Research progress in clinical diagnosis and treatment of congenital toxoplasmosis_West China Medical Journal

Authors：

XU Xiaoming ^1,2 , LI Jiao ^1,2 ,  SHI Jing ^1,2

1. Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SHI Jing, Email: shijing4556@sina.com

Keywords：

Congenital toxoplasmosis; diagnosis; treatment; progress

DOI：

10.7507/1002-0179.202211064

Video：

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Congenital toxoplasmosis is one of the most common types of intrauterine infection, with the triad of retinal choroiditis, intracranial calcification, and hydrocephalus as the main clinical manifestations, which can lead to serious sequelae such as cerebral palsy, cognitive impairment and visual impairment. Therefore, early diagnosis and early treatment are important to improve the prognosis of patients. Recommended treatment options include pyrimethamine, sulfadiazine combined with folic acid, or new drugs such as azithromycin and atorvastatin. This article reviews the research progress of epidemiology, clinical manifestations, diagnosis and treatment of congenital toxoplasmosis, in order to provide a reference for clinicians to improve their understanding of clinical diagnosis and treatment of this disease.

Citation： XU Xiaoming, LI Jiao, SHI Jing. Research progress in clinical diagnosis and treatment of congenital toxoplasmosis. West China Medical Journal, 2023, 38(4): 626-630. doi: 10.7507/1002-0179.202211064 Copy

