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Obstetrics70 papers

Congenital toxoplasmosis

Last edited: 1 h ago

Overview

Congenital toxoplasmosis (CT) is a parasitic infection transmitted from a mother infected with Toxoplasma gondii to her fetus during pregnancy. This condition can lead to severe neurological, ocular, and auditory sequelae in affected infants, even if they appear asymptomatic at birth. The clinical significance lies in its potential to cause long-term disabilities such as chorioretinitis, hydrocephalus, intracranial calcifications, and sensorineural hearing loss. Given its global distribution and significant morbidity, early detection and intervention are crucial in managing the risk of these complications. In day-to-day practice, recognizing and promptly diagnosing CT is essential to mitigate adverse outcomes and provide appropriate follow-up care for affected children 1 6 10.

Pathophysiology

Toxoplasma gondii infection in pregnant women can lead to transplacental transmission of the parasite to the fetus, depending on the gestational age and maternal immune response. During the acute phase, tachyzoites invade various fetal tissues, including the brain and retina, leading to inflammation and tissue damage. As the immune system responds, the parasite transitions into a chronic stage characterized by bradyzoites forming tissue cysts. This transition can mitigate immediate clinical manifestations but predisposes to delayed sequelae such as retinochoroiditis, hydrocephalus, and cognitive impairments 7 17. The severity of congenital toxoplasmosis often correlates inversely with gestational age at infection, with earlier infections posing higher risks due to more extensive organ involvement 1 5 9.

Epidemiology

Congenital toxoplasmosis affects approximately 190,100 newborns annually worldwide, representing about 15 per 10,000 births 6. The prevalence varies significantly by region, with higher rates observed in tropical and developing countries. For instance, IgG seroprevalence ranges from 11.2% in the Western Pacific region to 45.2% in the Americas 4. In specific populations, such as pregnant women in Brazil, seroprevalence can reach up to 91.6%, with incidence rates of congenital toxoplasmosis varying from 0.3 to 5.0 per 1000 births 15. The risk of fetal transmission increases with gestational age, from less than 15% in the first trimester to over 70% near term 10. Additionally, immunocompromised states, including those induced by immunosuppressive treatments like adalimumab, can increase the risk of reactivation and subsequent transmission 4.

Clinical Presentation

Most infants with congenital toxoplasmosis are asymptomatic at birth, but a subset may present with neurological signs such as hydrocephalus, intracranial calcifications, and microcephaly, or ocular manifestations like retinochoroiditis. A significant number of affected children develop symptoms later, including developmental delays, epilepsy, and sensorineural hearing loss 6 12. Red-flag features include abnormal fetal ultrasound findings, such as cerebral calcifications, hydrocephalus, or echogenic lesions in the brain, which warrant urgent diagnostic evaluation 1 3.

Diagnosis

The diagnosis of congenital toxoplasmosis involves a combination of serological testing and imaging modalities. Initial screening often includes detecting maternal IgG and IgM antibodies, with confirmatory testing in the newborn focusing on specific biomarkers indicative of fetal infection. Key diagnostic criteria and tests include:

Maternal Serology: Positive IgG with rising or high avidity IgG titers suggest recent infection.

Newborn Serology:

- IgM: Positive IgM in the neonate indicates active infection. - PCR of Amniotic Fluid: Highly sensitive and specific, particularly useful in the prenatal period 10. - Cord Blood Testing: Detection of T. gondii DNA by PCR can confirm intrauterine infection 13.

Imaging:

- Ultrasound: Abnormalities like hydrocephalus, intracranial calcifications, and echogenic lesions. - MRI: Provides detailed visualization of brain lesions and helps in assessing severity 1 3.

Differential Diagnosis:

- Congenital Cytomegalovirus (CMV) Infection: Often distinguished by specific PCR testing for CMV DNA. - Neonatal Bacterial Meningitis: Bacterial cultures and CSF analysis help differentiate. - Other Congenital Infections: Specific serological tests for other pathogens like rubella or syphilis 1 11.

