Introduction: Toxoplasma gondii (T. gondii) primary infection acquired during pregnancy can cause, in fetus and newborn, devastating consequences as miscarriage, congenital systemic disease or neuro-ophthalmological manifestations.

Objectives: The objective of our study was to investigate the incidence of congenital infection in a cohort of newborns and to evaluate the neurological, ophthalmological and auditive sequelae in infected ones. Besides, the study proposed to correlate the infection rate and the symptomatic cases rate with gestational age of maternal seroconversion, prenatal treatment and postnatal management.

Subjects, Materials and Methods: The study was conducted in a cohort of 220 patients admitted to three Hospitals of the area of Catania (Cannizzaro Hospital, Garibaldi Hospital and Policlinico Hospital) for suspicion for congenital toxoplasmosis from 1996 to 2017 [M 116 (52.7%), F 104 (47.2%); mean age at the enrollment: 1.28 months]. The patients were selected by prenatal screening in 217 cases (98.6%) or by a successive ophthalmological evaluation in three cases. The parameters analyzed were: gestational history, neonatal anamnesis and short and long-term follow up.

Results: We observed a mother-to-child transmission (MTCT) rate of 13.18% (29/220). No correlation between risk of fetal infection and maternal age (OR=0.33, p=0.124) was found, nor with type of prenatal treatment (spiramycin followed by pyrimethamine-sulphonamide versus spiramycin or pyrimethamine-sulphonamide alone) (OR=1.88, p=0.254). The analysis of correlation between MTCT rate and gestational age at maternal seroconversion showed a direct statistically significant interaction between the two parameters: rate of transmission of 5% at first trimester (OR=0.12), 23% at the second (OR=1.18) and 63% at the third trimester (OR=5.8; p<0.001).

Among the 29 infected patients, we found a rate of symptomatic cases of 20% at birth and of 59% in a long-term follow up, with 10% manifesting microcephaly, 19% brain abnormalities at birth- ultrasound, 4% behavioral disturbances, 7% epilepsy and 7% psychomotor delay associated with behavioral disturbance. We observed ophthalmological lesions in 21% at birth and 45% in the long-term follow up. No cases of hearing loss were found. No correlation between gestational age at maternal seroconversion and clinical manifestation (OR=0.93, p=0.93), ocular manifestation (OR=0.2, p=0.211) or neurological sequelae (OR=0.91, p=0.913) were observed. Furthermore, no statistically significant correlation between prematurity or intrauterine growth restriction and congenital toxoplasmosis was found.

Conclusions: prenatal serological screening is effective in selecting newborns who have to be submitted to follow up and treatment for congenital toxoplasmosis. The results of our study are in accordance with literature for some aspects (direct correlation between gestational age at maternal seroconversion and rate of MTCT) and in contradiction for others (we did not find any correlation between gestational age at maternal seroconversion and rate of symptomatic cases). Further randomized controlled clinical trials would better clarify the evolution of the disease in prenatal and postnatal age and the contribution of each variables in the occurrence of the infection.

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