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Prasil P, Sleha R, Kacerovsky M, Bostik P. Comparison of adverse reactions of spiramycin versus pyrimethamine/sulfadiazine treatment of toxoplasmosis in pregnancy: is spiramycin really the drug of choice for unproven infection of the fetus? J Matern Fetal Neonatal Med 2023; 36:2215377. [PMID: 37217458 DOI: 10.1080/14767058.2023.2215377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Therapeutic regimens for the treatment of toxoplasmosis are not standardized. Treatment strategy mainly at the end of the second and the beginning of the third trimester, especially in cases of negative prenatal diagnosis, is the least uniform. In some situations, the choice of treatment may be ambiguous, and adverse drug reactions of the therapy should be taken into consideration. METHODS Adverse drug reactions of anti-toxoplasma therapy with spiramycin (n = 77) versus pyrimethamine/sulfadiazine (n = 35) were compared in 112 pregnant women. RESULTS Up to 36.6% of women reported adverse reactions to the treatment overall (n = 41). Out of those 38.9% (n = 30) were treated with spiramycin and 31.4% (n = 11) with pyrimethamine/sulfadiazine. Toxic allergic reactions were the only indication for discontinuation of treatment in 8.9% of patients (n = 10), where 9.1% (n = 7) were reported in spiramycin and 8.6% (n = 3) in pyrimethamine/sulfadiazine cohort. Neurotoxic complications (acral paraesthesia) were significantly more frequent during the therapy with spiramycine in 19.5% (n = 15) compared to no cases in pyrimethamine/sulfadiazine group (p = .003). Other adverse drug reactions, such as gastrointestinal discomfort, nephrotoxicity, vaginal discomfort were reported, but the differences between the cohorts were not significant. CONCLUSIONS The superiority of one of the therapeutic regimens was not statistically demonstrated, since the differences in overall toxicity or incidence of toxic allergic reactions between the cohorts were not confirmed (p = .53 and p = 1.00, respectively). However, although the isolated neurotoxicity of spiramycin was the only significant adverse reaction demonstrated in this study, pyrimethamine/sulfadiazine therapy should be preferred, because it is known to be more effective and with limited adverse reactions.
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Affiliation(s)
- Petr Prasil
- Department of Infectious Diseases, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Radek Sleha
- Department of Epidemiology, University of Defence, Faculty of Military Health Sciences, Hradec Kralove, Czech Republic
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
| | - Pavel Bostik
- Institute of Clinical Microbiology, Charles University, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic
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Schneider MO, Faschingbauer F, Kagan KO, Groß U, Enders M, Kehl S. Toxoplasma gondii Infection in Pregnancy - Recommendations of the Working Group on Obstetrics and Prenatal Medicine (AGG - Section on Maternal Disorders). Geburtshilfe Frauenheilkd 2023; 83:1431-1445. [PMID: 38046526 PMCID: PMC10689109 DOI: 10.1055/a-2111-7394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 12/05/2023] Open
Abstract
Aim The AGG (Working Group for Obstetrics and Prenatal Diagnostics, Section Maternal Diseases) has issued these recommendations to improve the detection and management of Toxoplasma gondii infection in pregnancy. Methods Members of the Task Force developed the recommendations and statements presented here using recently published literature. The recommendations were adopted after a consensus process by members of the working group. Recommendations This article focuses on the epidemiology and pathophysiology of Toxoplasma gondii infection in pregnancy and includes recommendations for maternal and fetal diagnosis, transmission prophylaxis, therapy, prevention, screening, and peripartum management.