1.	Flores C, Villalobos-Cerrud D, Borace J, et al. Epidemiological aspects of maternal and congenital toxoplasmosis in Panama. Pathogens, 2021, 10(6): 764.
2.	Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ, 2013, 91(7): 501-508.
3.	Moodley A, Payton KSE. The term newborn: congenital infections. Clin Perinatol, 2021, 48(3): 485-511.
4.	罗潇, 张莉, 吕艳, 等. 我国弓形虫病误诊现状及其研究进展. 中国病原生物学杂志, 2018, 13(5): 556-558.
5.	Dubey JP, Murata FHA, Cerqueira-Cézar CK, et al. Congenital toxoplasmosis in humans: an update of worldwide rate of congenital infections - CORRIGENDUM. Parasitology, 2021, 148(13): 1716.
6.	Bigna JJ, Tochie JN, Tounouga DN, et al. Global, regional, and country seroprevalence of Toxoplasma gondii in pregnant women: a systematic review, modelling and meta-analysis. Sci Rep, 2020, 10(1): 12102.
7.	Rostami A, Riahi SM, Contopoulos-Ioannidis DG, et al. Acute toxoplasma infection in pregnant women worldwide: a systematic review and meta-analysis. PLoS Negl Trop Dis, 2019, 13(10): e0007807.
8.	Rostami A, Riahi SM, Gamble HR, et al. Global prevalence of latent toxoplasmosis in pregnant women: a systematic review and meta-analysis. Clin Microbiol Infect, 2020, 26(6): 673-683.
9.	Bollani L, Auriti C, Achille C, et al. Congenital toxoplasmosis: the state of the art. Front Pediatr, 2022, 10: 894573.
10.	Su YJ, Ma ZD, Qiao X, et al. Geospatial epidemiology of Toxoplasma gondii infection in livestock, pets, and humans in China, 1984-2020. Parasitol Res, 2022, 121(2): 743-750.
11.	沈继龙, 余莉. 我国弓形虫病流行概况及防治基础研究进展. 中国血吸虫病防治杂志, 2019, 31(1): 71-76.
12.	Dong H, Su R, Lu Y, et al. Prevalence, risk factors, and genotypes of Toxoplasma gondii in food animals and humans (2000-2017) from China. Front Microbiol, 2018, 9: 2108.
13.	Zhou Q, Wang Q, Shen H, et al. Seroepidemiological map of Toxoplasma gondii infection and associated risk factors in preconception period in China: a nationwide cross-sectional study. J Obstet Gynaecol Res, 2018, 44(6): 1134-1139.
14.	Deng H, Devleesschauwer B, Liu M, et al. Seroprevalence of Toxoplasma gondii in pregnant women and livestock in the mainland of China: a systematic review and hierarchical meta-analysis. Sci Rep, 2018, 8(1): 6218.
15.	俞淑丽, 钱春艳. 杭州市孕妇弓形虫和弓首线虫感染的血清学调查. 中国血吸虫病防治杂志, 2020, 32(5): 534-536.
16.	Voyiatzaki C, Orovas C, Trapali M, et al. The importance of use of the on-line databases as a source for systematic review of toxoplasmosis screening during pregnancy. Acta Inform Med, 2021, 29(3): 216-223.
17.	Arranz-Solís D, Mukhopadhyay D, Saeij JJP. Toxoplasma effectors that affect pregnancy outcome. Trends Parasitol, 2021, 37(4): 283-295.
18.	Gao X, Zhong Y, Liu Y, et al. The role and function of regulatory T cells in Toxoplasma gondii-induced adverse pregnancy outcomes. J Immunol Res, 2021, 2021: 8782672.
19.	Peyron F, L’ollivier C, Mandelbrot L, et al. Maternal and congenital toxoplasmosis: diagnosis and treatment recommendations of a French multidisciplinary working group. Pathogens, 2019, 8(1): 24.
20.	Ahmed M, Sood A, Gupta J. Toxoplasmosis in pregnancy. Eur J Obstet Gynecol Reprod Biol, 2020, 255: 44-50.
21.	Sana M, Rashid M, Rashid I, et al. Immune response against toxoplasmosis-some recent updates RH: Toxoplasma gondii immune response. Int J Immunopathol Pharmacol, 2022, 36: 3946320221078436.