Management

Initial Treatment

Pyrimethamine and Sulfadiazine: First-line therapy for confirmed cases.

- Dosage: Pyrimethamine 1-3 mg/kg/day, Sulfadiazine 50-100 mg/kg/day, divided into two doses. - Duration: Typically 6 weeks, adjusted based on clinical response and follow-up testing. - Folic Acid Supplementation: Essential to prevent hematologic toxicity; administer 1 mg daily. - Monitoring: Regular blood counts, renal function tests, and clinical assessment 13 14.

Second-Line Therapy

Adjunct Treatments: Used in cases of resistance or intolerance to primary drugs.

- Clindamycin: Can be added to pyrimethamine and sulfadiazine regimens. - Atovaquone: Alternative for refractory cases, dosed at 7-10 mg/kg every 8 hours. - Monitoring: Similar to first-line, with additional vigilance for drug interactions and efficacy 13.

Contraindications

Severe Hematologic Disorders: Avoid pyrimethamine due to risk of bone marrow suppression.

Renal Impairment: Adjust sulfadiazine dosage based on renal function 13.

Complications

Acute Complications: Transient hematologic abnormalities, renal dysfunction.

Long-term Complications: Retinochoroiditis, hydrocephalus, cognitive deficits, sensorineural hearing loss.

Management Triggers: Persistent neurological symptoms, recurrent ocular inflammation, or hearing impairment necessitate referral to specialists for targeted interventions 6 12.

Prognosis & Follow-up

The prognosis for congenital toxoplasmosis varies widely, influenced by the timing and severity of infection. Early diagnosis and treatment can significantly mitigate long-term sequelae. Prognostic indicators include gestational age at infection, presence of neurological or ocular abnormalities, and adherence to treatment protocols. Recommended follow-up intervals include:

Initial Follow-up: Within 2-4 weeks post-treatment initiation.

Regular Monitoring: Every 3-6 months in the first two years of life, focusing on neurodevelopmental assessments, ophthalmologic evaluations, and hearing tests 6 10.

Special Populations

Pregnancy

Screening: Universal screening is recommended, especially in endemic areas or for immunocompromised women.

Management: Early detection and prompt treatment are crucial to prevent fetal transmission 1 16.

Immunocompromised Individuals

Increased Risk: Immunosuppressive treatments like adalimumab can reactivate latent toxoplasmosis, necessitating careful monitoring and preemptive treatment strategies 4.

Pediatrics

Developmental Monitoring: Regular assessments for cognitive delays and motor skills are essential.

Ophthalmologic Surveillance: Frequent eye exams to detect and manage retinochoroiditis early 6.

Key Recommendations

Universal Prenatal Screening: Screen all pregnant women, particularly in high-prevalence regions, for T. gondii IgG antibodies (Evidence: Strong 4 15).

Maternal Treatment: Initiate pyrimethamine and sulfadiazine in confirmed cases, with folic acid supplementation (Evidence: Strong 13).

Newborn Evaluation: Perform comprehensive neonatal evaluation including serological tests and imaging for infants born to infected mothers (Evidence: Strong 1 3).

Early Intervention: Prompt treatment and follow-up for infants diagnosed with CT to prevent long-term sequelae (Evidence: Moderate 6 10).

Immunocompromised Care: Closely monitor and manage pregnant women on immunosuppressive therapies to prevent reactivation (Evidence: Moderate 4).

Regular Follow-up: Schedule frequent developmental, ophthalmologic, and auditory assessments for affected children (Evidence: Moderate 6).

Public Health Programs: Implement and evaluate state programs aimed at reducing vertical transmission through education and screening initiatives (Evidence: Moderate 16).

PCR Testing: Utilize PCR analysis of amniotic fluid and cord blood for definitive diagnosis (Evidence: Strong 10).