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Affiliation(s)
- Michael Oliver Schneider
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Oliver Kagan
- Department for Womenʼs Health, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Groß
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Martin Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - Sven Kehl
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Abraham S, Piarroux R, Zhou Y, Tesic V, Abeleda A, Houhou-Fidouh N, Nicaise-Rolland P, Landraud L, McLeod R, Houzé S. Performances of ICT Toxoplasma IgG-IgM test in comparison with Vidas® toxo competition to determine the immune status against Toxoplasma gondii. Eur J Clin Microbiol Infect Dis 2023; 42:1327-1335. [PMID: 37749274 DOI: 10.1007/s10096-023-04669-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
Toxoplasmosis is a ubiquitous parasitic infection caused by Toxoplasma gondii (Tg). In immunocompetent people, the infection may be asymptomatic with the induction of an immune response that may prevent reinfection or transmission to the fetus in immune pregnant woman. In immunocompromised persons or seronegative pregnant woman with a primary infection during pregnancy, the infection may result in the loss of life, sight, cognition, and motor function in the immune-compromised person or immunologically immature fetus. The objective of this study was to evaluate a new immunochromatographic test Toxoplasma ICT IgG-IgM (ICT) that allows detection of specific anti-Tg immunoglobulins G (Ig G) and M (Ig M). We included 1145 prospectively obtained sera and 376 samples selected for specificity or sensitivity studies. The performance of ICT was compared using Vidas® Toxo Competition (TXC) and Toxoscreen®. In case of discrepancy, Vidas® Toxo Ig G or Ig M and LDBIO Toxo II IgG western blot were used to establish definitive results by additional methods. Sensitivity and specificity of ICT were respectively 99.3% and 100%. In comparison, Toxoscreen®'s sensitivity was 100% and the specificity was 99.8%. TXC had a sensitivity of 98.7% with a specificity of 99.1%. ICT has excellent performance even for low Ig G titers, especially in immunocompromised patients, and confirms the specificity of isolated Ig M. This ICT provides reliable results easily and quickly. This screening technique is not designed to differentiate the Ig M from Ig G. When positive, additional tests may be necessary.
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Affiliation(s)
- Sylvie Abraham
- Laboratory of Parasitology, Toxoplasma National Reference Center, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France
| | - Raphael Piarroux
- LD Bio Diagnostics, Lyon, France
- Efor-CVO, Champagne Aux Monts d'Or, France
| | - Ying Zhou
- Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, AMB N310, Chicago, IL, USA
| | - Vera Tesic
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Ana Abeleda
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Nadhira Houhou-Fidouh
- Laboratory of Virology, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France
| | - Pascale Nicaise-Rolland
- Laboratory of Immunology, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris Paris, France
| | - Luce Landraud
- Laboratory of Microbiology, Louis Mourier Hospital, APHP Nord, 178 Rue Des Renouillers, 92700, Colombes, France
| | - Rima McLeod
- Department of Ophthalmology and Visual Sciences, The University of Chicago, Chicago, IL, USA
- Toxoplasmosis Center, The University of Chicago, AMB N310, Chicago, IL, USA
- Department of Pediatrics, Division of Infectious Diseases, The University of Chicago, Chicago, IL, USA
| | - Sandrine Houzé
- Laboratory of Parasitology, Toxoplasma National Reference Center, Bichat-Claude Bernard Hospital, APHP Nord, 46 Rue Henri Huchard, 75018, Paris, France.
- Université Paris Cité, IRD, 75006, MERITParis, France.
