1/16. 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 = gestation (Clic here for more details about this article) |
2/16. Preconception seroconversion and maternal seronegativity at delivery do not rule out the risk of congenital toxoplasmosis.We describe two unusual cases of congenital toxoplasmosis, one occurring after preconception maternal infection with cervical adenopathies and the other occurring after maternal infection at the very end of pregnancy with maternal seronegativity at delivery. These documented cases of congenital toxoplasmosis demonstrate the value of extending the serologic monitoring period during pregnancy, according to the individual clinical context.- - - - - - - - - - ranking = 0.42958007696146keywords = pregnancy (Clic here for more details about this article) |
3/16. Primary toxoplasma gondii infection in a pregnant human immunodeficiency virus-infected woman.We report a 36-year-old hiv-infected woman who developed primary toxoplasma gondii infection during pregnancy that was treated with spiramycin and antiretroviral drugs. There was no vertical transmission of toxoplasmosis and hiv.- - - - - - - - - - ranking = 0.21479003848073keywords = pregnancy (Clic here for more details about this article) |
4/16. 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 = 0.7629134102948keywords = gestation, pregnancy (Clic here for more details about this article) |
5/16. 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 = 0.8814567051474keywords = gestation, pregnancy (Clic here for more details about this article) |
6/16. Detection of congenital toxoplasmosis by chorionic villus sampling and early amniocentesis.We describe a strategy used in this case to detect congenital toxoplasmosis early in pregnancy. Combination of chorionic villus sampling and early amniocentesis with an in vitro cell culture technique makes prenatal diagnosis of congenital toxoplasmosis possible from the end of the first trimester of pregnancy.- - - - - - - - - - ranking = 0.42958007696146keywords = pregnancy (Clic here for more details about this article) |
7/16. prenatal diagnosis of congenital toxoplasmosis.prenatal diagnosis of congenital toxoplasmosis was attempted by means of fetal blood sampling at 20-24 weeks' gestation. It was possible to detect in fetal blood samples non-specific laboratory signs of fetal infection, specific antibodies of fetal origin (IgM), and parasitaemia by inoculation of the sample into mice. Amniotic-fluid samples were also inoculated into mice and parasites were often present when the fetus was infected. Ultrasound examination of the fetus was done repeatedly, mainly to detect any enlargement of the cerebral ventricles. Together the results of these examinations allowed a reliable diagnosis, which was confirmed by the presence of necrotic foci of toxoplasmic encephalitis in the fetus in every case. Only 1 case of congenital toxoplasmosis occurred among 209 cases with negative prenatal diagnoses.- - - - - - - - - - ranking = 0.33333333333333keywords = gestation (Clic here for more details about this article) |
8/16. Congenital toxoplasmosis after maternal infection before or slightly after conception.We report a newborn with typical lesions of congenital toxoplasmosis. Retrospectively, the time of infection could be located to or even before conception. A diagnostic work-up should be performed in every newborn whose mother presents persistent high antibody titers against toxoplasma during pregnancy.- - - - - - - - - - ranking = 0.21479003848073keywords = pregnancy (Clic here for more details about this article) |
9/16. Congenital toxoplasmosis associated with transient monoclonal IgGl-lambda gammopathy.A congenital toxoplasmosis infection was diagnosed in a newborn child with severe oculo-central nervous system involvement. antibodies to toxoplasma became detectable in the mother's serum during pregnancy, and at delivery both mother and child had high titers of IgG toxoplasma antibody. A normal protein profile was found in the serum of the mother, but transient monoclonal gammopathy (IgG1- lambda ) was found in the child. A specific antiidiotype serum raised against this monoclonal immunoglobulin failed to react with the serum of the mother and with other sera positive for toxoplasma antibody. The toxoplasma antibody in the serum of the newborn child was restricted to IgG-lambda, but no evidence was found that the monoclonal fraction was responsible for the antibody activity.- - - - - - - - - - ranking = 0.21479003848073keywords = pregnancy (Clic here for more details about this article) |
10/16. prognosis of pregnancy in patients with toxoplasmic retinochoroiditis.From the study of 18 pregnancies in 10 patients with toxoplasmic retinochoroiditis, it was concluded that the most important factor to be considered in advising pregnant patients with this disease is whether or not the antibody titer increases during pregnancy rather than the clinical pictures or the absolute values of antibody titer. Periodical titration of the antitoxoplasma antibody during pregnancy was recommended as a preventive measure against congenital toxoplasmosis. pregnancy may be continued if antibody titer does not increase during pregnancy, and it may be interrupted if the antibody titer increases.- - - - - - - - - - ranking = 1.5035302693651keywords = pregnancy (Clic here for more details about this article) |
| | Next -> |