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Severe Congenital Toxoplasmosis in the United States: Clinical and Serologic Findings in Untreated Infants

Olariu, Tudor Rares MD, PhD*,†; Remington, Jack S. MD*,†; McLeod, Rima MD‡,§; Alam, Ambereen MD§,¶; Montoya, Jose G. MD*,†

The Pediatric Infectious Disease Journal: December 2011 - Volume 30 - Issue 12 - p 1056–1061
doi: 10.1097/INF.0b013e3182343096
Original Studies

Background: Congenital toxoplasmosis can cause significant neurologic manifestations and other untoward sequelae.

Methods: The Palo Alto Medical Foundation Toxoplasma Serology Laboratory database was searched for data on infants 0 to 180 days old, in whom congenital toxoplasmosis had been confirmed and who had been tested for Toxoplasma gondii-specific immunoglobulin G (IgG), IgM, and IgA antibodies, between 1991 and 2005. Their clinical findings were confirmed at the National Collaborative Chicago-based Congenital Toxoplasmosis Study center. We reviewed available clinical data and laboratory profiles of 164 infants with congenital toxoplasmosis whose mothers had not been treated for the parasite during gestation.

Results: One or more severe clinical manifestations of congenital toxoplasmosis were reported in 84% of the infants and included eye disease (92.2%), brain calcifications (79.6%), and hydrocephalus (67.7%). In 61.6% of the infants, eye disease, brain calcifications, and hydrocephalus were present concurrently. T. gondii-specific IgM, IgA, and IgE antibodies were demonstrable in 86.6%, 77.4%, and 40.2% of the infants, respectively. Testing for IgM and IgA antibodies increased the sensitivity of making the diagnosis of congenital toxoplasmosis to 93% compared with testing for IgM or IgA individually. IgM and IgA antibodies were still present in 43.9% of infants diagnosed between 1 and 6 months of life.

Conclusions: Our study reveals that severe clinical signs of congenital toxoplasmosis including hydrocephalus, eye disease, or intracranial calcifications occurred in 85% infants whose sera were referred to our reference Toxoplasma Serology Laboratory during a period of 15 years. Laboratory tests, including serologic and polymerase chain reaction tests, were critical for diagnosis in the infants. Our results contrast remarkably with those of European investigators who rarely observe severe clinical signs in infants with congenital toxoplasmosis.

Supplemental Digital Content is available in the text.

From the *Toxoplasma Serology Laboratory, Palo Alto Medical Foundation, Palo Alto, CA; †Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA; ‡Department of Medicine, University of Chicago School of Medicine, Chicago, IL; §Toxoplasmosis Center, University of Chicago Medical Center, Chicago, IL; and ¶Department of Pediatrics, University of Chicago School of Medicine, Chicago, IL.

Accepted for publication July 3, 2011.

Tudor Rares Olariu is currently at Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041, Timisoara, Romania.

Supported in part by NIH NIAID R01 27530 and the Cornwell and Mann Family Foundation. The authors have no other conflicts of interest or funding to disclose.

Address for correspondence: Jose G. Montoya, MD, Toxoplasmosis Serology Laboratory, 795 El Camino Real, Palo Alto Medical Foundation, Palo Alto, CA 94301. E-mail:

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© 2011 Lippincott Williams & Wilkins, Inc.