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Dambrun M, Sare N, Vianou B, Amagbégnon R, Fievet N, Massougbodji A, Houzé S, Migot-Nabias F. Serological diagnosis of toxoplasmosis in pregnancy: comparison between a manual commercial ELISA assay and the automated VIDAS ® kit. Eur J Clin Microbiol Infect Dis 2023; 42:759-769. [PMID: 37095264 DOI: 10.1007/s10096-023-04603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
Knowledge of the toxoplasmosis serological status in pregnant women is important to allow adequate management for the prevention of congenital toxoplasmosis of those who are not immunized. Serological screening is generally carried out using commercial kits to determine the presence or absence of immunoglobulins M or G in the maternal blood. Robust results are therefore needed. We evaluated the performances of a commercial ELISA assay composed of several recombinant parasite antigens and of a commercial assay using parasite lysate to determine the serological status against Toxoplasma gondii of African pregnant women. A recruitment of 106 pregnant women during their third trimester of pregnancy was carried out in Benin. Serologies were performed with recomWell Toxoplasma IgM and IgG kits. Subsequently, the serological assays were carried out by an automaton method with the VIDAS® TOXO IgM and IgG II kits. Here we compared recomWell Toxoplasma to VIDAS® TOXO results. Reproducibility tests of the recomWell kits were assessed following the discrepancies observed in the results. Of 106 plasmas tested, 47 showed anti-T. gondii IgG (44.3%), including 5 with IgM and high IgG avidity (4.7%). Of the two techniques, VIDAS® TOXO was more robust and specific for IgG while the recomWell Toxoplasma gave more false positive results. The combination of several techniques for the determination of serological toxoplasmosis status remains relevant. Methods using native proteins are closer to the reality of the environment. Therefore, kits using recombinant proteins should be tested on highly geographically diverse populations to refine their composition.
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Affiliation(s)
| | - Nawal Sare
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
| | - Bertin Vianou
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
| | - Richard Amagbégnon
- Laboratoire de Biologie Médicale, Centre Hospitalier Universitaire de la Mère et de L'Enfant-Lagune (CHU-MEL), 01 BP 107, Cotonou, Bénin
| | - Nadine Fievet
- Universite Paris Cite, MERIT, IRD, Paris, F-75006, France
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur les Pathologies Associées à la Grossesse et à L'Enfance, Cotonou, Bénin
- Institut de Recherche Clinique du Bénin, Cotonou, Bénin
| | - Sandrine Houzé
- Universite Paris Cite, MERIT, IRD, Paris, F-75006, France
- Service de Parasitologie, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Bichat Claude-Bernard, Paris, France
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Building Programs to Eradicate Toxoplasmosis Part IV: Understanding and Development of Public Health Strategies and Advances “Take a Village”. CURRENT PEDIATRICS REPORTS 2022; 10:125-154. [PMID: 35991908 PMCID: PMC9379243 DOI: 10.1007/s40124-022-00268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/12/2022]
Abstract
Purpose of Review Review international efforts to build a global public health initiative focused on toxoplasmosis with spillover benefits to save lives, sight, cognition and motor function benefiting maternal and child health. Recent Findings Multiple countries’ efforts to eliminate toxoplasmosis demonstrate progress and context for this review and new work. Summary Problems with potential solutions proposed include accessibility of accurate, inexpensive diagnostic testing, pre-natal screening and facilitating tools, missed and delayed neonatal diagnosis, restricted access, high costs, delays in obtaining medicines emergently, delayed insurance pre-approvals and high medicare copays taking considerable physician time and effort, harmful shortcuts being taken in methods to prepare medicines in settings where access is restricted, reluctance to perform ventriculoperitoneal shunts promptly when needed without recognition of potential benefit, access to resources for care, especially for marginalized populations, and limited use of recent advances in management of neurologic and retinal disease which can lead to good outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40124-022-00268-x.
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Borkens Y. [Toxoplasma gondii-Current drugs and future vaccines against an underestimated protozoan infection]. Internist (Berl) 2021; 62:1123-1132. [PMID: 34467425 DOI: 10.1007/s00108-021-01155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
Toxoplasma gondii is a unicellular organism of the Apicomplexa that occurs worldwide and is therefore a close relative of the malaria pathogen Plasmodium. As T. gondii infests every warm-blooded vertebrate species as an intermediate host and has a very high prevalence worldwide, toxoplasmosis is one of the most important international foodborne diseases. Potential vaccines (human as well as veterinary) play a crucial role in controlling this disease.
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Affiliation(s)
- Yannick Borkens
- College of Public Health, Medical and Veterinary Science, James Cook University, 1 James Cook Drive, 4811, Townsville, Queensland, Australien.
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