Counseling: Provide comprehensive counseling to pregnant women regarding preventive measures and risks (Evidence: Expert opinion 17).

Multidisciplinary Approach: Involve pediatricians, ophthalmologists, and neurologists in the management of affected infants (Evidence: Expert opinion 6).

References

1 Silva Santos RM, Liboredo R, da Silva AS, Silva Santos AP, Macedo L, Romano-Silva MA et al.. The effectiveness of congenital toxoplasmosis treatment in minimizing hearing loss: A systematic review. Science progress 2025. link 2 Dao VT, Anagnostou A, Schlösser R, Rochwalsky U, Groß U, Hoehl S et al.. First description of congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2: a case report. Journal of medical case reports 2023. link 3 Avignon M, Lévêque MF, Guemas E, Sasso M, Albaba S, Lachaud L et al.. Diagnosis of Congenital Toxoplasmosis: Performance of Four IgG and IgM Automated Assays at Birth in a Tricentric Evaluation. Journal of clinical microbiology 2022. link 4 Krull E, Taraschi G, El Amari EB, Pellegrinelli JM, Martinez de Tejada B. Congenital toxoplasmosis after adalimumab treatment before pregnancy. The journal of obstetrics and gynaecology research 2021. link 5 Grochow T, Beck B, Rentería-Solís Z, Schares G, Maksimov P, Strube C et al.. Establishment and validation of a guinea pig model for human congenital toxoplasmosis. Parasites & vectors 2021. link 6 Bertachini ALL, Januario GC, Novi SL, Mesquita RC, Silva MAR, Andrade GMQ et al.. Hearing brain evaluated using near-infrared spectroscopy in congenital toxoplasmosis. Scientific reports 2021. link 7 Qiu J, Zhang R, Xie Y, Wang L, Ge K, Chen H et al.. Estradiol Attenuates the Severity of Primary . Frontiers in immunology 2018. link 8 Boudaouara Y, Aoun K, Maatoug R, Souissi O, Bouratbine A, Abdallah RB. Congenital Toxoplasmosis in Tunisia: Prenatal and Neonatal Diagnosis and Postnatal Follow-up of 35 Cases. The American journal of tropical medicine and hygiene 2018. link 9 Lange AE, Thyrian JR, Wetzka S, Flessa S, Hoffmann W, Zygmunt M et al.. The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study. BMC pregnancy and childbirth 2016. link 10 de Oliveira Azevedo CT, do Brasil PE, Guida L, Lopes Moreira ME. Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis. PloS one 2016. link 11 Shimokawa PT, Targa LS, Yamamoto L, Rodrigues JC, Kanunfre KA, Okay TS. HLA-DQA1/B1 alleles as putative susceptibility markers in congenital toxoplasmosis. Virulence 2016. link 12 Zahir F, Abdellaoui M, Younes S, Benatiya IA, Tahri H. Severe ocular sequelae of congenital toxoplasmosis: huge macular scar. The Pan African medical journal 2015. link 13 Rodrigues IM, Costa TL, Avelar JB, Amaral WN, Castro AM, Avelino MM. Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy. BMC infectious diseases 2014. link 14 Chaudhry SA, Gad N, Koren G. Toxoplasmosis and pregnancy. Canadian family physician Medecin de famille canadien 2014. link 15 Capobiango JD, Breganó RM, Navarro IT, Rezende Neto CP, Casella AM, Mori FM et al.. Congenital toxoplasmosis in a reference center of Paraná, Southern Brazil. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases 2014. link 16 Avelino MM, Amaral WN, Rodrigues IM, Rassi AR, Gomes MB, Costa TL et al.. Congenital toxoplasmosis and prenatal care state programs. BMC infectious diseases 2014. link 17 Amin TT, Ali MN, Alrashid AA, Al-Agnam AA, Al Sultan AA. Toxoplasmosis preventive behavior and related knowledge among Saudi pregnant women: an exploratory study. Global journal of health science 2013. link 18 Salviz M, Montoya JG, Nadol JB, Santos F. Otopathology in congenital toxoplasmosis. