1/21. Congenital toxoplasmosis: prenatal diagnosis, treatment and postnatal outcome.We report a female patient with congenital toxoplasmosis who presented with hydrops fetalis and cerebral abnormalities, detected on fetal ultrasound. Following prenatal treatment, the hydrops fetalis resolved and at four months of age she has normal growth and development. This case emphasizes the potential good prognosis in cases with congenital toxoplasmosis detected and treated prenatally.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
2/21. The ocular manifestations of congenital infection: a study of the early effect and long-term outcome of maternally transmitted rubella and toxoplasmosis.PURPOSE: To study the spectrum of adverse ocular effects which result from maternally transmitted rubella and toxoplasma infection; further, to record the long-term visual and neurodevelopmental outcomes of these 2 major causes of fetal infection. STUDY DESIGN AND patients: A series of 55 patients with congenital infection have been studied prospectively on a long-term basis. The study group included a cohort of 34 cases with congenital rubella syndrome demonstrated by virus isolation, and 21 cases with a clinical diagnosis of congenital toxoplasmosis and serologic confirmation. All patients had specific disease-related ocular defects. Rubella patients were first identified during or following the last major rubella epidemic in 1963-1964, and some have been followed serially since that time. A separate study group of representative toxoplasmosis patients presented for examination and diagnosis at varying time periods between 1967 and 1991. OBSERVATIONS AND RESULTS: This study confirms that a broad spectrum of fetal injury may result from intrauterine infection and that both persistent and delayed-onset effects may continue or occur as late as 30 years after original infection. Many factors contribute to the varied outcome of prenatal infection, the 2 most important being the presence of maternal immunity during early gestation and the stage of gestation during which fetal exposure occurs in a nonimmune mother. RUBELLA: As a criteria of inclusion, all 34 rubella patients in this study exhibited one or more ocular defects at the time of birth or in the immediate neonatal period. Cataracts were present in 29 (85%) of the 34, of which 21 (63%) were bilateral. Microphthalmia, the next most frequent defect, was present in 28 (82%) of the 34 infants and was bilateral in 22 (65%). glaucoma was recorded in 11 cases (29%) and presented either as a transient occurrence with early cloudy cornea in microphthalmic eyes (4 patients), as the infantile type with progressive buphthalmos (1 patient), or as a later-onset, aphakic glaucoma many months or years following cataract aspiration in 11 eyes of 6 patients. Rubella retinopathy was present in the majority of patients, although an accurate estimate of its incidence or laterality was not possible because of the frequency of cataracts and nystagmus and the difficulty in obtaining adequate fundus examination. toxoplasmosis: Twenty-one patients with congenital toxoplasmosis have been examined and followed for varying time periods, 7 for 20 years or more. The major reason for initial examination was parental awareness of an ocular deviation. Twelve children (57%) presented between the ages of 3 months and 4 years with an initial diagnosis of strabismus, 9 of whom had minor complaints or were diagnosed as part of routine examinations. All cases in this study have had evidence of retinochoroiditis, the primary ocular pathology of congenital toxoplasmosis. Two patients had chronic and recurrent inflammation with progressive vitreal traction bands, retinal detachments, and bilateral blindness. Macular lesions were always associated with central vision loss; however, over a period of years visual acuity gradually improved in several patients. Individuals with more severe ocular involvement were also afflicted with the most extensive central nervous system deficits, which occurred following exposure during the earliest weeks of gestation. CONCLUSIONS: Although congenital infection due to rubella virus has been almost completely eradicated in the united states, the long-term survivors from the prevaccination period continue to experience major complications from their early ocular and cerebral defects. They may be afflicted by the persistence of virus in their affected organs and the development of late manifestations of their congenital infection. Congenital toxoplasmosis continues to be the source of major defects for 3,000 to 4,100 infants in the united states each year; the spectrum of defects is wide and may vary from blindness and severe mental retardation to minor retinochoroidal lesions of little consequence. Effective solutions for either the prevention or treatment of congenital toxoplasmosis have not been developed in this country but are under intensive and continuing investigation.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
3/21. Imaging of an atypical case of congenital toxoplasmosis.In this article we describe the cranial computerized tomography findings of an infant with congenital toxoplasmosis, which was performed because she showed an atypical clinical course consisting of meningitis and multiple cerebral abscesses. In this case the cranial computerized tomography allowed the diagnosis of hydrocephalus and multiple cerebral abscesses, and guided the therapeutic approach.- - - - - - - - - - ranking = 2keywords = cerebral (Clic here for more details about this article) |
4/21. Fetal toxoplasmosis and negative amniocentesis: necessity of an ultrasound follow-up.prenatal diagnosis of congenital toxoplasmosis relies on the PCR test on amniotic fluid and ultrasound follow-up of the fetus. We report two cases of toxoplasma infection during the first trimester of gestation with a discrepant diagnosis of fetal infection. PCR performed more than four weeks after the estimated date of contamination was negative. Ultrasound follow-up was normal up to the third trimester when major hydrocephalus was detected, leading to pregnancy termination. In both cases, post-mortem examination revealed a diffuse infection with severe brain lesions. These observations confirm the necessity to continue a monthly ultrasound follow-up, even if amniocentesis is negative, in case of fetal toxoplasma infection in pregnancy.- - - - - - - - - - ranking = 0.031338870487692keywords = brain (Clic here for more details about this article) |
