Please refer on congenital cerebral toxoplasmosis for a specific discussion on this condition.
The incidence is highly variable dependent on individual countries.
The majority of infants (~75%) are asymptomatic. For those symptomatic, the severity of symptoms is related to the trimester of pregnancy when transmission occurred 11:
- first trimester: fetal death
- second trimester: retinochoroiditis, microcephaly, and mental retardation
- third trimester: lymphadenopathy, hepatosplenomegaly, eye injuries, and brain calcifications in the third trimester
Fetal transmission occurs in ~40% of cases where primary maternal infection is acquired during pregnancy 3. Transmission of infection acquired prior to conception is uncommon and in most cases infection is transmitted in the 3rd trimester. In ~10% cases the infection tends to be severe.
It classically gives a triad of (affected in ~80% 3):
- PCR test on amniotic fluid: more specific 7
- cordocentesis for the detection of T. gondii-specific IgM antibodies: usually detectable after 20 weeks of gestation
Intracranial findings that may be present sonographically include:
- fetal hydrocephalus
- fetal intracranial calcification: tends to be distributed randomly throughout the brain
There may also be presence of microcephaly.
Other findings include:
- development of fetal hydrops
- after birth late sequelae: mainly ocular and neurological
Treatment and prognosis
Treatment involves maternal therapy with medications such as spiramycin +/- sulfadiazine +/- pyrimethamine depending on gestational age and the infective status of the fetus. Prognosis is variable dependant on fetal CNS manifestations. Long term disability can occur with mental retardation and blindness. Overall mortality can be as high as 12% 10.
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