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Best practice and Fifteen-minute consultations
Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy
  1. Anja Saso1,2,
  2. Alasdair Bamford3,4,
  3. Karen Grewal5,
  4. Muna Noori6,
  5. James Hatcher7,
  6. Felice D'Arco8,
  7. Edward Guy9,
  8. Hermione Lyall10
  1. 1 Department of Academic Paediatrics, Imperial College London, London, UK
  2. 2 Vaccines & Immunity Theme, MRC The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
  3. 3 Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  4. 4 Section of Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
  5. 5 Tommy’s National Centre for Miscarriage Research, Imperial College London, London, UK
  6. 6 Department of Women and Children, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
  7. 7 Department of Microbiology, Laboratory Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
  8. 8 Department of Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  9. 9 Toxoplasma Reference Unit, Public Health Wales, Swansea, UK
  10. 10 Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Anja Saso, Academic Paediatrics, Imperial College London, London W2 1PY, UK; anja.saso{at}nhs.net

Abstract

Congenital toxoplasmosis occurs following transplacental transfer of Toxoplasma gondii. Irrespective of symptom status at birth, infants with congenital infection may develop serious long-term sequelae, including learning disability, seizures, hydrocephalus, motor and hearing deficits, chorioretinitis and retinal scarring with impaired vision. Timely diagnosis facilitates early initiation of therapy, aimed at prevention or amelioration of adverse clinical consequences. Diagnosis can be difficult, however, since acutely infected mothers are often asymptomatic and laboratory testing can be complex. Moreover, any decision to start treatment in the newborn must include careful consideration of the benefits and risks. This paper outlines a structured approach for managing an infant born to a woman with possible or confirmed T. gondii infection during pregnancy, including key aspects of the antenatal history, interpretation and timing of investigations, treatment and appropriate follow-up. Our recommendations are based on current evidence in the literature, consensus from two UK paediatric infectious disease centres and the UK specialist Toxoplasma Reference Unit.

  • toxoplasmosis
  • congenital infection
  • Toxoplasma gondii (T.gondii)
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2018-316603

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    Footnotes

    • Contributors AS conducted the literature review and wrote the first draft. KG and MN contributed specialist obstetrics and fetal medicine advice. JH contributed specialist microbiology advice. FDA contributed specialist neuroradiology advice and provided Figure 1. EG, AB and HL made expert recommendations for the management of infants at risk of congenital toxoplasmosis. All authors reviewed the content and suggested amendments that AS incorporated. All authors approved the final version.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.