Pediatric Neurosurgery Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica.
Universidad de Ciencias Médicas, UCIMED, San José, Costa Rica.
Childs Nerv Syst. 2024 Feb;40(2):295-301. doi: 10.1007/s00381-023-05915-2. Epub 2023 Mar 21.
Toxoplasma gondii is a parasite that is estimated to infect one-third of the world's population. It is acquired by ingesting contaminated water and food specially undercooked meat, contact with domestic or wild feline feces, and during pregnancy by transplacental transmission.Immunocompetent hosts are usually asymptomatic, and infection will be self-limited, while those patients whose immune system is debilitated by HIV infection, immunosuppressive therapy, long-term steroid treatment, and fetuses infected during gestation will show evidence of systemic activity which is more severe in the central nervous system and eyes due to insufficient immune response caused by their respective blood barriers. Congenital toxoplasmosis has an estimated incidence of 8% in mothers who were seronegative at the beginning of their pregnancy. Infection in the first trimester may result in spontaneous abortion or stillbirth; however, it is estimated that the highest risk for vertical transmission is during the second and third trimesters when blood flow and placenta thickness favor parasitic transmission.Congenital toxoplasmosis can be detected with periodic surveillance in endemic areas, and with appropriate treatment, the risk of vertical transmission can be reduced, and the severity of the disease can be reversed in infected fetuses.While most infected newborns will show no evidence of the disease, those who suffer active intrauterine complications will present with cerebral calcifications in 8-12% of cases, hydrocephalus in 4-30%, and chorioretinitis in 12-15%. Also, seizure disorders, spasticity, and varying degrees of neurocognitive deficits can be found in 12%.Four distinct patterns of hydrocephalus have been described: aqueductal stenosis with lateral and third ventricle dilatation, periforaminal calcifications leading to foramen of Monro stenosis with associated asymmetrical ventricle dilatation, a mix of aqueductal and foramen of Monro stenosis, and overt hydrocephalus without clear evidence of obstruction with predominant dilatation of occipital horns (colpocephaly).While all patients diagnosed with congenital toxoplasmosis should undergo pharmacological treatment, those presenting with hydrocephalus have traditionally been managed with CSF shunting; however, there are reports of at least 50% success when selected cases are treated with endoscopic third ventriculostomy. Successful hydrocephalus management with appropriate treatment leads to better intellectual outcomes.
刚地弓形虫估计会感染世界上三分之一的人口。人们通过摄入受污染的水和食物（尤其是未煮熟的肉）、接触家养或野生猫科动物的粪便，以及在怀孕期间通过胎盘传播而感染该寄生虫。免疫功能正常的宿主通常无症状，感染会自行限制，而那些因 HIV 感染、免疫抑制治疗、长期类固醇治疗而使免疫系统受损的患者，以及在怀孕期间感染的胎儿，由于各自的血脑屏障引起的免疫反应不足，会出现全身活动的证据，在中枢神经系统和眼睛中更为严重。先天性弓形虫病在妊娠初诊时血清学阴性的母亲中的估计发病率为 8%。妊娠第一 trimester 的感染可能导致自然流产或死胎；然而，据估计，垂直传播的最高风险发生在妊娠第二和第三 trimester，此时血流和胎盘厚度有利于寄生虫传播。在地方性流行地区可以通过定期监测来发现先天性弓形虫病，并且通过适当的治疗，可以降低垂直传播的风险，并可以逆转受感染胎儿的疾病严重程度。虽然大多数感染的新生儿没有疾病证据，但那些患有宫内并发症的新生儿中，8-12%有脑钙化，4-30%有脑积水，12-15%有脉络膜视网膜炎。此外，12%的新生儿还会出现癫痫发作、痉挛和不同程度的神经认知缺陷。已描述了四种不同类型的脑积水：导水管狭窄伴侧脑室和第三脑室扩张、周围性钙化导致中脑导水管狭窄伴侧脑室不对称性扩张、导水管和中脑导水管狭窄混合、无明显梗阻证据的明显脑积水，主要表现为枕角扩张（尖头畸形）。虽然所有诊断为先天性弓形虫病的患者都应接受药物治疗，但传统上，有脑积水的患者都采用脑脊液分流术治疗；然而，有报道称，在选择病例时，经内镜第三脑室造口术治疗至少有 50%的成功率。通过适当的治疗成功管理脑积水可导致更好的智力结局。
