From the Addenbrooke's Hospital, Cambridge.
Imperial College, London.
Pediatr Infect Dis J. 2022 Sep 1;41(9):e377-e382. doi: 10.1097/INF.0000000000003610. Epub 2022 Jul 7.
Toxoplasmosis and cytomegalovirus (CMV) congenital infection present with similar clinical pictures. Both infections have long-term sequelae that can be mitigated by early detection and treatment. Coinfection is uncommonly reported.
Dichorionic diamniotic twins born at 35 weeks of gestation were investigated for congenital infections due to abnormalities on the antenatal scan at 31 weeks of gestation. Antenatal investigations were delayed due to late booking and delay in maternal investigations. In the neonatal period, they suffered discordant symptoms and were both investigated for Toxoplasma gondii infection. This diagnosis was confirmed in twin 2 but proved difficult in twin 1 who had a weakly positive polymerase chain reaction with inconclusive serology. Twin 1 was also diagnosed with congenital CMV, further complicating the clinical picture. Toxoplasmosis can cause long-term sequelae, and definitive diagnosis requires serology at 12 months of age; in view of this, treatment for congenital toxoplasmosis was initiated in both twins. Twin 1 was also treated for congenital CMV.
Due to limitations in serological investigations in neonates, diagnosing congenital toxoplasmosis can be challenging, and initiating treatment may be warranted in suspected cases, given the risk of infective complications. Discordant presentations between twins are known in congenital toxoplasmosis and CMV, but coinfection has rarely been reported without concurrent immunocompromise. A high index of suspicion should be maintained in the twin of an infected neonate, and the possibility of multiple infections should be considered. Multidisciplinary working is crucial in reaching a diagnosis and treating appropriately.
弓形虫病和巨细胞病毒（CMV）先天性感染具有相似的临床表现。这两种感染都有长期的后遗症，可以通过早期发现和治疗来减轻。合并感染很少见。
由于 31 周产前检查时发现异常，对 35 周龄分娩的双绒毛膜双羊膜双胞胎进行先天性感染调查。由于预约时间晚和母亲检查延迟，产前检查被推迟。在新生儿期，他们出现了不同的症状，都被怀疑患有弓形虫感染。在双胞胎 2 中确诊了该诊断，但在双胞胎 1 中证实很困难，因为双胞胎 1 的聚合酶链反应呈弱阳性，血清学检查结果不确定。双胞胎 1 还被诊断为先天性 CMV，这进一步使病情复杂化。弓形虫病可导致长期后遗症，明确诊断需要在 12 个月大时进行血清学检查；鉴于此，对双胞胎 1 和双胞胎 2 都开始进行先天性弓形虫病的治疗。双胞胎 1 还接受了先天性 CMV 的治疗。
由于新生儿血清学检查的局限性，先天性弓形虫病的诊断具有挑战性，在疑似病例中可能需要开始治疗，因为存在感染并发症的风险。在先天性弓形虫病和 CMV 中，双胞胎之间的不同表现是已知的，但在没有合并免疫功能低下的情况下，合并感染很少见报道。在感染新生儿的双胞胎中应保持高度怀疑，应考虑多种感染的可能性。多学科合作对于做出诊断和进行适当治疗至关重要。
