Bollani Lina, Auriti Cinzia, Achille Cristian, Garofoli Francesca, De Rose Domenico Umberto, Meroni Valeria, Salvatori Guglielmo, Tzialla Chryssoula
Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy.
Front Pediatr. 2022 Jul 6;10:894573. doi: 10.3389/fped.2022.894573. eCollection 2022.
Infection with the protozoan parasite occurs worldwide and usually causes no symptoms. However, a primary infection of pregnant women, may infect the fetus by transplacental transmission. The risk of mother-to-child transmission depends on week of pregnancy at the time of maternal infection: it is low in the first trimester, may reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when infection occurs early in pregnancy than later. Systematic serologic testing in pregnant women who have no antibodies at the beginning of pregnancy, can accurately reveal active maternal infection. Therefore, the risk of fetal infection should be assessed and preventive treatment with spiramycin must be introduced as soon as possible to reduce the risk of mother-to-child transmission, and the severity of fetal infection. When maternal infection is confirmed, prenatal diagnosis with Polymerase Chain Reaction (PCR) on amniotic fluid is recommended. If fetal infection is certain, the maternal treatment is changed to a combination of pyrimethamine-sulfonamide and folinic acid. Congenitally infected newborns are usually asymptomatic at birth, but at risk for tardive sequelae, such as blindness. When congenital infection is evident, disease include retinochoroiditis, cerebral calcifications, hydrocephalus, neurocognitive impairment. The diagnosis of congenital infection must be confirmed at birth and management, specific therapy, and follow-up with multidisciplinary counseling, must be guaranteed.
原生动物寄生虫感染在全球范围内都有发生，通常不会引起症状。然而，孕妇的初次感染可能会通过胎盘传播感染胎儿。母婴传播的风险取决于母亲感染时的孕周：在孕早期风险较低，在妊娠最后几天可能达到90%。然而，相反的是，妊娠早期感染比晚期感染时胎儿疾病更严重。对妊娠初期没有抗体的孕妇进行系统的血清学检测，可以准确地发现母亲的活动性感染。因此，应该评估胎儿感染的风险，并尽快采用螺旋霉素进行预防性治疗，以降低母婴传播的风险以及胎儿感染的严重程度。当确认母亲感染后，建议对羊水进行聚合酶链反应（PCR）产前诊断。如果确定胎儿感染，母亲的治疗改为乙胺嘧啶-磺胺和亚叶酸联合使用。先天性感染的新生儿出生时通常无症状，但有迟发性后遗症的风险，如失明。当先天性感染明显时，疾病包括视网膜脉络膜炎、脑钙化、脑积水、神经认知障碍。先天性感染的诊断必须在出生时得到确认，并且必须保证进行管理、特定治疗以及多学科咨询的随访。
