efficacy of three therapeutic regimens [Spiramicyn alone (Spy) vs. Pyrimethamine-Sulfadiazine (P/S) vs. Spiramicyn with Trimethoprim-Sulfamethoxazole (Spy+TMP-SMX)] for the prevention of mother-to-fetus transmission of T. gondii infection.
170 women were included: 58 (34.1%) had certain congenital toxoplasmosis (CT), 61 (35.9%) a probable infection and 41 (24.1%) possible infection. In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001).
The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. A prospective trial comparing the combination Spy+TMP-SMX with P/S would be necessary to provide definitive evidence on the best regimen for pregnant women with T. gondii infection.
关于弓形虫感染孕妇的最佳治疗方法以预防垂直传播给胎儿的证据不足。
我们进行了一项为期28年的回顾性研究，旨在比较三种治疗方案[单独使用螺旋霉素（Spy）与乙胺嘧啶-磺胺嘧啶（P/S）与螺旋霉素联合甲氧苄啶-磺胺甲恶唑（Spy+TMP-SMX）]预防弓形虫感染母婴传播的疗效。
纳入170名女性：58名（34.1%）患有确诊的先天性弓形虫病（CT），61名（35.9%）可能感染，41名（24.1%）可能感染。总共97名母亲（57.1%）接受了Spy+TMP-SMX联合治疗，64名母亲（37.6%）仅接受了Spy治疗，8名母亲（4.7%）接受了P/S治疗。感染婴儿为20/170（11.7%）。然而，接受Spy+TMP-SMX治疗的母亲所生婴儿中有8.2%（8/97）被感染，接受Spy治疗的女性所生婴儿中有20%（11/55）被感染，接受P/S治疗的母亲所生婴儿中有12.5%（1/8）被感染。逻辑回归分析表明，与Spy+TMP-SMX联合治疗相比，单独使用Spy治疗与CT风险增加相关（OR，2.78，95%CI 1.04-7.41，P值0.041）。将Spy+TMP-SMX与P/S联合治疗进行比较时未观察到差异（OR 1.59；95%CI 0.17 - 14.58；P值0.682）。当按感染孕周和母亲治疗类型进行校正分析时，结果得到证实（OR 7.72；95%CI 3.40-17.53，P值<0.001）。
与单独使用Spy相比，Spy+TMP-SMX联合治疗在降低弓形虫母婴传播风险方面可能更有效；此外，这种联合治疗并不劣于P/S，P/S是目前预防CT的国际标准孕产妇治疗方法。有必要进行一项前瞻性试验，比较Spy+TMP-SMX联合治疗与P/S，以提供关于弓形虫感染孕妇最佳治疗方案的确切证据。