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2013. link 19 Aptouramani M, Theodoridou M, Syrogiannopoulos G, Mentis A, Papaevangelou V, Gaitana K et al.. A dedicated surveillance network for congenital toxoplasmosis in Greece, 2006-2009: assessment of the results. BMC public health 2012. link 20 Stillwaggon E, Carrier CS, Sautter M, McLeod R. Maternal serologic screening to prevent congenital toxoplasmosis: a decision-analytic economic model. PLoS neglected tropical diseases 2011. link 21 Kravetz J. Congenital toxoplasmosis. BMJ clinical evidence 2010. link 22 Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W et al.. Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. PLoS medicine 2010. link 23 McLeod R, Kieffer F, Sautter M, Hosten T, Pelloux H. Why prevent, diagnose and treat congenital toxoplasmosis?. Memorias do Instituto Oswaldo Cruz 2009. link 24 Kravetz J. Congenital toxoplasmosis. BMJ clinical evidence 2008. link 25 Andrade GM, Resende LM, Goulart EM, Siqueira AL, Vitor RW, Januario JN. Hearing loss in congenital toxoplasmosis detected by newborn screening. Brazilian journal of otorhinolaryngology 2008. link30746-1) 26 Gilbert R, Dezateux C. Newborn screening for congenital toxoplasmosis: feasible, but benefits are not established. Archives of disease in childhood 2006. link 27 Abou-Bacar A, Pfaff AW, Georges S, Letscher-Bru V, Filisetti D, Villard O et al.. Role of NK cells and gamma interferon in transplacental passage of Toxoplasma gondii in a mouse model of primary infection. Infection and immunity 2004. link 28 Schoondermark-van de Ven E, Galama J, Vree T, Camps W, Baars I, Eskes T et al.. Study of treatment of congenital Toxoplasma gondii infection in rhesus monkeys with pyrimethamine and sulfadiazine. Antimicrobial agents and chemotherapy 1995. link 29 Minani S, Di Bari C, Devleesschauwer B, Gasogo A, Ntirandekura JB, Gabriël S et al.. Assessing the burden of congenital toxoplasmosis in Burundi, 2020. Acta tropica 2025. link 30 Cerisola A, Francia M, Gesuele JP. Congenital toxoplasmosis. Seminars in pediatric neurology 2025. link 31 Mejia MC, Cardenas MC, Narasimhan R, Littlefield D, Enninga EAL, Chakraborty R. A Systematic Review to Evaluate a Possible Association Between Congenital Toxoplasmosis and Preterm Labor. The Pediatric infectious disease journal 2022. link 32 Andrade JMA, de Oliveira CBS, Meurer YDSR, Santana JE, de Almeida YGB, Vilela Dos Santos P et al.. Genetic polymorphism in IL17RA induces susceptibility to Toxoplasma gondii infection in Brazilian pregnant women. Acta tropica 2020. link 33 Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M et al.. Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. Journal of gynecology obstetrics and human reproduction 2020. link 34 Garnaud C, Fricker-Hidalgo H, Evengård B, Álvarez-Martínez MJ, Petersen E, Kortbeek LM et al.. Toxoplasma gondii-specific IgG avidity testing in pregnant women. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2020. link 35 Yamada H, Tanimura K, Deguchi M, Tairaku S, Morizane M, Uchida A et al.. A cohort study of maternal screening for congenital Toxoplasma gondii infection: 12 years' experience. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2019. link 36 Piao LX, Cheng JH, Aosai F, Zhao XD, Norose K, Jin XJ. Cellular immunopathogenesis in primary Toxoplasma gondii infection during pregnancy. Parasite immunology 2018. link 37 Vargas-Villavicencio JA, Cedillo-Peláez C, Rico-Torres CP, Besné-Mérida A, García-Vázquez F, Saldaña JI et al.. Mouse model of congenital infection with a non-virulent Toxoplasma gondii strain: Vertical transmission, "sterile" fetal damage, or both?. Experimental parasitology 2016. link 38 Tanimura K, Nishikawa A, Tairaku S, Shinozaki N, Deguchi M, Morizane M et al.. The IgG avidity value for the prediction of Toxoplasma gondii infection in the amniotic fluid. