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Prevention, diagnosis, and treatment of fetal toxoplasmosis
1Department of Pediatrics, University of Western Ontario, London, Canada.
Despite the limitations, the available data lead to the conclusion that treatment of the mother may be of benefit to the fetus. To date, harmful effects of maternal therapy on the fetus have not been substantiated. Current recommendations for fetal therapy of toxoplasmosis include the initiation of spiramycin in the pregnant woman when acquired toxoplasmosis is strongly suspected in pregnancy. Prompt detection of infection in the mother is important in order to start therapy as early as possible. An attempt to determine the status of the fetus is undertaken by prenatal diagnostic procedures such as amniocentesis, cordocentesis, and ultrasonography. After confirmation of fetal infection, repeated courses of a combination of pyrimethamine, sulfadiazine, and folinic acid should be alternated with courses of spiramycin. If the fetus is not infected, spiramycin should be continued in repeated courses or throughout pregnancy. Pregnancy termination tends to be reserved for cases in whom ultrasonographic examination demonstrates the fetus to be severely affected. The importance of postnatal follow-up and treatment, although not addressed in this article, must be emphasized. The advent of fetal therapy offers hope that the problem of congenital toxoplasmosis will become less common. In addition to currently available options, the future may offer new avenues of therapy, such as the possibility of treating infected fetuses by the intra-amniotic infusion of drugs.
Despite the limitations, the available data lead to the conclusion that treatment of the mother may be of benefit to the fetus. To date, harmful effects of maternal therapy on the fetus have not been substantiated. Current recommendations for fetal therapy of toxoplasmosis include the initiation of spiramycin in the pregnant woman when acquired toxoplasmosis is strongly suspected in pregnancy. Prompt detection of infection in the mother is important in order to start therapy as early as possible. An attempt to determine the status of the fetus is undertaken by prenatal diagnostic procedures such as amniocentesis, cordocentesis, and ultrasonography. After confirmation of fetal infection, repeated courses of a combination of pyrimethamine, sulfadiazine, and folinic acid should be alternated with courses of spiramycin. If the fetus is not infected, spiramycin should be continued in repeated courses or throughout pregnancy. Pregnancy termination tends to be reserved for cases in whom ultrasonographic examination demonstrates the fetus to be severely affected. The importance of postnatal follow-up and treatment, although not addressed in this article, must be emphasized. The advent of fetal therapy offers hope that the problem of congenital toxoplasmosis will become less common. In addition to currently available options, the future may offer new avenues of therapy, such as the possibility of treating infected fetuses by the intra-amniotic infusion of drugs.