Guerina N G, Hsu H W, Meissner H C, Maguire J H, Lynfield R, Stechenberg B, Abroms I, Pasternack M S, Hoff R, Eaton R B
Division of Infectious Diseases, Children's Hospital, Boston, Mass.
N Engl J Med. 1994 Jun 30;330(26):1858-63. doi: 10.1056/NEJM199406303302604.
Most infants with congenital Toxoplasma gondii infection have no symptoms at birth, but many will have retinal disease or neurologic abnormalities later in life. Early detection and treatment of congenital toxoplasmosis may reduce these sequelae.
In Massachusetts since January 1986, and in New Hampshire since July 1988, newborns have been screened for intrauterine infection with T. gondii by means of an IgM capture immunoassay of blood specimens routinely collected for screening for metabolic disorders. Congenital infection is confirmed by assays for specific IgG and IgM antibodies in serum from infants and their mothers. For this study, infants with serologic evidence of infection underwent extensive clinical evaluation and received one year of treatment.
Through June 1992, 100 of 635,000 infants tested had positive screening tests. Congenital infection was confirmed in 52 infants, 50 of whom were identified only through neonatal screening and not through initial clinical examination. However, after the serologic results became available, more detailed examinations revealed abnormalities of either the central nervous system or the retina in 19 of 48 infants evaluated (40 percent). After treatment, only 1 of 46 children had a neurologic deficit (hemiplegia attributable to a cerebral lesion present at birth). Thirty-nine treated children had follow-up ophthalmologic examinations when one to six years old; four (10 percent) had eye lesions that may have developed postnatally (a macular lesion in one child and minor retinal scars in three).
Routine neonatal screening for toxoplasmosis identifies congenital infections that are subclinical, and early treatment may reduce the severe long-term sequelae.
大多数先天性弓形虫感染婴儿出生时无症状，但许多人在日后会出现视网膜疾病或神经异常。先天性弓形虫病的早期检测和治疗可能会减少这些后遗症。
自1986年1月起在马萨诸塞州，以及自1988年7月起在新罕布什尔州，通过对常规收集用于代谢紊乱筛查的血液标本进行IgM捕获免疫测定，对新生儿进行宫内弓形虫感染筛查。通过检测婴儿及其母亲血清中的特异性IgG和IgM抗体来确诊先天性感染。对于本研究，有血清学感染证据的婴儿接受了广泛的临床评估并接受了一年的治疗。
截至1992年6月，在635,000名接受检测的婴儿中，有100名筛查结果呈阳性。52名婴儿被确诊为先天性感染，其中50名仅通过新生儿筛查发现，而非通过初始临床检查。然而，在血清学结果出来后，更详细的检查发现，在接受评估的48名婴儿中有19名（40%）存在中枢神经系统或视网膜异常。治疗后，46名儿童中只有1名有神经功能缺损（因出生时存在的脑损伤导致偏瘫）。39名接受治疗的儿童在1至6岁时进行了眼科随访检查；4名（10%）有可能在出生后出现的眼部病变（1名儿童有黄斑病变，3名有轻微视网膜瘢痕）。
常规新生儿弓形虫病筛查可识别亚临床先天性感染，早期治疗可能会减少严重的长期后遗症。