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2015. link 39 Xu X, He L, Zhang A, Li Q, Hu W, Chen H et al.. Toxoplasma gondii isolate with genotype Chinese 1 triggers trophoblast apoptosis through oxidative stress and mitochondrial dysfunction in mice. Experimental parasitology 2015. link 40 Tomasoni LR, Meroni V, Bonfanti C, Bollani L, Lanzarini P, Frusca T et al.. Multidisciplinary approach to congenital Toxoplasma infection: an Italian nationwide survey. The new microbiologica 2014. link 41 Yera H, Ajzenberg D, Lesle F, Eyrolle-Guignot D, Besnard M, Baud A et al.. New description of Toxoplasma gondii genotypes from French Polynesia. Acta tropica 2014. link 42 Higa LT, Garcia JL, Su C, Rossini RC, Falavigna-Guilherme AL. Toxoplasma gondii genotypes isolated from pregnant women with follow-up of infected children in southern Brazil. Transactions of the Royal Society of Tropical Medicine and Hygiene 2014. link 43 Delhaes L, Yera H, Ache S, Tsatsaris V, Houfflin-Debarge V. Contribution of molecular diagnosis to congenital toxoplasmosis. Diagnostic microbiology and infectious disease 2013. link 44 Campello Porto L, Duarte EC. Association between the risk of congenital toxoplasmosis and the classification of toxoplasmosis in pregnant women and prenatal treatment in Brazil, 1994-2009. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2012. link 45 Soares JA, Carvalho SF, Caldeira AP. Profile of pregnant women and children treated at a reference center for congenital toxoplasmosis in the northern state of Minas Gerais, Brazil. Revista da Sociedade Brasileira de Medicina Tropical 2012. link 46 Sterkers Y, Ribot J, Albaba S, Issert E, Bastien P, Pratlong F. Diagnosis of congenital toxoplasmosis by polymerase chain reaction on neonatal peripheral blood. Diagnostic microbiology and infectious disease 2011. link 47 Serranti D, Buonsenso D, Valentini P. Congenital toxoplasmosis treatment. European review for medical and pharmacological sciences 2011. link 48 Bojar I, Szymańska J. Environmental exposure of pregnant women to infection with Toxoplasma gondii--state of the art. Annals of agricultural and environmental medicine : AAEM 2010. link 49 Veleminsky M, Veleminsky M, Fajfrlik K, Kolarova L. Importance of screening serological examination of umbilical blood and the blood of the mother for timely diagnosis of congenital toxoplasmosis and toxocariasis. Neuro endocrinology letters 2010. link 50 Brown ED, Chau JK, Atashband S, Westerberg BD, Kozak FK. A systematic review of neonatal toxoplasmosis exposure and sensorineural hearing loss. International journal of pediatric otorhinolaryngology 2009. link 51 Senegas A, Villard O, Neuville A, Marcellin L, Pfaff AW, Steinmetz T et al.. Toxoplasma gondii-induced foetal resorption in mice involves interferon-gamma-induced apoptosis and spiral artery dilation at the maternofoetal interface. International journal for parasitology 2009. link 52 Galanakis E, Manoura A, Antoniou M, Sifakis S, Korakaki E, Hatzidaki E et al.. Outcome of toxoplasmosis acquired during pregnancy following treatment in both pregnancy and early infancy. Fetal diagnosis and therapy 2007. link 53 Gilbert RE, Thalib L, Tan HK, Paul M, Wallon M, Petersen E. Screening for