22.	Rojas-Pirela M, Medina L, Rojas MV, et al. Congenital transmission of apicomplexan parasites: a review. Front Microbiol, 2021, 12: 751648.
23.	Bonifácio LG, Melo M, Ayo CM, et al. TNFα rs1799964 TT genotype may be a susceptibility factor for vertical transmission of Toxoplasma gondii and clinical signs in newborns from pregnant women with acute toxoplasmosis. Mol Biol Rep, 2022, 49(6): 4759-4768.
24.	Bollani L, Strocchio L, Stronati M. Congenital toxoplasmosis. Early Hum Dev, 2013, 89: S70-S72.
25.	Maldonado YA, Read JS, Committee on Infectious Diseases. Diagnosis, treatment, and prevention of congenital toxoplasmosis in the United States. Pediatrics, 2017, 139(2): e20163860.
26.	Lago EG, Endres MM, Scheeren MFDC, et al. Ocular outcome of Brazilian patients with congenital toxoplasmosis. Pediatr Infect Dis J, 2021, 40(1): e21-e27.
27.	Conceição AR, Belucik DN, Missio L, et al. Ocular findings in infants with congenital toxoplasmosis after a toxoplasmosis outbreak. Ophthalmology, 2021, 128(9): 1346-1355.
28.	Hutson SL, Wheeler KM, McLone D, Patterns of hydrocephalus caused by congenital Toxoplasma gondii infection associate with parasite genetics. Clin Infect Dis, 2015, 61(12): 1831-1834.
29.	Strang AGGF, Ferrari RG, do Rosário DK, et al. The congenital toxoplasmosis burden in Brazil: systematic review and meta-analysis. Acta Trop, 2020, 211: 105608.
30.	Hajj RE, Tawk L, Itani S, et al. Toxoplasmosis: current and emerging parasite druggable targets. Microorganisms, 2021, 9(12): 2531.
31.	Li J, Zhao J, Yang X, et al. One severe case of congenital toxoplasmosis in China with good response to azithromycin. BMC Infect Dis, 2021, 21(1): 920.
32.	Petersen E, Meroni V, Vasconcelos-Santos DV, Mandelbrot L, et al. Congenital toxoplasmosis: should we still care about screening?. Food Waterborne Parasitol, 2022, 27: e00162.
33.	Picone O, Fuchs F, Benoist G, et al. Toxoplasmosis screening during pregnancy in France: opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod, 2020, 49(7): 101814.
34.	Prusa AR, Kasper DC, Sawers L, et al. Congenital toxoplasmosis in Austria: prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis, 2017, 11(7): e0005648.
35.	张宁, 于月新, 封志纯, 等. 孕前 TORCH 筛查专家共识. 发育医学电子杂志, 2019, 7(2): 81-85.
36.	中华医学会妇产科学分会产科学组. 孕前和孕期保健指南(2018). 中华围产医学杂志, 2018, 21(3): 145-152.
37.	Robert MG, Brenier-Pinchart MP, Garnaud C, et al. Molecular diagnosis of toxoplasmosis: recent advances and a look to the future. Expert Rev Anti Infect Ther, 2021, 19(12): 1529-1542.
38.	Reed G, Agarwal-Sinha S. Atypical bilateral multifocal congenital toxoplasmosis retinochoroiditis: case report with literature review. J Investig Med High Impact Case Rep, 2020, 8: 2324709620961615.
39.	Teimouri A, Mohtasebi S, Kazemirad E, et al. Role of Toxoplasma gondii IgG avidity testing in discriminating between acute and chronic toxoplasmosis in pregnancy. J Clin Microbiol, 2020, 58(9): e00505-20.
40.	de Araújo TE, Dos Santos LI, Gomes AO, et al. Putative biomarkers for early diagnosis and prognosis of congenital ocular toxoplasmosis. Sci Rep, 2020, 10(1): 16757.
41.	Olariu TR, Press C, Talucod J, et al. Congenital toxoplasmosis in the United States: clinical and serologic findings in infants born to mothers treated during pregnancy. Parasite, 2019, 26: 13.