5/21. Too late prenatal diagnosis of fetal toxoplasmosis: a case report.OBJECTIVE: We describe a case of severe fetal hydrocephalus due to toxoplasmosis which could not be diagnosed until late gestational age due to the lack of a serologic surveillance program during pregnancy; moreover, this case points to the usefulness of molecular biology tools in the diagnostic process. Abnormal ultrasound in the 2nd trimester was noticed and toxoplasma gondii was demonstrated in amniotic fluid at the 28th week of gestation both by PCR and by mice inoculation. Fansidar and folinic acid were administered. The newborn suffered from progressive hydrocephalus, seizures, and pathological muscular tonus; ultrasound examination showed massive cerebral calcifications. Ophthalmologic examination revealed bilateral choroidoretinitis. Congenital toxoplasmosis was confirmed by the detection of anti- T. gondii IgM and IgA in the neonatal serum. CONCLUSION: The presented case is an example of severe fetal toxoplasmosis diagnosed and treated in utero.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
6/21. Possible reasons for failure of conventional tests for diagnosis of fatal congenital toxoplasmosis: report of a case diagnosed by PCR and immunoblot.Diagnosis of subclinical congenital toxoplasmosis has to rely on serological methods or isolation of the parasite. We present a case of congenital toxoplasmosis, in which conventional tests failed to establish the diagnosis. It was shown that this infant developed an intrathecal antibody response that was directed only against one of two toxoplasma gondii strains used for routine diagnosis. In contrast to conventional tests, the diagnosis of cerebral toxoplasmosis could be established by using immunoblot and polymerase chain reaction (PCR). We therefore suggest that in unclarified cases, PCR and immunoblot, using at least two different strains of T. gondii, should be considered as additional tools for diagnosis of an infection with toxoplasma and that examination of cerebrospinal fluid may be critical.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
7/21. Globe calcification in congenital toxoplasmosis.Various patterns of distribution of intracerebral calcification have been described in congenital toxoplasmosis. We report a case of congenital toxoplasmosis with a rare finding of calcification in the globe detected by CT scan that has not been described earlier.- - - - - - - - - - ranking = 1keywords = cerebral (Clic here for more details about this article) |
8/21. Identification of toxoplasma gondii infections by BI gene amplification.The diagnosis of toxoplasmosis in congenitally infected children or in immunocompromised patients can be difficult; serology is not reliable, and the diagnosis must be based on the combination of symptomatology and the direct demonstration of the parasite in clinical specimens by microscopy, antigen detection, or inoculation of samples into mice or tissue cultures. These techniques are either insensitive or time-consuming. To determine the value of the polymerase chain reaction (PCR) for the diagnosis of toxoplasma gondii infections, we compared this technique with conventional detection techniques, such as microscopy, tissue culturing, and mouse inoculation. We were able to detect T. gondii by PCR in clinical specimens and tissue samples that were obtained postmortem from a bone marrow recipient with cerebral toxoplasmosis and from three congenitally infected children. The presence of T. gondii was demonstrated in brain tissue, cerebrospinal fluid, the heart, and skeletal muscle tested fresh or after fixation in Formalin. In only one sample was T. gondii isolated by mouse inoculation but not detected by PCR. Because it is a sensitive, relatively rapid, and specific method and because it can be applied to a variety of different clinical samples, PCR can be considered a valuable additional tool for the identification of T. gondii infections.- - - - - - - - - - ranking = 1.0313388704877keywords = cerebral, brain (Clic here for more details about this article) |
9/21. Benign partial epilepsy with centrotemporal (or rolandic) spikes and brain lesion.We describe three patients with benign partial epilepsy with centrotemporal spikes (BECT) in association with proven brain lesion (agenesis of the corpus callosum, lipoma of the corpus callosum, and congenital toxoplasmosis, respectively). The age of onset, the ictal signs, the interictal electroencephalographic findings and the favorable outcome of epilepsy even after withdrawal of drug therapy led to the diagnosis of BECT although organic brain lesions were present. In such cases, the epilepsy should not be ascribed to the lesions but should be considered benign even though fortuitiously associated with brain lesions.- - - - - - - - - - ranking = 0.21937209341384keywords = brain (Clic here for more details about this article) |
10/21. Congenital toxoplasmosis in a 15 day-old infant. A case report.A case congenital toxoplasmosis in a 15-day old infant was reported, citing the difficulties encountered in establishing the diagnosis due to the wide range of the disease's clinical spectrum. Congenital toxoplasmosis was suspected after finding hydrocephalus, cerebral calcification, and chorioretinitis. serology tests with the ELISA technique were highly positive for antibodies against IgG, whereas anti-IgM was negative. The patient died before the second serological analysis was done. The final diagnosis of congenital toxoplasmosis was eventually established at autopsy, based on the detection of T. gondii in the brain, testicular, liver, spleen and striated muscle tissues.- - - - - - - - - - ranking = 1.0313388704877keywords = cerebral, brain (Clic here for more details about this article) |
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