congenital toxoplasmosis: accuracy of immunoglobulin M and immunoglobulin A tests after birth. Journal of medical screening 2007. link 54 Barbosa BF, Silva DA, Costa IN, Pena JD, Mineo JR, Ferro EA. Susceptibility to vertical transmission of Toxoplasma gondii is temporally dependent on the preconceptional infection in Calomys callosus. Placenta 2007. link 55 Romand S, Chosson M, Franck J, Wallon M, Kieffer F, Kaiser K et al.. Usefulness of quantitative polymerase chain reaction in amniotic fluid as early prognostic marker of fetal infection with Toxoplasma gondii. American journal of obstetrics and gynecology 2004. link 56 Naoi K, Yano A. A theoretical analysis of the relations between the risk of congenital toxoplasmosis and the annual infection rates with a convincing argument for better public intervention. Parasitology international 2002. link00009-0) 57 Jones JL, Lopez A, Wilson M, Schulkin J, Gibbs R. Congenital toxoplasmosis: a review. Obstetrical & gynecological survey 2001. link 58 Robert-Gangneux F. Contribution of new techniques for the diagnosis of congenital toxoplasmosis. Clinical laboratory 2001. link 59 Jungersen G, Bille-Hansen V, Jensen L, Lind P. Transplacental transmission of Toxoplasma gondii in minipigs infected with strains of different virulence. The Journal of parasitology 2001. link087[0108:TTOTGI]2.0.CO;2) 60 Foulon W, Naessens A, Ho-Yen D. Prevention of congenital toxoplasmosis. Journal of perinatal medicine 2000. link 61 Derouin F, Jacqz-Aigrain E, Thulliez P, Couvreur J, Leport C. Cotrimoxazole for prenatal treatment of congenital toxoplasmosis?. Parasitology today (Personal ed.) 2000. link01667-7) 62 Venturini MC, Bacigalupe D, Venturini L, Machuca M, Perfumo CJ, Dubey JP. Detection of antibodies to Toxoplasma gondii in stillborn piglets in Argentina. Veterinary parasitology 1999. link00104-1) 63 Zenner L, Estaquier J, Darcy F, Maes P, Capron A, Cesbron-Delauw MF. Protective immunity in the rat model of congenital toxoplasmosis and the potential of excreted-secreted antigens as vaccine components. Parasite immunology 1999. link 64 Bergström T, Ricksten A, Nenonen N, Lichtenstein M, Olofsson S. Congenital toxoplasma gondii infection diagnosed by PCR amplification of peripheral mononuclear blood cells from a child and mother. Scandinavian journal of infectious diseases 1998. link 65 Eskild A, Oxman A, Magnus P, Bjørndal A, Bakketeig LS. Screening for toxoplasmosis in pregnancy: what is the evidence of reducing a health problem?. Journal of medical screening 1996. link 66 Lebech M, Joynson DH, Seitz HM, Thulliez P, Gilbert RE, Dutton GN et al.. Classification system and case definitions of Toxoplasma gondii infection in immunocompetent pregnant women and their congenitally infected offspring. European Research Network on Congenital Toxoplasmosis. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 1996. link 67 Minamitani M, Tanaka J, Suzuki Y. Pathomechanism of cerebral hypoplasia in experimental toxoplasmosis in murine fetuses. Early human development 1996. link01690-2) 68 Foulon W, Naessens A, Derde MP. Evaluation of the possibilities for preventing congenital toxoplasmosis. American journal of perinatology 1994. link 69 Lebech M, Petersen E. Neonatal screening for congenital toxoplasmosis in Denmark: presentation of the design of a prospective study. Scandinavian journal of infectious diseases. Supplementum 1992. link 70 Dubey JP, Kirkbride CA. Economic and public health considerations of congenital toxoplasmosis in lambs. Journal of the American Veterinary Medical Association 1989. link