1. Flores C, Villalobos-Cerrud D, Borace J, et al. Epidemiological aspects of maternal and congenital toxoplasmosis in Panama. Pathogens, 2021, 10(6): 764.
2. Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ, 2013, 91(7): 501-508.
3. Moodley A, Payton KSE. The term newborn: congenital infections. Clin Perinatol, 2021, 48(3): 485-511.
4. 罗潇, 张莉, 吕艳, 等. 我国弓形虫病误诊现状及其研究进展. 中国病原生物学杂志, 2018, 13(5): 556-558.
5. Dubey JP, Murata FHA, Cerqueira-Cézar CK, et al. Congenital toxoplasmosis in humans: an update of worldwide rate of congenital infections - CORRIGENDUM. Parasitology, 2021, 148(13): 1716.
6. Bigna JJ, Tochie JN, Tounouga DN, et al. Global, regional, and country seroprevalence of Toxoplasma gondii in pregnant women: a systematic review, modelling and meta-analysis. Sci Rep, 2020, 10(1): 12102.
7. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, et al. Acute toxoplasma infection in pregnant women worldwide: a systematic review and meta-analysis. PLoS Negl Trop Dis, 2019, 13(10): e0007807.
8. Rostami A, Riahi SM, Gamble HR, et al. Global prevalence of latent toxoplasmosis in pregnant women: a systematic review and meta-analysis. Clin Microbiol Infect, 2020, 26(6): 673-683.
9. Bollani L, Auriti C, Achille C, et al. Congenital toxoplasmosis: the state of the art. Front Pediatr, 2022, 10: 894573.
10. Su YJ, Ma ZD, Qiao X, et al. Geospatial epidemiology of Toxoplasma gondii infection in livestock, pets, and humans in China, 1984-2020. Parasitol Res, 2022, 121(2): 743-750.
11. 沈继龙, 余莉. 我国弓形虫病流行概况及防治基础研究进展. 中国血吸虫病防治杂志, 2019, 31(1): 71-76.
12. Dong H, Su R, Lu Y, et al. Prevalence, risk factors, and genotypes of Toxoplasma gondii in food animals and humans (2000-2017) from China. Front Microbiol, 2018, 9: 2108.
13. Zhou Q, Wang Q, Shen H, et al. Seroepidemiological map of Toxoplasma gondii infection and associated risk factors in preconception period in China: a nationwide cross-sectional study. J Obstet Gynaecol Res, 2018, 44(6): 1134-1139.
14. Deng H, Devleesschauwer B, Liu M, et al. Seroprevalence of Toxoplasma gondii in pregnant women and livestock in the mainland of China: a systematic review and hierarchical meta-analysis. Sci Rep, 2018, 8(1): 6218.
15. 俞淑丽, 钱春艳. 杭州市孕妇弓形虫和弓首线虫感染的血清学调查. 中国血吸虫病防治杂志, 2020, 32(5): 534-536.
16. Voyiatzaki C, Orovas C, Trapali M, et al. The importance of use of the on-line databases as a source for systematic review of toxoplasmosis screening during pregnancy. Acta Inform Med, 2021, 29(3): 216-223.
17. Arranz-Solís D, Mukhopadhyay D, Saeij JJP. Toxoplasma effectors that affect pregnancy outcome. Trends Parasitol, 2021, 37(4): 283-295.
18. Gao X, Zhong Y, Liu Y, et al. The role and function of regulatory T cells in Toxoplasma gondii-induced adverse pregnancy outcomes. J Immunol Res, 2021, 2021: 8782672.
19. Peyron F, L’ollivier C, Mandelbrot L, et al. Maternal and congenital toxoplasmosis: diagnosis and treatment recommendations of a French multidisciplinary working group. Pathogens, 2019, 8(1): 24.
20. Ahmed M, Sood A, Gupta J. Toxoplasmosis in pregnancy. Eur J Obstet Gynecol Reprod Biol, 2020, 255: 44-50.
21. Sana M, Rashid M, Rashid I, et al. Immune response against toxoplasmosis-some recent updates RH: Toxoplasma gondii immune response. Int J Immunopathol Pharmacol, 2022, 36: 3946320221078436.
22. Rojas-Pirela M, Medina L, Rojas MV, et al. Congenital transmission of apicomplexan parasites: a review. Front Microbiol, 2021, 12: 751648.
23. Bonifácio LG, Melo M, Ayo CM, et al. TNFα rs1799964 TT genotype may be a susceptibility factor for vertical transmission of Toxoplasma gondii and clinical signs in newborns from pregnant women with acute toxoplasmosis. Mol Biol Rep, 2022, 49(6): 4759-4768.
24. Bollani L, Strocchio L, Stronati M. Congenital toxoplasmosis. Early Hum Dev, 2013, 89: S70-S72.
25. Maldonado YA, Read JS, Committee on Infectious Diseases. Diagnosis, treatment, and prevention of congenital toxoplasmosis in the United States. Pediatrics, 2017, 139(2): e20163860.
26. Lago EG, Endres MM, Scheeren MFDC, et al. Ocular outcome of Brazilian patients with congenital toxoplasmosis. Pediatr Infect Dis J, 2021, 40(1): e21-e27.
27. Conceição AR, Belucik DN, Missio L, et al. Ocular findings in infants with congenital toxoplasmosis after a toxoplasmosis outbreak. Ophthalmology, 2021, 128(9): 1346-1355.
28. Hutson SL, Wheeler KM, McLone D, Patterns of hydrocephalus caused by congenital Toxoplasma gondii infection associate with parasite genetics. Clin Infect Dis, 2015, 61(12): 1831-1834.
29. Strang AGGF, Ferrari RG, do Rosário DK, et al. The congenital toxoplasmosis burden in Brazil: systematic review and meta-analysis. Acta Trop, 2020, 211: 105608.
30. Hajj RE, Tawk L, Itani S, et al. Toxoplasmosis: current and emerging parasite druggable targets. Microorganisms, 2021, 9(12): 2531.
31. Li J, Zhao J, Yang X, et al. One severe case of congenital toxoplasmosis in China with good response to azithromycin. BMC Infect Dis, 2021, 21(1): 920.
32. Petersen E, Meroni V, Vasconcelos-Santos DV, Mandelbrot L, et al. Congenital toxoplasmosis: should we still care about screening?. Food Waterborne Parasitol, 2022, 27: e00162.
33. Picone O, Fuchs F, Benoist G, et al. Toxoplasmosis screening during pregnancy in France: opinion of an expert panel for the CNGOF. J Gynecol Obstet Hum Reprod, 2020, 49(7): 101814.
34. Prusa AR, Kasper DC, Sawers L, et al. Congenital toxoplasmosis in Austria: prenatal screening for prevention is cost-saving. PLoS Negl Trop Dis, 2017, 11(7): e0005648.
35. 张宁, 于月新, 封志纯, 等. 孕前 TORCH 筛查专家共识. 发育医学电子杂志, 2019, 7(2): 81-85.
36. 中华医学会妇产科学分会产科学组. 孕前和孕期保健指南(2018). 中华围产医学杂志, 2018, 21(3): 145-152.
37. Robert MG, Brenier-Pinchart MP, Garnaud C, et al. Molecular diagnosis of toxoplasmosis: recent advances and a look to the future. Expert Rev Anti Infect Ther, 2021, 19(12): 1529-1542.
38. Reed G, Agarwal-Sinha S. Atypical bilateral multifocal congenital toxoplasmosis retinochoroiditis: case report with literature review. J Investig Med High Impact Case Rep, 2020, 8: 2324709620961615.
39. Teimouri A, Mohtasebi S, Kazemirad E, et al. Role of Toxoplasma gondii IgG avidity testing in discriminating between acute and chronic toxoplasmosis in pregnancy. J Clin Microbiol, 2020, 58(9): e00505-20.
40. de Araújo TE, Dos Santos LI, Gomes AO, et al. Putative biomarkers for early diagnosis and prognosis of congenital ocular toxoplasmosis. Sci Rep, 2020, 10(1): 16757.
41. Olariu TR, Press C, Talucod J, et al. Congenital toxoplasmosis in the United States: clinical and serologic findings in infants born to mothers treated during pregnancy. Parasite, 2019, 26: 13.

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