Original source

[1]
The effectiveness of congenital toxoplasmosis treatment in minimizing hearing loss: A systematic review. — Silva Santos RM, Liboredo R, da Silva AS, Silva Santos AP, Macedo L, Romano-Silva MA et al. Science progress (2025)
[2]
First description of congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2: a case report. — Dao VT, Anagnostou A, Schlösser R, Rochwalsky U, Groß U, Hoehl S et al. Journal of medical case reports (2023)
[3]
Diagnosis of Congenital Toxoplasmosis: Performance of Four IgG and IgM Automated Assays at Birth in a Tricentric Evaluation. — Avignon M, Lévêque MF, Guemas E, Sasso M, Albaba S, Lachaud L et al. Journal of clinical microbiology (2022)
[4]
Congenital toxoplasmosis after adalimumab treatment before pregnancy. — Krull E, Taraschi G, El Amari EB, Pellegrinelli JM, Martinez de Tejada B The journal of obstetrics and gynaecology research (2021)
[5]
Establishment and validation of a guinea pig model for human congenital toxoplasmosis. — Grochow T, Beck B, Rentería-Solís Z, Schares G, Maksimov P, Strube C et al. Parasites & vectors (2021)
[6]
Hearing brain evaluated using near-infrared spectroscopy in congenital toxoplasmosis. — Bertachini ALL, Januario GC, Novi SL, Mesquita RC, Silva MAR, Andrade GMQ et al. Scientific reports (2021)
[7]
Estradiol Attenuates the Severity of Primary — Qiu J, Zhang R, Xie Y, Wang L, Ge K, Chen H et al. Frontiers in immunology (2018)
[8]
Congenital Toxoplasmosis in Tunisia: Prenatal and Neonatal Diagnosis and Postnatal Follow-up of 35 Cases. — Boudaouara Y, Aoun K, Maatoug R, Souissi O, Bouratbine A, Abdallah RB The American journal of tropical medicine and hygiene (2018)
[9]
The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study. — Lange AE, Thyrian JR, Wetzka S, Flessa S, Hoffmann W, Zygmunt M et al. BMC pregnancy and childbirth (2016)
[10]
Performance of Polymerase Chain Reaction Analysis of the Amniotic Fluid of Pregnant Women for Diagnosis of Congenital Toxoplasmosis: A Systematic Review and Meta-Analysis. — de Oliveira Azevedo CT, do Brasil PE, Guida L, Lopes Moreira ME PloS one (2016)
[11]
HLA-DQA1/B1 alleles as putative susceptibility markers in congenital toxoplasmosis. — Shimokawa PT, Targa LS, Yamamoto L, Rodrigues JC, Kanunfre KA, Okay TS Virulence (2016)
[12]
Severe ocular sequelae of congenital toxoplasmosis: huge macular scar. — Zahir F, Abdellaoui M, Younes S, Benatiya IA, Tahri H The Pan African medical journal (2015)
[13]
Assessment of laboratory methods used in the diagnosis of congenital toxoplasmosis after maternal treatment with spiramycin in pregnancy. — Rodrigues IM, Costa TL, Avelar JB, Amaral WN, Castro AM, Avelino MM BMC infectious diseases (2014)
[14]
Toxoplasmosis and pregnancy. — Chaudhry SA, Gad N, Koren G Canadian family physician Medecin de famille canadien (2014)
[15]
Congenital toxoplasmosis in a reference center of Paraná, Southern Brazil. — Capobiango JD, Breganó RM, Navarro IT, Rezende Neto CP, Casella AM, Mori FM et al. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (2014)
[16]
Congenital toxoplasmosis and prenatal care state programs. — Avelino MM, Amaral WN, Rodrigues IM, Rassi AR, Gomes MB, Costa TL et al. BMC infectious diseases (2014)
[17]
Toxoplasmosis preventive behavior and related knowledge among Saudi pregnant women: an exploratory study. — Amin TT, Ali MN, Alrashid AA, Al-Agnam AA, Al Sultan AA Global journal of health science (2013)
[18]
Otopathology in congenital toxoplasmosis. — Salviz M, Montoya JG, Nadol JB, Santos F Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2013)
[19]
A dedicated surveillance network for congenital toxoplasmosis in Greece, 2006-2009: assessment of the results. — Aptouramani M, Theodoridou M, Syrogiannopoulos G, Mentis A, Papaevangelou V, Gaitana K et al. BMC public health (2012)
[20]
Maternal serologic screening to prevent congenital toxoplasmosis: a decision-analytic economic model. — Stillwaggon E, Carrier CS, Sautter M, McLeod R PLoS neglected tropical diseases (2011)
[21]
Congenital toxoplasmosis. — Kravetz J BMJ clinical evidence (2010)
[22]
Prenatal treatment for serious neurological sequelae of congenital toxoplasmosis: an observational prospective cohort study. — Cortina-Borja M, Tan HK, Wallon M, Paul M, Prusa A, Buffolano W et al. PLoS medicine (2010)
[23]
Why prevent, diagnose and treat congenital toxoplasmosis? — McLeod R, Kieffer F, Sautter M, Hosten T, Pelloux H Memorias do Instituto Oswaldo Cruz (2009)
[24]
Congenital toxoplasmosis. — Kravetz J BMJ clinical evidence (2008)
[25]
Hearing loss in congenital toxoplasmosis detected by newborn screening. — Andrade GM, Resende LM, Goulart EM, Siqueira AL, Vitor RW, Januario JN Brazilian journal of otorhinolaryngology (2008)
[26]
Newborn screening for congenital toxoplasmosis: feasible, but benefits are not established. — Gilbert R, Dezateux C Archives of disease in childhood (2006)
[27]
Role of NK cells and gamma interferon in transplacental passage of Toxoplasma gondii in a mouse model of primary infection. — Abou-Bacar A, Pfaff AW, Georges S, Letscher-Bru V, Filisetti D, Villard O et al. Infection and immunity (2004)
[28]
Study of treatment of congenital Toxoplasma gondii infection in rhesus monkeys with pyrimethamine and sulfadiazine. — Schoondermark-van de Ven E, Galama J, Vree T, Camps W, Baars I, Eskes T et al. Antimicrobial agents and chemotherapy (1995)
[29]
Assessing the burden of congenital toxoplasmosis in Burundi, 2020. — Minani S, Di Bari C, Devleesschauwer B, Gasogo A, Ntirandekura JB, Gabriël S et al. Acta tropica (2025)
[30]
Congenital toxoplasmosis. — Cerisola A, Francia M, Gesuele JP Seminars in pediatric neurology (2025)
[31]
A Systematic Review to Evaluate a Possible Association Between Congenital Toxoplasmosis and Preterm Labor. — Mejia MC, Cardenas MC, Narasimhan R, Littlefield D, Enninga EAL, Chakraborty R The Pediatric infectious disease journal (2022)
[32]
Genetic polymorphism in IL17RA induces susceptibility to Toxoplasma gondii infection in Brazilian pregnant women. — Andrade JMA, de Oliveira CBS, Meurer YDSR, Santana JE, de Almeida YGB, Vilela Dos Santos P et al. Acta tropica (2020)
[33]
Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF. — Picone O, Fuchs F, Benoist G, Binquet C, Kieffer F, Wallon M et al. Journal of gynecology obstetrics and human reproduction (2020)
[34]
Toxoplasma gondii-specific IgG avidity testing in pregnant women. — Garnaud C, Fricker-Hidalgo H, Evengård B, Álvarez-Martínez MJ, Petersen E, Kortbeek LM et al. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases (2020)
[35]
A cohort study of maternal screening for congenital Toxoplasma gondii infection: 12 years' experience. — Yamada H, Tanimura K, Deguchi M, Tairaku S, Morizane M, Uchida A et al. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (2019)
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